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Han EJ, Mukdad LA, Alhiyari Y, Nakhla MN, Sajed DP, St. John MA. A 22-year single institution review of 119 cases of salivary duct carcinoma. Laryngoscope Investig Otolaryngol 2024; 9:e1234. [PMID: 38525121 PMCID: PMC10960238 DOI: 10.1002/lio2.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/29/2023] [Accepted: 02/25/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Salivary duct carcinoma (SDC) is a rare and aggressive salivary gland malignancy. Herein, we present the largest single-institution review of SDC to date. Methods This is a retrospective cohort study of all histologically confirmed cases of SDC seen at our institution from January 1, 2002, to August 1, 2022. Patient demographics, treatment, histological characteristics, tumor staging, and outcomes were extracted from the electronic medical record. Kaplan-Meier and Cox regression survival analyses were performed. Results This study included 119 patients with a mean age of 66.2 years. Most primary tumors arose from the parotid gland (72.3%), and 23.5% were noted to be carcinoma ex-pleomorphic adenoma. 57.1% of patients presented with regional lymph node metastasis, whereas 23.5% presented with distant disease. Kaplan-Meier analysis demonstrated a 62.4% 5-year overall survival (OS) and a 69.0% 5-year disease-specific survival (DSS). Univariate analyses indicated that presence of regional lymph node disease (p<.001), distant metastasis (p<.001), perineural invasion (p = .027), and lymphovascular invasion (p = .018) were predictive of decreased OS and DSS. Trastuzumab administration was not associated with survival in HER-2-positive patients receiving chemotherapy. Multivariate analyses demonstrated that presence of nodal disease (HR 30.337, 95% CI 2.782-330.851, p = .005) and carcinoma ex pleomorphic adenoma (HR 5.54, 95% CI 1.024-29.933, p = .047) were associated with decreased OS. Conclusion Our patients had more favorable survival rates compared to prior studies, which may be due to lower incidence of nodal disease. Factors associated with worse survival included nodal and distant metastases, perineural invasion, lymphovascular invasion, and tumor size. Level of Evidence Level 3.
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Affiliation(s)
- Ethan J. Han
- Department of Head & Neck SurgeryUCLALos AngelesCaliforniaUSA
| | - Laith A. Mukdad
- Department of Head & Neck SurgeryUCLALos AngelesCaliforniaUSA
| | - Yazeed Alhiyari
- Department of Head & Neck SurgeryUCLALos AngelesCaliforniaUSA
| | | | - Dipti P. Sajed
- Department of Pathology and Laboratory Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Maie A. St. John
- Department of Head & Neck SurgeryUCLALos AngelesCaliforniaUSA
- UCLA Head and Neck Cancer ProgramUCLA Medical CenterLos AngelesCaliforniaUSA
- Jonsson Comprehensive Cancer CenterUCLA Medical CenterLos AngelesCaliforniaUSA
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Topilow NJ, Stevens SM, Chen Y, Patel U, Dubovy SR, Johnson TE. A rare case of mucoepidermoid carcinoma ex pleomorphic adenoma of the lacrimal gland. Orbit 2023; 42:311-315. [PMID: 34939520 DOI: 10.1080/01676830.2021.1998916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Carcinoma ex pleomorphic adenoma (CEPA) of the lacrimal gland is a rare malignant tumor that arises from a pre-existing pleomorphic adenoma. Lacrimal gland CEPA with mucoepidermoid histological subtype is exceedingly rare. Diagnosis can be aided by radiographic findings, though the gold standard is histopathological analysis following excisional biopsy. Management options include complete surgical excision with or without adjuvant radiation therapy based on tumor grade and invasiveness. We present a 76-year-old woman with 6 months of diplopia and unilateral proptosis. Her initial exam was remarkable for hypoglobus, proptosis, and limited elevation of the right eye. Computed tomography (CT) scan demonstrated a superior, well-circumscribed, extraconal orbital mass. An excisional biopsy was performed, and histopathological findings were consistent with mucoepidermoid carcinoma ex pleomorphic adenoma with positive margins in the tumor capsule. The patient received radiation therapy and remains markedly improved with no disease recurrence at 5 months post-operatively.
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Affiliation(s)
- Nicole J Topilow
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shanlee M Stevens
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ying Chen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Umangi Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas E Johnson
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Pei Y, Li W. Clinical parameters predictors of malignant transformation of recurrent parotid pleomorphic adenoma. Sci Rep 2023; 13:4543. [PMID: 36941273 PMCID: PMC10027859 DOI: 10.1038/s41598-023-29714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/09/2023] [Indexed: 03/23/2023] Open
Abstract
Malignant transformation (MT) in recurrent parotid pleomorphic adenomas (PAs) is rare; therefore its occurrence lacks reliable predictive factors. Our goal was to clarify the predictors for MT of recurrent parotid PAs based on preoperative clinical parameters. Patients with a clinical diagnosis of recurrent parotid PA were retrospectively enrolled. The association between clinicopathologic variables and MT of PA was assessed using univariate and multivariate analyses. MT occurred in 11.8% of the 467 patients. In univariate analysis, three or more previous recurrences, newly developed facial nerve paralysis, difficulty in mouth opening, tumors with the largest tumor diameter ≥ 2.4 cm, and abnormal neck lymph node enlargement were associated with MT occurrence. Further, multivariate analysis showed that three or more previous recurrences, newly developed facial nerve paralysis, difficulty in mouth opening, and abnormal neck lymph node enlargement were independently related to MT. MT of recurrent PA was not uncommon. Clinical signs of malignancy included newly developed facial nerve paralysis, difficulty in mouth opening, three or more previous recurrences, and abnormal neck lymph node enlargement.
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Affiliation(s)
- Yu Pei
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenlu Li
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Tondi-Resta I, Hobday SB, Gubbiotti MA, Jalaly JB, Rassekh CH, Montone KT, Baloch ZW. Carcinoma Ex Pleomorphic Adenomas: An Institutional Experience and Literature Review. Am J Clin Pathol 2023; 159:502-515. [PMID: 36921078 DOI: 10.1093/ajcp/aqac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/13/2022] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To provide an institutional experience with cases diagnosed as carcinoma ex pleomorphic adenoma (CXPA), including the cytologic and histologic findings and clinical follow-up, followed by a comparison to the experience documented in the literature. METHODS We identified cases of CXPA diagnosed at our institution from 2011 to 2021 and reviewed the cytologic and histologic diagnoses, as well as the treatment and clinical outcomes. Additionally, a literature review of the English literature was performed on CXPAs from 2011 to 2021. RESULTS Forty-one cases of CXPA were identified, with the majority subclassified as adenocarcinoma, not otherwise specified. Five tumors underwent cytogenetic studies and five underwent molecular studies. To date, 36 patients are alive, 8 of whom experienced locoregional recurrence or distant metastasis. CONCLUSIONS Our institutional experience was comparable to that reported in the literature. Further studies are required to inquire about the role of molecular profiles of CXPAs in clinical risk assessment.
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Affiliation(s)
| | - Sara B Hobday
- Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Christopher H Rassekh
- Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Malignant salivary gland tumours: treatment outcomes from a tertiary referral centre in the UK. Br J Oral Maxillofac Surg 2023; 61:295-301. [PMID: 37045618 DOI: 10.1016/j.bjoms.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
Salivary gland malignant tumours are a complex and highly variable pathological group. Their diagnosis can be challenging, and management is guided by multidisciplinary teams. This project aimed to establish clinicopathological and sociodemographic features that significantly impacted overall disease-free or progression-free survival in patients diagnosed with malignant salivary gland disease between 2010 and 2019 in a tertiary referral centre. In total, 86 patients were included for analysis, with a female:male gender ratio of 1.3:1. Mean age at diagnosis was 57.7 years. Mucoepidermoid carcinomas constituted almost 25% (n = 20) of all cases, with adenoid cystic carcinomas (20%, n = 17) and acinic cell carcinomas (17.5%, n = 15) being the next most frequently diagnosed. The parotid gland was the most frequently affected site (80.2%, n = 69). Perineural and lymphovascular invasion, and a maximum tumour dimension of ≥4 cm were highly associated with the decision to provide a neck dissection as part of treatment. Involved margins, extracapsular spread, and lymphovascular and perineural invasion were associated with the need for adjuvant treatment. However, no factors remained statistically significant on multivariate analysis. This retrospective service evaluation demonstrates the difficulty of predicting treatment outcomes for patients diagnosed with malignant salivary gland disease.
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Khademi B, Zia Z, Kohandel-Shirazi M. Mucoepidermoid Carcinoma Ex Pleomorphic Adenoma of Lacrimal Gland: Case Report and Review of Literature. Ophthalmic Plast Reconstr Surg 2023; 39:e22-e25. [PMID: 35943428 DOI: 10.1097/iop.0000000000002258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Carcinoma ex pleomorphic adenoma (Ca ex PA) is defined as an infiltrative carcinoma arising from a primary or recurrent benign pleomorphic adenoma. Ca ex PA with the histologic subtype mucoepidermoid carcinoma is extremely uncommon. Only 2 previous reports in the lacrimal gland have been documented. We reported a 55-year-old lady with a firm, solid, nontender mass in the supralateral quadrant of the right orbit at the area of the lacrimal gland. After wide excision of mass, pathology revealed high-grade mucoepidermoid carcinoma Ex pleomorphic adenoma. To reduce tumor recurrence 60 Gray radiation was delivered to the orbital cavity. She is still tumor-free 1 year after completion of treatment.
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Affiliation(s)
- Behzad Khademi
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz, Iran
| | - Zahra Zia
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, School of Medicine, Shiraz, Iran
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Systematic review of prognostic factors in carcinoma ex pleomorphic adenoma. Oral Oncol 2022; 133:106052. [DOI: 10.1016/j.oraloncology.2022.106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022]
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Żurek M, Jasak K, Jaros K, Daniel P, Niemczyk K, Rzepakowska A. Clinico-Epidemiological Analysis of Most Prevalent Parotid Gland Carcinomas in Poland over a 20-Year Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10247. [PMID: 36011881 PMCID: PMC9408518 DOI: 10.3390/ijerph191610247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: Malignant tumours of the salivary glands have different clinical and histopathological characteristics. They most commonly involve the parotid gland. Histopathologically, the most common are mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (AcCC), adenocarcinoma, carcinoma in pleomorphic adenoma (CPA), and squamous cell carcinoma (SCC). (2) Methods: We analysed 2318 patients with malignant parotid gland tumours reported to the National Cancer Registry (NCR) in Poland over 20 years (1999-2018). The demographic characteristics of patients, clinical factors, and overall survival (OS) were analysed. (3) Results: The average age was 61.33 ± 16.1 years. The majority were males (55%) and urban citizens (64%). High percentage of carcinomas was diagnosed in locoregional (33.7%) and systemic (10.4%) stadium. The most prevalent diagnoses were SCC (33.3%) and adenocarcinoma (19.6%). Surgical resection with adjuvant RT (42.1%) was the most common treatment. The OS analysis showed a median survival time of 5.6 years. The most favorable median OS was found in patients with AcCC (18.30 years), the worst for SCC (1.58 years). (4) Conclusion: AcCC has the best prognosis and SCC the worst. Tumour stadium, treatment, and demographic factors affect prognosis. Improvements in diagnosis and re-evaluation of treatment standards are necessary to enhance the outcome of patients with parotid gland cancers in Poland.
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Affiliation(s)
- Michał Żurek
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Żwirki i Wigury Str., 02-091 Warsaw, Poland
- Department of Analyses and Strategies, Ministry of Health, Miodowa 15 Str., 00-952 Warsaw, Poland
| | - Kamil Jasak
- Students Scientific Research Group at the Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Karolina Jaros
- Students Scientific Research Group at the Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Piotr Daniel
- Students Scientific Research Group at the Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Anna Rzepakowska
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
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