Sialoblastoma and hepatoblastoma in a newborn infant

Infant with Parotid Sialoblastoma and Nevus Sebaceous, Treated with Surgery and Adjuvant Chemotherapy

Sialoblastoma is an extremely rare embryonal tumor derived from salivary gland primordial cells. Treatment usually consists of surgery alone; however, in some cases, chemotherapy is required and is administered with good response. We present a case of a 5-week-old girl diagnosed with a parotid gland tumor and co-existing nevus sebaceous on the face. Initial tumorectomy was microscopically non-radical and histopathology revealed sialoblastoma. The patient received adjuvant chemotherapy consisting of vincristine, actinomycin, and cyclophosphamide. Due to imaging studies being inconclusive regarding response and possible residual disease, a second surgery (total parotidectomy) was performed. The histopathology results showed fields of necrosis in the parotid gland but no neoplastic cells in the material. The patient remains under watchful observation and there is no evidence of relapse 12 months after the second surgery. The adjuvant chemotherapy regimen with vincristine, actinomycin, and cyclophosphamide is a viable option of treatment in children with sialoblastoma.

The Cellular and Molecular Landscape of Synchronous Pediatric Sialoblastoma and Hepatoblastoma

Sialoblastoma (SBL) is an infrequent embryonal malignant tumor originating from the salivary gland, resembling primitive salivary gland anlage, whereas hepatoblastoma (HB) is the most common pediatric liver malignancy. The simultaneous occurrence of both tumors is extremely rare. Here we reported a case of a 6-month-old infant diagnosed with synchronous SBL and HB. The patient received neoadjuvant chemotherapy followed by surgical resection. Fresh tissues of both tumors were collected before and after chemotherapy, which were further profiled by whole exome sequencing (WES) and single-cell RNA sequencing (scRNA-seq). WES analysis revealed potential somatic driver mutation PIK3CA p.Glu454Lys for SBL and canonical mutation CTNNB1 p.Ser45Pro for HB. No shared somatic variants or common copy number alterations were found between SBL and HB primary tumor samples. Though scRNA-seq, single-cell atlases were constructed for both tumors. SBL may recapitulate a pre-acinar stage in the development of salivary gland, including basaloid, duct-like, myoepithelial-like, and cycling phenotypes. In the meantime, HB was composed of tumor cells resembling different stages of the liver, including hepatocyte-like, hepatic progenitor-like, and hepatoblast-like cells. After chemotherapy, both tumors were induced into a more mature phenotype. In terms of transcriptional signatures, SBL and HB showed enhanced expression of epithelial markers KRT8, KRT18, and essential embryo development genes SDC1, MDK, indicating the disruption of normal embryo epithelium development. Finally, heterozygous deleterious germline mutation BLM and FANCI were identified which could predispose the patient to higher cancer risk. It partially explained the reason for the co-occurrence of SBL and HB. Taken together, we provided valuable resources for deciphering cellular heterogeneity and adaptive change of tumor cells after chemotherapy for synchronous SBL and HB, providing insights into the mechanisms leading to synchronous pediatric tumors.

Two Synchronous Neonatal Tumors: An Extremely Rare Case

We report a case of a newborn with two synchronous tumors-sialoblastoma and hepatoblastoma-diagnosed at 20 weeks of gestation by magnetic resonance imaging (MRI) and ultrasonography (US). The aim of this study was to describe the management of this case together with a review of the literature. Our patient had a large facial tumor associated with extremely high alpha-fetoprotein levels. Diagnosis of the tumors was made by surgical biopsy, showing typical features in both. Sialoblastoma is a potentially aggressive tumor. In our case, the Ki67 index in the sialoblastoma was between 20 and 30%, indicating a possibly unfavorable behavior. The infant underwent surgery and chemotherapy in different steps. Complete surgical resection with clean margins is considered to be the best treatment option for sialoblastoma. Only four similar cases were previously reported. Timely management by a multidisciplinary team is essential in these difficult cases. In our patient, outcome was good at the time of this report.

Sialoblastoma in chin and management of treatment

OBJECTIVE

Sialoblastoma is a rare salivary gland tumor mainly located in parotid. In this article, we aimed to review the clinical manifestations and treatments of sialoblastoma, especially to provide effective chemotherapy regimens to instruct internal medicine therapy for unresectable or recurrent tumors.

METHOD

We reported a 1-year old girl who presented a left-sided firm facial mass and subsequently diagnosed as sialoblastoma. Afterwards, we reviewed and analyzed relevant literatures.

RESULTS

Sixty-four cases of pediatric sialoblastoma were reviewed. Of them, surgical excision was the basic treatment, 17 cases received chemotherapy, and 15 cases got good response. Lung metastasis was reported in six patients, all of whom had good response to chemotherapy.

CONCLUSION

Chemotherapy may play an important role in residual, extensive, metastatic and relapsed cases. In addition, lung metastasis was unlikely to exert a significant effect on prognosis.

Pediatric sialoblastoma: Evaluation and management

OBJECTIVES

Sialoblastoma is a rare congenital salivary gland tumor of epithelial origin. The objectives of this study are to review the literature regarding clinical presentation of sialoblastoma, evaluate the effectiveness of various treatment methods, and present guidelines for evaluation and management in the pediatric population.

DATA SOURCES

Case presentation and literature review.

REVIEW METHODS

A comprehensive search was conducted to identify cases of pediatric sialoblastoma in the English-language literature. The presentation, evaluation, and management of reported cases were analyzed. We also report an invasive and recurrent case in a pediatric patient to highlight the aggressive nature of these lesions.

RESULTS

Sixty-two cases of pediatric sialoblastoma were reviewed. The age at initial presentation ranged from before birth to 15 years. The parotid gland was the most common location (n = 47). Surgical excision was the primary treatment in all patients. Nine patients developed metastatic disease of the lung, lymph nodes, or bone. Almost a third of patients had recurrence and over two thirds of patients were tumor-free for at least 1 year following their last treatment intervention.

CONCLUSION

Prompt and complete surgical excision should be recommended to prevent local and systemic recurrence of pediatric sialoblastoma. Chemotherapy has also shown promise in several cases, and clinical genomics may shed light on more therapy options. Patients should be closely followed for at least 12 months following diagnosis, or longer depending on the histopathological staging of the tumor.

Disorders and tumors of the salivary glands in children

Salivary gland neoplasms are rare in children. In infants most tumors are benign hemangiomas, with some notable exceptions, such as sialoblastomas. An asymptomatic swelling in the periauricular region is the most common presenting complaint in older children. Approximately 50% of these lesions are malignant, which dictates a thorough diagnostic evaluation by a head and neck surgeon. Surgical excision is the primary treatment modality. Prognosis is primarily determined by histopathologic findings. This review discusses neoplastic lesions of the salivary glands in children, and malignant epithelial tumors in particular.

Sialoblastoma of the parotid gland in a 13-year-old girl with multiple recurrences and long-term follow-up

BACKGROUND

Sialoblastoma is an extremely rare congenital salivary gland tumor of epithelial origin. It is usually localized in the parotid or submandibular gland and presents primarily at birth or in early childhood.

METHODS

We report a case of a 13-year-old girl with a sialoblastoma of the parotid gland presenting as an asymptomatic painless mass.

RESULTS

The patient showed multiple recurrences and, based on the histopathological finding of facial nerve infiltration, was treated surgically with total parotidectomy and facial nerve reconstruction.

CONCLUSION

Because of the rare occurrence of sialoblastoma, there is no evidence-based treatment of choice. The treatment should be individualized, taking into consideration the patient's age, the high locoregional recurrence rate, the local aggressive characteristics, and the potential metastatic activity of this rare tumor. A close follow-up of the patient is strongly recommended.

Diagnosis and Treatment of a Preterm Infant With Inoperable Congenital Hepatoblastoma--A Case Report

Reports of hepatoblastoma (HB) in preterm infants are quite rare. Herein, we report the clinical management of a preterm infant with inoperable congenital HB. A female fetus that had been diagnosed with a large liver tumor consistent with hemangioma was delivered by emergency cesarean section at 33 weeks of gestation because of fetal distress. Effective antitumor therapy could not be performed, resulting in rapid deterioration and death. The postmortem histopathologic analysis confirmed the tumor as a HB. This report demonstrates the difficulties inherent in both the image diagnosis of HB and in providing efficacious treatments for preterm infants with HB.

Sialoblastoma: A literature review from 1966-2011

Sialoblastoma is a rare congenital tumour of the salivary glands arising mainly from the parotid gland. It is usually diagnosed at birth or shortly thereafter with a significant variability in histological appearance and clinical course. In extensive search of PubMed indexed journals, we got 46 cases of "sialobalstoma/embryoma/congenital basal adenoma", with one case was of German literature and three additional cases of adult sialobalstoma. This article has extensively reviewed the clinical, histopathological and immunohistochemical features, Magnetic resonance imaging (MRI) and Computerized Tomography (CT) findings, treatment and prognosis.

Childhood cancers: what is a possible role of infectious agents?

The etiology of childhood cancers has been studied for more than 40 years. However, most if not all cancers occurring in children are attributed to unknown causes. This review is focused on the role of infections in cancer development and progression in children. The main infectious agents include human herpesviruses, polyoma viruses, and human papilloma viruses. It is known that infections can lead to carcinogenesis through various mechanisms, and most likely act in addition to genetic and environmental factors. Given the importance of the infectious etiology of childhood cancers, clinical implications and possible prevention strategies are discussed.

Outcomes for patients with congenital hepatoblastoma

BACKGROUND

Congenital hepatoblastoma, diagnosed in the first month of life, has been reported to have a poor prognosis; however, a comprehensive evaluation of this entity is lacking.

PROCEDURE

We retrospectively reviewed two patients from the senior authors' personal series and 25 cases identified in the databases of several multicenter group studies (INT-0098, P9645, 881, P9346, HB 89, HB94, and HB 99). We compared this series with cases of congenital hepatoblastoma previously published in the literature.

RESULTS

The 3-year survival in our case series was 86% (18/21) with a follow-up of 44-230 months (median 85.5 months). Presentation and treatment were not substantially different from hepatoblastoma cohorts unselected for age. Survival was comparable to the reported disease free survival for a similar cohort of hepatoblastoma patients unselected for age between 1986 and 2002 (82.5%) [von Schweinitz et al., Eur J Cancer 1997; 33:1243-1249]. The 2-year survival of cases reported in the literature was 0% (0/9) and 42% (10/24) for patients reported before and after 1990, respectively.

CONCLUSIONS

Congenital hepatoblastoma does not appear to confer a worse prognosis. The improved survival of our current series of patients, collected from the past 20 years of German and American multicenter trials and personal series, suggests that the outcome of hepatoblastoma at this young age is much better than has been historically reported. More rigorous analysis should be conducted in future multicenter trials. It is possible that congenital hepatoblastoma should be treated like all other patients with hepatoblastoma provided that the child is stable enough to proceed with surgery and chemotherapy.

Surgical excision of sialoblastoma in the parotid gland in newborn

OBJECTIVES

To evaluate outcome of surgical excision of sialoblastoma in the parotid gland in newborn.

PATIENTS AND METHODS

This was a retrospective review of 3 pediatric patients with sialoblastoma in the parotid gland that underwent surgical resections. All patients are newborn boys. The lesions ranged from 5 cm × 5 cm to 8 cm × 5 cm in size. The tumor was resected en bloc, and the facial nerve was preserved.

RESULTS

None surgical complications occurred. The mean follow-up was 34 months; none patients had recurrent lesions.

CONCLUSION

Surgical dissection of sialoblastoma in the parotid gland in the newborn is most efficient and safe.

Congenital minor salivary gland sialoblastoma: a case report and review of the literature

Sialoblastoma is the most common epithelial tumor of the salivary gland. We report a case of congenital sialoblastoma arising in a minor salivary gland of the buccal mucosa of a male infant. After radiologic evaluation, an incisional biopsy was performed and then the mass was excised en bloc. Histologic features were both favorable and unfavorable. However, there was no recurrence for 5 months. In spite of a reported histologic grading system, the clinical course of isolated sialoblastoma is considered unpredictable. More published case reports of this rare tumor may enable histologic and clinical correlation in order to accurately predict prognosis.

Management of sialoblastoma with surgery and brachytherapy

Sialoblastoma is a rare congenital or perinatal salivary gland tumor with significant variability in histological appearance and biological behavior. We reported one case of sialoblastoma occurring in the parotid gland of an 18-month-old female. The tumor was excised with negative margins, and the sacrificed facial nerve was reconstructed with great auricular nerve graft. The tumor recurred 6 months after operation and was treated with (125)I seed implant brachytherapy. No recurrence was found after 21 months of follow-up.

Sialoblastoma of salivary glands in children: chemotherapy should be discussed as an alternative to mutilating surgery

Sialoblastoma is a very rare congenital salivary gland tumor. No consensus has been reached concerning the treatment of this tumor due to its rarity. The treatment of reference is surgery, which can be mutilating, in the case of a locally invasive tumor. The treatment of metastatic disease is also controversial. The authors report a new case of a 6-year-old girl with a progressively growing left parotid mass since birth. The first cytological diagnosis was that of pleomorphic adenoma. Due to local progression, superficial parotidectomy was performed at the age of 3.5 years and revealed a diagnosis of sialoblastoma. Six months later, local recurrence and lung metastasis were treated by neoadjuvant chemotherapy with a very good partial response on the local recurrence and the lung metastasis, allowing complete parotidectomy with sacrifice of the facial nerve. Bilateral lung biopsies after adjuvant chemotherapy showed total necrosis. No recurrence was observed with a follow-up of 1 year. This case and a review of the literature confirm the very good chemosensitivity of this tumor and argue in favor of neoadjuvant chemotherapy for locally invasive tumors rather than extensive mutilating surgery.

Selective pathologies of the head and neck in children: a developmental perspective

The range of pathology seen in the head and neck region is truly amazing and to a large extent probably mirrors the complex signaling pathways and careful orchestration of events that occurs between the primordial germ layers during the development of this region. As is true in general for the entire discipline of pediatric pathology, the head and neck pathology within this age group is as diverse and different as its adult counterpart. Cases that come across the pediatric head and neck surgical pathology bench are more heavily weighted toward developmental and congenital lesions such as branchial cleft anomalies, thyroglossal duct cysts, ectopias, heterotopias, choristomas, and primitive tumors. Many congenital "benign" lesions can cause significant morbidity and even mortality if they compress the airway or other vital structures. Exciting investigations into the molecular embryology of craniofacial development have begun to shed light on the pathogenesis of craniofacial developmental lesions and syndromes. Much more investigation is needed, however, to intertwine aberrations in the molecular ontogeny and development of the head and neck regions to the represented pathology. This review will integrate traditional morphologic embryology with some of the recent advances in the molecular pathways of head and neck development followed by a discussion of a variety of developmental lesions finishing with tumors presumed to be derived from pluripotent/progenitor cells and tumors that show anomalous or aborted development.

What's new in the AFIP fascicle on salivary gland tumors: a few highlights from the 4th Series Atlas

After a 12 year interval from the previous fascicle, a new fascicle on Tumors of the Salivary Glands in the new fourth series of the AFIP Atlas of Tumor Pathology was published in 2008. The data, presentation, illustrations, tables, and physical characteristics of the newest fascicle have been updated and improved. There have only been a few alterations and additions to the classification of tumors and tumor-like non-neoplastic conditions of salivary gland. Three of the most significant are discussed in this paper. Sialoblastoma has been reclassified as malignant; inflammatory pseudotumor has been reclassified as neoplastic and re-identified as inflammatory myofibroblastic tumor; and sclerosing polycystic adenosis is a new entity among tumor-like conditions.