Congenital sialoblastoma (embryoma) associated with premature centromere division and high level of alpha-fetoprotein

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.

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.

Sialoblastoma of the cheek: A case report and review of the literature

Sialoblastoma is a rare salivary gland tumor that recapitulates the primitive salivary gland anlage. The authors herein report a case of sialoblastoma of a minor salivary gland, clinically presenting with progressive enlargement of a mass in the cheek of a 1-year-old female infant. Histopathologically, the mass consisted of tight clusters of basaloid cells and partially formed ductal and pseudo-ductal spaces separated by thin fibrous bands. Immunohistchemical studies demonstrated the presence of cytokeratin AE1/AE3, p63, CD99, α-fetoprotein (AFP) and Hep Par-1 expression in a considerable number of tumor cells. The clinical and pathological characteristics are presented and relevant literature is reviewed. Early complete surgical excision is recommended for the treatment of sialoblastoma. Radiation may be considered in cases with incomplete resection of the tumor. Chemotherapy may play a vital role in extensive, metastatic, or relapsed cases, or in cases with inadequate excision. The follow-up treatment should be frequent and prolonged. To the best of our knowledge, this is the first reported case of sialoblastoma of the cheek with immunoreactivity for AFP and Hep Par-1, which may be associated with the embryonic origin of the tumor. AFP may be a useful marker of tumor response in patient with sialoblastoma.

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.

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.

How to manage an unresectable or recurrent sialoblastoma

Only 2-5% of all salivary gland tumors occur in children. Sialoblastoma is an extremely rare salivary gland tumor diagnosed at birth or shortly thereafter with significant variability in histological range and clinical course, so that it may be difficult to predict the most appropriate therapy. In cases where surgical removal is not curative or technically feasible, chemotherapy may be attempted. We report herein a patient with progression of a huge partially resected sialoblastoma who was successfully treated with chemotherapy. Systemic chemotherapy with vincristine, actinomycin D, and cyclophosphamide (VAC) seems to be an effective adjuvant or neoadjuvant treatment option for unresectable or recurrent sialoblastoma.

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.

Normal fetal salivary glands at 14-16 weeks of gestation as observed by transvaginal ultrasound imaging

OBJECTIVES

Absence or congenital anomalies of the parotid glands are associated with significant long-term morbidity. To date there are no published data on ultrasonographic detection of these defects in early pregnancy. We set out to demonstrate and measure the fetal parotid and submandibular salivary glands at 14-16 weeks using transvaginal ultrasound imaging.

METHODS

During a routine fetal anomaly detection scan in 30 consecutive patients, an attempt was made to examine the fetal parotid and submandibular glands. The fetal head was scanned in transverse sections just below the fetal ears, and the area of the parotid and submandibular glands was inspected. The examination time was not prolonged for the purpose of measuring the salivary glands. The fetal biparietal diameter and the femur length were also documented.

RESULTS

The median gestational age was 15.4 (range, 14.4-16.5) weeks. In all 30 patients examined, at least one pair of parotid and submandibular glands was clearly visualized and measured. In seven patients the parotid and submandibular glands were visualized on both sides. The median length of the parotid gland was 7.5 (range, 5.5-11.5) mm and that of the submandibular gland was 5.4 (range, 3.7-8.5) mm.

CONCLUSIONS

The fetal salivary glands can be demonstrated by transvaginal ultrasound imaging at 14-16 weeks of gestation. This is the first reported study presenting the normal values of salivary gland measurements, which may be important in detecting fetuses with congenital absence or other malformations of the glands.

Sialoblastoma in adults: distinction from adenoid cystic carcinoma

Essentially, sialoblastoma is a disease of infancy with the oldest case presenting at 4 years of age. About one third of pediatric sialoblastoma cases will have a cribriform growth pattern. No adult cases have been reported with a specific diagnosis of sialoblastoma. If even focal cribriforming were present, such cases have undoubtedly been diagnosed as adenoid cystic carcinoma. Such was the circumstance in the 3 adult tumors presented in this report. Each case, however, has the primitive histopathology with discrete nests of basaloid tumor cells, associated bilayered ductal structures and the fibromyxoid stroma characteristic for sialoblastoma with its resemblance to fetal salivary gland or salivary gland with arrested development. One key example has 28-year follow-up. Sialoblastoma, whether in a child or adult with or without a cribriform growth pattern, appears to have a more favorable prognosis than adenoid cystic carcinoma. Aspects of the histological differential diagnosis of these 2 tumors are discussed.

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.

Sialoblastoma and hepatoblastoma in a newborn infant

We report a case of a newborn infant who had simultaneous sialoblastoma and hepatoblastoma tumours at birth. The diagnoses were made on post mortem examination. Both of these are rare tumours in the neonatal period.

Sialoblastoma arising in ectopic salivary gland tissue

Sialoblastoma is a rare, congenital or perinatal tumour predominately affecting the parotid or submandibular salivary glands. We report a case of sialoblastoma arising in ectopic salivary gland tissue in the anterior cheek of a female infant. This lesion clinically and on ultrasound mimicked a haemangioma. Following imaging and tissue diagnosis, the lesion was surgically excised with clear margins. The patient remained disease free at 6 months follow up.

Treatment of metastatic sialoblastoma with chemotherapy and surgery

Tumors of the salivary gland are very uncommon in children. Sialoblastoma is a rare, aggressive, blastomatous, and potentially malignant congenital tumor. Distant metastases are rare. We present a case of sialoblastoma with lung metastases that developed in a 4-year-old girl adjacent to a congenital nevus in the left cheek. The tumor was inoperable at diagnosis but the largest of the pulmonary metastases was removed surgically. The patient responded well to chemotherapy and underwent surgical excision of the primary tumor, followed by three more courses of chemotherapy.

Premature chromatid separation in a woman with carcinoma in situ of the uterine cervix and in her son with keratoacanthoma

An increased frequency of cells with premature chromatid separation (PCS) involving most chromosomes of a metaphase was observed in blood cultures of both a woman and her son with tumor. The mother had carcinoma in situ of the cervix, diagnosed at age of 42 years, and her son had keratoacanthoma, diagnosed at age of 23 years. To our knowledge, these are the first reported cases of carcinoma in situ of the uterine cervix and keratoacanthoma in patients with PCS. These findings provide additional evidence for a possible association of PCS and predisposition to malignancies.

Sialoblastoma: a clinicopathologic and immunohistochemical study of 7 cases

Sialoblastoma is a rare congenital or perinatal salivary tumor that varies in histologic features and biologic potential. Seven cases from the files of the Armed Forces Institute of Pathology are presented. These tumors occurred in 4 males and 3 females with ages ranging from prenatal to 6 months at the time of discovery. Five lesions originated from the parotid gland; 2 lesions were from the submandibular gland. All lesions presented as nodular to multinodular swellings and ranged in size from 2.0 to 7.0 cm. The principal sign or symptom was rapid growth. Two histologic patterns with differing behavior predominated: (1) a favorable pattern had semiencapsulation of cytologically benign basaloid tumor cells with intervening stroma; and (2) an unfavorable histology of anaplastic basaloid tumor cells, minimal stroma, and broad pushing to infiltrative periphery. Four and three tumors had favorable and unfavorable growth patterns, respectively. One unfavorable lesion had vascular invasion, and another demonstrated perineural invasion. All 3 tumors with unfavorable histology recurred. Tumor cells in 3 cases were immunohistochemically reactive for keratin, S-100, smooth muscle actin, and calponin to varying degrees. All 3 tumors were reactive for p63. alpha-Fetoprotein was expressed in 2 unfavorable tumors. Ki67 was expressed at 3% in a favorable tumor and 40% and 80% in the 2 unfavorable lesions. Treatment involved surgical excision. One patient received adjuvant chemotherapy. Two sialoblastomas resulted in recurrences within a year and another developed a recurrence after 4 years. One sialoblastoma developed lung metastasis within 1 month of the original biopsy. Although a clinical correlation is suggested by a favorable/unfavorable histologic grading system the biologic behavior is nonetheless considered unpredictable.