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Skrypnyk M, Yatsenko T, Riabets O, Salama Y, Skikevych M, Osada T, Tobita M, Takahashi S, Hattori K, Heissig B. Interleukin-10 induces TNF-driven apoptosis and ROS production in salivary gland cancer cells. Heliyon 2024; 10:e31777. [PMID: 38882335 PMCID: PMC11176751 DOI: 10.1016/j.heliyon.2024.e31777] [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: 01/23/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
Treatment resistance after chemo-/immunotherapy occurs in patients with head and neck squamous cell cancers (HNSCs), including salivary gland cancers (SGCs). Interleukin-10 (IL-10), a cytokine with pro- and anti-cancer effects, has an unclear impact on HNSC/SGC cells. We show that HNSC patients exhibiting high expression of IL-10 and its receptor IL-10Rα experience have prolonged overall survival. Immunoreactive IL-10 was low in ductal cells of human SGC biopsies. Human (A253) and murine WR21-SGC cells expressed IL-10Rβ, but only A253 cells expressed IL-10 and IL-10Rα. The addition of recombinant IL-10 impaired SGC cell proliferation and induced apoptosis in vitro. N-acetylcysteine restored IL-10-induced reactive oxygen species (ROS) production but did not prevent IL-10-mediated viability loss. Mechanistically, recIL-10 delayed cell cycle progression from G0/G1 to the S phase with cyclin D downregulation and upregulation of NF-kB. IL-10 increased tumor necrosis factor-α (TNF-α) in A253 and WR21 and FasL in WR21 cells. Neutralizing antibodies against TNF-α and NF-kB inhibition restored SGC proliferation after IL-10 treatment, emphasizing the critical role of TNF-α and NF-kB in IL-10-mediated anti-tumor effects. These findings underscore the potential of IL-10 to impede SGC cell growth through apoptosis induction, unraveling potential therapeutic targets for intervention in salivary gland carcinomas.
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Affiliation(s)
- Maksym Skrypnyk
- Department of Research Support Utilizing Bioresource Bank, Graduate School of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Tetiana Yatsenko
- Department of Research Support Utilizing Bioresource Bank, Graduate School of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Oleksandra Riabets
- Department of Research Support Utilizing Bioresource Bank, Graduate School of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Yousef Salama
- An-Najah Center for Cancer and Stem Cell Research, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus 99900800, Palestine
| | - Margarita Skikevych
- Department of Surgical Dentistry and Maxillofacial Surgery with Plastic and Reconstructive Surgery of Head and Neck, Poltava State Medical University, 23 Shevchenko Street. Poltava, Ukraine
| | - Taro Osada
- Department of Gastroenterology Juntendo University Urayasu Hospital, Japan
| | - Morikuni Tobita
- Department of Oral and Maxillofacial Surgery, Juntendo University School of Medicine, Japan
| | - Satoshi Takahashi
- Division of Clinical Precision Research Platform, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Koichi Hattori
- Center for Genome and Regenerative Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Beate Heissig
- Department of Research Support Utilizing Bioresource Bank, Graduate School of Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
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Wided C, Ghada B, Mouaffak C, Fadwa G, Nour Sayda BM, Souha BY. Mucoepidermoid carcinoma of the hard palate mimicking a dental abscess: Case report. SAGE Open Med Case Rep 2024; 12:2050313X241261159. [PMID: 38881972 PMCID: PMC11179542 DOI: 10.1177/2050313x241261159] [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: 03/10/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Mucoepidermoid carcinoma is a malignant tumor that arises from the salivary glands. The recommended treatment strategy typically involves surgical intervention, sometimes complemented by radiotherapy, depending on the histological grade of the tumor. A case of a 22-year-old female patient without medical history was described. The clinical examination revealed a bluish lesion located on the hard palate. The histological examination confirmed the diagnosis of a low-grade mucoepidermoid carcinoma. Resection of the lesion was performed and oro-nasal communication was immediately closed by a prosthetic obturator and later on by a rotational palate flap. The patient was followed up for 12 months, and there was no evidence of any recurrence. This article highlights the importance of prompt clinical diagnosis of such lesions and provides an opportunity to review these cancer therapeutic measures to reduce postoperative morbidity.
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Affiliation(s)
- Chaouachi Wided
- Department of Oral Surgery, University Hospital Farhat Hached Sousse, University of Monastir, Tunisia
- Research Laboratory: LR 12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Tunisia
| | - Bouslama Ghada
- Department of Oral Surgery, University Hospital Farhat Hached Sousse, University of Monastir, Tunisia
- Research Laboratory: LR 12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Tunisia
| | - Chaabani Mouaffak
- Department of Oral Surgery, University Hospital Farhat Hached Sousse, University of Monastir, Tunisia
- Research Laboratory: LR 12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Tunisia
| | - Ghanmi Fadwa
- Department of Oral Surgery, University Hospital Farhat Hached Sousse, University of Monastir, Tunisia
- Research Laboratory: LR 12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Tunisia
| | - Ben Messoud Nour Sayda
- Department of Oral Surgery, University Hospital Farhat Hached Sousse, University of Monastir, Tunisia
- Research Laboratory: LR 12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Tunisia
| | - Ben Youssef Souha
- Department of Oral Surgery, University Hospital Farhat Hached Sousse, University of Monastir, Tunisia
- Research Laboratory: LR 12SP10: Functional and Aesthetic Rehabilitation of Maxillary, Tunisia
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Faur AC, Buzaș R, Lăzărescu AE, Ghenciu LA. Current Developments in Diagnosis of Salivary Gland Tumors: From Structure to Artificial Intelligence. Life (Basel) 2024; 14:727. [PMID: 38929710 PMCID: PMC11204840 DOI: 10.3390/life14060727] [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: 04/26/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Salivary glands tumors are uncommon neoplasms with variable incidence, heterogenous histologies and unpredictable biological behaviour. Most tumors are located in the parotid gland. Benign salivary tumors represent 54-79% of cases and pleomorphic adenoma is frequently diagnosed in this group. Salivary glands malignant tumors that are more commonly diagnosed are adenoid cystic carcinomas and mucoepidermoid carcinomas. Because of their diversity and overlapping features, these tumors require complex methods of evaluation. Diagnostic procedures include imaging techniques combined with clinical examination, fine needle aspiration and histopathological investigation of the excised specimens. This narrative review describes the advances in the diagnosis methods of these unusual tumors-from histomorphology to artificial intelligence algorithms.
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Affiliation(s)
- Alexandra Corina Faur
- Department of Anatomy and Embriology, ”Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania; (A.C.F.); (A.E.L.)
| | - Roxana Buzaș
- Department of Internal Medicine I, Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, ”Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania
| | - Adrian Emil Lăzărescu
- Department of Anatomy and Embriology, ”Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania; (A.C.F.); (A.E.L.)
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, ”Victor Babeș”University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timișoara, Romania;
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Selvarajah K, Chen J, Hsu Y, Koo K, Iseli T, Wiesenfeld D, Sim F. Head and neck mucoepidermoid carcinoma: does AFIP histological grading correlate with rate of nodal metastases? Oral Maxillofac Surg 2024; 28:577-583. [PMID: 37344706 DOI: 10.1007/s10006-023-01163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE The aim of this study is to retrospectively evaluate the presentation of head and neck mucoepidermoid carcinoma at the Royal Melbourne Hospital and identify the significance of AFIP histological grading on the risk of neck metastasis and cancer free survival. MATERIALS AND METHODS This study is a retrospective cohort analysis of patients treated for head and neck mucoepidermoid carcinoma at the RMH between 2005 and 2022. Patient demographics, treatment, pathology, in particular the AFIP histological grading of the primary tumour, and outcomes were collected and tabulated. Time to recurrence was recorded, and survival outcomes were calculated with Kaplan-Meier method. Comparisons were made on different histological grading and regional metastases. RESULTS Thirty-three patients were identified and thirty met the inclusion criteria. There was an age range of 18-77 years (median 54 years) with no significant sex difference. Our patients had a 94% 5-year survival and an 86% 10-year survival. Thirteen patients had elective neck dissection and 2 out of 13 (15%) of the patients had positive neck disease. Of the two patients with regional metastasis, the primary tumour was graded as intermediate and low grade. No high-grade MEC patients had regional metastasis. CONCLUSION Mucoepidermoid carcinoma of the head and neck is associated with a good disease-specific and overall survival despite the presence of regional metastasis. The AFIP histological grading system did not have a statistically significant correlation to the incidence of nodal metastasis.
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Affiliation(s)
| | - Jane Chen
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Yuan Hsu
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Kendrick Koo
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Tim Iseli
- Royal Melbourne Hospital, Parkville, Australia
| | | | - Felix Sim
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, 3050, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Punita L, Naik N, Prasad P, Kesari A, Shankar R, Kumar A, Kapoor V, Kumar S, Rastogi N, Agrawal S, Mishra S. Salivary gland tumors: an audit from a tertiary care centre in Northern India. Indian J Otolaryngol Head Neck Surg 2024; 76:2660-2674. [PMID: 38883502 PMCID: PMC11169334 DOI: 10.1007/s12070-023-04348-2] [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: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 06/18/2024] Open
Abstract
Salivary gland tumors are relatively rare and can exhibit various clinical behaviors. The study aims to understand the natural history, pathology, diagnostic workup, and treatment strategies for these tumors to improve patient outcomes. The audit included patients with salivary gland tumors detected through radiology or cytology. Patients underwent surgery, with some receiving adjuvant treatment. Demographic information, treatment interventions, and survival outcomes were analyzed using SPSS software. A total 89 as malignant salivart gland tumours were audited Malignant tumors were predominantly found in the parotid gland, with fewer cases in the minor salivary gland and submandibular gland.The median age of presentation was 47 years, and the majority of patients were male. The study examined various pathological and clinical factors, including tumor stage, nodal status, and the presence of facial palsy. Surgical procedures and histological types of tumors were documented. Adverse histological features like positive margins, lymph node positivity, lympho-vascular invasion, extracapsular spread, and perineural invasion were noted. POSTOP RT was administered to high-risk patients. Most malignant salivary gland tumors were found in the parotid gland, while minor salivary gland tumors were underrepresented in the audit. Surgical practices were diverse. Radiotherapy protocols were relatively standardized. The study found that certain histological features, such as lymph node positivity, margin positivity, lympho-vascular invasion, perineural invasion, and extracapsular spread, were associated with adverse effects on DFS and OS. The findings suggest that specific histological features, including LVI and ECE have emerged as independent prognostic factors for DFS and OS.
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Affiliation(s)
- L Punita
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
| | - Nagendra Naik
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
| | - Pallavi Prasad
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Amit Kesari
- Department of Neuro-Otology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Ravi Shankar
- Department of Neuro-Otology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Anoop Kumar
- Department of Biostatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Vishwas Kapoor
- Department of Biostatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
| | - Neeraj Rastogi
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
| | - Sushma Agrawal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
| | - Shagun Mishra
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014 India
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Mula-Hussain L, Lum K, Alaslani O, Bebedjian R, Grimard L, Sinclair J, Dos Santos MP. Perimesencephalic subarachnoid hemorrhage as a rare delayed complication of radiation therapy in a patient with parotid basaloid squamous cell carcinoma. J Med Imaging Radiat Sci 2024; 55:354-359. [PMID: 38418293 DOI: 10.1016/j.jmir.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/08/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
In this case report, we address a rare entity of parotid cancer: basaloid squamous cell carcinoma, which was surgically unresectable and had thus far only been treated with radiation therapy. Following twenty years of continuous remission, our patient presented with an acute perimesencephalic subarachnoid hemorrhage. The cause of the acute perimesencephalic subarachnoid hemorrhage was a delayed complication of radiation therapy.
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Affiliation(s)
- Layth Mula-Hussain
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Keanu Lum
- Department of Radiology, Radiation Oncology and Medical Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Ottawa, ON, Canada
| | - Ohoud Alaslani
- Department of Radiology, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Razmik Bebedjian
- Department of Medicine, Neurology Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Laval Grimard
- Department of Radiology, Radiation Oncology and Medical Physics, The Ottawa Hospital; Ottawa, ON, Canada
| | - John Sinclair
- Department of Surgery, Neurosurgery Division, The Ottawa Hospital; University of Ottawa; Ottawa, ON, Canada
| | - Marlise P Dos Santos
- Department of Radiology, Radiation Oncology and Physics, Section of Diagnostic and Interventional Neuroradiology, The Ottawa Hospital; Associate Professor of Radiology, University of Ottawa; Clinician Investigator, Neurosciences Program, Ottawa Hospital Research Institute; Scientist, Brain and Mind Research Institute; Ottawa ON, Canada.
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7
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Smith E, Zaro C, Dhingra JK. Salivary Gland Tumors: A 20 Year Review From a Single Community Practice. EAR, NOSE & THROAT JOURNAL 2024:1455613241233085. [PMID: 38445603 DOI: 10.1177/01455613241233085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Objective: Salivary gland tumors are a heterogenous group of lesions with variable pathology and clinical outcomes. Most published data are derived from studies conducted at tertiary care centers. Our study analyzed the experience from a community setting to determine significant differences, if any, in pathological distribution and clinical outcomes compared to the existing literature. Methods: We performed a retrospective analysis of all major salivary gland tumors that presented to a large community practice over a 20 year period. Retrospective chart analysis was performed for demographics, clinical presentation, imaging, cytology, histopathology, and clinical outcome data. Results: Of 806 patients, the parotid gland was the most common site in 683 patients (84.7%), followed by submandibular in 78 (9.7%) and sublingual in 45 (5.6%). A total of 203 patients were managed conservatively with observation without definitive diagnosis or lost to follow-up. A total of 495 patients underwent surgical intervention within the community practice. Twenty-six patients underwent surgical excision at an outside hospital. Eighty-two patients were determined to have a benign diagnosis based on ultrasound-guided fine needle aspiration or excisional biopsy alone. Final histopathology was benign in 505 cases (83.7%), while 98 tumors (16.3%) received a diagnosis of primary or secondary malignancy. For the parotid gland, pleomorphic adenoma (155) and Warthin's tumor (155) were the most common benign diagnoses, while mucoepidermoid carcinoma (13), adenocarcinoma (8), and acinic cell carcinoma (8) were the most common primary malignancies. Conclusions: We found a higher rate of benign tumor pathology compared to the existing literature. While the outcome data on surgical treatment of benign tumors are comparable to the existing literature, the same conclusion cannot be drawn for malignant tumors, given relatively small numbers in our series and likely disparity in the complexity of the surgical cases in tertiary care centers.
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Affiliation(s)
- Emily Smith
- Tufts University School of Medicine, Boston, MA, USA
| | - Christopher Zaro
- University of Massachusetts T. H. Chan Medical School, Worcester, MA, USA
| | - Jagdish K Dhingra
- Tufts University School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA
- ENT Specialists, Inc., Brockton, MA, USA
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Varga R, Iro AK, Thimsen V, Sievert M, Agaimy A, Balk M, Rupp R, Grundtner P, Koch M, Iro H, Mantsopoulos K. Locoregional metastatic behavior in a complex mosaic of primary malignant tumors of the parotid gland. Am J Otolaryngol 2023; 44:103973. [PMID: 37429129 DOI: 10.1016/j.amjoto.2023.103973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND The aim of the study was to investigate primary locoregional metastatic behavior in a large sample of various malignant tumors of the parotid gland with varying grades following surgical treatment consisting of complete parotidectomy and neck dissection. METHODS The records of all patients treated for primary malignant tumors of the parotid gland by means of complete parotidectomy and neck dissection between 2007 and 2022 were studied retrospectively. RESULTS 196 patients formed our study sample (98 females, 98 males). The mean age was 65.7 years (22-101 years). 92 cases presented with low-grade subtypes, 19 with intermediate-grade, and 85 with high-grade carcinomas. The locoregional lymphatic network had been invaded in a total of 66/196 cases (33.6 %). The intraparotid lymph nodes were positive in 54/196 cases (27.5 %) and the cervical lymph nodes in 41/196 cases (20.9 %). In 12 out of the 66 cases with a pN+ status, the neck had been invaded without involvement of the intraparotideal lymph nodes (18.2 %). Male patients tended to suffer from more aggressive carcinomas, and high-grade subtypes presented significantly more frequently as locally advanced tumors. Higher grading was significantly associated with the involvement of the parotid (p < 0.001) and cervical (p < 0.001) lymph nodes. Intermediate and low-grade cases presented similar behavior concerning tumorous invasion of the lymphatic network of the parotid gland (p = 0.522) and the neck (p = 0.467). CONCLUSION The locoregional metastatic potential of parotid malignant tumors depends upon a variety of histopathologic factors, which have to be considered in the decision-making process concerning the management of locoregional lymph nodes.
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Affiliation(s)
- Regina Varga
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ann-Kristin Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Vivian Thimsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Balk
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Philipp Grundtner
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Gule-Monroe MK, Calle S, Policeni B, Juliano AF, Agarwal M, Chow LQM, Dubey P, Friedman ER, Hagiwara M, Hanrahan KD, Jain V, Rath TJ, Smith RB, Subramaniam RM, Taheri MR, Yom SS, Zander D, Burns J. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol 2023; 20:S521-S564. [PMID: 38040469 DOI: 10.1016/j.jacr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susana Calle
- Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Q M Chow
- University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology
| | | | | | - Mari Hagiwara
- New York University Langone Health, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Russell B Smith
- Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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10
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Hofmann E, Priebe J, Rieke DT, Doll C, Coordes A, Olze H, Hofmann VM, Heiland M, Beck-Broichsitter B. Prognostic factors in surgically treated malignant salivary gland tumors. Oral Oncol 2023; 144:106484. [PMID: 37421674 DOI: 10.1016/j.oraloncology.2023.106484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To identify prognostic factors for evidence-based risk stratification in malignant salivary gland tumors. METHODS This retrospective study identified 162 patients who presented with malignant salivary gland tumors between 2010 and 2020. Final analysis included 91 patients who underwent surgical treatment at our institution and were followed-up for ≥ 1 year. Medical records were reviewed and patients were categorized according to their risk profile. RESULTS This study included 91 patients (51 males, 40 females, mean age 61 years). The most frequent entities were adenoid cystic carcinoma (n = 13, 14.3%) and mucoepidermoid carcinoma (n = 12, 13.2%). Kaplan-Meier analysis demonstrated a five-year overall survival (OS) of 66.2% and a recurrence-free survival (RFS) of 50.5%. Age > 60 years (p = 0.011), categorization into high-risk group (p = 0.011), UICC stage (p = 0.020), T stage (p = 0.032), grading (p = 0.045) and vascular invasion (p < 0.001) were significantly associated with OS; age > 60 years (p = 0.014), categorization into high-risk group (p < 0.001), UICC stage (p = 0.021), T stage (p = 0.017), grading (p = 0.011), vascular invasion (p = 0.012) and lymphovascular invasion (p < 0.001) were significantly associated with RFS. Multivariate Cox regression with backward elimination identified T stage (HR 1.835; 95% CI 1.187-2.836; p = 0.006) and grading (HR 2.233; 95% CI 1.113-4.480; p = 0.024) as significant factors for OS. Grading (HR 2.499; 95% CI 1.344-4.648; p = 0.004) was confirmed as a significant factor for RFS. CONCLUSION Considering the risk of recurrence and distant metastasis in malignant salivary gland tumors, locoregional surgical control may not be sufficient and adjuvant therapies such as radiotherapy and/or systemic therapies should be considered.
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Affiliation(s)
- Elena Hofmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany.
| | - Janine Priebe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Damian Tobias Rieke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Comprehensive Cancer Center, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Annekatrin Coordes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Otorhinolaryngology, Campus Virchow Klinikum/ Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; University Medical Centre Ruppin Brandenburg, Brandenburg Medical School, Department of Otorhinolaryngology, Head and Neck Surgery, Fehrbelliner Straße 38, 16816 Neuruppin, Germany; Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Joint Faculty of the University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, House 9, 14469 Potsdam, Germany
| | - Heidi Olze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Otorhinolaryngology, Campus Virchow Klinikum/ Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Veit M Hofmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Otorhinolaryngology, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Benedicta Beck-Broichsitter
- Katharinenhospital Klinikum Stuttgart, Department of Oral and Maxillofacial Surgery, Kriegsbergstraße 60, 70174 Stuttgart, Germany
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11
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Britze TE, Jakobsen KK, Grønhøj C, von Buchwald C. A systematic review on the role of biomarkers in liquid biopsies and saliva samples in the monitoring of salivary gland cancer. Acta Otolaryngol 2023; 143:709-713. [PMID: 37534452 DOI: 10.1080/00016489.2023.2238757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Salivary gland cancer is a rare disease, and approximately 20% of tumors in the salivary glands are malignant. Reliable biomarkers may have a role in monitoring salivary gland cancer. AIM To review the current literature on the role of biomarkers in liquid biopsies and saliva samples in the monitoring of salivary gland cancer. MATERIALS AND METHOD This study systematically reviewed the literature on studies detecting salivary gland cancer by biomarkers in liquid biopsies and saliva samples by systematically searching PubMed and Embase between 1 January 2013 and 7 March 2023. RESULTS Five studies covering 64 malignant cases of salivary gland cancer were included, which considered inflammatory biomarkers or markers of genetic material in either blood or saliva. In saliva, there were demonstrated elevations of CA-19-9 in malignant cases, and elevations of miRNA in malignant and benign cases. In blood, there were demonstrated elevations of IL-33 in malignant and benign cases, elevations of ctDNA in malignant cases, and elevations of CTC in malignant cases. CONCLUSION AND SIGNIFICANCE The studies indicate that there is potential in the detection method. The studies detecting genetic material by liquid biopsies showed the most promising results. At present, there is still progression to be made before the method can be implemented for diagnostic use.
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Affiliation(s)
- Theresa Emilia Britze
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
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12
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Moratin J, Horn D, Semmelmayer K, Ristow O, Engel M, Hoffmann J, Bleymehl M, Held T, Zittel S, Freudlsperger C. Surgical Treatment of Carcinomas of the Oral Minor Salivary Glands-Oncological Outcome in Dependence of Tumor Entity and Therapeutic Strategies. Cancers (Basel) 2023; 15:3895. [PMID: 37568711 PMCID: PMC10417329 DOI: 10.3390/cancers15153895] [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: 07/05/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this study was to analyze the clinical outcomes of three types of minor salivary gland carcinomas (adenoid-cystic carcinomas (ACC), adeno carcinomas not otherwise specified (AC-NOS), and mucoepidermoid carcinomas (MEC)) after primary surgical therapy. A retrospective cohort study was designed and patients with cancer of the minor oral salivary glands treated in our department in the years 2011 to 2022 were included. Clinicopathological data were evaluated to compare overall survival and progression-free survival between the entities. Eighty-one patients were included. The rates of cervical metastases were 38.9% for ACC, 25% for MEC, and 9.1% for AC-NOS. ACC exhibited significantly higher rates of local and systemic disease recurrence (p = 0.02), and the presence of neck node metastases was confirmed as an independent prognostic factor for progression-free survival (p = 0.014). Treatment success in terms of oncological outcome varied significantly between the different entities and implies different treatment regimens for each tumor entity.
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Affiliation(s)
- Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Dominik Horn
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Medical Center, Kirrberger Straße, D-66424 Homburg, Germany;
| | - Karl Semmelmayer
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Michael Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Moritz Bleymehl
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Thomas Held
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany;
- National Center for Tumor Diseases, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Sven Zittel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
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13
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Cheng EY, Kim JH, Grose EM, Philteos J, Levin M, de Almeida J, Goldstein D. Clinicopathological Predictors of Survival for Parotid Mucoepidermoid Carcinoma: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:611-618. [PMID: 35316125 DOI: 10.1177/01945998221086845] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Various prognostic factors are associated with the survival of patients with parotid mucoepidermoid carcinoma (MEC). The aim of this systematic review is to summarize the clinical and pathologic prognostic factors on survival outcomes in patients with parotid MEC. DATA SOURCES Articles published from database inception to July 2020 on OVID Medline, OVID Embase, Cochrane Central, and Scopus. REVIEW METHODS Studies were included that reported clinical or pathologic prognostic factors on survival outcomes for adult patients with parotid MEC. Data extraction, risk of bias, and quality assessment were conducted by 2 independent reviewers. RESULTS A total of 4290 titles were reviewed, 396 retrieved for full-text screening, and 18 included in the review. The average risk of bias was high, and quality assessment for the prognostic factors ranged from very low to moderate. Prognostic factors that were consistently associated with negative survival outcomes on multivariate analysis included histologic grade (hazard ratio [HR], 5.66), nodal status (HR, 2.86), distant metastasis (HR, 3.10-5.80), intraparotid metastasis (HR, 13.52), and age (HR, 1.02-6.86). Prognostic factors that inconsistently reported associations with survival outcomes were TNM stage, T classification, and N classification. CONCLUSION Histologic grade, nodal status, distant metastasis, intraparotid metastasis, and age were associated with worse survival outcomes. These prognostic factors should be considered when determining the most appropriate treatment and follow-up plan for patients with parotid MEC.
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Affiliation(s)
| | - Joo Hyun Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elysia M Grose
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Marc Levin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada
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14
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Saprina OA, Kropotov MA, Tulyandin SA, Ganina KA, Kozlov NA, Vizigina BB. Current trends in the treatment of recurrent adenocystic cancer of the salivary glands: case report. HEAD AND NECK TUMORS (HNT) 2023. [DOI: 10.17650/2222-1468-2022-12-4-109-115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Salivary gland carcinomas is a rare family of neoplasms with different histological characteristics and biological behavior. Treatment regimens have remained virtually unchanged for decades, leaving the leading role for surgical treatment and radiation therapy. However, a special place in the salivary gland carcinomas group is occupied by adenoid cystic carcinoma, which is quite often characterized by a recurrent and / or metastatic course with the use of chemotherapy as the main option in treatment. It is worth noting the fact that the results of standard chemotherapy regimens show unsatisfactory results, respectively, with recurrent or metastatic adenoid cystic carcinoma, treatment options are minimal. Accordingly, there is a need to study new therapeutic methods for the treatment of this disease. In this situation, high hopes were placed on targeted therapy, in particular, the family of epidermal growth factor receptors, c-Kit are the most frequently studied molecular targets. Due to the rare occurrence of adenoid cystic carcinoma, the number of cases of using targeted therapy for analysis is relatively small, so each clinical observation is of particular value. The following is a clinical case of treatment of recurrent adenoid cystic carcinoma using a personalized treatment approach.Aim. To describe the clinical observation of the use of targeted drugs in recurrent or metastatic adenocystic cancer of the salivary glands.
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Affiliation(s)
- O. A. Saprina
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - M. A. Kropotov
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - S. A. Tulyandin
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - K. A. Ganina
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - N. A. Kozlov
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - B. B. Vizigina
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
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15
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Kapsalas A, Thimsen V, Varga R, Agaimy A, Sievert M, Balk M, Rupp R, Koch M, Iro H, Mantsopoulos K. Investigation of locoregional metastatic behavior in low-grade malignant tumors of the parotid gland. Am J Otolaryngol 2023; 44:103824. [PMID: 36889143 DOI: 10.1016/j.amjoto.2023.103824] [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: 01/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The aim of the study was to investigate primary locoregional metastatic behavior in a large sample of low-grade malignant tumors of the parotid gland following surgical treatment consisting of complete parotidectomy and neck dissection. METHODS The records of all patients treated for low-grade malignant tumors of the parotid gland by complete parotidectomy and neck dissection between 2007 and 2022 were studied retrospectively. RESULTS 94 patients formed our study sample (50 females, 44 males, female to male ratio: 1.14). The mean age was 59 years (range 15-95 years). The mean number of lymph nodes in the specimen from complete parotidectomy was 3.33 (range: 0-12). The mean number of involved lymph nodes in the parotid gland was 0.05 (range: 0-1). The mean number of lymph nodes in the specimen from the ipsilateral neck dissection was 16.2 (range 4-42). The mean number of involved lymph nodes in the neck dissection specimen was 0.09 (range: 0-2). Comparison of T1-T2 vs. T3-T4 cases revealed no statistically significant difference concerning the tumorous involvement of the lymphatic network (x2 = 0.719, p = 0.396). CONCLUSION Low-grade primary malignant tumors of the parotid gland are characterized by an initially low metastatic potential, which justifies conservative forms of surgical treatment.
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Affiliation(s)
- Andreas Kapsalas
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Vivian Thimsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Regina Varga
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Balk
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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16
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Zhang Y, Zhang M, Zhang J, Zhao K, Yuan X, Di W, Liu Y, Lu P. Sintilimab combined with chemotherapy successfully treated a patient with advanced submandibular gland tumor. Immunotherapy 2023; 15:27-33. [PMID: 36617958 DOI: 10.2217/imt-2022-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Primary submandibular gland tumors are relatively rare. Due to its low incidence and broad spectrum phenotypic, biological and clinical heterogeneity types, a wide range of options have been developed to treat this tumor. To date, however, efficacious standard treatment regimens are lacking. Here, the authors present a case of a patient with an advanced submandibular gland tumor. Histological and imaging results diagnosed the case as stage IV submandibular gland adenocarcinoma with multiple metastases. The patient was subjected to systemic platinum-based chemotherapy combined with sintilimab. A primary lesion complete response was observed after six cycles of treatment. This case affirms the efficacy of the PD-1 inhibitor sintilimab combined with platinum-based chemotherapy as a first-line treatment for advanced submandibular gland tumors.
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Affiliation(s)
- Yingfang Zhang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Min Zhang
- Department of Oncology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Jing Zhang
- Department of Oncology, Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Kelei Zhao
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Xiaohan Yuan
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Wenyu Di
- Department of Pathology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Yanting Liu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Ping Lu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
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17
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Yang M, Yun H, Lee KC, Lim CW, Kim B. Clear cell variant mucoepidermoid carcinoma of salivary gland in a grey wolf (
Canis lupus
). Vet Med Sci 2022; 8:2678-2682. [DOI: 10.1002/vms3.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Myeon‐Sik Yang
- Laboratory of Veterinary Pathology College of Veterinary Medicine Jeonbuk National University Iksan‐si Jeollabuk‐do Republic of Korea
| | - Hyejin Yun
- Laboratory of Veterinary Pathology College of Veterinary Medicine Jeonbuk National University Iksan‐si Jeollabuk‐do Republic of Korea
| | - Ki Chang Lee
- Laboratory of Veterinary Radiology College of Veterinary Medicine Jeonbuk National University Iksan‐si Jeollabuk‐do Republic of Korea
| | - Chae Woong Lim
- Laboratory of Veterinary Pathology College of Veterinary Medicine Jeonbuk National University Iksan‐si Jeollabuk‐do Republic of Korea
| | - Bumseok Kim
- Laboratory of Veterinary Pathology College of Veterinary Medicine Jeonbuk National University Iksan‐si Jeollabuk‐do Republic of Korea
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18
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Hu Z, Wang B, Pan X, Cao D, Gao A, Yang X, Chen Y, Lin Z. Using deep learning to distinguish malignant from benign parotid tumors on plain computed tomography images. Front Oncol 2022; 12:919088. [PMID: 35978811 PMCID: PMC9376440 DOI: 10.3389/fonc.2022.919088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Evaluating the diagnostic efficiency of deep-learning models to distinguish malignant from benign parotid tumors on plain computed tomography (CT) images. Materials and methods The CT images of 283 patients with parotid tumors were enrolled and analyzed retrospectively. Of them, 150 were benign and 133 were malignant according to pathology results. A total of 917 regions of interest of parotid tumors were cropped (456 benign and 461 malignant). Three deep-learning networks (ResNet50, VGG16_bn, and DenseNet169) were used for diagnosis (approximately 3:1 for training and testing). The diagnostic efficiencies (accuracy, sensitivity, specificity, and area under the curve [AUC]) of three networks were calculated and compared based on the 917 images. To simulate the process of human diagnosis, a voting model was developed at the end of the networks and the 283 tumors were classified as benign or malignant. Meanwhile, 917 tumor images were classified by two radiologists (A and B) and original CT images were classified by radiologist B. The diagnostic efficiencies of the three deep-learning network models (after voting) and the two radiologists were calculated. Results For the 917 CT images, ResNet50 presented high accuracy and sensitivity for diagnosing malignant parotid tumors; the accuracy, sensitivity, specificity, and AUC were 90.8%, 91.3%, 90.4%, and 0.96, respectively. For the 283 tumors, the accuracy, sensitivity, and specificity of ResNet50 (after voting) were 92.3%, 93.5% and 91.2%, respectively. Conclusion ResNet50 presented high sensitivity in distinguishing malignant from benign parotid tumors on plain CT images; this made it a promising auxiliary diagnostic method to screen malignant parotid tumors.
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Affiliation(s)
- Ziyang Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Baixin Wang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiao Pan
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dantong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xudong Yang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Zitong Lin, ; Ying Chen, ; Xudong Yang,
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- *Correspondence: Zitong Lin, ; Ying Chen, ; Xudong Yang,
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Zitong Lin, ; Ying Chen, ; Xudong Yang,
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Taniuchi M, Kawata R, Terada T, Higashino M, Nishimura H, Kurisu Y, Kuwabara H, Hirose Y. Management and outcome of parotid mucoepidermoid carcinoma by histological grade: A 21‐year review. Laryngoscope Investig Otolaryngol 2022; 7:766-773. [PMID: 35734046 PMCID: PMC9194965 DOI: 10.1002/lio2.809] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Mucoepidermoid carcinoma (MEC) is the most common malignancy of the parotid gland, but the outcome depends on the histological grade. Therefore, the aim of this study was to evaluate MEC on the basis of histological grade. Study Design Retrospective analysis. Methods We performed a retrospective analysis of data from patients whose initial treatment for MEC of the parotid gland was performed at our department between 1999 and 2021. We examined the association between the Armed Forces Institute of Pathology (AFIP) grade and outcome. Results The AFIP grades were as follows: low, 26 cases; intermediate, 9 cases; and high, 31 cases. About 50% of cases were correctly diagnosed as malignant, and both grade and histology were accurately determined by fine‐needle aspiration cytology in 20% of cases. The 5‐year disease‐free survival rate was 95.5% and 53.8% in the low‐/intermediate‐ and high‐grade cases, respectively. In the high‐grade group, cases with recurrence were found to have a higher rate of lymph nodes metastasis than cases without recurrence. Furthermore, in this high‐grade group, total sacrifice of the facial nerve did not reduce local recurrence. However, radical resection in the cases without tumor invasion to the nerve has decreased the local recurrence rate. The CRTC1‐MAML2 fusion gene was expressed in 42.3% of low‐/intermediate‐ and 14.3% of high‐grade cases. Conclusions The survival rate in MEC was quite different between the low‐/intermediate‐ and high‐grade cases. However, the rate of correct assessment of the grade by fine‐needle aspiration cytology was poor. In high‐grade cases, total sacrifice of the facial nerve may improve the rate of local recurrence in cases without invasion of the main trunk of the nerve. Expression of the CRTC1‐MAML2 fusion gene could be helpful in not only the assessment of grade but the prediction of recurrence. Level of Evidence 4
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Affiliation(s)
- Masataka Taniuchi
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Tetsuya Terada
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Masaaki Higashino
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Hiromi Nishimura
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Yoshitaka Kurisu
- Department of Pathology Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Hiroko Kuwabara
- Department of Pathology Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Yoshinobu Hirose
- Department of Pathology Osaka Medical and Pharmaceutical University Takatsuki Japan
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Javaheripour A, Saatloo MV, Vahed N, Gavgani LF, Kouhsoltani M. Evaluation of HER2/neu expression in different types of salivary gland tumors: a systematic review and meta-analysis. J Med Life 2022; 15:595-600. [PMID: 35815077 PMCID: PMC9262268 DOI: 10.25122/jml-2021-0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
This study is a systematic review and meta-analysis to assess the overexpression rate of HER2 in patients with salivary gland tumors. We included peer-reviewed publications from 1995 to 2020, indexed in medical databases, using search terms such as "human epidermal growth factor receptor 2 (HER2)" and "salivary gland tumors", and extracted relevant data. The extracted data were analyzed with RevMan 5.3 software. Intra-and intergroup post hoc analyses of outcome variables were performed using t-tests, and the rates of HER2 positivity among studies were evaluated. 80 studies were included in the analysis. The positive rates of HER2 ranged from 3.3% to 84.0% and 1% to 9% in malignant and benign subtypes, respectively. The highest HER2 overexpression rate among malignant tumors was in salivary ductal carcinomas (SDC), with a 45% positive rate (CI 95%: 21.9-70.3%). Mucoepidermoid carcinoma (MEC) had the highest positive rate of 84% (CI 95%: 74.1-90.0%). Among benign salivary gland tumors, the highest rate was found in myoepithelioma, with a positive rate of 9% (CI 95%: 1.7-33.6%). The highest rate of HER2 overexpression is present in malignant subtypes of salivary gland tumors, more specifically in salivary ductal carcinoma, mucoepidermoid carcinomas, salivary duct carcinoma in situ, and carcinoma ex pleomorphic adenoma.
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Affiliation(s)
- Aylar Javaheripour
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maedeh Vakili Saatloo
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Nafiseh Vahed
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Faraji Gavgani
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Kouhsoltani
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding Author: Maryam Kouhsoltani, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Tabriz University of Medical sciences, Tabriz, Iran. E-mail:
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21
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Noguchi K, Kanda S, Yoshida K, Funaoka Y, Yamanegi K, Yoshikawa K, Takaoka K, Kishimoto H, Nakano Y. Establishment of a patient‑derived mucoepidermoid carcinoma cell line with the CRTC1‑MAML2 fusion gene. Mol Clin Oncol 2022; 16:75. [PMID: 35251626 PMCID: PMC8848773 DOI: 10.3892/mco.2022.2508] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 10/08/2021] [Indexed: 12/05/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the major and minor salivary glands. Surgical resection is the only curative treatment and there is no effective post-operative therapy for MEC. The present study reports an Institutional Review Board-approved case of a 45-year-old Japanese female diagnosed with low-grade MEC in the hard palate. Radical resection, supraomohyoid neck dissection and antero-lateral thigh flap reconstruction was performed. A MEC cell line was then established from the resected tumor tissue. Short tandem repeat profiling confirmed the origin and authenticity of the cell line, that harbors a CRTC1-MAML2 translocation, which is frequently observed in MEC. Amphiregulin (AREG), identified as one of the targets of the CRTC1-MAML2 fusion gene, was expressed in the cell line. The AREG receptor, epidermal growth factor receptor (EGFR) was also highly phosphorylated. The results predicted that AREG-EGFR signaling, which is required for tumor growth and survival, might be activated in the cell line in a cell-autonomous manner. As AREG expression is associated with EGFR-targeted drug resistance, this cell line might assist with the identification of novel strategies for MEC treatment.
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Affiliation(s)
- Kazuma Noguchi
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Shuji Kanda
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Kazunari Yoshida
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Yusuke Funaoka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Koji Yamanegi
- Department of Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Kyohei Yoshikawa
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Kazuki Takaoka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Hiromitsu Kishimoto
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
| | - Yoshiro Nakano
- Department of Genetics, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan
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22
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Luna LP, Coffey W, Alvin MD, Shanechi AM, Sankaran N, Rodriguez EF, Naeem Z, Aygun N, Khan M. Parotid Warthin's tumor: novel MR imaging score as diagnostic indicator. Clin Imaging 2021; 81:9-14. [PMID: 34598007 DOI: 10.1016/j.clinimag.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite known characteristic radiologic and clinical features, differentiation between Warthin's tumor (WT) and other parotid tumors remains challenging. The purpose of this study was to more precisely assess the MR imaging features of WT and to develop a scoring system combining the most specific characteristics. METHODS A total of 208 patients with parotid gland tumors and presurgical MRI were included. Tumors were divided into 5 histological subtypes, and different MRI features were compared between groups. An MRI scoring test was developed including MR parameters that contributed significantly in distinguishing WT from other tumors. RESULTS The best MRI features for differentiating between WTs from other tumors included bilaterality (P = 0.002), multifocality (P < 0.001), ADC values <905.1 (P < 0.001), and high signal intensity on T1-W images (P < 0.001). Six or more points on the 14-point scoring MRI scale was associated with an area under the curve of 0.99 (Accuracy of 98%), while a cut-off value of 7 indicated 100% specificity and 100% positive predictive value. CONCLUSIONS Ill-defined margins, low T1-W signal, and location in the upper 2/3 of the parotid gland excluded WTs in 100% of cases. The proposed scoring method allows WTs to be distinguished from other tumors with high accuracy. KEY POINTS
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Affiliation(s)
- Licia P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - William Coffey
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Matthew D Alvin
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amirali Modir Shanechi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nisha Sankaran
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Erika F Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zunaira Naeem
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nafi Aygun
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Majid Khan
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA; Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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23
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Suzuki H, Abe T, Sasaki E, Nagao T, Murashima A, Fujieda H, Higaki E, Hanai N. Synchronous Resection of Parotid Metastasis With Esophagectomy: A Case Report. In Vivo 2021; 35:2337-2340. [PMID: 34182515 DOI: 10.21873/invivo.12509] [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: 04/11/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preoperative diagnosis of parotid tumor is mainly performed via imaging and cytology to avoid both facial nerve injury and tumor seeding. Synchronous resection of solitary parotid metastasis with esophagectomy for esophageal squamous cell carcinoma is rarely performed. CASE REPORT This is a case report of a 58-year-old male patient with a left preauricular tumor, which was cytologically diagnosed as squamous cell carcinoma. Esophageal squamous cell carcinoma was pathologically diagnosed following 18F-fluorodeoxyglucose positron emission tomography with computed tomography. His diagnosis was cT2N0M0 esophageal squamous cell carcinoma with cT3N0M0 parotid carcinoma. Esophagectomy for esophageal cancer, as well as parotidectomy were performed. Pathological diagnosis of pT1bN1M1 (parotid) esophageal squamous cell carcinoma was based on exclusion diagnosis of no primary tumor from several specialists and pathological findings including immunohistochemical staining. CONCLUSION Reporting of more cases of rare synchronous metastasectomy and esophagectomy is needed to clarify treatment strategies.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuya Nagao
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiro Murashima
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hironori Fujieda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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24
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France K, AlMuzaini AAAY, Mupparapu M. Radiographic Interpretation in Oral Medicine and Hospital Dental Practice. Dent Clin North Am 2021; 65:509-528. [PMID: 34051928 DOI: 10.1016/j.cden.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Oral medicine practice includes the diagnosis and nonsurgical treatment of oral and orofacial diseases and oral manifestations of systemic conditions. Oral medicine specialists in medical and dental settings often require imaging in assessment and treatment of these conditions. This article reviews imaging that may be used in practice, particularly as relevant for facial pain, bone conditions, and salivary gland disease. It reviews imaging that may be considered in a hospital setting for assessment of admitted patients, patient evaluation before surgical procedures, and provision of dentistry in a hospital setting for patients who cannot submit to treatment in an outpatient setting.
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Affiliation(s)
- Katherine France
- University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | | | - Mel Mupparapu
- University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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25
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Strizova Z, Kuchar M, Capkova L, Komarc M, Skrivan J, Bartunkova J, Plzak J, Smrz D. Fas-Fas Ligand Interplay in the Periphery of Salivary Gland Carcinomas as a New Checkpoint Predictor for Disease Severity and Immunotherapy Response. Biomedicines 2021; 9:biomedicines9040402. [PMID: 33917866 PMCID: PMC8068215 DOI: 10.3390/biomedicines9040402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 02/05/2023] Open
Abstract
Salivary gland carcinomas (SGCs) are extremely morphologically heterogeneous, and treatment options for this disease are limited. Immunotherapy with immune checkpoint inhibitors (ICIs) represents a revolutionary treatment approach. However, SGCs remain largely resistant to this therapy. An increasing body of evidence suggests that resistance to ICI therapy is modulated by the Fas (CD95)–Fas ligand (FasL, CD178) interplay between tumor cells and immune cells. In this study, we examined the Fas–FasL interplay between tumor cells and tumor-infiltrating immune cells (TIICs) in the center and periphery of SGCs from 62 patients. We found that the Fas-expressing tumor cells accumulated in the center of SGC tumors with increasing tumor stage. Furthermore, this accumulation occurred regardless of the presence of TIICs expressing high levels of FasL. On the contrary, a loss of Fas-expressing TIICs with increasing tumor stage was found in the tumor periphery, whereas FasL expression in tumor cells in the tumor periphery correlated with tumor stage. These data suggest that SGC cells are resistant to FasL-induced apoptosis by TIICs but could utilize FasL to eliminate these cells in high-stage tumors to provide resistance to immunotherapy.
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Affiliation(s)
- Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic; (Z.S.); (J.B.)
| | - Martin Kuchar
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic; (M.K.); (J.P.)
| | - Linda Capkova
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic;
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, 15006 Prague, Czech Republic;
| | - Jiri Skrivan
- Department of Otorhinolaryngology, Second Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic;
| | - Jirina Bartunkova
- Department of Immunology, Second Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic; (Z.S.); (J.B.)
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic; (M.K.); (J.P.)
| | - Daniel Smrz
- Department of Immunology, Second Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic; (Z.S.); (J.B.)
- Correspondence:
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26
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Almas T, Hussain S, Ehtesham M, Alsufyani R, Khan MK. Mucoepidermoid Carcinoma of the Parotid Gland Presenting as a Fungating Exophytic Mass: A Surgical Challenge Rooted in Extensive Nerve Encasement. Cureus 2020; 12:e10990. [PMID: 33209546 PMCID: PMC7667710 DOI: 10.7759/cureus.10990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Parotid glands, which are predominantly composed of serous acini, are the largest salivary glands in the human body. Mucoepidermoid carcinoma (MEC) of the parotid gland is the most common parotid tumour that routinely presents as a painless, fixed mass below the ears. However, its presentation as a fungating mass remains exceedingly rare. Due to the intimate anatomical relationship between the parotid gland and the facial nerve, parotid malignancies can culminate in facial nerve palsy, posing an onerous surgical challenge. In this paper, we chronicle the case of a male who presented with a fungating/exophytic mass and facial nerve weakness. A superficial parotidectomy was performed, and the eventual histopathological workup divulged an advanced mucoepidermoid parotid carcinoma entirely encasing the marginal mandibular nerve. Consequently, the marginal mandibular nerve was sacrificed, alluding to the remarkable surgical challenge encountered. Clinically, this manifested as an impairment of the motor function in the patient's left lower lip.
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27
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Cash H, Harbison RA, Futran N, Parvathaneni U, Laramore GE, Liao J, Cannon R, Rodriguez C, Houlton JJ. Neutron Therapy for High-Grade Salivary Carcinomas in the Adjuvant and Primary Treatment Setting. Laryngoscope 2020; 131:541-547. [PMID: 32603506 DOI: 10.1002/lary.28830] [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: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our primary objective was to compare differences in survival of patients with high-grade salivary gland carcinomas (SGCs) receiving adjuvant neutron versus photon radiotherapy using a hospital-based national cohort and restricted mean survival time (RMST) analysis. Our secondary objective was to compare survival of similar patients treated with primary neutron versus photon radiation. STUDY DESIGN Multicenter, retrospective population-based study of patients within the National Cancer Database from 2004 to 2014. METHODS One thousand eight hundred forty-four patients were selected on diagnosis of high-grade parotid and submandibular malignancies. One thousand seven hundred seventy-seven patients receiving photon and 67 patients receiving neutron therapy were identified who met inclusion criteria. Patients were then categorized as having primary surgery with adjuvant radiation or primary radiation without prior surgery. Bivariate analysis was performed to assess for differences between groups, and RMST analysis was performed at 1-, 2-, and 5-year timepoints with controlling for available covariate data. RESULTS There was no significant difference in RMST for patients receiving neutrons over photons at 1, 2, and 5 years in the adjuvant setting. Among patients undergoing primary radiotherapy, there was a difference in RMST of 2.29 months at 1 year and 5.05 months at 2 years for neutrons over photons, though this benefit was not observed at 5 years post-therapy. CONCLUSIONS For patients with high grade SGCs undergoing adjuvant photon versus neutron radiotherapy, there was no difference in RMST. There was observed to be a significant difference in RMST at 1 and 2 years among patients undergoing primary neutron therapy of up to 5 months. Given the benefit observed with primary neutron therapy, it should be considered in both the primary and adjuvant treatment setting. LEVEL OF EVIDENCE 4 Laryngoscope, 131:541-547, 2021.
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Affiliation(s)
- Harrison Cash
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - R Alex Harbison
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Neal Futran
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - George E Laramore
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Jay Liao
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Richard Cannon
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Cristina Rodriguez
- Department of Medicine, Division of Oncology, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
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Intra-Cystic (In Situ) Mucoepidermoid Carcinoma: A Clinico-Pathological Study of 14 Cases. J Clin Med 2020; 9:jcm9041157. [PMID: 32325647 PMCID: PMC7231055 DOI: 10.3390/jcm9041157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS To report on the clinico-pathological features of a series of 14 intra-oral mucoepidermoid carcinomas showing exclusive intra-cystic growth. Materials and methods All mucoepidermoid carcinomas diagnosed in the period 1990–2012 were retrieved; the original histological preparations were reviewed to confirm the diagnosis and from selected cases, showing exclusive intra-cystic neoplastic components, additional sections were cut at three subsequent 200 m intervals and stained with Hematoxylin–Eosin, PAS, Mucicarmine and Alcian Blue, to possibly identify tumor invasion of the adjacent tissues, which could have been overlooked in the original histological preparations. Additionally, pertinent findings collected from the clinical charts and follow-up data were analyzed. Results We identified 14 intraoral mucoepidermoid carcinomas
treated by conservative surgery and with a minimum follow up of five years. The neoplasms were located in the hard palate (nine cases), the soft palate (two), the cheek (two) and the retromolar
trigone (one). In all instances, histological examination revealed the presence of a single cystic space, containing clusters of columnar, intermediate, epidermoid, clear and mucous-producing cells, the latter exhibiting distinct intra-cytoplasmic mucin production, as confirmed by PAS, Mucicarmine and Alcian Blue stains. The cysts were entirely circumscribed by fibrous connective tissue, and no solid areas or infiltrating tumor cell clusters were detected. Conservative surgical resection was performed in all cases, and no recurrences or nodal metastases were observed during follow up. Conclusions Mucoepidermoid carcinomas showing prominent (>20%) intra-cystic proliferation currently are considered low-grade tumors. In addition, we also unveil the possibility that mucoepidermoid
carcinomas, at least in their early growth phase, may display an exclusive intra-cystic component and might be considered as in situ carcinomas, unable to infiltrate adjacent tissues and metastasize.
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Is serum bilirubin level a predictor factor in parotid gland carcinoma? Braz J Otorhinolaryngol 2019; 86:339-342. [PMID: 31523023 PMCID: PMC9422569 DOI: 10.1016/j.bjorl.2019.01.013] [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: 12/11/2018] [Accepted: 01/23/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Bilirubin levels have been associated with risk of several malignancies. The association between pretreatment serum bilirubin levels and overall survival of patients with parotid gland carcinoma is unclear. Objectives In this study, we assessed the effect of serum bilirubin levels to overall survival in malignant parotid tumors. Methods This study included a total of 35 patients, 15 female and 20 male. The mean age of these patients was 60.7 ± 14.5 years. All patients who were diagnosed with parotid gland carcinoma and underwent total parotidectomy between 2008 and 2018, were retrospectively assessed. The relationship between the overall survival of patients and total bilirubin, direct bilirubin, and indirect bilirubin levels was estimated. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off points. Results Patients with low direct bilirubin, total bilirubin and indirect bilirubin had significantly longer overall survival than those with high levels. Cut-off values for total bilirubin, direct bilirubin and indirect bilirubin were detected as 0.545 mg/dL, 0.175 mg/dL and 0.435 mg/dL, respectively. Conclusion In our study, we observed that increased preoperative bilirubin levels are associated with reduced survival time in the postoperative period of patients with parotid gland carcinoma.
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30
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Akbaba S, Heusel A, Mock A, Held T, Lang K, Hoerner-Rieber J, Forster T, Katayama S, Kargus S, Rieken S, Plinkert P, Herfarth K, Debus J, Adeberg S. The impact of age on the outcome of patients treated with radiotherapy for mucoepidermoid carcinoma (MEC) of the salivary glands in the head and neck: A 15-year single-center experience. Oral Oncol 2019; 97:115-123. [PMID: 31494395 DOI: 10.1016/j.oraloncology.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/02/2019] [Accepted: 08/25/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Data regarding treatment and survival outcome of patients with mucoepidermoid carcinoma of the head and neck are limited to case reports and case series. As a consequence of lacking evidence, treatment guidelines do not exist. We aimed to analyze the effect of modern radiotherapy in form of intensity modulated radiotherapy (IMRT) either with simultaneously integrated boost or carbon ion boost on local control and survival for a relatively large patient collective. MATERIALS AND METHODS Patient records of 62 consecutive patients treated with postoperative (n = 53, 85%) or definitive (n = 9, 15%) radiotherapy between 2004 and 2019 were analyzed retrospectively. Kaplan-Meier estimates for overall survival (OS), distant progression-free survival (PFS), local control (LC) and locoregional control (LRC) were statistically calculated and prognostic factors were identified using the log-rank test. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The median follow-up was 47 months (range, 4-188 months). The 3-year OS, DPFS, LC and LRC, estimated by Kaplan-Meier curves, were 82%, 87%, 89% and 92%, the estimated 5-year OS, DPFS, LC and LRC were 78%, 87%, 84% and 88%, respectively. In univariate analysis, age >56 years (vs. age ≤56 years) was identified as the only independent negative prognostic factor for decreased OS (HR = 1.078; 95%-CI = 1.029-1.130; p = 0.001), DPFS (HR = 1.055; 95%-CI = 1.000-1.114; p = 0.051) and LC (HR = 1.087; 95%-CI = 1.022-1.157; p = 0.008). Treatment was well tolerated without any grade ≥4 toxicity. Acute and late grade 3 toxicities were rare with 16% acute (n = 10) and 13% late toxicities (n = 8). CONCLUSION Radiotherapy with intensity modulated radiotherapy including either simultaneously integrated photon boost or active raster-scanning carbon ion boost for mucoepidermoid carcinomas of the head and neck resulted in excellent survival outcome and locoregional control with moderate toxicity. However, patients older than 56 years seem to have a disadvantage in all calculated endpoints (OS, DPFS, LRC) due to frequent local and distant relapses. CONDENSED ABSTRACT Modern radiotherapy with intensity modulated radiotherapy including either a simultaneously integrated photon boost or carbon ion boost for mucoepidermoid carcinoma results in excellent survival outcome and locoregional control with moderate toxicity. The 5-year OS, DPFS, LC and LRC, estimated by Kaplan-Meier curves, were 89%, 75%, 84% and 80%, respectively. Patients older than 56 years seem to have a disadvantage in all calculated endpoints (OS, DPFS, LRC).
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Affiliation(s)
- Sati Akbaba
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Astrid Heusel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Andreas Mock
- Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Juliane Hoerner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Sonja Katayama
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Peter Plinkert
- Department of Otorhinolaryngology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
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Kim YH, Chung WK, Jeong JU, Cho IJ, Yoon MS, Song JY, Nam TK, Ahn SJ, Lee DH, Yoon TM, Lee JK, Lim SC. Evaluation of Prognostic Factors for the Parotid Cancer Treated With Surgery and Postoperative Radiotherapy. Clin Exp Otorhinolaryngol 2019; 13:69-76. [PMID: 31480828 PMCID: PMC7010496 DOI: 10.21053/ceo.2019.00388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/16/2019] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the prognostic factors and treatment outcomes of primary parotid carcinoma treated with surgery and postoperative radiotherapy (PORT). Methods We reviewed retrospectively 57 patients with primary parotid carcinoma who were treated with surgery and PORT between 2005 and 2014. Superficial parotidectomy was performed in 19 patients, total parotidectomy in 10 patients, and total parotidectomy with lymph node dissection in 28 patients PORT on the tumor bed was performed in 41 patients, while PORT on tumor bed and ipsilateral cervical lymph nodes was performed in 16 patients. Results With a median follow-up of 66 months, the 5-year overall survival, disease-free survival, locoregional control, and distant control rates were 77.0%, 60.2%, 77.6%, and 72.8%, respectively. The 5-year overall survival by stage was 100%, 100%, 80.0%, and 46.4% in stage I, II, III, and IV, respectively. Recurrences at primary lesions were found in seven patients, while at cervical nodes in six patients. Distant recurrences were developed in 12 patients. No patient with the low and intermediate histologic grade developed distant failure. As prognostic factors, the histologic grade for overall survival (P=0.005), pathological T-stage (P=0.009) and differentiation grade (P=0.009) for disease-free survival, pathological T-stage for locoregional control (P=0.007), and lympho-vascular invasion (P=0.023) for distant recurrence were significant on multivariate analysis. Conclusion This study revealed that differentiation grade, histologic grade, pathological T-stage, and lympho-vascular invasion were significant independent prognostic factors on clinical outcomes.
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Affiliation(s)
- Yong-Hyub Kim
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Woong-Ki Chung
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ick Joon Cho
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ju-Young Song
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Dong Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Chul Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Galdirs TM, Kappler M, Reich W, Eckert AW. Current aspects of salivary gland tumors - a systematic review of the literature. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc12. [PMID: 31523610 PMCID: PMC6734194 DOI: 10.3205/iprs000138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: This study provides an up-to-date overview of the distribution of salivary gland tumors in relation to sex, land of treatment, localization of the tumor in the mouths, and benign/malignant disease of this type of tumor. We hypothesized that the distribution of patients with salivary gland tumors could vary according to country, gender, age and tumor specificity. In addition there is a comparison of the primary classification of salivary gland tumors from 1981 and the recent classification from 2005. Materialsand methods: Data from the Medline database PubMed.gov and supplementary sources were used to conduct a systematic literature search. For this purpose, data from different studies were independently collected using a previously designed questionnaire. Results: The first section analyzes the general features of the relevant salivary gland tumors from 141 studies involving a total of 25,826 patients across 30 different countries in terms of gender and the occurrence of benign/malignant salivary gland tumors. These data were summarized and presented. Conclusion: This review offers an insight into the dramatic local differences with regard to salivary gland tumor occurrence as a stepping stone to further classify such data in order to derive effective therapy options, prognosis and widen the general understanding of the subject.
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Affiliation(s)
- Theresa Marie Galdirs
- Martin Luther University Halle-Wittenberg, University hospital, Department of Oral and Maxillofacial Plastic Surgery, Halle, Germany
| | - Matthias Kappler
- Martin Luther University Halle-Wittenberg, University hospital, Department of Oral and Maxillofacial Plastic Surgery, Halle, Germany
| | - Waldemar Reich
- Martin Luther University Halle-Wittenberg, University hospital, Department of Oral and Maxillofacial Plastic Surgery, Halle, Germany
| | - Alexander W Eckert
- Martin Luther University Halle-Wittenberg, University hospital, Department of Oral and Maxillofacial Plastic Surgery, Halle, Germany
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Alraddadi T, Aldhahri S, Alharbi J, Malas M, Islam T, Altuwaijri A, Al-Qahtani K. Predictors for Salivary Gland Cancer Recurrence at Two Tertiary Hospitals in Saudi Arabia. Cureus 2019; 11:e5288. [PMID: 31576277 PMCID: PMC6764638 DOI: 10.7759/cureus.5288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Tumors of salivary glands are enlarged as a low-risk mass and mostly benign in nature. The treatment of salivary gland malignancy remains quite challenging because of its relative infrequency, unreliable biological manners, and risk of re-emergence. For effective treatment planning, prediction of factors associated with the recurrence of salivary gland malignancy is essential. Aim The objective of this study was to identify the factors associated with recurrence of salivary gland malignancy at two tertiary hospitals in Saudi Arabia. Material and methods A cross-sectional study was conducted at two tertiary hospitals in Saudi Arabia, where data of patients were recorded from the medical records of hospitals from 2012 to 2018. 63 patients who were diagnosed with salivary gland malignancy, whether originated from parotid, submandibular, sublingual, and minor salivary glands were included in the study. Descriptive statistics are shown in mean, frequency, and percentages, while comparative analysis was done using the Chi-square test, where p < 0.05 is considered significant. Results This study included 63 participants. The majority of malignant salivary gland cancers arise from the parotid gland (47.6%), and mucoepidermoid carcinoma was the commonest form of malignancy in 36.5% of the studied population. Out of 63 patients, 17 had a recurrence of cancer, and the initial advanced stage of the disease is apparently associated with the re-emergence of salivary gland cancer. Conclusion The initial advanced stage of cancer has a significant role in the recurrence of salivary gland malignancy. As salivary gland malignancy is rare and has unreliable behavior, establishing an adequate treatment plan prediction for recurrence is essential.
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Affiliation(s)
| | | | | | - Moayyad Malas
- Otolaryngology, King Khaled Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | - Tahera Islam
- Miscellaneous, College of Medicine and Research Center, King Saud University, Riyadh, SAU
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Shang X, Fang Q, Liu F, Wu J, Luo R, Qi J. Deep Parotid Lymph Node Metastasis Is Associated With Recurrence in High-Grade Mucoepidermoid Carcinoma of the Parotid Gland. J Oral Maxillofac Surg 2019; 77:1505-1509. [DOI: 10.1016/j.joms.2019.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
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Szewczyk M, Marszałek A, Sygut J, Golusiński P, Golusiński W. Prognostic markers in salivary gland cancer and their impact on survival. Head Neck 2019; 41:3338-3347. [PMID: 31246357 DOI: 10.1002/hed.25857] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The role of molecular markers in salivary gland carcinoma (SGC) is not well understood. We evaluated molecular marker expression and their prognostic value. METHODS Immunohistochemical analysis of 124 tumor specimens was performed to determine expression of androgen (AR), estrogen (ER), and progesterone (PR) receptors and epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), programmed death ligand 1 receptor (PD-L1), and PD-L1 in tumor-infiltrating mononuclear cell (TIMC). Survival outcomes (disease-free survival [DFS] and overall survival [OS]), pT and N classification, margin status, and treatment failure were assessed. RESULTS Most patients (78; 62.9%) had early-stage SGC. AR positivity and EGFR positivity were detected in 21.0% and 78.6%, respectively, of tumors. AR positivity and PD-L1 negativity were associated with locally advanced disease. PD-L1-negativity was associated with higher recurrence (38.5% vs 0%; P < .001) and worse DFS. OS and DFS were worse in patients with AR+ or HER2+ disease. CONCLUSIONS Several molecular markers-AR and HER2 positivity and PD-L1 negativity-were associated with worse clinical outcomes. Prospective, multi-institutional trials are needed to determine the prognostic value of these markers.
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Affiliation(s)
- Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Andrzej Marszałek
- Department of Cancer Pathology and Prophylaxis, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Jacek Sygut
- Department of Cancer Pathology and Prophylaxis, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Paweł Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland.,Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Zielona Góra, Poland.,Department of Biology and Environmental Studies, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
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Parotid gland carcinoma: 32 years’ experience from a single institute. The Journal of Laryngology & Otology 2019; 133:604-609. [DOI: 10.1017/s0022215119001130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundParotid gland carcinoma is a rare and complicated histopathological classification. Therefore, assembling a sufficient number of cases with long-term outcomes in a single institute can present a challenge.MethodThe medical records of 108 parotid gland carcinoma patients who were treated at Kyushu University Hospital, Fukuoka, Japan, between 1983 and 2014 were reviewed. The survival outcomes were analysed according to clinicopathological findings.ResultsForty-six patients had low clinical stage tumours (I–II), and 62 patients had high clinical stage tumours (III–IV). Fifty-two, 10 and 46 patients had low-, intermediate- and high-grade tumours, respectively. Twenty-seven of 65 cases had positive surgical margins. In high clinical stage and intermediate- to high-grade tumours, adjuvant radiation therapy was correlated with local recurrence-free survival (p = 0.0244). Intermediate- to high-grade tumours and positive surgical margins were significantly associated with disease-specific survival in multivariate analysis (p = 0.0002 and p = 0.0058).ConclusionThe results of this study show that adjuvant radiation therapy is useful for improved local control in patients with high clinical stage and intermediate- to high-grade tumours.
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Heme Oxygenase-1 is a Key Molecule Underlying Differential Response of TW-37-Induced Apoptosis in Human Mucoepidermoid Carcinoma Cells. Molecules 2019; 24:molecules24091700. [PMID: 31052354 PMCID: PMC6539960 DOI: 10.3390/molecules24091700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 12/25/2022] Open
Abstract
TW-37 is a small-molecule inhibitor of Bcl-2 family proteins, which can induce anti-cancer activities in various types of cancer. In the current study, we investigated the potential molecular mechanism underlying the differential response to TW-37-induced apoptosis in two human mucoepidermoid carcinoma (MEC) cell lines. The differential response and underlying molecular mechanism of human MEC cells to TW-37 was evaluated by trypan blue exclusion assay, western blotting, 4’, 6-diamidino-2-phenylindole staining, annexin V/propidium iodide double staining, analysis of the sub-G1 population, human apoptosis array, and measurements of intracellular reactive oxygen species (ROS). TW-37 decreased cell viability and induced apoptosis in YD-15 cells, but not in MC3 cells. Proteome profiling using a human apoptosis array revealed four candidate proteins and of these, heme oxygenase-1 (HO-1) was mainly related to the differential response to TW-37 of YD-15 and MC3 cells. TW-37 also led to a significant increase in intracellular levels of ROS in YD-15 cells, which is associated with apoptosis induction. The ectopic expression of HO-1 recovered YD-15 cells from TW-37-induced apoptosis by reducing intracellular levels of ROS. The expression of HO-1 was reduced through both transcriptional and post-translational modification during TW-37-mediated apoptosis. We conclude that HO-1 is a potential indicator to estimate response to TW37-induced apoptosis in human MEC.
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Szewczyk M, Golusiński P, Pazdrowski J, Pieńkowski P, Marszałek S, Sygut J, Golusiński W. Patterns of treatment failure in salivary gland cancers. Rep Pract Oncol Radiother 2018; 23:260-265. [PMID: 29991930 DOI: 10.1016/j.rpor.2018.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/08/2018] [Accepted: 05/05/2018] [Indexed: 10/28/2022] Open
Abstract
Aim The purpose of the study was to publish our experience of salivary gland cancer treatment with large number of patients treated at a single institution. Background Salivary gland cancers are rare tumors of the head and neck representing about 5% of cancers in that region and about 0.5% of all malignancies. Due to the rarity of the disease, most of the studies regarding treatment outcome consist of low number of patients, thus making it difficult to draw conclusions. Material and methods 115 patients with primary salivary gland cancer were included in a retrospective study. The subsites of tumor were the parotid gland (58% patients), submandibular gland (19%) and minor salivary glands (23%). All patients underwent primary surgical resection. The following were collected: age, stage of the disease, T status, N status, grade of tumor, perineurial invasion, lymphovascular invasion, extracapsular spread, final histological margin status and postoperative treatment. Details of local, regional or distant recurrence, disease free survival and overall survival were included. Results The majority (65%) of patients presented in early stage, T1 and T2 tumors. 81% of patients were N0. Free surgical margins were achieved in 18% of patients, close in 28% patients and positive surgical margins in 54% (62) patients. Factors that significantly increased the risk of recurrence: T stage (p = 0.0006); N-positive status (p < 0.0001); advanced stage of the disease (p < 0.0001); high grade of tumor (p = 0.0007); PNI (p = 0.0061); LVI (p = 0.0022); ECS (p = 0.0136); positive surgical margins (p = 0.0022). On multivariate analysis, high grade of tumor and positive surgical margins remained significant independent adverse factors for recurrence formation. Conclusions This report shows a single institution results of oncological treatment in patients with malignant salivary gland tumors, where positive surgical margins strongly correlate with patients' worse outcome. Whether to extend the procedure, which very often requires sacrificing the nerve is still a question of debate.
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Affiliation(s)
- Mateusz Szewczyk
- Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Paweł Golusiński
- Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland.,Department of Biology and Environmental Studies, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Jakub Pazdrowski
- Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Piotr Pieńkowski
- Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Sławomir Marszałek
- Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland.,Department of Rehabilitation in Internal Medicine, University School of Physical Education, Poznan, Poland
| | - Jacek Sygut
- Department of Cancer Pathology and Prophylaxis, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
| | - Wojciech Golusiński
- Department of Head and Neck Surgery. Poznan University of Medical Sciences, The Greater Poland Cancer Centre, Garbary 15, 61-866 Poznan, Poland
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Maffi-Berthier L, Le pelletier F, Ejeil AL. Benign myoepithelioma of the hard palate: a clinical and histological diagnostic challenge. Case report and literature review. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Myoepithelioma (ME) is a rare salivary gland tumor. Constructed aroung a clinical case, this article aims to gather up up-to-date epidemiological, clinical and histological data about myoeptihelioma with emphasis on the diagnostic approach and differential diagnoses, paraclinical exams and the main histological features reported for its characterization. Observation: A 41-year-old female, presenting a 1-year slowly enlarging palatine nodule was referred to the Oral Pathology Consultation. Clinical data and paraclinic examination were non-specific. A thorough histological examination, comparing clinical data with cyto-architectural and immunostaining profile of the tumor allowed a positive diagnosis of ME. Discussion: The clinical aspect of ME is close from other more frequent tumors within the same areas. Accordingly, its discovery is often incidental and its diagnosis histological. ME display variable architecture and composition, requiring full tumor examination for proper diagnosis. When benign, ME act as mixed tumor regarding local extension, prognosis and recurrence. Malignant ME behaves as a low-grade malignant tumor with metastatic potential. Conclusion: Despite its rarity, ME should be hypothesized in front of a palatine nodule. Clinician and pathologist should be particularly cautious regarding nature, malignancy and follow-up of this tumor, since few data are up-to-now available.
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Rajasekaran K, Stubbs V, Chen J, Yalamanchi P, Cannady S, Brant J, Newman J. Mucoepidermoid carcinoma of the parotid gland: A National Cancer Database study. Am J Otolaryngol 2018; 39:321-326. [PMID: 29559174 DOI: 10.1016/j.amjoto.2018.03.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe the demographics, tumor characteristics, and prognostic features of mucoepidermoid carcinoma of the parotid gland. MATERIALS AND METHODS A retrospective study of the National Cancer Database was reviewed for all mucoepidermoid carcinomas of the parotid gland between 2004 and 2012). Patient demographics and tumor characteristics were abstracted and analyzed. Univariate and multivariate Cox multivariate regression models were used to identify predictors of survival. RESULTS A total of 4431 patients met inclusion criteria. Average age at diagnosis was 57 years (median 62, SD 19), with no overall sex preference (52% female), and majority white (78%). The 1-year overall survival was 92.9% (95% CI [92.1-93.6]) and 5-year overall survival was 75.2% (95% CI [73.8-76.7%]). Median overall survival was not reached at 5 years. Factors associated with decreased survival were increasing age, comorbidities, high tumor grade, advanced pathologic group stage, and positive surgical margins. Female sex was the only factor associated with improved survival. Controlling for either histopathologic grade or pathologic stage to determine how patient demographics and tumor characteristics affected overall survival yielded similar results. Of note, intermediate grade tumors, although not independently associated with worse survival, when seen in conjunction with tumors ≥T2 and/or ≥N2, a negative impact on overall survival was seen. CONCLUSION Although mucoepidermoid carcinoma of the parotid gland is the most common parotid gland malignancy, it is still a rare tumor with a lack of large population-based studies. Advanced stage and high-grade tumors are significant predictors of decreased survival. Females have improved survival compared to males.
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Affiliation(s)
- Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Vanessa Stubbs
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Jinbo Chen
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
| | - Pratyusha Yalamanchi
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Steven Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Jason Brant
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Jason Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
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Zichi C, Tampellini M, Tucci M, Sonetto C, Baratelli C, Brizzi MP, Scagliotti GV. FOLFOX activity in a rare case of metastatic colonic adenocarcinoma of the tongue: a case report. BMC Cancer 2018; 18:470. [PMID: 29699528 PMCID: PMC5918988 DOI: 10.1186/s12885-018-4395-5] [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: 06/17/2017] [Accepted: 04/17/2018] [Indexed: 11/30/2022] Open
Abstract
Background Adenocarcinomas of the oral cavity are rare neoplasms, and only four cases of primary colonic adenocarcinoma of the tongue have ever been described in literature. Very few information about chemotherapy sensitiveness of this type of neoplasia is available, with only one regimen that showed some activity in a metastatic patient. Case presentation We describe the case of a patient bearing a metastatic colonic adenocarcinoma of the tongue submitted to a first-line chemotherapy with oxaliplatin, 5-fluorouracil and folinic acid (FOLFOX regimen). After chemotherapy the patient obtained the complete disappearance of the primitive neoplasia located in the body of the tongue, and a tumor size reduction > 50% of liver and lung metastases. Conclusions This case demonstrated the activity of the combination of oxaliplatin and 5-fluorouracil in this very rare neoplasia. The FOLFOX regimen might be considered either in advanced and especially in the neoadjuvant setting, when the reduction of the primary tumor is highly needed.
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Affiliation(s)
- Clizia Zichi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marco Tampellini
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Marcello Tucci
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Cristina Sonetto
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Chiara Baratelli
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Maria P Brizzi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Giorgio V Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Li R, Dou S, Ruan M, Zhang C, Zhu G. A feasibility and safety study of concurrent chemotherapy based on genetic testing in patients with high-risk salivary gland tumors: Preliminary results. Medicine (Baltimore) 2018; 97:e0564. [PMID: 29703045 PMCID: PMC5944525 DOI: 10.1097/md.0000000000010564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This prospective study was conducted to evaluate the feasibility and safety of customized chemotherapy regimens based on the gene characteristics of salivary gland tumors. METHODS Patients were enrolled with histologically confirmed intermediate or high grade, stage T3-4, N1-3 disease, and T1-2, N0 patients with a close (≤1 mm) or microscopically positive surgical margin were also enrolled in the study. All patients received radical surgery and postoperative concurrent chemoradiotherapy. To evaluate the responsiveness of therapies, the chemotherapy regimen was based on gene targets, β-tubulin III, ABCB1, STMN1, and CYP1B1 (for docetaxel) and TYMS (for pemetrexed). The primary endpoints were treatment compliance and acute toxicities. RESULTS A total of 20 patients were enrolled between September 2013 and January 2016. The median age was 46 years (range: 23-70 years). Genetic testing showed that 8 patients may have been sensitive to docetaxel, 5 patients may have been sensitive to pemetrexed, and 7 patients sensitive to either docetaxel or pemetrexed. All patients received the full dose of radiation. A total of 19 patients (95%) completed 2 cycles of concurrent chemotherapy (CCT). One patient treated concurrently with pemetrexed experienced grade 3 neutropenia. Three patients experienced grade 3 oral mucositis, and 2 patients experienced grade 3 dermatitis. CONCLUSION Our study demonstrated that a CCT selecting method based on the gene targets associated with drug sensitivity was clinically feasible and safe. Further studies enrolled more patients with longer follow-up times are needed to confirm the clinical efficacy of this CCT selecting method.
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Poletti AM, Imparato S, Signorelli GC, Cugini G, Colombo G. The multiplanar analysis of the retromandibular vein in surgical planning for parotid gland tumors. Eur Arch Otorhinolaryngol 2018; 275:1587-1593. [PMID: 29589143 DOI: 10.1007/s00405-018-4953-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the effectiveness of the multiplanar analysis of the retromandibular vein in establishing the position of the parotid gland tumor and its relationship with the facial nerve, together with the most common radiological criteria (facial nerve line, Utrecht line, retromandibular vein and parapharyngeal space variations) using the magnetic resonance imaging. STUDY DESIGN Retrospective study SETTING: Tertiary Academic Hospital SUBJECTS AND METHODS: 128 preoperative magnetic resonances were analyzed to study preoperative tumor location (medial or lateral to the expected course of the facial nerve) based on comparison between the radiological criteria and the surgical findings. RESULTS FN line had the lowest accuracy at 77%, whereas the retromandibular vein achieved 85% accuracy and the UT line achieved accuracy of 93%. The retromandibular vein could not be identified in 11 cases (9%). The multiplanar evaluation of the retromandibular vein allowed us to identify it on almost all MR images (99% of cases) and reach 87% of accuracy. The parapharyngeal space evaluation achieved 92% of accuracy. In the subgroup of 66 cases where the neoplasms were strictly related to the main trunk, where the surgery entailed manipulation if situated laterally to the tumor, the multiplanar evaluation of the retromandibular vein reached 98% of accuracy and UT line achieved 94%. CONCLUSIONS The multiplanar modality, combined with the evaluation of the parapharyngeal space, is effective in helping the surgeon to achieve accurate planning: it enables the tumor to be located and the facial nerve course predicted with a good precision.
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Affiliation(s)
- Arturo Mario Poletti
- Otorhinolaryngology Department, Saudi German Hospital Dubai, Dubai, UAE. .,Otorhinolaryngology Department, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy.
| | - Sara Imparato
- Radiology Department, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giulia Carlotta Signorelli
- Otorhinolaryngology Department, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Giovanni Cugini
- Otorhinolaryngology Department, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
| | - Giovanni Colombo
- Otorhinolaryngology Department, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Milan, Italy
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Yu HJ, Ahn CH, Yang IH, Won DH, Jin B, Cho NP, Hong SD, Shin JA, Cho SD. Apoptosis induced by methanol extract of Potentilla discolor in human mucoepidermoid carcinoma cells through STAT3/PUMA signaling axis. Mol Med Rep 2018; 17:5258-5264. [PMID: 29363716 PMCID: PMC5865991 DOI: 10.3892/mmr.2018.8468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/16/2018] [Indexed: 11/23/2022] Open
Abstract
Potentilla discolor has been used in traditional Chinese medicine for the treatment of hyperglycemia. However, the potential role of Potentilla discolor against cancer and its mode of action remain to be fully elucidated. The present study explored the apoptotic effect of methanol extract of Potentilla discolor (MEPD) in human mucoepidermoid carcinoma (MEC) cell lines of salivary glands. MEPD markedly suppressed the growth and induced apoptotic cell death in MC3 and YD15 cells. MEPD treatment significantly upregulated the expression of PUMA and reduced STAT3 phosphorylation. Overexpression of STAT3 partially recovered the growth of MEC cells inhibited by MEPD. In addition, dephosphorylation of STAT3 by cryptotanshinone (a potent STAT3 inhibitor) was sufficient to inhibit the growth of MEC cells and induce apoptosis via affecting PUMA protein. These results suggest that MEPD has a potential anticancer property via the STAT3/PUMA signaling axis in human MEC cells of salivary gland.
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Affiliation(s)
- Hyun-Ju Yu
- Department of Oral Pathology, School of Dentistry, Institute of Biodegradable Material, Institute of Oral Bioscience, Chonbuk National University, Jeonju, Jeollabuk-do 54896, Republic of Korea
| | - Chi-Hyun Ahn
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, Republic of Korea
| | - In-Hyoung Yang
- Department of Oral Pathology, School of Dentistry, Institute of Biodegradable Material, Institute of Oral Bioscience, Chonbuk National University, Jeonju, Jeollabuk-do 54896, Republic of Korea
| | - Dong-Hoon Won
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, Republic of Korea
| | - Bohwan Jin
- Laboratory Animal Center, CHA University, CHA Biocomplex, Sampyeong-Dong, Seongnam, Gyeonggi 13488, Republic of Korea
| | - Nam-Pyo Cho
- Department of Oral Pathology, School of Dentistry, Institute of Biodegradable Material, Institute of Oral Bioscience, Chonbuk National University, Jeonju, Jeollabuk-do 54896, Republic of Korea
| | - Seong Doo Hong
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, Republic of Korea
| | - Ji-Ae Shin
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, Republic of Korea
| | - Sung-Dae Cho
- Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, Republic of Korea
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Zhang X, Zeng X, Lan X, Huang J, Luo K, Tian K, Wu X, Xiao F, Li S. Reoperation following the use of non-standardized procedures for malignant parotid tumors. Oncol Lett 2017; 14:6701-6707. [PMID: 29163697 DOI: 10.3892/ol.2017.7020] [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: 02/28/2016] [Accepted: 07/27/2017] [Indexed: 11/06/2022] Open
Abstract
Non-standardized or conservative procedures are employed when parotid tumors involving the facial nerve or parotid carcinoma are misdiagnosed as benign parotid tumors prior to or during surgery. Remedial measures are usually required when the pathological diagnosis of a malignant parotid tumor is confirmed following surgery. The aim of the present study was to systematically evaluate reoperation subsequent to treatment with non-standardized procedures for malignant parotid tumors, and to explore the preoperative diagnoses, the primary procedure selection and the necessity of reoperation following non-standardized procedures in malignant parotid tumors. A total of 30 patients who met the inclusion criteria, were diagnosed with a malignant parotid tumor and underwent reoperation following the use of a non-standardized procedure were included in the present study. Surgical conditions and clinical data were analyzed. Among the patients with a malignant parotid tumor who underwent reoperation subsequent to a non-standardized procedure, the incidence of residual tumor, as confirmed by pathological examination, was 63.3% (19/30). The intact facial nerve preservation rate was 83.3% (25/30), the facial nerve branch resection rate was 6.7% (2/30), the facial partial nerve resection rate was 6.7% (2/30) and the facial nerve resection rate was 3.3% (1/30). In total, 3 patients underwent facial nerve reconstruction, 3 patients underwent a local flap repair of skin defects in the parotid region and 3 patients underwent pectoralis major muscle flap repair. The current findings indicate that the qualitative diagnosis of malignant parotid tumors prior to surgery is difficult, there is a high incidence of residual tumor following non-standardized procedures, and that reoperation in a timely manner is required in such cases.
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Affiliation(s)
- Xiangmin Zhang
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Xiangfu Zeng
- Department of General Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi 341000, P.R. China
| | - Xiaolin Lan
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Jing Huang
- Ganzhou Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Keqing Luo
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Keqiang Tian
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Xiuhong Wu
- Department of Radiation Oncology, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Fufu Xiao
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
| | - Shaojin Li
- Ganzhou Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi 341000, P.R. China
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Hirvonen K, Rantanen M, Haapaniemi A, Pitkäniemi J, Malila N, Mäkitie AA. Second primary cancer after major salivary gland carcinoma. Head Neck 2017; 40:251-258. [PMID: 28960648 DOI: 10.1002/hed.24937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/13/2017] [Accepted: 07/27/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We investigated the risk of second primary cancers after major salivary gland carcinoma in Finland, with a population of 5.5 million. METHODS Nationwide cancer registry data were used to identify patients with major salivary gland carcinoma diagnosed between 1953 and 2014. Standardized incidence ratios (SIRs) were estimated to compare their second primary cancer risk with the respective site-specific cancer risk in the general population. RESULTS There were 1727 patients with major salivary gland carcinomas and 222 second primary cancers had been diagnosed in these patients (SIR 1.43). The risk was increased for cancers of the thyroid (SIR 5.12), breast (SIR 1.63), respiratory organs (SIR 1.63), male genital organs (SIR 1.48), melanoma of the skin (SIR 3.35), and nonmelanoma skin cancer (SIR 2.50). The risk was high during the first 5 years and after 20 years of diagnosis. CONCLUSION Second primary cancers can occur among patients with major salivary gland carcinoma even after a long time period. This needs to be recognized in the follow-up of these patients.
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Affiliation(s)
- Karoliina Hirvonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Panelli Santos KCP, Matsuzaki H, Unetsubo T, Tsuyoshi S, Nagatsuka H, Asaumi JI. De novo myoepithelial carcinoma with multiple metastases arising from a submandibular salivary gland: A case report. Oncol Lett 2017; 13:2679-2683. [PMID: 28454450 PMCID: PMC5403181 DOI: 10.3892/ol.2017.5783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/18/2016] [Indexed: 11/05/2022] Open
Abstract
Salivary gland carcinomas are rare tumors, representing ~0.5% of all malignancies. Myoepithelioma is also uncommon, representing ~1% of all salivary gland tumors. Myoepithelial carcinoma (MC) is even rarer, representing 0.2 to 0.6% of all salivary gland tumors. We herein report a case of MC with multiple metastases arising from a submandibular gland in a 71-year-old male patient and present the associated imaging findings. The patient was considered to have a de novo type of myoepithelial carcinoma, which is reportedly associated with higher malignancy than the transformation type of the disease (i.e., a malignant change from pleomorphic adenoma or myoepithelioma). This was reflected in the multiple lung and bone metastases sites and strong positivity for p53 and Ki-67.
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Affiliation(s)
- Karina Cecília Panelli Panelli Santos
- Department of Oral and Maxillofacial Radiology, Field of Tumor Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama 700-8558, Japan
| | - Hidenobu Matsuzaki
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Kita-ku, Okayama 700-8558, Japan
| | - Teruhisa Unetsubo
- Department of Oral and Maxillofacial Radiology, Field of Tumor Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama 700-8558, Japan
| | - Shimo Tsuyoshi
- Department of Oral and Maxillofacial Surgery and Biopathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama 700-8558, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama 700-8558, Japan
| | - Jun-Ichi Asaumi
- Department of Oral and Maxillofacial Radiology, Field of Tumor Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama 700-8558, Japan
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Nagano CP, Coutinho-Camillo CM, Pinto CA, Soares FA, Santos F, Fonseca I, Lourenço SV. Cytokeratin immunoprofile of primary and metastatic adenoid cystic carcinoma of salivary glands: a report of two cases. AUTOPSY AND CASE REPORTS 2016; 6:57-63. [PMID: 28210575 PMCID: PMC5304563 DOI: 10.4322/acr.2016.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/25/2016] [Indexed: 11/23/2022] Open
Abstract
Distant metastases from salivary gland tumors are considered infrequent: the incidence of distant metastases ranges from 24% to 61% according to different histotypes and to the site of the primary mass. The most common site of distant metastases due to salivary gland malignancies is the lung. From the pathology point of view, cytokeratins (CK) are important differentiation markers in salivary gland tumors, which are often used for the diagnostic process. Their employment also may be useful to identify and confirm the diagnosis of their distant metastases. We report the expression of CK in two cases of primary and metastatic adenoid cystic carcinoma (ACC) and their CK profiles of the primary and metastatic masses. Both patients—one male and one female—were diagnosed with an ACC cribriform and tubular, respectively, with lung metastases. In case 1, the metastatic mass presented the same histotype and CK profile of the primary tumor. For case 2, the metastatic lung mass was distinct from the primary mass (a solid ACC) and presented a different CK profile. Although salivary gland metastatic disease presents a poor prognosis, both patients reported herein are alive despite the presence of the disease in long-term follow-up. Therefore, the modifications seen in the CK profiles do not appear to be predictive of tumor behavior and outcome. The use of a CK profile seems to be useful to identify the nature of a distant mass and its possible correlations with a primary salivary gland tumor.
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Affiliation(s)
| | | | - Clovis Antônio Pinto
- Department of Surgical Pathology - AC Camargo Cancer Center, São Paulo/SP - Brazil
| | - Fernando Augusto Soares
- Department of Stomatology - Dental School - Universidade de São Paulo, São Paulo/SP - Brazil.; Department of Surgical Pathology - AC Camargo Cancer Center, São Paulo/SP - Brazil
| | - Filipa Santos
- Instituto Português de Oncologia - Universidade de Lisboa, Lisboa - Portugal
| | - Isabel Fonseca
- Instituto Português de Oncologia - Universidade de Lisboa, Lisboa - Portugal
| | - Silvia Vanessa Lourenço
- Department of Stomatology - Dental School - Universidade de São Paulo, São Paulo/SP - Brazil
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Li FJ, Wang XJ, Zhou XL. WISP-1 overexpression upregulates cell proliferation in human salivary gland carcinomas via regulating MMP-2 expression. Onco Targets Ther 2016; 9:6539-6548. [PMID: 27799801 PMCID: PMC5085305 DOI: 10.2147/ott.s107166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND WISP-1 is a member of the CCN family of growth factors and has been reported to play an important role in tumorigenesis by triggering downstream events via integrin signaling. However, little is known about the role of WISP-1 in proliferation of salivary gland carcinoma (SGC) cells. METHODS In this study, we investigated the WISP-1 expression in SGC tissues via immunohistochemical staining, Western blotting assay, and real-time quantitative polymerase chain reaction method, and then evaluated the regulatory role of WISP-1 in the growth of SGC A-253 cells. In addition, the role of MMP-2 in the WISP-1-mediated growth regulation was also investigated. RESULTS It was demonstrated that the WISP-1 expression was upregulated at both mRNA and protein levels in 15 of 21 SGC tumor tissues, compared to the non-tumor tissues (five of 21), associated with the lymph node dissection and bone invasion. The in vitro CCK-8 assay and colony-forming assay demonstrated that the exogenous WISP-1 treatment or the WISP-1 overexpression promoted the growth of A-253 cells. In addition, we confirmed that the WISP-1 overexpression upregulated the MMP-2 expression in A-253 cells with the gain-of-function and loss-of-function strategies, and that the MMP-2 knockdown attenuated the WISP-1-mediated growth promotion of A-253 cells. CONCLUSION We found that WISP-1 was overexpressed in the human SGCs, and the WISP-1 overexpression promoted the salivary gland cell proliferation via upregulating MMP-2 expression. Our study recognized the oncogenic role of WISP-1 in human SGCs, which could serve as a potential target for anticancer therapy.
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Affiliation(s)
- Fu-Jun Li
- Department of Stomatology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China
| | - Xin-Juan Wang
- Department of Stomatology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China
| | - Xiao-Li Zhou
- Department of Stomatology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China
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50
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Green B, Rahimi S, Brennan PA. Salivary gland malignancies - an update on current management for oral healthcare practitioners. Oral Dis 2016; 22:735-739. [DOI: 10.1111/odi.12498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 12/01/2022]
Affiliation(s)
- B Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - S Rahimi
- Department of Histopathology; Queen Alexandra Hospital; Portsmouth UK
| | - PA Brennan
- Oral and Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
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