[Classification of salivary gland tumors]

Parotid swelling revealing an unusual pathological state: HIV and ewing sarcoma

Swelling of the parotid region is a frequent reason for consultation and the first clinical sign of both benign and malignant parotid tumors.

These parotid tumors represent 80 % of tumors of the main salivary glands. They present a highly variable clinical and radiological picture and are known to have a wide histological diversity. Some histological types are rare entities found in the parotid gland, such as Ewing's sarcoma and lymphoepithelial cyst, the latter of which is often associated with HIV co-morbidity, and therefore requires careful and adequate therapeutic attitudes and strategies.

We report two cases of parotid swelling revealing unusual pathologies: HIV and Ewing's sarcoma.

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Swelling of the parotid region is a frequent reason for consultation.

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Some histological types are rare entities found in the parotid gland.

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The pathological examination of the surgical specimen provides a definitive diagnosis.

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Age can be a concealing element, therefore a careful medical attitude is the key.

[Proposal for the selection and delineation of clinical target volumes for the radiotherapy of submandibular gland tumours]

This article provides a proposal for the selection and delineation of clinical target volumes for the treatment with radiation of submandibular glands tumours. This article does not deal with external radiotherapy indications but specifies the volumes to be treated if radiotherapy is chosen. High-risk and low-risk peritumoral clinical target volumes are described based on the probability of local tumoral spread. High-risk and low-risk clinical target volumes are illustrated on CT-scan slices. A proposal for the selection of nodal clinical target volumeis also proposed.

Effectiveness of the Pattern-Based Approach in the Cytodiagnosis of Salivary Gland Lesions

OBJECTIVE

The aim of this study is to investigate, primarily, the effectiveness of the application of pattern-based analysis in the diagnosis of salivary gland (SG) lesions. Secondarily, an attempt was made to study the cytomorphology of the various lesions in detail and discuss the pitfalls and solutions involved in the challenging conditions at cytology.

MATERIALS AND METHODS

This was a prospective, cross-sectional study. All SG lesions over 2 years were subjected to fine-needle aspiration cytology with patients' prior informed consent. The lesions were classified based on the predominant pattern, and a provisional diagnosis was made. The secondary pattern and other features, such as background, were then taken note of, and a combined cytological diagnosis was rendered. The entire spectrum of lesions was divided into 6 morphological categories.

RESULTS

We had a total of 72 SG lesions. The most commonly affected gland was the parotid gland in 79.16% (57/72) of the cases. Surgery was performed in 26 cases (36.11%). A concordant diagnosis was obtained in 22 cases. The sensitivity, specificity and diagnostic accuracy by the pattern-based approach was 75, 100 and 88.46%, respectively. There were no false-positive cases, but 2 false-negative cases were recorded.

CONCLUSION

The precise cytological preoperative diagnosis of SG lesions is important for the management of patients. The pattern-based approach can be used routinely in the cytological diagnosis of SG lesions.

[Sub-mandibular tumors: epidemiological and histological profiles]

Introduction

Il s'agit de déterminer les profils épidémiologiques et histologiques des tumeurs submandibulaires.

Méthodes

Il s'agissait d'une étude rétrospective et descriptive de 10 ans (1er janvier 2000 au 31 décembre 2009), réalisée dans le service universitaire d'ORL de l'hôpital de Fann. Etaient inclus dans cette étude tous patients porteurs d'une tumeur submandibulaire (opéré ou non), confirmée par un document histologique.

Résultats

Vingt-une tumeurs submandibulaires ont été colligées. L’âge moyen des patients était de 34,42 ans (± 14,10), avec des extrêmes de 2 et 55 ans. Quinze patients (71,4%) étaient de sexe féminin, soit un sex-ratio de 0,4. Les résultats histologiques étaient obtenus à partir de 4 biopsies et de 17 pièces opératoires. Dans 13 cas (61,9%) la tumeur était bénigne et dans 8 cas (38,1%) la tumeur était maligne. L'adénome pléomorphe dans 12 cas (57,1%), le carcinome épidermoïde dans 4 cas (19%) et l'adénocarcinome dans 2 cas (9,5%) étaient les types histologiques fréquents. Treize (13) patients étaient porteurs d'une tumeur bénigne, dont huit (8) patients étaient de sexe féminin. Huit (8) patients étaient porteurs d'une tumeur maligne. Sept patients étaient de sexe féminin.

Conclusion

Cette étude sur les tumeurs submandibulaires est marquée par une prédominance féminine et une fréquence élevée des adénomes pléomorphes et des carcinomes épidermoïdes.

Metachronous adenoid cystic carcinoma in the peripheral lung and at base of the tongue

Primary lung adenoid cystic carcinoma (ACC) is extremely rare and accounts for approximately 0.1%-0.2% of all lung cancers. ACC of the head and neck has generally been regarded as a slow-growing, low-grade malignancy which has a tendency for local recurrence and frequent distant metastasis. When ACC of the lung is identified, physicians must determine whether it represents distant metastasis or a primary lung cancer. Thyroid transcription factor-1 staining is one of the most useful methods to differentiate primary from metastatic lesions in lung cancer. Herein we report a case of metachronous, not synchronous, ACC at the peripheral lung followed by ACC presentation at the base of the tongue, and review of relevant literatures.

[Epidemiological profile of primary malignant tumors of the salivary glands: about 154 cases]

Introduction

Les tumeurs des glandes salivaires sont des tumeurs rares représentant 3à 5% des tumeurs de la tête et du cou. La classification de l'OMS 2005 distingue les tumeurs épithéliales, les tumeurs mésenchymateuses, les tumeurs hématologiques et les tumeurs secondaires.

Méthodes

Notre travail consiste en une étude rétrospective réalisée sur une période de 10 ans allant de janvier 2002 à janvier 2012. Les critères d'inclusion étaient: l'âge, le sexe, le siège de la tumeur et le type histologique.

Résultats

L'incidence annuelle des tumeurs malignes primitives des glandes salivaires dans notre série était de 15 cas par an. Cent cinquante quatre cas de tumeurs malignes primitives des glandes salivaires ont été colligés sans prédominance de sexe (78 femmes (50,6%) et 76 hommes (49,4%)). La moyenne d'âge était de 60 ans avec des extrêmes de 4 et 83 ans et un pic de fréquence entre 51et 70 ans. Deux tiers des cas (65%) avaient une localisation au niveau des glandes principales avec 66 cas au niveau de la parotide (43%) et 34 cas au niveau de la glande sous maxillaire (22%). Cinquante quatre patients avaient une tumeur maligne des glandes salivaires accessoires (35%) dont 61% au niveau du palais. Aucun cas de tumeur maligne de la glande sublinguale n'a été recensé dans notre étude. Le type histologique prédominant dans notre série était le carcinome adénoïde kystique et retrouvé chez 43 patients (27,9%), suivi de l'adénocarcinome sans autre indication chez 37 patients (24%) puis du carcinome mucoépidermoïde chez 16 patients (10,4%) et de l'adénocarcinome polymorphe de bas grade également chez 16 patients (10. 4%).

Conclusion

Les tumeurs malignes des glandes salivaires représentent un ensemble hétérogène de maladies de caractérisation complexe et de fréquence variable.

[Malignant parotid tumors: epidemiology in Togo]

INTRODUCTION

We had for aim to determine the epidemiological profile of malignant parotid tumors in sub-Saharan country: Togo.

PATIENTS AND METHODS

We retrospectively studied the files of patients seen and treated for malignant parotid tumors, from January 1989 to December 31, 2008, at the Tokoin teaching hospital. Patients treated for another malignant tumor at the same time were excluded from the study.

RESULT AND DISCUSSION

Ninety-six patients were included. Thirty-one tumors (32.29%) were malignant, in 18 male and 13 female patients with a sex ratio of 1.38. The average age was 39years (range 24-70years of age). Two patients could not undergo surgery. Histologically, there were 10 cases of squamous cell carcinoma (32.26%), 6 cases of adenoid cystic carcinoma (19.4%), 6 cases of adenocarcinoma (19.4%), 4 cases of carcinoma in pleomorphic adenoma (12.90%), 3 cases of mucoepidermoid carcinoma (9.7%), 1 case of acinar carcinoma (3.2%), and 1 case of cystadenocarcinoma (3.2%).

DISCUSSION

Squamous cell carcinoma was the most frequent histological type observed in Togo, contrary to literature data for which mucoepidermoid carcinoma is the most frequent malignant parotid tumor.

[Salivary gland tumors in children]

Salivary gland tumors in children are rare: they correspond to 8-10% of head and neck pediatric tumors. Clinicians of all disciplines should be aware of this diagnosis in front of non-inflammatory mass of the parotid or in the territory of other salivary glands. In children, 50% of salivary gland tumors are malignant which contrasts with a 10-25% risk in adults. Epithelial tumors are the most common, mucoepidermoïd carcinomas of the parotid in particular. Surgery is the treatment of choice in epithelial tumors. Adjuvant radiotherapy may be indicated in case of unfavorable prognostic factors but must be balanced with the risk of radiation-induced growth defects and secondary cancer. The role of chemotherapy is limited in these tumors, but should be discussed in case of an inoperable or metastatic lesion.

Extracellular matrix metalloproteinase inducer expression in salivary gland tumors: a correlation with microvessel density

The purpose of this study was to investigate the expression pattern of extracellular matrix metalloproteinase inducer (EMMPRIN) as well as the correlation between EMMPRIN and microvessel density (MVD) in salivary gland tumors. Extracellular matrix metalloproteinase inducer expression and MVD were examined immunohistochemically on paraffin-embedded tissue specimens from 95 patients with salivary gland tumors, who underwent surgical resection from 1998 to 2006. Reverse transcription-polymerase chain reaction was used to monitor EMMPRIN mRNA expression in frozen samples. Extracellular matrix metalloproteinase inducer expression in mucoepidermoid carcinomas and adenoid cystic carcinomas was significantly higher than in normal salivary gland tissues and pleomorphic adenomas (P < 0.05). The MVD of mucoepidermoid carcinomas and adenoid cystic carcinomas was significantly higher compared with pleomorphic adenomas (P < 0.05). The MVD of the EMMPRIN-positive expression group was significantly higher than the MVD of the EMMPRIN-negative expression group (P < 0.05). Extracellular matrix metalloproteinase inducer mRNA expression in malignant salivary gland tumors was higher than that in pleomorphic adenomas (P < 0.05). This study suggests that EMMPRIN expression is an important feature of malignant salivary gland tumors and can be used as a biologic marker to characterize salivary gland tumors. Extracellular matrix metalloproteinase inducer is also a positive angiogenic factor in salivary gland tumors.

Thoracoscopic management including lobectomy for a primary peripheral pulmonary adenoid cystic carcinoma in a cirrhotic patient

Primary peripheral adenoid cystic carcinoma is a relatively rare type of lung carcinoma. A 49-year-old male with significant hepatic cirrhosis presented with an incidental right upper lobe nodule suspicious for malignancy and an additional imaging suggesting contralateral mediastinal lymph node involvement. Thoracoscopic management included a left-sided lymph node dissection and a right-sided lobectomy in this medically high-risk patient.