Second primary malignancies following salivary gland cancers

Salivary Secretory Carcinoma in a Patient with Immature Ovary Teratoma

Introduction

Secretory carcinoma, previously known as mammary analog secretory carcinoma, is a rare malignancy of salivary glands. It has a diversity of microscopic patterns and is similar to other salivary gland tumors.

Case Report

This report presents the case of a 32-year-old female patient with a painless swelling of the upper lip and a history of recent surgery for an immature ovarian teratoma. The microscopic sections revealed a circumscribed neoplasm composed of macrocystic, papillary-cystic, and microcystic patterns with bland vesicular nuclei and vacuolated cytoplasm. Tumoral cells were strongly positive for mammaglobin, SOX10, GATA3, S-100, and vimentin. The diagnosis of salivary gland secretory carcinoma was made. After 22 months, there has been no recurrence.

Conclusions

As secretory carcinoma is a relatively new entity, it is necessary to understand its characteristics. Although the overall incidence of second primary cancer in patients with salivary gland cancers is low, the possibility of its presence in such patients should be considered.

Effectiveness and risk of second primary malignancies after radiotherapy in major salivary gland carcinomas: A retrospective study using SEER database

OBJECTIVE

To investigate the effectiveness of radiotherapy and its association with second primary malignancies (SPMs) risk in major salivary gland carcinomas (MSGCs) patients.

METHODS

Cohort 1 included 7274 surgically treated MSGC patients from the Surveillance, Epidemiology, and End Results database, assessing the effectiveness of radiotherapy. Cohort 2 (n = 4213) comprised patients with ≥5-year survival in Cohort 1 to study SPMs.

RESULTS

Radiotherapy decreased overall survival in MSGCs patients, but improved it in high-grade MSGCs. Cumulative SPMs incidences at 25 years were 16.5% in the radiotherapy (RT) group compared to 14.5% in the non-radiotherapy (NRT) group. For second head and neck carcinomas (SHNCs), incidences were 3.4% in RT versus 1.6% in NRT. Radiotherapy increased the relative risks of tumors, particularly SHNCs (RR = 1.78). The 10-year OS rates of SHNCs after radiotherapy were significantly lower.

CONCLUSION

Radiotherapy improves survival in advanced-stage MSGCs but increases the risk of developing SPMs, particularly SHNCs.

Risk of second primary malignancy after minor salivary gland cancer: A Surveillance, Epidemiology, and End Results database analysis

BACKGROUND

Minor salivary gland cancer (MiSGC) is a group of tumors with varied disease course in the head and neck. We evaluated the risk of a second primary malignancy (SPM) in MiSGC patients and identified possible prognostic factors for survival using a large population database.

METHODS

We used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data to evaluate the risk and prognosis of SPM in patients diagnosed with MiSGC.

RESULTS

The risk of SPM increased in MiSGC patients compared with the endemic rate. The risk of SPM was slightly greater in female patients and who underwent radiotherapy. Age at primary diagnosis, sex, race, year of diagnosis, SEER stage, radiotherapy, SPM, histology, and tumor site were significant survival prognostic indicators of MiSGC patients.

CONCLUSION

Radiotherapy and female sex were risk factors for SPM after MiSGC. Long-term surveillance for SPM was important in MiSGC patients.

Risk of breast cancer in women after a salivary gland carcinoma or pleomorphic adenoma in the Netherlands

Salivary and mammary gland tumors show morphological similarities and share various characteristics, including frequent overexpression of hormone receptors and female preponderance. Although this may suggest a common etiology, it remains unclear whether patients with a salivary gland tumor carry an increased risk of breast cancer (BC). Our purpose was to determine the risk of BC in women diagnosed with salivary gland carcinoma (SGC) or pleomorphic adenoma (SGPA). BC incidence (invasive and in situ) was assessed in two nationwide cohorts: one comprising 1567 women diagnosed with SGC and one with 2083 women with SGPA. BC incidence was compared with general population rates using standardized incidence ratio (SIR). BC risk was assessed according to age at SGC/SGPA diagnosis, follow‐up time and (for SGC patients) histological subtype. The mean follow‐up was 7.0 years after SGC and 9.9 after SGPA diagnosis. During follow‐up, 52 patients with SGC and 74 patients with SGPA developed BC. The median time to BC was 6 years after SGC and 7 after SGPA. The cumulative risk at 10 years of follow‐up was 3.1% after SGC and 3.5% after SGPA (95% Confidence Interval (95%CI) 2.1%–4.7% and 2.6%–4.6%, respectively). BC incidence was 1.59 times (95%CI 1.19–2.09) higher in the SGC‐cohort than expected based on incidence rates in the general population. SGPA‐patients showed a 1.48 times (95%CI 1.16–1.86) higher incidence. Women with SGC or SGPA have a slightly increased risk of BC. The magnitude of risk justifies raising awareness, but is no reason for BC screening.

Second primary cancer after major salivary gland carcinoma

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.

Second primaries after major salivary gland cancer

OBJECTIVES

To evaluate the risk of second primary cancers in patients with major salivary gland cancer using a large population database and to examine the effects of sex, salivary gland cancer histology, and radiation therapy on the risk of second primaries.

STUDY DESIGN

Population-based study using the Surveillance, Epidemiology, and End Result (SEER) cancer database.

SUBJECT AND METHODS

The subjects were 15,572 men and women ages 15 and above, diagnosed with cancer of the major salivary glands from 1973 to 2006.

RESULTS

There was an increased risk of oral cavity (standardized incidence ratio [SIR] = 3.48, P < .05), salivary (SIR = 9.97, P < .05), lung and bronchus (SIR = 1.60, P < .05), kidney (SIR = 1.68, P < .05), and thyroid (SIR = 2.66, P < .05) cancers. Men had an increased risk of developing kidney cancer (SIR = 1.70, P < .05) compared with women (SIR = 1.64, P > .05). Patients with mucoepidermoid carcinoma had an increased risk of a second salivary gland cancer (SIR = 8.97, P < .05) and thyroid cancer (SIR = 3.97, P < .05). Patients with adenoid cystic carcinoma had an increased risk of oral cavity (SIR = 3.76, P < .05) and nasopharyngeal (SIR = 16.88, P < .05) cancers. Patients with acinar cell carcinoma had an increased risk of salivary (SIR = 31.36, P < .05), kidney (SIR = 2.98, P < .05), and thyroid (SIR = 3.85, P < .05) cancers. Patients who received radiation therapy had a higher incidence of lung and bronchus (SIR = 2.11, P < .05), laryngeal (SIR = 3.08, P < .05), and thyroid (SIR = 2.95, P < .05) cancers compared with patients who did not receive radiation therapy (SIR = 1.18, 0.48, and 2.39, respectively; P > .05). Patients had an increased risk of developing second primaries, even 10 years after diagnosis of primary salivary gland cancer.

CONCLUSIONS

Patients with major salivary gland cancers are at a risk for certain second primary cancers. This highlights the need for long-term surveillance in these patients, not only for recurrence but also for second primary cancers.

Increased risk of breast cancer development after diagnosis of salivary gland tumour

The aim of this study was to evaluate whether patients with salivary gland tumours are at increased risk of developing breast cancer. A retrospective cohort study was performed. Female patients (n = 439) with a salivary gland tumour (major and minor) were included. The diagnosis was confirmed histologically. The median follow-up was 5.4 years. Fifteen patients out of 439 with a salivary gland tumour subsequently developed breast cancer, with a mean time interval of 64 months. On the basis of incidence rates in the general population 5.93 breast cancers would be expected. The standardised incidence ratio (SIR) was 2.5 (95% confidence interval: 1.4-4.2; P = 0.003). Increased SIRs were also observed for other solid malignancies, but the numbers were small (n < 5). It is concluded that female patients with a salivary gland tumour have a 2.5 times increased risk of developing breast cancer. Breast screening of these patients is therefore recommended.

Management of malignant salivary gland tumours

Malignant tumours of both major and minor salivary glands are extremely rare: the parotid gland is most frequently affected by malignant change, followed by the submandibular gland. Malignant tumours of minor salivary glands may occur anywhere in the upper aerodigestive tract, but more common sites are the upper lip, junction of hard and soft palate and paranasal sinuses.

Absence of Epstein-Barr virus encoded RNA and latent membrane protein (LMP1) in salivary gland neoplasms

A series of 55 (42 benign and 13 malignant) salivary gland tumours were investigated by immunohistochemistry, to detect Epstein-Barr virus (EBV) latent membrane protein (LMP1) and by in situ hybridization for EBV-encoded RNA. Non-neoplastic gland from all the patients with tumours and 15 control glands were also examined. All cases, both neoplastic and non-neoplastic were negative for LMP1 and failed to show any positive signal by in situ hybridization for EBV RNA. One undifferentiated carcinoma from a European patient was included in the group. These results confirm previous reports of an ethnic association between EBV and undifferentiated carcinomas of the salivary gland. They do not support an aetiological role for EBV in other salivary gland tumours.

Sclerosing polycystic adenosis of major salivary glands. A clinicopathologic analysis of nine cases

We describe nine cases of a histologically distinct and previously unreported lesion of the major salivary glands. The patients ranged in age from 12 to 63 years and included four males, five females. The lesions were slow-growing masses in the parotid gland (eight cases) and submandibular gland (one case). The clinical impression in each case was a benign salivary gland tumor. Grossly, the lesions were discrete, pale, rubbery nodules embedded within the salivary gland parenchyma. Microscopically, the lesions were unencapsulated, circumscribed masses of sclerotic and hyalinized collagenous tissue. Irregularly distributed throughout the collagenous tissue in a vaguely lobular pattern were hyperplastic ductal and acinar elements that were usually accompanied by cystically ectatic ducts. The dilated ducts frequently showed apocrine-like metaplasia and epithelial hyperplasia, which often formed transluminal bridges in a cribriform pattern. This epithelial hyperplasia sometimes surrounded eosinophilic globules as seen in so-called collagenous spherulosis. The combination of fibrosis, epithelial hyperplasia, and cystic changes were reminiscent of fibrocystic changes of the breast. Focally, acinar elements contained large, intensely eosinophilic, periodic acid-Schiff's-positive, intracytoplasmic granules believed to represent altered zymogen granules. A sparse to focally intense lymphocytic infiltrate accompanied the epithelial proliferations. Previous interpretations of these masses have included mucoepidermoid carcinoma, low-grade adenocarcinoma, benign adenoma, and mixed tumor. The limited available follow-up suggests that this process has a favorable prognosis despite recurrences in two cases. It is postulated that these lesions represent a pseudoneoplastic condition that results in both fibrosis and epithelial proliferation. We suggest the term sclerosing polycystic adenosis for these rare lesions.

Multiple tumours of the salivary glands--terminology and nomenclature

Multiple tumours of the salivary glands are very rare and their combinations according to histological classification of the tumours, localisation and origin (origin in independent topographical areas or in the same tissue) are diverse. The following two categories can be distinguished: common occurrence of multiple salivary gland tumours with identical histology, or with different histology. In either group the tumours can be unilateral or bilateral, synchronous or metachronous. The most common multiple tumours with an identical histology are Warthin tumours and pleomorphic adenomas. Bilateral occurrence has been observed especially in oncocytomas, acinic cell carcinomas and basal cell adenomas. In the group of multiple tumours with differing histology, Warthin tumours and pleomorphic adenomas show a number of combinations with other adenomas or carcinomas of the salivary glands. Notable also is the simultaneous occurrence of salivary gland tumours with other oral tumours or extraglandular tumours, especially thyroid carcinomas and breast carcinomas. Multiple salivary gland tumours must be distinguished by nomenclature from tumours with biphasic differentiation and hybrid tumours. Tumours with biphasic differentiation are defined as regular, recurring mixtures of two cellular components in the same tumour and have a corresponding term in the tumour classification. Hybrid tumours are very rare and are composed of two different tumour entities within the same topographical area. Each of the tumour entities conforms with an exactly defined tumour category.

Hodgkin's disease secondary to recurrent adenoid cystic carcinoma of the parotid gland

A case of Hodgkin's disease presenting as a second primary malignancy in a patient admitted eight years previously for total parotidectomy for an adenoid cystic carcinoma is reported.

Multiple primary cancers in Connecticut, 1935-82

Recently, the National Cancer Institute published a comprehensive monograph on multiple primary cancers in Connecticut and Denmark. This paper summarizes some of the observations made on the Connecticut population. Data compiled by the Connecticut Tumor Registry have extended our knowledge about the patterns of multiple primary cancers, especially among long-term survivors of cancer and among patients with relatively rare tumors about which little information currently exists. When compared with the general Connecticut population, cancer patients had a 31 percent (RR = 1.31) increased risk of developing a second cancer and a 23 percent (RR = 1.23) elevated risk of second cancer at a different site from the first. Common environmental exposures seemed responsible for the excess occurrence of many second cancers, particularly those related to cigarette smoking, alcohol consumption, or both. For example, persons with epithelial cancers of the lung, larynx, esophagus, buccal cavity, and pharynx were particularly prone to develop new cancers in the same or contiguous tissue throughout their lifetimes. Cancers of the colon, uterine corpus, breast, and ovary frequently occurred together, suggesting underlying hormonal or dietary influences. Only patients with prostate cancer were at significantly low risk for second cancer development; this might be an artifact of case finding, since advanced age at initial diagnosis was generally associated with an underascertainment of second cancers. Radiotherapy may have caused rectal and other cancer among patients with cancers of the female genital tract, and leukemia among patients with uterine corpus cancer. Chemotherapy with alkylating agents probably contributed to the excess of acute nonlymphocytic leukemia following multiple myeloma or cancers of the breast and ovary. Genetic susceptibility seemed to explain some tumor complexes, such as the multiple occurrences of cutaneous melanoma and the excess of bone cancer following retinoblastoma. Research into multiple cancer syndromes should enhance our understanding of carcinogenic factors and mechanisms and the development of strategies for cancer prevention and control.

A rarely observed case of primary multiple carcinomas of the head and neck

We report a 71-year-old male patient with five separate primary metachronous squamous cell carcinomas of the head and neck (parotid, tongue, soft palate, larynx and hypopharynx) that occurred over a period of 8 years. The long survival of the patient after discovery of his first neoplasm (parotid) is the result of careful vigilance during the follow-up period and diligently planned therapies for each of his multiple primary tumors after radical surgery had been performed on his first neoplasm.