Salivary gland anlage tumor of the nasopharynx: a clinicopathologic and immunohistochemical study of three cases

Salivary Gland Anlage Tumor: A Case Report on Abnormal Breathing Found in a Late-Preterm Infant

There are many etiologies for respiratory distress in newborns, one of the rare causes being nasopharyngeal tumors. Of that category, salivary gland anlage tumor (SGAT) is exceedingly rare. Symptoms of SGAT vary by patient, but the most common presenting symptom is respiratory distress. The rarity of SGAT and infantile nasopharyngeal tumors in general can lead to delayed diagnosis in newborns with respiratory distress. We report an unexpected and incidental finding of this potentially life-threatening condition in the neonatal population. A preterm male infant with respiratory distress, who was undergoing a neurological workup for new hypotonia, was found to have an incidental nasopharyngeal mass after brain MRI. Upon eventual minimally invasive endoscopic surgical excision and pathologic workup for the mass, the patient was diagnosed with SGAT. The patient has since been with outpatient follow-up visits with no evidence of recurrence of the mass. The purpose of this report is to present a rare and often overlooked life-threatening diagnosis of respiratory distress in the neonatal population.

Salivary gland anlage tumor: Evaluation and management of a rare pediatric condition

BACKGROUND

Neonates and infants are obligatory nasal breathers. Nasal obstruction can therefore be life-threatening and prompt recognition of its cause is critical. Salivary gland anlage tumor (SGAT) is a rare, benign condition that can present with nasal obstruction and respiratory distress within the first weeks of life. Our objective was to outline the clinical presentation, evaluation, and management of SGAT and provide a review of existing literature.

METHODS

A retrospective chart review was performed at a tertiary children's hospital. A comprehensive literature search for SGAT was conducted using Medline, Embase, PubMed, and EBSCO. We present a case from our institution to describe the clinical approach to SGAT.

RESULTS

Forty-one cases of previously reported SGAT, plus our new patient, were included. Patients presented with respiratory distress (30/42, 71.4%), feeding difficulty (14/42, 33.3%) and/or upper airway obstruction (13/42, 31.0%). The majority of tumors were in the nasopharynx (25/42, 59.5%). Surgical excision (36/42, 85.7%) was most commonly performed. Surgical approaches have evolved to include transoral, transpalatal, transnasal endoscopic or a combination of the above. Our patient had a suspected residual/recurrent tumor, later found to be negative on pathology. To date, there have been no reported recurrences.

CONCLUSIONS

SGAT is a rare pediatric condition that is often excluded from the differential diagnosis of nasal obstruction. Clinical evaluation includes flexible nasopharyngoscopy and neuroimaging. Management involves surgical resection, except in cases of spontaneous expulsion. Tissue pathology is required for definitive diagnosis. Tissue biopsy should be performed on follow-up if there is a suspicion for recurrence.

Salivary gland anlage tumor: molecular profiling sheds light on a morphologic question

OBJECTIVE

Salivary gland anlage tumor (SGAT), previously described as a squamous proliferative lesion or "congenital pleomorphic adenoma," is a rare, benign entity that presents within the first months of life. It occurs almost exclusively in the nasopharynx or posterior nasal cavity and demonstrates a biphasic composition of epithelial and mesenchymal elements. Although the clinical and histologic features of SGAT are well described, its etiology remains poorly understood. SGAT is currently considered a hamartoma rather than a neoplasm, partly because of its benign behavior and lack of reported recurrence after treatment. However, investigators have not yet evaluated this concept by using genomic methods.

STUDY DESIGN

Here, we present 3 SGAT cases where we performed whole-exome sequencing.

RESULTS

Examination of sequence data, with specific attention to variants affecting 964 cancer-related genes, showed no plausible driver-type alterations.

CONCLUSIONS

The lack of apparent driver mutations supports the classification of this entity as a hamartomatous (nonneoplastic) process.

Nasopharyngeal Salivary Gland Anlage Tumour: A rare cause of neonatal respiratory distress

A salivary gland anlage tumour (SGAT) is a very rare type of benign tumour that usually presents in early infancy with respiratory distress which is exacerbated upon feeding. We report a full-term male neonate who was referred to the Al Nahdha Hospital, Muscat, Oman, in 2015 with severe neonatal respiratory distress due to a nasopharyngeal obstruction immediately after birth. Computed tomography and magnetic resonance imaging revealed a well-circumscribed mass in the nasopharynx, without intracranial extension. Histopathological analysis of the lesion confirmed a diagnosis of SGAT. Following excision of the tumour, the postoperative period was uneventful. No recurrence was observed over the next two years. This case report highlights the importance of the early recognition of this extremely rare and potentially life-threatening, yet easily curable, condition.

Extragonadal germ cell tumors: a review with emphasis on pathologic features, clinical prognostic variables, and differential diagnostic considerations

Extragonadal germ cell tumors (GCTs) are relatively uncommon, but represent 1% to 5% of all GCTs. Their morphology varies widely and includes mature teratoma, immature teratoma, seminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, and mixed GCTs. Noncentral nervous system extragonadal GCTs are found in a variety of anatomic locations, but most commonly affect the mediastinum and sacrococcygeal region. Predicting behavior in these tumors can be confusing because it is based on a combination of varying factors including patient age, histologic subtype, anatomic site, and clinical stage. This review attempts to dissect these issues by separating the discussion into 3 age groups: neonatal (congenital), children (prepubertal), and adult (postpubertal). Within each individual age group, we cover the significance of anatomic site, morphology, and staging parameters. In addition, we discuss the spectrum of associated secondary malignancies and their impact on patient outcome. Finally, we provide a detailed survey of differential diagnostic considerations grouped by anatomic site.