Tumours of the minor (oropharyngeal) salivary glands: a demographic study of 336 cases

Malignant salivary gland tumors of the tongue: A multicenter REFCOR study

Salivary carcinomas of minor salivary glands are very infrequent tumors. When located in the tongue, the therapeutic strategy may comprise upfront surgery, which may be debilitating, and/or (chemo-)radiotherapy. The aim of this study was to identify the prognostic factors of salivary carcinomas of the tongue in a population-based cohort. This retrospective multicentric study, based on the "Réseau d'Expertise Français sur les Cancers ORL Rares" (REFCOR), included all the patients with a salivary carcinoma of the tongue, diagnosed between January 2009 and December 2018. Dubious slides were reviewed by REFCOR expert pathologists to ensure diagnostic accuracy. Treatment was performed in accordance with national REFCOR recommendations. From 28 centers, 103 patients were included in this study. Median age at diagnosis was 63 years, and 60.2% were female. Tumors were adenoid cystic carcinomas (41.7%), mucoepidermoid carcinomas (30.1%), and other adenocarcinomas (28.2%). Primary treatment was surgical for 61.2% of them. Five-year overall survival (OS) and event-free survival (EFS) rates were 84.7% and 38.6%, respectively. In multivariable analysis, EFS was significantly worse in case of nonsurgical treatment, alcohol consumption, and glossotonsillar sulcus involvement. N-positive status was the only significant prognostic factor for OS in multivariable analysis. Salivary carcinomas of the tongue represent a heterogeneous group of rare tumors, with a high risk of recurrence. In this national cohort, surgery was associated with better EFS and N-status was the main independent prognostic factor for OS.

Oncologic outcomes of the most prevalent major salivary gland cancers: retrospective cohort study from single center

BACKGROUND

The preoperative diagnosis of salivary gland cancer (SGC) is crucial for the application of appropriate treatment, particularly involving the extension of the resection.

METHODS

Retrospective search of medical database identified 116 patients treated surgically with malignant tumors of salivary gland between 2010 and 2020. Analysis included the demographical data, clinical course, type of surgical and adjuvant treatment, histology type and margin status, perivascular invasion (LVI), perineural invasion (PNI), metastatic lymph nodes (LN). Facial nerve function, recurrence-free and overall survival were evaluated. Adequate statistics were used for data analysis.

RESULTS

The final cohort included 63 SGC patients, with adenoid cystic carcinoma the most common pathological type (27%, n = 17), followed by adenocarcinoma (17.4% n = 11). T1 and T2 patients accounted for majority cases (n = 46). The lymph node metastases were confirmed with the histopathology in 31.7% (n = 20). Distant metastases were observed in 4.8% of cases (n = 3). 38% (n = 24) of SGC were treated selectively with surgery, 49.2% (n = 31) had postoperative radiotherapy and 15.9% (n = 10)-radio-chemotherapy. The final facial nerve function was impaired in 38% of patients. Mean overall survival (OS) for all patients was 108.7 (± 132.1) months, and was the most favorable for acinar cell carcinoma (118.9 ± 45.4) and the poorest for squamous cell carcinoma (44 ± 32). Cox regression analysis of disease-free survival and OS identified significant association only with patients' age over 65 years, the hazard ratio of 7.955 and 6.486, respectively.

CONCLUSIONS

The efficacy of treatment modalities for SGC should be verified with regard to the histopathological type, but also the patients' age should be taken into account.

Assessing Morphological Diversity of Acinic Cell Carcinoma of Salivary Glands at a Tertiary Care Hospital in Pakistan

INTRODUCTION

Acinic cell carcinoma (AciCC) is a rare clinical entity and a salivary gland malignancy. It is associated with wide histological variations in the cytomorphological patterns.

METHODS

Sixty cases diagnosed as AciCC from 2002 to 2023 were assessed for diverse cytomorphological patterns.

RESULTS

The mean age of patients at the time of diagnosis was 44.35±16.8 years ranging from 15 to 81 years. Females comprised 58.3% for a F: M ratio of 1.4:1. Fifty three cases (88.3%) occurred in the parotid gland, two cases in the nasal region (3.3%), and one case each in the soft plate and upper lip (1.7%). The location of the remaining three cases was not specified. The most common presenting complaint was a well-defined facial swelling associated with pain. The average tumor size was 3.8±1.9 cm. The most predominant architectural pattern was solid (83.3%) followed by microcystic (60%), then follicular (41.7%), papillary cystic (14.3%), and tubulocystic (28.6%), and AciCC with de-differentiation/high-grade transformation was reported in three cases (5%). In 83.3% of the cases (50 out of 60), we noticed a mixture of two or more growth patterns. Other degenerative changes included prominent lymphoid stroma, hemorrhage, and cystic change.

CONCLUSION

Awareness and recognition of diverse cytomorphological patterns of AciCC, especially in institutions of a developing country where there is limited availability of highly specific and sensitive immunohistochemical stains or molecular diagnostics, are crucial and essential.

Unusual Presentation of Adenoid Cystic Carcinoma of the Tongue: A Case Report and Review of the Literature

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that affects the salivary glands. Its notable characteristics include aggressive local growth, infiltration of nerves (perineural invasion), a propensity to disseminate to other parts of the body (metastasize), and a high likelihood of recurrence. Here, we present the case of a 71-year-old male patient who presented with swelling on the posterior left side of his tongue, which had been causing him difficulty in chewing for the past six months. The parotid gland is frequently impacted in the head and neck area, with the tongue being comparatively uncommon. While distant metastasis is frequent, metastasis to nearby lymph nodes is not as common. However, if it does occur, it is associated with a poor prognosis and reduces the average survival age of the patient. The preferred treatment for ACC is surgical removal with wide resected margins. If it metastasizes to lymph nodes, then adjunct therapy is the treatment modality for the lesion. ACC exhibits three histopathological patterns: solid, tubular, and cribriform. The solid type is associated with a poorer prognosis compared to cribriform type, which typically has a better prognosis. This case, occurring on the tongue, is rare.

Pleomorphic Adenoma of the Oral Cavity: Systematic Review

Pleomorphic adenomas are the most commonly presented salivary gland tumor; however, exact etiologies are unknown. We present a systemic review investigating the demographics, clinical presentations, characteristics, and anatomical locations of oral cavity pleomorphic adenoma. Three electronic databases (PubMed, MEDLINE, and Scopus) and one search engine (Google Scholar) were used to identify studies published in English with no restrictions on the year of publication up to the first week of August 2022. Studies retrieved from the literature involved clinical presentations, characteristics, and anatomical locations of oral cavity pleomorphic adenoma, data presented as frequencies and percentages. Our systematic review included 71 studies out of 2110 identified. Pleomorphic adenoma in the oral cavity was found more commonly in females [1508 (42.9%)] than males, with an age range of 6-83 years. The most common tumor location was the palate, followed by the lips; the jaw was the least common location identified. Most cases were not characterized of having a pleomorphic adenoma [(2,918 (83%))]. The most commonly mentioned characteristic was a painless mass [(561 (16%))] and the least common characteristics were dysphagia, change in sensation, and ill-fitting prosthesis. Pleomorphic adenoma of the oral cavity can have many presentations. In any oral cavity mass, pleomorphic adenoma should be included in the differential diagnosis and a complete surgical excision preferred treatment.

[Why is the histomorphological diagnosis of small salivary gland tumours so much more difficult?]

There is a widespread impression among clinicians and pathologists that the histomorphological diagnosis of minor salivary gland tumours is more difficult and more frequently misdiagnosed than that of major glands. This is based on subjective clinical impression; scientific proof of and potential reasons for this difference are lacking. We identified 14 putative clinical, histopathological and combined clinical-histological reasons and four consequences, which together could explain the perceived greater difficulty of diagnosing minor gland tumours. We performed a thorough literature search and a statistical comparison of data from a personal large consultation series (biased for "difficult" cases) with cumulated data from a routine, unselected (non-consultation) series from the literature. Through this comparison, we could prove with statistical significance a series of reasons and consequences for this greater diagnostic difficulty in minor glands. Frequent incisional biopsies, almost obligatory low-grade bland cytology in malignant tumours and insufficient clinical-pathological communication emerged as the most important reasons. The special anatomic location of the hard palate contributes to further diagnostic difficulties, such as tumour necrosis, mucosal ulceration, pseudoinvasion and the "tumoural-mucosal fusion" phenomenon. Knowledge of these pitfalls in clinic and pathology can help overcome these difficulties and reduce the misdiagnosis rate in minor gland tumours. Our findings result in a series of recommendations both for the clinic and pathology.

Bioinformatic Analysis for Mucoepidermoid and Adenoid Cystic Carcinoma of Therapeutic Targets

Salivary gland neoplasms are a heterogeneous neoplasm group, including mucoepidermoid carcinoma (MECa), adenoid cystic carcinoma (AdCC), and many others. Objective: We aimed to identify new critical genes of MECa and AdCC using bioinformatics analysis. Methods: Gene expression profile of GSE153283 was analyzed by the GEO2R online tool to use the DAVID software for their subsequent enrichment. Protein–protein interactions (PPI) were visualized using String. Cytoscape with MCODE plugin followed by Kaplan–Meier online for overall survival analysis were performed. Results: 97 upregulated genes were identified for MECa and 86 for AdCC. PPI analysis revealed 22 genes for MECa and 63 for AdCC that were validated by Kaplan–Meier that showed FN1 and SPP1 for MECa, and EGF and ERBB2 for AdCC as more significant candidate genes for each neoplasm. Conclusion: With bioinformatics methods, we identify upregulated genes in MECa and AdCC. The resulting candidate genes as possible therapeutic targets were FN1, SPP1, EGF, and ERBB2, and all those genes had been tested as a target in other neoplasm kinds but not salivary gland neoplasm. The bioinformatic evidence is a solid strategy to select them for more extensive research with clinical impact.

National analysis of positive surgical margins in oropharyngeal salivary gland malignancies

OBJECTIVE

Positive surgical margins (PSM) are associated with worse survival in oropharyngeal salivary gland malignancies (OPSGM), but existing literature is limited to small series. Our objective was to identify risk factors for PSM using the national cancer database (NCDB), including a transoral robotic surgical (TORS) approach.

METHODS

NCDB was queried for patients with T1-T4a OPSGM undergoing resection between 2010 and 2017. Risk factors for PSM were determined using logistic regression. Overall survival (OS) was analyzed using Kaplan-Meier and Cox proportional hazards models.

RESULTS

Of 785 patients, 165 (21.0 %) had PSM. Age, stage T4a tumors (OR 2.00, 95 % Confidence Interval [CI]: 1.03-3.88), adenoid cystic carcinoma (OR 2.02, 95 % CI: 1.29-3.18), and treatment at lower volume institutions (OR 1.68, 95 % CI: 1.09-2.59) were all independently associated with PSM. TORS versus a non-robotic approach was not associated with PSM (23.9 % vs 20.4 %, p 0.358), respectively. Positive margins were independently associated with a worse OS than negative margins (HR 1.63, 95 % CI: 1.03-2.59). Adjuvant radiation therapy was associated with improved survival in high grade tumors with positive margins.

CONCLUSION

This study represents the largest review assessing risk factors for positive margins in OPSGM. Histologic type (adenoid cystic carcinoma), age, T4a tumor stage and treatment at a lower volume institution were all predictive of positive margins. With increasing use of TORS over the last decade, there does not appear to be a greater risk of positive margins using this modality in select patients.

LEVEL OF EVIDENCE

N/A.

Primary minor salivary gland tumors: A retrospective review of cases seen in a tertiary institution in South East Nigeria

Background

Tumors of the minor salivary glands (MSGs) are rare. They constitute a wide range of histologic types despite their low frequency.

Aim

The aim of this study is to evaluate the clinical and pathological features of 11 different tumors of MSGs presented at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu and to compare them with similar studies done elsewhere.

Patients and Method

This is a retrospective study of patients with tumors involving the MSGs seen at the OMFS and ORL clinics, UNTH. Information regarding demographic characteristics, duration at first presentation, types of tumors, site and side affected, and treatment given were recorded in patients' medical records. Data were analyzed using SPSS version 23; qualitative variables were compared using Chi-square test.

Result

One hundred and thirty three cases of various lesions involving the salivary gland were seen within the study period. Fifty three (39.8%) patients met the inclusion criteria and are reported further. Twenty eight (28) cases occurred in males. The mean age of the patients was 39.8 years STD 16.5, while the mean duration of the swellings at presentation was 45.5 months STD 35.4. Pleomorphic adenoma was the most common of the 29 (54.7%) benign histopathologic type seen. The soft palate was the commonest site affected 37 (69.8%). Local excision with wide margin was adequate in treating majority of the swellings 40 (75.5%), while 1 (1.9%) case of recurrence was seen within the study period.

Conclusion

Tumors involving the MSGs are uncommon; males are mostly affected in our environment.

Development of head and neck pathology in Europe

This review gives a brief history of the development of head and neck pathology in Europe from a humble beginning in the 1930s to the explosive activities the last 15 years. During the decades before the introduction of immunohistochemistry in the 1980s, head and neck pathology grew as a subspeciality in many European countries. In the late 1940s, the Institute of Laryngology and Otology with its own pathology laboratory was founded in London, and in 1964 the World Health Organization (WHO) International Reference Centre for the Histological Classification of Salivary Tumours was established at the Bland-Sutton Institute of Pathology, also in London. International collaboration, and very much so in Europe, led to the publication of the first WHO Classification of Salivary Gland Tumours in 1972. In the 1960s, a salivary gland register was organised in Hamburg and in Cologne the microlaryngoscopy was invented enabling microscopic endoscopic examination and rather shortly afterwards a carbon dioxide laser attached to the microscope became established and laryngeal lesions could be treated by laser vaporisation. During the last three decades, the use of immunohistochemistry supplemented with cytogenetic and refined molecular techniques has greatly facilitated the pathological diagnostics of head and neck lesions and has had a huge impact on research. Collaboration between different European centres has drastically increased partly due to establishment of scientific societies such as the Head and Neck Working Group (HNWG) within the European Society of Pathology and the International Head and Neck Scientific Group (IHNSG). A very large number of European pathologists have contributed to the 2nd, 3rd and 4th WHO books, and are involved in the upcoming 5th edition. Accredited educational meetings and courses are nowadays regularly arranged in Europe. Numerous textbooks on head and neck pathology have been written and edited by European pathologists. The increased collaboration has created larger series of tumours for research and new entities, mainly defined by their genetic abnormalities, are continuously emerging from Europe, particularly regarding salivary gland neoplasms and "undifferentiated" sinonasal tumours. These findings have led to a better and more precise classification and open the possibilities for new treatment strategies.

Why is the histomorphological diagnosis of tumours of minor salivary glands much more difficult?

AIMS

There is a widespread perception among clinicians and pathologists that the histomorphological assessment of minor salivary gland (MinSG) tumours is more difficult and hampered by more misdiagnoses than that of major salivary gland tumours. This is based on a vague, subjective clinical impression, lacking scientific proof. The aim of the present study was to identify and statistically verify potential reasons that could explain this difference.

METHODS AND RESULTS

We identified 14 putative clinical, pathological and combined clinicopathological reasons that, altogether, could explain the phenomenon of the perceived greater diagnostic difficulty associated with MinSG tumours. We performed a comprehensive literature search and a statistical comparison of data from a large personal consultation series (biased for difficult cases) with cumulated data from straightforward, unselected (non-consultation) series from the literature. By performing this comparison, we identified, with statistical significance, a comprehensive series of reasons, as well as of consequences, of the greater difficulty in diagnosing MinSG tumours.

CONCLUSIONS

Among the 14 criteria, high frequencies of initial incisional biopsies and of a low-grade category in malignant tumours emerged as the two most important reasons for enhanced diagnostic difficulty. Very rare entities, unusual locations, shortcomings in clinicopathological communication, and pecularities of the special anatomical location of the hard palate, such as tumour necrosis, mucosal ulceration, pseudoinvasion, and the peculiar phenomenon of 'tumoral-mucosal fusion', contribute to further diagnostic difficulties. The awareness of these shortcomings and pitfalls enables us to provide a series of recommendations for clinicians and pathologists that might aid in assessment and reduce the rate of misdiagnosis of MinSG tumours.

Synchronous pleomorphic adenoma in the infratemporal fossa and contralateral submandibular gland and endoscopic removal

The objective of this article is to elucidate on our experience with the first case reported in the literature of a synchronous presentation of pleomorphic adenoma (PA) in infratemporal fossa as well as the contralateral submandibular gland. PA most commonly arises from the major salivary glands but has also been reported to arise from minor salivary glands in unusual sites such as the nasal septum, main stem bronchus, trachea, lacrimal gland, external auditory canal, etc. However, it seldom involves the infratemporal fossa and extremely few cases are reported in the literature and coexistent contralateral synchronous PA is nowhere reported in literature. The infratemporal fossa tumour posed a diagnostic dilemma and therapeutic challenge because of its concealed location which we dealt successfully with endoscopic sublabial trans maxillary approach.

Autophagy and salivary gland cancer: A putative target for salivary gland tumors

Salivary gland carcinomas are a group of heterogeneous tumors of different histological subtypes, presenting relatively low incidence but the entire variable of types. Although novel treatment options for salivary gland carcinomas patients' outcomes have improved, the treatment of this type of cancer is still not standardized. In addition, a significant number of patients, with a lack of optimal treatment strategies, have reduced survival. In the last two decades, a plethora of evidence pointed to the importance of autophagy, an essential catabolic process of cytoplasmatic component digestion, in cancer. In vitro and in vivo studies highlight the importance of autophagy in salivary gland carcinomas development as a tumor suppressor or promoter mechanism. Despite the potential of autophagy in salivary gland carcinomas development, no therapies are currently available that specifically focus on autophagy modulation in salivary gland carcinomas. In this review, we summarize current knowledge and clinical trials in regard to the interplay between autophagy and the development of salivary gland carcinomas. Autophagy manipulation may be a putative therapeutic strategy for salivary gland carcinomas patients.

Development and validation of a prognostic model incorporating [18F]FDG PET/CT radiomics for patients with minor salivary gland carcinoma

OBJECTIVES

The aim of this study was to develop and validate a prognostic model incorporating [¹⁸F]FDG PET/CT radiomics for patients of minor salivary gland carcinoma (MSGC).

METHODS

We retrospectively reviewed the pretreatment [¹⁸F]FDG PET/CT images of 75 MSGC patients treated with curative intent. Using a 1.5:1 ratio, the patients were randomly divided into a training and validation group. The main outcome measurements were overall survival (OS) and relapse-free survival (RFS). All of the patients were followed up for at least 30 months or until death. Following segmentation of tumors and lymph nodes on PET images, radiomic features were extracted. The prognostic significance of PET radiomics and clinical parameters in the training group was examined using receiver operating characteristic curve analysis. Variables showing a significant impact on OS and RFS were entered into multivariable Cox regression models. Recursive partitioning analysis was subsequently implemented to devise a prognostic index, whose performance was examined in the validation group. Finally, the performance of the index was compared with clinical variables in the entire cohort and nomograms for surgically treated cases.

RESULTS

The training and validation groups consisted of 45 and 30 patients, respectively. The median follow-up time in the entire cohort was 59.5 months. Eighteen relapse, 19 dead, and thirteen relapse, eight dead events were found in the training and validation cohorts, respectively. In the training group, two factors were identified as independently associated with poor OS, i.e., (1) tumors with both high maximum standardized uptake value (SUV_max) and discretized intensity entropy and (2) poor performance status or N2c-N3 stage. A prognostic model based on the above factors was devised and showed significant higher concordance index (C-index) for OS than those of AJCC stage and high-risk histology (C-index: 0.83 vs. 0.65, P = 0.005; 0.83 vs. 0.54, P < 0.001, respectively). This index also demonstrated superior performance than nomogram for OS (C-index: 0.88 vs. 0.70, P = 0.017) and that for RFS (C-index: 0.87 vs. 0.72, P = 0.004).

CONCLUSIONS

We devised a novel prognostic model that incorporates [¹⁸F]FDG PET/CT radiomics and may help refine outcome prediction in patients with MSGC.

Pleomorphic adenoma of the upper lip

We present a rare case of pleomorphic adenoma in the upper lip region, with erosion of the maxillary bone and distortion of the facial appearance. A 20-year-old man presented with a painless mass on his upper lip, which had gradually increased in size over a period of 2 years. Computed tomography demonstrated a 30 mm × 28 mm enhancing mass in the upper lip region with no invasion to the surrounding tissues. Erosion of the maxillary bone posterior to this lesion was noted. The lesion was excised completely with a wedge of mucosa overlying the tumoral mass, accompanied with abdominal fat grafting to prevent labial asymmetry. Histological examination confirmed the diagnosis of a minor salivary gland pleomorphic adenoma in the upper lip. The pathology, clinical manifestations, and treatment of intraoral pleomorphic adenomas are reviewed.

Pleomorphic Adenoma in the Lower Lip: A Case Report and a Review

Pleomorphic adenoma constitutes 50% of salivary gland tumors affecting mostly the parotid gland extraorally, and the palate intraorally. While the upper lip is a common site, it is unusual to encounter this tumor in the lower lip. A 26-year-old man complained of a persistent lump affecting the lower lip. The lesion was excised and was shown on histopathological examination to be a pleomorphic adenoma with squamous metaplasia. At the 18-month review appointment, there was complete healing and no recurrence. Pleomorphic adenoma in the lower lip should be considered among the differential diagnosis of lower labial swellings, especially in young patients. There needs to be reconsideration of the epidemiological and histological characteristics.

Pleomorphic Adenoma of the Cheek: A Case Report

Pleomorphic adenoma (PA) is the most common benign tumor affecting both major and minor salivary glands. Parotid gland is the most commonly affected major salivary gland. Among minor salivary glands, palate is the most commonly affected site followed by lips, cheeks, gingiva, floor of the mouth, and tongue. PA of buccal minor salivary glands is a very rare occurrence both in adults and children. In this report, we present a case of PA of buccal minor salivary gland in an adult patient who was successfully treated by wide local surgical excision, and after a follow-up period of one year there was no recurrence. A review of literature of PA of cheek is also presented.

Salivary Gland Malignancies

Salivary gland tumors are rare pathologic entities that are derived from major and minor salivary gland tissue located throughout the head and neck region. These tumors are distinctly heterogenous, comprising numerous cell types, especially those deemed malignant. The incidence of malignant salivary gland tumors is widely distributed in both adult and pediatric patient populations. Accurate diagnosis and optimal treatment of these tumors pose challenges to both interpreting pathologists and ablative surgeons. This article examines the epidemiology and pathology of malignant tumors of the major and minor salivary glands and provides recommendations for the most successful treatment approaches.

Role of Antioxidants in Minor Salivary Glands Cancer in the Elderly

BACKGROUND

Minor salivary gland tumors (MSGTs) are infrequent, representing 10% to 15% of all salivary neoplasms. Despite this low frequency, a significant increase in the incidence of these tumors has been reported in the lasts 30 years. While tumors of the salivary glands can appear at any age, different authors consider the peak of incidence to be associated with old age (60+). The etiopathogenesis of MSGTs remains unclear. In this context, the aim of this study was to explore the hypothesis that age-related changes in salivary antioxidant capacity are involved in the pathogenesis of minor salivary glands tumors to identify possible preventive measures.Furthermore the study aimed to describe the clinico-pathological features of a multi-institutional case series of MSGTs which results are consistent with data in the literature.

METHODS

An electronic search of the English language literature was performed using PubMed and Google scholar (<scholar.google.com>). Databases were screened for papers using a number of search strings constructed using relevant terms (minor salivary glands tumors, elderly, diet, antioxidant, saliva, salivary glands).

RESULTS

According to the world literature, the peak of incidence of MSGTs is between the fifth and seventh decades of life. To date, the only confirmed risk factor for salivary gland tumors is the exposure to ionizing radiation. The significantly reduced salivary antioxidant capacity in old people may explain the higher prevalence of these tumors in the elderly population.

CONCLUSIONS

Further investigation is required to determine the real etiopathogenesis of MSGTs and why these tumors result more frequent in elderly patients.

Pleomorphic Adenoma of Minor Salivary Glands in Child

Introduction:

Tumors of salivary glands are very rare in children overall, and rarely in minor salivary glands. Among them pleoomorphic adenoma (PA) is the most common benign tumor of salivary glands in children and it acounts 60% of all salivary neoplasms, frequently found in major salivary glands (85 %) and rarely in minor salivary glands (10-15%). PA appears as painless oval mass, elastic consistency and smooth surface. It characterized by slow evolution of growing. The diagnosis can be confirmed only by histopathological features, after total excision of the lesion.

Case report:

This case report present the uncommon case of the formation well circumscribed in upper lip region, nearby the frenulum labii oris superior in 10 years old school girl. After clinical intraoral examination of the formation approximately 2cm in size the surgical treatment has been done and histopathologic analysis resulted as PA.

Conclusion:

Long term follow-up examination is necessary due to possible recurence or malignancy alteration.

Management of salivary gland carcinomas - a review

Salivary gland carcinomas are a heterogeneous group of tumors with many histological subtypes which occur in both major and minor salivary glands. However, they have a relatively low of incidence. Their rarity limits study size and the ability to perform phase III trials. Therefore, to date, the entire management is usually varied. Certain published studies have paid more attention to the systemic therapy in the management of metastatic or locally recurrent salivary gland cancer, while little effort has been made to study the entire management for this lesions. Although results of treatment for patients with salivary gland carcinoma have improved in recent years, the treatment of salivary gland cancers is still not standardized. And some patients who haven’t received optimal treatment strategies had a reduced survival. In this review, the topics covered include surgery and radiotherapy, selective neck dissection, chemotherapy, and targeted therapy, which aimed to summarize the optimal management approaches and to develop recommendations for managing this lesions. For these rare cancers, there is also a need for a determined, coordinated effort to conduct high-quality clinical trials.

Distribution of nerve fibers during the development of palatine glands in rats

BACKGROUND

Salivary gland maturation and function are modulated by the nervous system. Nevertheless, little is known about salivary gland innervation during development, particularly minor salivary glands. This study investigated the development of the innervation of the palatine glands of rat.

MATERIALS AND METHODS

Frozen sections of rat palatine glands at different stages were immunohistochemically labeled for detection of the general nerve markers protein gene product 9.5 (PGP 9.5) and growth associated protein 43 (GAP-43), and the autonomic nerve markers calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY).

RESULTS

PGP 9.5 and GAP-43-immunoreactive fibers (IRF) were present in the mesenchyme and in association with developing acini, ducts and blood vessels. GAP-43-IRF were more abundant and diffuse than PGP 9.5-IRF at early stages, but showed similar distribution with growth, ramifying out from thick bundles in connective tissues until encircling the secretory units observed around postnatal day 21 (PN21). CGRP-IRF were detected in the mesenchyme at embryonic day 20 (E20) and PN0. CGRP-IRF became numerous around PN7 and PN10. They then decreased to the adult level at PN21, mainly located around ducts and infrequently blood vessels. NPY-IRF were sparsely detected in the mesenchyme at E20, then detected in close proximity to acini in addition to blood vessels at PN3. NPY-IRF increased till reaching the adult stage, and were mainly associated with blood vessels and around mucous cells and some serous demilunes.

CONCLUSION

The findings indicated a developmental modification of the sensory and autonomic innervation which may play a role in the functional maturation of the palatine salivary glands.

Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients

Objective We sought to describe the patient, tumor, and survival characteristics of minor salivary gland carcinoma (MSGC) of the oropharynx using a large, population-based database. Study Design Cross-sectional analysis of the National Cancer Institute's SEER database (Surveillance, Epidemiology. and End Results). Subjects and Methods We reviewed the SEER database for all cases of MSGC of the oropharynx from 1988 to 2013. Relevant demographic, clinicopathologic, and survival variables were extracted and analyzed. Cox multivariate regression was performed to identify prognostic factors. Results We identified 1426 cases of MSGC of the oropharynx (mean age, 58 years; 51% female). The soft palate (39.2%) and base of tongue (38.6%) were the most commonly involved sites. The most common histologic subtypes were mucoepidermoid carcinoma (32.1%), adenocarcinoma (25.9%), and adenoid cystic carcinoma (23.3%). Five- and 10-year rates of disease-specific survival were 75.1% and 61.6%, respectively. Independent prognostic factors included tumor grade, T stage, N stage, and age >70 years. Conclusions This study represents the largest multivariate survival analysis of MSGC of the oropharynx to date. Independent prognosticators include tumor grade, T stage, N stage, and age.

Basal Cell Adenoma of Retromolar Region from Minor Salivary Gland Origin in a 45-Year-Old Female: A Case Report

Basal cell adenoma is a rare benign salivary gland neoplasm. The most common location is in parotid region. Clinically, gradual growth and firm consistency are seen. They account for 1 to 3% among all salivary gland neoplasms. Prominent basaloid cells with cluster of isomorphic cells and interspersed trabeculae are present histopathologically. In this article, we present a rare case of basal cell adenoma of retromolar region from minor salivary gland origin.

Adenoid cystic carcinoma: A rare late presentation of the mobile tongue

Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm of the salivary glands. We present a case of a 70-year-old male patient with a swelling over the dorsal and ventral surface of anterior two third of the tongue which was causing him difficulty in mastication since 10 months. Ultrasound and magnetic resonance imaging were done following which the surgical excision of the lesion was performed and histopathological diagnosis of ACC was achieved. It was rare to find ACC in such an old man with such a large lesion presenting so late in the rare site of the mobile tongue. ACC is a slowly growing, highly invasive cancer with a high recurrence rate and chances of metastases, so surgery is the choice of treatment with mandatory long-term follow-up.

Mucoepidermoid carcinoma of the palate: A rare case report

Mucoepidermoid carcinomas (MECs) of minor salivary gland origin are rare in children and adolescents and have been reported rarely. Literature regarding their clinical features and biologic behavior is scanty. The purpose of this case report is to discuss the clinical manifestation, diagnosis, and treatment plan of MEC of the palate. A 16-year-old male subject visited the Department of Periodontics, The Oxford Dental College and Hospital, Bangalore, India complaining of a painless swelling in the left posterior area of the hard palate since 6 months. Several clinical, radiographic, and histopathological investigations were carried out to rule out the lesion. Incisional biopsy of the lesion confirmed the diagnosis of lesion as MEC of the palate following which a wide surgical excision with adjacent free margins was carried out. This case report highlights the need for proper diagnosis and treatment plan in the cases of malignant tumors as it can lead to morbidity and mortality.

Pleomorphic adenoma in the nasal cavity: a clinicopathological study of ten cases in Finland

The objective of the study was to investigate the nationwide occurrence of sinonasal pleomorphic adenoma in Finland. A retrospective study was conducted at The Departments of Otorhinolaryngology-Head and Neck Surgery, and Pathology at the five university hospitals in Finland. Data were obtained by searching for sinonasal pleomorphic adenoma cases in the clinical and histopathological registries at these institutions for the past two to four decades. All patients who had had a histologically proven pleomorphic adenoma in the sinonasal area were included as participants. Ten cases with pleomorphic adenoma of the nasal cavity were found. The majority of these tumours originated in the septum, and there were no malignant transformations. Pleomorphic adenomas of the nasal cavity were found to be extremely rare in this nationwide investigation.

Minor salivary gland tumors in the Indian population: A series of cases over a ten year period

PROBLEM CONSIDERED

Minor salivary glands are found in the sino-nasal cavities, oropharynx, larynx and trachea with the majority being found in the oral cavity. 80% or more of minor salivary gland tumors are malignant and they tend to have a great variation in presentation and histology. We sought out to compare the presentation of various minor salivary gland tumors (MSGT's) in the Indian population as compared to that reported in different races and regions.

METHODS

We report a clinical case series in which 17 patients with biopsy proven minor salivary gland tumors both benign and malignant at various intraoral sites viz the palate, cheek, retromolar trigone and floor of the mouth were operated upon and followed up over a span of 10 years from 2001 to 2011.

RESULTS

15 patients were treated timely with complete removal of the lesions by wide local excision and as confirmed by histopathology; one patient with adenoid cystic carcinoma delayed in seeking treatment and expired within a month and another with salivary duct carcinoma presented with advanced disease and regional metastases in the form of multiple ipsilateral enlarged lymph nodes and distant metastases in the liver. He was given palliative radiotherapy but he died after six weeks of receiving treatment.

CONCLUSION

the results that we obtained for Indians were comparable to the various population studies done around the world.

Frequency and distribution pattern of minor salivary gland tumors in a northeastern Chinese population: a retrospective study of 485 patients

PURPOSE

The relative frequency of individual minor salivary gland tumors (MSGTs) is not well documented in the literature. The aim of this study was to determine the range and demographics of all histologically diagnosed MSGTs in a northeastern Chinese population.

MATERIALS AND METHODS

A total of 485 cases of MSGT were retrospectively studied. The files of the Department of Oral and Maxillofacial Pathology, School of Stomatology, China Medical University served as a source of material for this study. All epithelial tumors from minor salivary glands accessioned from August 2004 to April 2014 were analyzed for demographic features, anatomic location of tumors, and pathologic classification. Tumors were classified according to the 2005 World Health Organization classification of salivary gland tumors. Statistical analysis was performed using analysis of variance.

RESULTS

MSGTs were identified in 485 (2.60%) of 18,670 accessed cases. There were 268 (55.26%) benign and 217 (44.74%) malignant tumors. Female outnumbered male patients (male-to-female ratio, 1:1.43). The mean ages of patients with benign and malignant MSGTs were 47.58 and 51.51 years, respectively. Pleomorphic adenoma and adenoid cystic carcinoma were the most frequent types of benign and malignant tumors, respectively. The palate was the most commonly affected site (64.74%), followed by the buccal mucosa (7.63%) and the tongue (5.98%).

CONCLUSIONS

From the results of this study and a review of the literature, it is suggested that MSGTs in the northeastern Chinese population may be characterized by a higher incidence of MSGTs than in the populations of other reviewed regions, a higher incidence of myoepithelioma, a rarer occurrence of polymorphous low-grade adenocarcinoma, and an absence of canalicular adenoma occurrence.

Mucoepidermoid carcinoma of the palate in a 5-year-old girl: case report and literature review

BACKGROUND

Minor salivary gland tumors in children are uncommon. However, despite the low overall incidence, there is a high incidence of malignancy in these young patients which is reported to be above 50 %, with mucoepidermoid carcinoma (MEC) predominating. We hope that this case report will contribute to the enlightenment of the behavior and prognosis of pediatric MEC of palatal minor salivary gland tumors.

CASE REPORT

A 5-year-old girl was admitted to our center with a histologically confirmed MEC of the left hard palate. Primary incision for drainage of a supposed abscess and secondary biopsy had been performed elsewhere 14 days before. After further workup, we excised the tumor and the adjacent bone; clear margins of 10 mm were revealed. Adjuvant therapy was not necessary. The defect was allowed to undergo secondary wound healing. As of the 1-year follow-up, there had been no recurrences.

CONCLUSION

For differential diagnosis, MEC should be considered in cases of soft, slow-growing, painless, pale bluish-purple lumps of the palate even in young patients. Especially for nonresponders to initial treatment, early biopsy is recommended for histological confirmation or exclusion of a minor salivary gland tumor.

Atypical Presentation of an Upper Lip Pleomorphic Adenoma: Case Report

The pleomorphic adenoma (PA) or mixed tumor is the most common neoplasm of the salivary glands, usually presenting with a non-specific clinical manifestation and a diverse histopathological pattern. The region of the lips is the second most common site for minor gland neoplasms. The aim of this paper is to report the case of a 39 year old caucasian woman presenting with a swelling on the right side of the upper lip combined with a history of trauma in the region of the upper right central incisor, eight years ago. The swelling was attributed to the periapical lesion of the upper right central incisor that was observed on the orthopantomography. Intraoperatively the surgeon came upon a nodule of firm consistency in the mucolabial fold. The histopathologic diagnosis of this lesion was benign mixed tumor of salivary gland. This report discusses the deviation in frequency of mixed salivary gland tumor between upper and lower lip, the clinical differential diagnosis, the histopathological pattern and the appropriate treatment.

New insight into benign tumours of major salivary glands by proteomic approach

Major salivary gland tumours are uncommon neoplasms of the head and neck. The increase of precise pre-operative diagnosis is crucial for their correct management and the identification of molecular markers would surely improve the required accuracy. In this study we performed a comparative proteomic analysis of fine needle aspiration fluids of the most frequent benign neoplasms of major salivary glands, namely pleomorphic adenoma and Warthin's tumour, in order to draw their proteomic profiles and to point out their significant features. Thirty-five patients submitted to parotidectomy were included in the study, 22 were identified to have pleomorphic adenoma and 14 Warthin's tumour. Fine needle aspiration samples were processed using a two-dimensional electrophoresis/mass spectrometry-based approach. A total of 26 differentially expressed proteins were identified. Ingenuity software was used to search the biological processes to which these proteins belong and to construct potential networks. Intriguingly, all Warthin's tumour up-regulated proteins such as Ig gamma-1 chain C region, Ig kappa chain C region and Ig alpha-1 chain C region and S100A9 were correlated to immunological and inflammatory diseases, while pleomorphic adenomas such as annexin A1, annexin A4, macrophage-capping protein, apolipoprotein E and alpha crystalline B chain were associated with cell death, apoptosis and tumorigenesis, showing different features of two benign tumours. Overall, our results shed new light on the potential usefulness of a proteomic approach to study parotid tumours and in particular up regulated proteins are able to discriminate two types of benign parotid lesions.

Pleomorphic adenoma: a rare intraoral pediatric tumor

Minor salivary gland tumors are rare in the pediatric population. The most common minor salivary gland neoplasm is pleomorphic adenoma of the hard palate. We report a case of a 7-year-old patient presenting with a slow-growing palatal lesion, which upon diagnosis we confirm to be a pleomorphic adenoma. These lesions require radical excision with careful dissection due to risks of malignant transformation, pain, interference with dentition, and tumor seeding. Given the risk of recurrence, it is important that these patients be monitored long term following extirpation. Our patient remains recurrence free at most recent follow-up, 5 years following initial extirpation. The addition of this case contributes further information regarding demographics, diagnosis, and treatment of these tumors.

Parotid tail pleomorphic adenoma extending to the parapharyngeal space

Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.

Intraoral minor salivary gland tumours: a retrospective study from a dental and maxillofacial surgery centre in salem, Tamil Nadu

ABSTRACT

Minor salivary gland tumors (MSGTs) constitute a heterogeneous group of neoplasms with variation in histopathology. These are rare neoplasms usually occurring in the palate. Dental examination may provide an opportunity for early detection.

AIM

This study was undertaken to do an epidemiological survey of minor salivary gland tumours reporting to a single dental and maxillofacial surgery centre and to determine the correlation of the histopathologic characteristics with the clinical features.

MATERIALS AND METHODS

A retrospective survey of the histopathological findings of 1,020 consecutive biopsy reports in a single dental and maxillofacial surgery centre was done to identify cases of MSGT. The results were tabulated based on various criteria.

RESULTS

In our study, only 8 tumors were benign (26.67 %), and 22 tumors were malignant (73.33 %). Mucoepidermoid carcinoma (MEC) was the most common tumor (15 of 30). Pleomorphic adenoma was most common benign MSGT in our series (7 of 30). This was followed by adenoid cystic carcinoma (6 of 30). Palate was the most common site (13 of 30) followed by buccal mucosa (5 of 30) and lip (4 of 30).

CONCLUSIONS

Unlike many previous studies, malignant salivary gland tumours were predominant. MEC was the most common malignant tumour in our study similar to many other studies. The palate was the most common site for minor salivary gland neoplasms.

Human papillomavirus-16 associated adenocarcinoma NOS of base of tongue

The causative role of human papillomavirus (HPV) in a subset of squamous cell carcinomas of the oropharynx (OSCC) is now well established with HPV-16 being detected in approximately 92% of HPV-positive OSCC in North America. Recently HPV has also been found in some non-squamous oropharyngeal carcinomas including adenosquamous carcinomas, neuroendocrine carcinomas, and undifferentiated "lymphoepithelioma-like" carcinomas. Herein, we report a HPV-16 positive adenocarcinoma NOS arising in the base of the tongue of a non-smoker, 64 year-old male. To our knowledge, this is the first time this association has been clearly documented. The adenocarcinoma was diffusely positive for p16 and HPV-16 was demonstrated by in situ hybridization and linear array analysis. Q-PCR demonstrated a viral load of 4 copies per cancer cell, whereas qRT-PCR for E6/E7 transcript levels were 30 copies per 1,000 human ribosomal protein large P0 (RPLP0) reference gene. The presence of HPV in non-squamous oropharyngeal carcinomas raises the possibility that HPV is also involved in the carcinogenesis of some uncommon carcinomas of the region.

Adenoid cystic carcinoma of the parotid gland

Adenoid cystic carcinoma (ACC) of salivary glands is a slow-growing malignant tumor, characterized by wide local infiltration, perineural spread, a propensity to local recurrence and late distant metastasis. Although ACC is the second most common malignant salivary gland neoplasm and constitutes approximately one-third of all salivary gland malignancies, it is relatively rare in parotid gland. Here, we present a case report of a cribriform type of ACC involving parotid salivary gland in a 66-year-old female.

A clinical analysis of nine new pediatric and adolescent cases of benign minor salivary gland neoplasms and a review of the literature

INTRODUCTION

Minor salivary gland neoplasms of epithelial origin are rare in children and adolescents and most are not well documented, except for a few small series and case reports. This study represents a retrospective clinical analysis of nine cases of benign epithelial salivary gland neoplasms accessioned over a 35-year period at the Louisiana State University School of Dentistry and combines the data with well-documented cases from the English-language literature.

METHODS

A retrospective clinical analysis of nine cases of benign epithelial salivary gland neoplasms was performed over a 35-year period at the Louisiana State University School of Dentistry and combined with data of well-documented cases from the English-language literature.

RESULTS

The nine benign salivary gland neoplasms in patients aged 19 months to 18 years accounted for 2.3% of the Louisiana State University School of Dentistry accessioned salivary gland tumors. These nine cases comprised eight pleomorphic adenomas and one cystadenoma. There were 40 cases in the literature, of which 34 were pleomorphic adenomas. Combining the data for the 42 pleomorphic adenomas resulted in a mean age of 12 years with a 2.8:1 female predilection. The hard palate and/or soft palate were the most common site (69.1%). The average duration and size was 2.1 years and 2.4cm, respectively. Bone involvement occurred in seven cases. Wide local excision was the treatment most often employed. Cases followed for two years or more had a recurrence rate of 13.0%. The remaining seven neoplasms in the combined data comprised myoepithelioma, cystadenoma and sialadenoma papilliferum.

CONCLUSIONS

A relatively long duration (2 years) of a submucosal mass in a minor salivary gland-bearing area with or without bone involvement occurring in a child or adolescent should raise the question of a possible salivary gland neoplasm. A pleomorphic adenoma is the most common benign salivary gland neoplasm in the first and second decade of life. Complete surgical excision affords the best chance of preventing recurrence for pleomorphic adenomas. The recurrence rate of pleomorphic adenomas with two or more years follow-up is 13.0%. Other types of minor salivary gland neoplasms are exceedingly rare and therefore data is sparse, precluding any valid conclusions.

An analysis of salivary gland neoplasms: a 12-year, single-institution experience in Turkey

The epidemiology of salivary gland tumors worldwide is not very well defined. Although many studies on this subject have been undertaken, the data are generally focused on specific topics such as parotid gland neoplasms or tumors of the major salivary glands. We conducted a study to establish the prevalence and distribution of benign and malignant neoplasms of both the major and minor salivary glands at a single institution. We reviewed 244,204 cases that had come through our pathology department from January 1994 through December 2005 and found 235 cases of a salivary gland neoplasm (0.09%). The female-to-male ratio was 1.04:1, and the mean age of the patients was 47 years. Of the 235 neoplasms, 159 (67.66%) were located in the parotid gland, 34 (14.47%) in the submandibular gland, and 42 (17.87%) in the minor salivary glands. A total of 146 tumors (62.13%) were benign and 89 (37.87%) were malignant. Pleomorphic adenoma was the most common neoplasm, occurring in 98 cases (41.70%). The most common malignancy was mucoepidermoid carcinoma, with 27 cases (11.49%). Our data demonstrate that the characteristics of salivary gland tumors in a Turkish population at a single institution are similar to those reported in the literature worldwide.

Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature

Introduction

Because well-documented cases of mucoepidermoid carcinomas that are of minor salivary gland origin and occur in children and adolescents have rarely been reported, little information regarding their clinical features and biologic behavior is available. This case report represents a retrospective clinical analysis of five minor salivary gland mucoepidermoid carcinomas accessioned from a 35-year period at the Louisiana State University School of Dentistry and combines the data with 15 well-documented cases from the English language literature.

Case presentation

The five mucoepidermoid carcinomas in patients from birth to 19 years of age accounted for 1.3% of the accessioned minor salivary gland neoplasms. There were an additional 15 well-documented cases in the literature. Combining the data for the 20 mucoepidermoid carcinomas resulted in a mean age of 13.5 years and a 2.3:1 female-to-male ratio. Collectively, the hard palate, soft palate, and hard palate/soft palate junction accounted for 85% of the cases. Thirty-five percent of the cases presented as a fluctuant submucosal swelling with surface color alterations. The average duration was five months, and bone involvement occurred in seven cases. A histologic grade of low to intermediate predominated (95%). Surgical removal was the treatment in all cases. Thirteen cases had adequate follow-up of three years or more, and recurrence was documented in only one case. There were no cases of death or metastasis in this series.

Conclusions

In children and adolescents, mucoepidermoid carcinomas have a female predilection and occur most commonly on the hard or soft palate or both. A fluctuant submucosal lump with a bluish color is a helpful diagnostic clue. The histologic grades of most mucoepidermoid carcinomas in the first and second decades of life are low and, to a lesser degree, intermediate. Complete surgical excision is the treatment of choice and results in a recurrence rate of less than 10%.

Simultaneous palatal pleomorphic adenoma and mandibular keratocystic odontogenic tumor in a pediatric patient

BACKGROUND

Neoplasms of the salivary gland account for 3% of all head and neck tumors; most of these occur in the parotid gland and are benign; 80% of them are pleomorphic adenomas. Benign neoplasms of the salivary gland are rare in children compared with adults. Keratocystic odontogenic tumor (KCOT) is considered the second most frequent neoplasm of all odontogenic tumors after the ameloblastoma. In the present report, we introduce the unusual presentation of a child with a simultaneous pleomorphic adenoma of the right hard palate and a KCOT of the left mandibular angle.

DISCUSSION

The case is significant for 2 reasons; according to the literature, there are few reports of pleomorphic adenoma arising from a minor salivary gland of the palate in a patient younger than 18 years. This is to our knowledge the first recorded instance of simultaneous palatal pleomorphic adenoma and mandibular KCOT occurring in a child.

Pleomorphic adenoma of the upper lip

This case report describes a rare and unusual lesion found in a 33-year-old male, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, large firm mass, about 3 cm in diameter, almost obstructing the nares and characterized by slow growth. Complete excision was performed and the histopathologic analysis showed pleomorphic adenoma. The tumor did not recur. A brief review of the relevant literature is also presented.