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Gui L, Zhu Y, Zhang Y, Tang L, Yao J. Epidemiology, prognostic factors, and treatment of head and neck mucoepidermoid carcinoma: Analysis of the surveillance, epidemiology, and end results database. Braz J Otorhinolaryngol 2024; 90:101450. [PMID: 39053162 DOI: 10.1016/j.bjorl.2024.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES To investigate prognostic factors in patients with head and neck Mucoepidermoid Carcinoma (MEC), especially the impact of treatment modalities on survival. METHODS Patients with primary head and neck MEC between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors related to Overall Survival (OS) and Cancer-Specific Survival (CSS), as well as the impact of treatments, were evaluated by multivariable Cox regression analysis. RESULTS We identified 2692 patients diagnosed with head and neck MEC, of whom 1397 (51.89%) had a parotid gland primary, 569 (22.14%) died, and 341 (12.67%) died of MEC. Older age (≥53 years), males, unmarried, lower income, tumor site in other head and neck areas, higher tumor grade, larger tumor size, and higher stage were related to poorer OS and CSS. Patients who did not undergo surgery (HR=3.20, 95% CI 2.45‒4.18) had worse OS, while no significant difference was detected between partial and total organ excision on patients' OS (p=0.729). For combination therapy, patients who received radiotherapy only (HR=3.21, 95% CI 2.27-4.53) or no surgery and no radiotherapy (HR=2.59, 95% CI 1.83-3.67) were correlated with worse OS (vs. surgery only), but no significant difference was detected between surgery only and surgery combined with radiotherapy on patients' OS (p=0.218). For CSS, the corresponding results were consistent with OS. CONCLUSION Surgical resection only may be a better survival option for head and neck MEC.
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Affiliation(s)
- Lin Gui
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Medical Oncology, Beijing, China.
| | - Yiming Zhu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Head and Neck Surgical Oncology, Beijing, China
| | - Ye Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Radiation Oncology, Beijing, China
| | - Le Tang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Medical Oncology, Beijing, China
| | - Jiarui Yao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Department of Medical Oncology, Beijing, China
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Selvarajah K, Chen J, Hsu Y, Koo K, Iseli T, Wiesenfeld D, Sim F. Head and neck mucoepidermoid carcinoma: does AFIP histological grading correlate with rate of nodal metastases? Oral Maxillofac Surg 2024; 28:577-583. [PMID: 37344706 DOI: 10.1007/s10006-023-01163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE The aim of this study is to retrospectively evaluate the presentation of head and neck mucoepidermoid carcinoma at the Royal Melbourne Hospital and identify the significance of AFIP histological grading on the risk of neck metastasis and cancer free survival. MATERIALS AND METHODS This study is a retrospective cohort analysis of patients treated for head and neck mucoepidermoid carcinoma at the RMH between 2005 and 2022. Patient demographics, treatment, pathology, in particular the AFIP histological grading of the primary tumour, and outcomes were collected and tabulated. Time to recurrence was recorded, and survival outcomes were calculated with Kaplan-Meier method. Comparisons were made on different histological grading and regional metastases. RESULTS Thirty-three patients were identified and thirty met the inclusion criteria. There was an age range of 18-77 years (median 54 years) with no significant sex difference. Our patients had a 94% 5-year survival and an 86% 10-year survival. Thirteen patients had elective neck dissection and 2 out of 13 (15%) of the patients had positive neck disease. Of the two patients with regional metastasis, the primary tumour was graded as intermediate and low grade. No high-grade MEC patients had regional metastasis. CONCLUSION Mucoepidermoid carcinoma of the head and neck is associated with a good disease-specific and overall survival despite the presence of regional metastasis. The AFIP histological grading system did not have a statistically significant correlation to the incidence of nodal metastasis.
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Affiliation(s)
| | - Jane Chen
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Yuan Hsu
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Kendrick Koo
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Tim Iseli
- Royal Melbourne Hospital, Parkville, Australia
| | | | - Felix Sim
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, 3050, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Costa RF, de Oliveira CA, Gomes ÁNDM, Lourenço SV, Coutinho-Camillo CM. Molecular Aspects of Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma of the Salivary Gland. Head Neck Pathol 2024; 18:34. [PMID: 38658430 PMCID: PMC11043314 DOI: 10.1007/s12105-024-01629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Salivary gland tumors (SGTs) are rare and highly heterogeneous lesions, making diagnosis a challenging activity. In addition, the small number of studies and samples evaluated difficults the determination of prognosis and diagnosis. Despite the solid advances achieved by research, there is still an intense need to investigate biomarkers for diagnosis, prognosis and that explain the evolution and progression of SGTs. METHODS We performed a comprehensive literature review of the molecular alterations focusing on the most frequent malignant SGTs: mucoepidermoid carcinoma and adenoid cystic carcinoma. RESULTS Due to the importance of biomarkers in the tumorigenenic process, this review aimed to address the mechanisms involved and to describe molecular and biomarker pathways to better understand some aspects of the pathophysiology of salivary gland tumorigenesis. CONCLUSIONS Molecular analysis is essential not only to improve the diagnosis and prognosis of the tumors but also to identify novel driver pathways in the precision medicine scenario.
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Affiliation(s)
- Raisa Ferreira Costa
- International Research Center, A.C.Camargo Cancer Center, Rua Taguá, 440 - Primeiro andar, São Paulo, 01508-010, Brazil
| | - Carolinne Alves de Oliveira
- International Research Center, A.C.Camargo Cancer Center, Rua Taguá, 440 - Primeiro andar, São Paulo, 01508-010, Brazil
| | - Ágatha Nagli de Mello Gomes
- International Research Center, A.C.Camargo Cancer Center, Rua Taguá, 440 - Primeiro andar, São Paulo, 01508-010, Brazil
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Xu B, Alzumaili B, Furlan KC, Martinez GH, Cohen M, Ganly I, Ghossein RA, Katabi N. Critical Appraisal of Histologic Grading for Mucoepidermoid Carcinoma of Salivary Gland: Is an Objective Prognostic 2-tiered Grading System Possible? Am J Surg Pathol 2023; 47:1219-1229. [PMID: 37694548 PMCID: PMC11198890 DOI: 10.1097/pas.0000000000002120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Multiple 3-tiered grading systems exist for mucoepidermoid carcinoma (MEC), leading to controversial results on the frequency and prognostic values of each grade. We aimed to identify prognostic histologic factors and to evaluate grading schemes in this retrospective study of 262 resected primary head and neck MECs. The rate of nodal metastasis was 8.4%. Large tumor size, tumor fibrosis, infiltrative border, lymphovascular invasion, perineural invasion, atypical mitosis, mitotic index (MI) ≥4/2 mm 2 (4/10 HPFs), necrosis, and pT4 stage were associated with increased risk of nodal metastasis. The 5-year recurrence-free survival (RFS) was 95%. Significant prognostic factors for RFS included infiltrative border, tumor-associated lymphoid stroma, architectural patterns (macrocystic, microcystic, and noncystic), anaplasia, atypical mitosis, MI, necrosis, lymphovascular invasion, margin, pT stage, and tumor size. Nuclear anaplasia, high mitotic rate, and ≥25% microcystic component were significant independent prognostic factors on multivariate survival analysis. There was no significant difference between low-grade (LG) and intermediate-grade (IG) MECs in terms of risk of nodal metastasis and outcomes using all 4 known grading systems. Rather, high-grade MEC was consistently associated with an increased risk of nodal metastasis at presentation and decreased RFS and distant metastasis-free survival (DMFS) compared with the LG/IG MECs. We therefore recommend simplifying MEC grading to a 2-tiered grading scheme using MI and/or tumor necrosis. Using a 2-tiered grading, high-grade histology independently predict RFS, and is associated with a 25% risk of nodal metastasis, a 5-year RFS of 76%, and a 5-year DMFS of 76%, whereas LG MEC has a nodal metastasis rate of 7.0%, 5-year RFS of 97% and 5-year DMFS of 99%.
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Affiliation(s)
- Bin Xu
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Bayan Alzumaili
- Departmental of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karina C. Furlan
- Departmental of Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Marc Cohen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Nora Katabi
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
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Kapoor A, Bakshi J, Panda NK, Sharma V, Bal A, Rampal M, Sedai R, Saharan D, Agarwal G, Gautamjit. Pathological Inconsistencies in Advanced Malignancies of the Parotid Gland. Indian J Otolaryngol Head Neck Surg 2023; 75:311-317. [PMID: 37275068 PMCID: PMC10235400 DOI: 10.1007/s12070-022-03160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Archit Kapoor
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Naresh K Panda
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Vikas Sharma
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Amanjeet Bal
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Mayank Rampal
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Raghab Sedai
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Deepak Saharan
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Ganesh Agarwal
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Gautamjit
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
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Zhang D, Wei Y, Chai Y, Qi F, Dong M. Prognostic Assessment and Risk Stratification in Patients With Postoperative Major Salivary Acinar Cell Carcinoma. Otolaryngol Head Neck Surg 2023; 168:1119-1129. [PMID: 36939406 DOI: 10.1002/ohn.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the clinicopathological features and prognosis of postoperative major salivary acinar cell carcinoma (MSACC) and develop a prognostic model. STUDY DESIGN Retrospective cohort analysis of a public database. SETTING Patients with MSACC were identified from the Surveillance, Epidemiology, and End Results database (1975-2019). METHODS Overall survival (OS) was evaluated using Kaplan-Meier curves and a log-rank test. Univariate and multivariate Cox analyses were performed to explore independent prognostic factors. The prognostic model was constructed using screened variables and further visualized with a nomogram and web calculator, and assessed by concordance index, the area under the curve, calibration curve, and decision-making curve analysis. RESULTS An upward trend in the incidence of MSACC was observed throughout the study period. A total of 1398 patients were enrolled (training cohort: 978; validation cohort: 420), and the 5- and 10-year OS rates were 97.7% and 81.6%, respectively. Age, marital status, sex, histological grade, T stage, and lymph node status were identified as prognostic factors for OS. A novel nomogram was developed and showed excellent discrimination and clinical applicability. Additionally, a web calculator was designed to dynamically predict patient survival. Based on the nomogram-based score, a risk stratification system was constructed to distinguish patients with different risks. The OS of high-risk patients was significantly lower than that of the low-risk subgroup. CONCLUSION Long-term survival in postoperative MSACC was influenced by 6 prognostic factors. The proposed model enables individualized survival prediction and risk stratification, prompting us to be vigilant in high-risk subgroups and consider timely adjustment of subsequent treatment.
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Affiliation(s)
- Di Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuce Wei
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Chai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Qi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Mei Dong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Mucoepidermoid Carcinoma of the Salivary Gland: Demographics and Comparative Analysis in U.S. Children and Adults with Future Perspective of Management. Cancers (Basel) 2022; 15:cancers15010250. [PMID: 36612247 PMCID: PMC9818327 DOI: 10.3390/cancers15010250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Salivary gland neoplasms are uncommon in both pediatric and adult populations. Mucoepidermoid carcinoma (MEC) is one of the most common salivary gland tumors and usually presents with atypical clinical features. This study sought to evaluate the demographic and clinical factors affecting outcomes in adults and pediatric populations with MEC that could be used to risk stratification for treatment selection and clinical trial enrollment. Methods: Data on 4507 MEC patients were extracted from the Surveillance Epidemiology and End Result (SEER) database (2000−2018). Patients aged ≤ 18 years were classified into the pediatric population, and those older than 18 years were placed in the adult group. Kaplan−Meier survival curves were created to analyze survival probabilities for various independent factors. Results: The pediatric population comprised 3.7% of the entire cohort, with a predominance of females (51.5%), while the adult population constituted 96.3% of the cohort, with a predominance of female patients (52.2%). Caucasians were the predominant race overall (75.3%), while more African Americans were seen in the pediatric group. In tumor size of <2 cm overall, poorly differentiated tumors with higher metastasis rates were observed more in adults (11.3% and 9.3%) than in the pediatric population (3.0% and 4.8%, p < 0.05). Surgical resection was the most common treatment option (53.9%), making up 63.6% of the pediatric and 53.5% of the adult groups. A combination of surgical resection and radiation was used in 29.8% of the entire cohort while a combination of surgical resection, radiation, and chemotherapy made up only 3.2%. The pediatric group had a lower overall mortality rate (5.5%) than the adult group (28.6%). Females had a higher 5-year survival rate in comparison to males (86.5%, and 73.7%, respectively). Surgical resection led to a more prolonged overall survival and 5-year cancer-specific survival (98.4% (C.I, 93.7−99.6) in the pediatric group and 88.8% (C.I, 87.5−90.0) in the adult group), respectively. Metastasis to the lung, bone, brain, and/or liver was found to have significantly lower survival rates. Multivariate analysis demonstrated that adults (hazard ratio [HR] = 7.4), Asian or Pacific Islander (HR = 0.5), male (HR = 0.8), poorly differentiated histology (HR = 3.8), undifferentiated histology (HR = 4.5), regional spread (HR = 2.1), and distant spread (HR = 3.2) were associated with increased mortality (p < 0.05). Conclusions: Mucoepidermoid carcinoma of the salivary glands primarily affects Whites and is more aggressive in adults than in the pediatric population. Even with surgical resection, the overall survival is poor in the adult population as compared to its pediatric counterparts. Advanced age, larger tumor size, male sex, and lymph node invasion are associated with increased mortality.
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Abdulhussain MM. Expression of Bcl-2 and clinicopathological variables in salivary glands mucoepidermoid carcinoma. Int J Health Sci (Qassim) 2022; 16:26-31. [PMID: 36475030 PMCID: PMC9682879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Mucoepidermoid carcinoma (MEC) has several diagnostic, biological, and histopathological manifestations, each of which presents issues and difficulties in terms of diagnosis, grading, classification, and therapy. The goal of this study was to find out how the anti-apoptotic protein Bcl2 was expressed in salivary gland (SG) MEC and how it related to a number of clinicopathological factors. METHODS The present study comprised 30 MECs of the SG lesions that were histopathologically diagnosed. The immunohistochemistry method was used to determine Bcl-2 expression. The spss software version 20.0 was used to find a link between Bcl-2 expression and clinical and histological features. RESULTS The patients' average age was 49.93 years, and MEC of SGs was more common in females. The palate was the most commonly involved area, accounting for 13 (43.3%) of cases, followed by the parotid glands, which accounted for 8 (26.7%). High-grade tumors accounted for 14 (46.7%) of the cases, whereas mild-grade tumors accounted for 10 (33.3%) and moderate-grade tumors accounted for 6% (20.0%). Bcl-2 immunostaining was associated with gender (P = 0.047), there was also a significant (P = 0.002) difference in tumor grade and age groups. Furthermore, no significant relationships between Bcl-2 expression and the other variables were discovered. CONCLUSION Gender and age affect MEC tumor aggressiveness and grade. High-grade MEC tumors expressed Bcl-2 strongly and moderately, whereas low-grade tumors expressed it moderately. Bcl-2 may predict MEC tumor aggressiveness. MEC therapy may target Bcl-2.
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Singareddy R, Bajwa HK, Reddy MM, Alluri KR, Raju KVVN, Rao TS, Rao LMC. Mucoepidermoid Carcinoma of the Salivary Gland: Long Term Outcomes from a Tertiary Cancer Center in India. Indian J Otolaryngol Head Neck Surg 2022; 74:1763-1767. [PMID: 36452837 PMCID: PMC9702244 DOI: 10.1007/s12070-019-01781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022] Open
Abstract
To analyze the patterns of failure and factors affecting recurrence and overall survival in mucoepidermoid carcinoma of the salivary gland. The hospital records were retrospectively analyzed from October 2010 to January 2016. Patients diagnosed as mucoepidermoid carcinoma of the salivary gland were eligible for analysis. All patients received surgery as the primary treatment modality with or without post operative radiotherapy. Statistical analysis for factors affecting recurrence was done by cox regression analysis and p value less than 0.05 was considered significant. A total of 116 patients were diagnosed to have malignant salivary gland tumors of which 69 were mucoepidermoid carcinomas (69.5%). The median age was 43 years (8-75 years). Majority of the tumors occurred in major salivary glands gland (77%). 51% patients were females. Most common stage was stage II (36%) followed by stage I (27.5%), stage IV (20.3%) and stage III (16%). High grade carcinomas comprised 34.8%, intermediate grade 30.4% and low grade 34.8%. 36 patients (52.2%) received adjuvant radiotherapy (60 Gy in 30 fractions). At a median follow up of 42 months (8-70 months), 8 (11.6%) patients died (7 cancer related and 1 noncancer related). The locoregional recurrence rate was 4.3% whereas the distant metastasis rate was 11.6%. Most common site of distant metastasis was lung. The mean disease free survival time was 61.4 months and the mean overall survival was 62 months. On univariate analysis, age < 50 years, node positive, presence of PNI, high grade, presence of LVI and local recurrence were significant factors for distant metastasis (p < 0.05). On multivariate analysis, high grade, presence of LVI and local recurrence were significant factors for distant metastasis (p < 0.05). Mucoepidermoid carcinomas of salivary gland have good long term local control and overall survival. Majority of the recurrences are distant metastasis. High grade, LVI and local recurrence are significant risk factors for distant relapse.
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Affiliation(s)
- Rohith Singareddy
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
- Department of Radiotherapy, Basavatarakam Indo American Cancer Hospital and Research Institute, Road No-10, Banjara Hills, Hyderabad, 500034 India
| | - Harjot Kaur Bajwa
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Mahendra M. Reddy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Krishnam Raju Alluri
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - K. V. V. N. Raju
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - T. Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
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Żurek M, Jasak K, Jaros K, Daniel P, Niemczyk K, Rzepakowska A. Clinico-Epidemiological Analysis of Most Prevalent Parotid Gland Carcinomas in Poland over a 20-Year Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10247. [PMID: 36011881 PMCID: PMC9408518 DOI: 10.3390/ijerph191610247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: Malignant tumours of the salivary glands have different clinical and histopathological characteristics. They most commonly involve the parotid gland. Histopathologically, the most common are mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (AcCC), adenocarcinoma, carcinoma in pleomorphic adenoma (CPA), and squamous cell carcinoma (SCC). (2) Methods: We analysed 2318 patients with malignant parotid gland tumours reported to the National Cancer Registry (NCR) in Poland over 20 years (1999-2018). The demographic characteristics of patients, clinical factors, and overall survival (OS) were analysed. (3) Results: The average age was 61.33 ± 16.1 years. The majority were males (55%) and urban citizens (64%). High percentage of carcinomas was diagnosed in locoregional (33.7%) and systemic (10.4%) stadium. The most prevalent diagnoses were SCC (33.3%) and adenocarcinoma (19.6%). Surgical resection with adjuvant RT (42.1%) was the most common treatment. The OS analysis showed a median survival time of 5.6 years. The most favorable median OS was found in patients with AcCC (18.30 years), the worst for SCC (1.58 years). (4) Conclusion: AcCC has the best prognosis and SCC the worst. Tumour stadium, treatment, and demographic factors affect prognosis. Improvements in diagnosis and re-evaluation of treatment standards are necessary to enhance the outcome of patients with parotid gland cancers in Poland.
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Affiliation(s)
- Michał Żurek
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 61 Żwirki i Wigury Str., 02-091 Warsaw, Poland
- Department of Analyses and Strategies, Ministry of Health, Miodowa 15 Str., 00-952 Warsaw, Poland
| | - Kamil Jasak
- Students Scientific Research Group at the Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Karolina Jaros
- Students Scientific Research Group at the Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Piotr Daniel
- Students Scientific Research Group at the Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Anna Rzepakowska
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
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Mannelli G, Comini LV, Sacchetto A, Santoro R, Spinelli G, Bonomo P, Desideri I, Bossi P, Orlandi E, Alderotti G, Franchi A, Palomba A, Eccher A, Marchioni D, Nocini R, Piazza C, Molteni G. Estimating survival after salvage surgery for recurrent salivary gland cancers: Systematic review. Head Neck 2022; 44:1961-1975. [PMID: 35441406 PMCID: PMC9545583 DOI: 10.1002/hed.27062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Recurrent salivary gland carcinomas (RSCs) are poorly characterized and their clinical features and treatment options have not yet been fully described. The goal of this study was to analyze the therapeutic strategies and oncological outcomes of RSC patients through a literature review analysis. This systematic review was performed according to the PRISMA statements. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework. Two thousand seven hundred and four records were selected and 1817 recurrences were studied. Three hundred and sixty-five patients underwent salvage surgery (20.1%) and their 5-year mortality rate, overall survival and disease-free survival were 35%, 70%, and 42%, respectively. RSCs are aggressive neoplasms with a high rate of distant metastases (28.9%). Salvage surgery can be considered in patients with limited local and/or regional recurrences, even in case of single distant relapse, appearing within the first 3 years of follow-up.
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Affiliation(s)
- Giuditta Mannelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Lara V Comini
- Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Sacchetto
- Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Verona, Italy
| | - Roberto Santoro
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST (Azienda Socio Sanitaria Territoriale) Spedali Civili, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giammarco Alderotti
- Department of Statistics, Computer Science, Applications "G. Parenti" (DiSIA), University of Florence, Florence, Italy
| | - Alessandro Franchi
- Department of Translational Research, School of Medicine, University of Pisa, Pisa, Italy
| | - Annarita Palomba
- Unit of Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Albino Eccher
- Pathology Unit, Department of Pathology and Diagnostics, University Hospital of Verona, Verona, Italy
| | - Daniele Marchioni
- Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Verona, Italy
| | - Riccardo Nocini
- Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Verona, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Gabriele Molteni
- Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Verona, Italy
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12
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Metastatic mucoepidermoid carcinoma to the pleura: a case report. J Med Case Rep 2022; 16:69. [PMID: 35168684 PMCID: PMC8848957 DOI: 10.1186/s13256-022-03285-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mucoepidermoid carcinoma is the most common malignant neoplasm arising from the salivary glands (Ali et al. in J Ayub Med Coll Abbottabad 20(2): 141-2, 2008, Xi et al. in World J Surg Oncol 10: 232, 2012). When arising from anatomic sites other than the salivary glands it can be a diagnostic challenge. Primary and metastatic mucoepidermoid carcinoma from and to the pleura are extremely rare entities that are frequently misdiagnosed as adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma (Xi et al. in World J Surg Oncol 10: 232, 2012). CASE PRESENTATION We describe an unusual case of a 64-year-old Caucasian female patient with metastatic high-grade mucoepidermoid carcinoma to the pleura, morphologically resembling squamous cell carcinoma. Molecular studies of both the parotid gland and pleural tumors helped prove the metastatic nature of the pleural lesion. CONCLUSIONS Metastatic mucoepidermoid carcinoma to the pleura is a rare entity, frequently misdiagnosed as squamous cell carcinoma. Differentiating between a lung primary and a metastatic disease has treatment implications and prognostic significance for the patient. When morphologic and immunophenotypic overlap exists, molecular testing can help distinguish mucoepidermoid carcinoma from other neoplasms.
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13
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Sharma S, Khan S, Valiathan M. Mucoepidermoid carcinoma - A common neoplasm at an unusual site, mimicking a benign cyst on cytology: Diagnostic pitfall! J Oral Maxillofac Pathol 2022; 26:S30-S33. [PMID: 35450250 PMCID: PMC9017840 DOI: 10.4103/jomfp.jomfp_277_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/10/2022] [Indexed: 11/04/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) is known to be a relatively common neoplasm of the major and minor salivary glands that can secondarily involve skin. The clinical manifestations, diagnostic cytology and histopathology of MEC presenting as a clinically benign periauricular cystic nodule have been analyzed. The challenge of accurate diagnosis can be illustrated by the fact that initially, on cytology, this tumor was misdiagnosed as a benign epidermal inclusion cyst due to the presence of mucin-filled cells which were misinterpreted as cyst macrophages. This case report emphasizes the need to include parotid tumors in the differential diagnosis of all periauricular cyst-like expansions. We also briefly discuss the reasons for false-positive cytology in this case. Delay in accurate diagnosis may result in larger surgical procedures, such as radical neck dissection, that may otherwise be avoided.
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Affiliation(s)
- Swati Sharma
- Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
| | - Sadaf Khan
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India
| | - Manna Valiathan
- Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India
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14
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Mimica X, Yuan A, Hay A, Katabi N, Zanoni DK, Valero C, Shah JP, Wong RJ, Cohen MA, Patel SG, Ganly I. Mucoepidermoid carcinoma: Evaluating the prognostic impact of primary tumor site. Oral Oncol 2021; 123:105602. [PMID: 34768210 DOI: 10.1016/j.oraloncology.2021.105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
Mucoepidermoid carcinoma (MEC) is one of the most common salivary gland malignancies. Our aim was to evaluate the prognostic impact of primary tumor site in patients with MEC. MATERIAL AND METHODS This cohort identified 308 patients with MEC who underwent primary surgery between 1985 and 2015. Survival outcomes were determined using the Kaplan-Meier method. Hazard ratios for primary site were determined using the Cox proportional-hazards model. RESULTS One hundred eighty (58%) patients were diagnosed with minor and 128 (42%) with major salivary gland cancer. Primary site in the minor salivary gland group included 137 (44%) oral cavity, 38 (12%) pharynx, 3 (0.9%) nasal cavity, and 2 (0.6%) trachea and larynx. The major salivary gland group included 118 (38%) parotid, 8 (3%) submandibular, and 2 (0.6%) sublingual. With a median follow-up of 73 months, 5-year overall survival and disease-specific survival were 84% and 91%, respectively. Patients with tumors located in the hard palate and retromolar trigone had the best survival, while patients with tumors located in the paranasal sinuses and submandibular gland had the poorest survival. After controlling for tumor grade and stage, MEC primary site was not predictive of survival or recurrence. On multivariate analysis, worse DSS was associated with stage III-IV tumors (HR: 7,11; 95% CI: 1.19-26.43; p = 0.0034) and high-grade tumors (HR: 19.12; 95% CI: 2.26-162.77; p = 0.0068). CONCLUSIONS While high grade and advanced overall stage were found to be independent predictors of worse survival, primary tumor site was not predictive of poor outcome.
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Affiliation(s)
- Ximena Mimica
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Head and Neck Department of Surgery, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Avery Yuan
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ashley Hay
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Daniella Karassawa Zanoni
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Valero
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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15
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Makino K, Nakajima K, Tsutsumi S, Toriyama A, Nonaka S, Okura H, Matsuzaka K, Nagao T, Izumi H, Tomita S, Ishii H. Mucoepidermoid carcinoma of the lacrimal gland in a patient with the CRTC1-MAML2 fusion gene. Radiol Case Rep 2021; 16:3643-3646. [PMID: 34630791 PMCID: PMC8493510 DOI: 10.1016/j.radcr.2021.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) of the lacrimal gland (LG) is a rare entity. A 47-year-old woman was aware of periorbital swelling for 3 months. At presentation, the patient showed periorbital swelling in the right eye. CT scan showed an isodense mass in the anterior superolateral part of the orbit. MRI delineated the mass as enhancing, extra-conal tumor appearing isointense on T1-weighted sequences, and to be of mixed intensity on T2-weighted sequences. The tumor was totally resected. Microscopically, the tumor tissue was comprised of squamous, epithelioid cells, and cells with plump and clear cytoplasm. Necrosis, neural invasion, or mitotic figures were not observed. Immunohistochemical examination revealed intense staining for cytokeratin 7. A subset of the cells was positively stained with periodic acid-Schiff and mucicarmine stains. Genetic analysis revealed the presence of the CRTC1-MAML2 fusion. The CRTC1-MAML2 fusion may be a useful indicator for the prognosis and planning of adjuvant therapy.
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Affiliation(s)
- Kensaku Makino
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kei Nakajima
- Clinical Pathophysiology, Tokyo Dental College, Tokyo, Japan
| | - Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akane Toriyama
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Senshu Nonaka
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hidehiro Okura
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Izumi
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shigeki Tomita
- Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
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16
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Dahan LS, Giorgi R, Vergez S, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Garrel R, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Moya-Plana A, Even C, Radulesco T, Michel J, Baujat B, Fakhry N, Albert S, Andry G, Babin E, Bach C, Badet JM, Badoual C, Baglin A, Banal A, Barry B, Baudin E, Baujat B, Bensadoun R, Bertolus C, Bessède JP, Blanchard D, Borel C, Bozorg-Grayeli A, Breheret R, Breton P, Brugel L, Calais G, Casiraghi O, Cassagnau E, Castillo L, Ceruse P, Chabolle F, Chevalier D, Chobaut J, Choussy O, Cosmidis A, Coste A, Costes V, Crampette L, Darrouzet V, Demez P, Dessi P, Devauchelle B, Dolivet G, Dubrulle F, Duflo S, Dufour X, Faivre S, Fakhry N, Ferron C, Floret F, de Gabory L, Garrel R, Geoffrois L, Gilain L, Giovanni A, Girod A, Guerrier B, Hans S, Herman P, Hofman P, Housset M, Jankowski R, Jegoux F, Juliéron M, Kaminsky MC, Kolb F, St Guily JL, Laccoureye L, Lallemant B, Lang P, Lartigau E, Lavieille JP, Lefevre M, Leroy X, Malard O, Massip F, Mauvais O, Merol JC, Michel J, Mom T, Morinière S, de Monès E, Moulin G, Noel G, Poissonnet G, Prades JM, Radulesco T, de Raucourt D, Reyt E, Righini C, Robin YM, Rolland F, Ruhin B, Sarroul N, Schultz P, Serrano E, Sterkers O, Strunski V, Sudaka A, Tassart M, Testelin S, Thariat J, Timochenko A, Toussaint B, Coste EU, Valette G, Van den Abbeele T, Varoquaux A, Veillon F, Vergez S, Wassef M. Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases. Eur J Surg Oncol 2021; 47:1376-1383. [DOI: 10.1016/j.ejso.2020.11.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
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17
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Lee K, Mirza O, Dobbs S, Jayaram S. Poorly differentiated mucoepidermoid carcinoma of the thyroid. BMJ Case Rep 2020; 13:13/12/e236539. [PMID: 33318270 PMCID: PMC7737045 DOI: 10.1136/bcr-2020-236539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mucoepidermoid carcinomas (MECs) are the most common malignant tumour of the salivary glands. MECs have also been reported to occur in atypical sites. Primary MECs of the thyroid gland are extremely rare, accounting for 0.5% of thyroid malignancies with approximately 48 cases reported in the literature. In most cases, these are low-grade neoplasms with good long-term prognosis. We present the case of a 74-year-old patient with poorly differentiated MEC of the thyroid gland, which behaved aggressively resulting in rapid decline and death of the patient. The exact pathophysiology of the disease remains unclear and there is no consensus on the optimal treatment for this histological subtype. Recognition and diagnosis of this rare neoplasm are important as this can help guide optimal treatment, although in high-grade poorly differentiated cases, treatment options remain limited.
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Affiliation(s)
| | - Omar Mirza
- ENT, North Manchester General Hospital, Manchester, UK
| | - Sian Dobbs
- ENT, Fairfield General Hospital, Bury, UK
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18
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Porcheri C, Meisel CT, Mitsiadis TA. Molecular and Cellular Modelling of Salivary Gland Tumors Open New Landscapes in Diagnosis and Treatment. Cancers (Basel) 2020; 12:E3107. [PMID: 33114321 PMCID: PMC7690880 DOI: 10.3390/cancers12113107] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
Salivary gland tumors are neoplasms affecting the major and minor salivary glands of the oral cavity. Their complex pathological appearance and overlapping morphological features between subtypes, pose major challenges in the identification, classification, and staging of the tumor. Recently developed techniques of three-dimensional culture and organotypic modelling provide useful platforms for the clinical and biological characterization of these malignancies. Additionally, new advances in genetic and molecular screenings allow precise diagnosis and monitoring of tumor progression. Finally, novel therapeutic tools with increased efficiency and accuracy are emerging. In this review, we summarize the most common salivary gland neoplasms and provide an overview of the state-of-the-art tools to model, diagnose, and treat salivary gland tumors.
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Affiliation(s)
- Cristina Porcheri
- Orofacial Development and Regeneration, Institute of Oral Biology, University of Zurich, Plattenstrasse 11, 8032 Zurich, Switzerland; (C.T.M.); (T.A.M.)
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19
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Reny DC, Ranasinghe VJ, Magana LC, Kaufman AC, Chalian AA, O'Malley BW, Weinstein GS, Brody RM. Predictors of Nodal Metastasis in Mucoepidermoid Carcinoma of the Oral Cavity and Oropharynx. ORL J Otorhinolaryngol Relat Spec 2020; 82:327-334. [PMID: 32810854 DOI: 10.1159/000509142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Mucoepidermoid carcinoma (MEC) of the upper aerodigestive tract (UADT) is an uncommon malignancy, with limited literature available on its clinical and pathologic characteristics. Here, we describe the behavior of MEC of the UADT including pathologic characteristics and predictors of nodal metastasis. METHODS Retrospective cohort study of patients with MEC of the UADT treated at an academic medical center from January 2008 to May 2018. Data was collected about demographics and tumor characteristics including clinical and histological data. The two-tailed Student t test and χ2 analysis were performed to assess for predictors of nodal metastasis. RESULTS We identified 44 patients with minor salivary gland MEC of the oral cavity (OC) and oropharynx (OP). All patients were treated with primary site surgery. The primary site was the OC in 25 patients (57%) and OP in 19 (43%). Low-grade histology was seen in 27 specimens (61.4%), intermediate histology in 9 specimens (20.5%), and high-grade histology in 8 specimens (18.2%). Perineural invasion was noted in 10 specimens (22.7%). Neck dissection was performed in 17 patients (39%), with pathologically positive nodes found in 9 (20.5%). Notably, 5 of the 9 positive nodal specimens were found in clinically node-negative necks. Pathologically positive cervical lymph nodes were significantly associated with the OP as the primary site (p = 0.0005), perineural invasion (p = 0.012), lymphovascular invasion (p < 0.001), and high-grade histology (p = 0.004) in the primary specimen. DISCUSSION MEC of the UADT is an uncommon malignancy. Our findings suggest elective neck dissection should be considered with perineural and lymphovascular invasion, high-grade tumor, and the OP as the primary site.
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Affiliation(s)
- Danielle C Reny
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Viran J Ranasinghe
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda C Magana
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam C Kaufman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ara A Chalian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bert W O'Malley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory S Weinstein
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
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20
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Pérez-de-Oliveira ME, Wagner VP, Araújo ALD, Martins MD, Santos-Silva AR, Bingle L, Vargas PA. Prognostic value of CRTC1-MAML2 translocation in salivary mucoepidermoid carcinoma: Systematic review and meta-analysis. J Oral Pathol Med 2019; 49:386-394. [PMID: 31661572 DOI: 10.1111/jop.12970] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
The presence of the CRTC1-MAML2 translocation has been described in mucoepidermoid carcinoma (MEC) as a predictor of better survival rates. However, the real prognostic value of the translocation has been debated due to recent controversial findings. The aim of this study was to perform a systematic review to understand the prognostic potential of the CRTC1-MAML2 translocation in MEC. An electronic search was carried out using the MEDLINE/PubMed, EMBASE and Scopus databases. Articles that assessed the association between the CRTC1-MAML2 translocation and survival of MEC patients were selected for the systematic review. Ten published articles were included in the qualitative synthesis. The prevalence of the translocation varied from 33.7% to 69.7%. Seven studies observed a significant association between the presence of the CRTC1-MAML2 translocation and a favourable clinical outcome, which could improve disease-free, disease-specific or overall survival. Five studies were included in the quantitative synthesis. Fixed-effects model confirmed that translocation-positive patients have a decreased risk of death (combined odds ratio 0.08, 95% confidence interval - 0.03-0.23, P < .00001). The detection of the CRTC1-MAML2 translocation appears to be useful as a prognostic factor in MEC. However, the level of evidence is not as high as it could be once important limitations were found in the published studies.
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Affiliation(s)
- Maria Eduarda Pérez-de-Oliveira
- Department of Oral Diagnosis, Semiology and Oral Pathology Areas, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Vivian P Wagner
- Department of Oral Diagnosis, Semiology and Oral Pathology Areas, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Anna Luíza Damaceno Araújo
- Department of Oral Diagnosis, Semiology and Oral Pathology Areas, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Manoela D Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Semiology and Oral Pathology Areas, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - Lynne Bingle
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Pablo A Vargas
- Department of Oral Diagnosis, Semiology and Oral Pathology Areas, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
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21
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Hu JQ, Yu PC, Shi X, Liu WL, Zhang TT, Lei BW, Huang NS, Xu WB, Han LT, Ma B, Liao T, Wei WJ, Wang Y, Lu ZW, Wang YL, Ji QH. Prognostic Nomograms for Predicting Overall Survival and Cancer-Specific Survival of Patients with Major Salivary Gland Mucoepidermoid Carcinoma. J Cancer 2019; 10:4380-4388. [PMID: 31413758 PMCID: PMC6691701 DOI: 10.7150/jca.27992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 05/04/2019] [Indexed: 12/21/2022] Open
Abstract
Background: The aim of this study was to develop and validate prognostic nomograms predicting overall (OS) and cancer-specific survival (CSS) of patients with major salivary gland (MaSG) mucoepidermoid carcinoma (MEC). Methods: 1398 MaSG-MEC patients were identified from the Surveillance, Epidemiology and End Results (SEER) database. They were randomly and equally divided into a training cohort (n=699) and a validation cohort (n=699). The best subsets of covariates were identified to develop nomograms predicting OS and CSS based on the smallest Akaike Information Criterion (AIC) value in the multivariate Cox models. The nomograms were internally and externally validated by the bootstrap resampling method. The predictive ability was evaluated by Harrell's Concordance Index (C-index). Results: For the training cohort, eight (age at diagnosis, tumor grade, primary site, surgery, radiation, T, N and M classification) and seven predictors (all the above factors except primary site) were selected to create the nomograms estimating the 3- and 5- year OS and CSS, respectively. C-index indicated better predictive performance of the nomograms than the 7th AJCC staging system, which was confirmed by both internal (via the training cohort: OS: 0.888 vs 0.785, CSS: 0.938 vs 0.821) and external validation (via the validation cohort: OS: 0.844 vs 0.743, CSS: 0.882 vs 0.787). The calibration plots also revealed good agreements between the nomogram-based prediction and observed survival. Conclusions: We have proposed and validated the nomograms predicting OS and CSS of MaSG-MEC. They are proved to be of higher predictive value than the AJCC staging system and may be adopted in future clinical practice.
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Affiliation(s)
- Jia-Qian Hu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Peng-Cheng Yu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiao Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wan-Lin Liu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ting-Ting Zhang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Bo-Wen Lei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Nai-Si Huang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wei-Bo Xu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Li-Tao Han
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ben Ma
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Tian Liao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhong-Wu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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Triantafillou V, Maina IW, Kuan EC, Kohanski MA, Tong CC, Patel NN, Carey RM, Workman AD, Palmer JN, Adappa ND, Brant JA. Sinonasal mucoepidermoid carcinoma: a review of the National Cancer Database. Int Forum Allergy Rhinol 2019; 9:1046-1053. [PMID: 31314958 DOI: 10.1002/alr.22379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/26/2019] [Accepted: 06/21/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary sinonasal mucoepidermoid carcinoma (SN-MEC) is a malignancy arising from seromucinous glands of the nasal cavity and paranasal sinuses. Given its rarity, few large-scale studies have been performed. In this study we describe the incidence and determinants of survival of patients with SN-MEC leveraging the National Cancer Database (NCDB). METHODS This was a retrospective, population-based cohort study of patients diagnosed with SN-MEC between 2004 and 2012 within the NCDB. The main outcome measure was overall survival (OS). RESULTS A total of 164 patients were identified. The cohort was composed of 47.6% males. Mean age at diagnosis was 59.7 years. The maxillary sinus was the most common primary site, accounting for 45.7% of cases. Eleven percent of patients presented with nodal disease, whereas 2.1% had distant metastases. Stage IV disease was seen in 30.4% of cases. A total of 79.8% of the patients underwent surgery, 61.0% received radiation therapy, and 15.1% had chemotherapy. OS at 1, 2, and 5 years was 83%, 77.0%, and 57%, respectively. On multivariate analysis, Medicaid insurance status (hazard ratio [HR], 7.29; 95% confidence interval [CI], 1.74-30.57), advanced tumor size (HR, 4.94; 95% CI, 1.19-20.5), and advanced nodal disease (N1: HR, 9.48; 95% CI, 1.66-54.23; N2B: HR, 19.3; 95% CI, 1.07-350.64) were associated with worse OS. CONCLUSION Mucoepidermoid carcinoma is the most common salivary gland malignancy but a rare sinonasal malignancy, with 5-year survival for SN-MEC approximating 50%. A significant proportion of patients present with advanced disease. Both socioeconomic factors and tumor characteristics are associated with survival.
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Affiliation(s)
- Vasiliki Triantafillou
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ivy W Maina
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, Irvine Medical Center, University of California, Orange, CA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charles C Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neil N Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alan D Workman
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Wu ZY, Wu WJ, Zheng L, Huang MW, Shi Y, Lv XM, Liu SM, Zhang JG, Zhang J. Efficacy of combined surgery and 125 I seed brachytherapy for treatment of primary mucoepidermoid carcinoma of the parotid gland. Head Neck 2019; 41:3219-3225. [PMID: 31116488 DOI: 10.1002/hed.25813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to determine the effectiveness and safety of surgery combined with postoperative 125 I seed brachytherapy for treatment of primary mucoepidermoid carcinoma (MEC) of the parotid gland. METHODS Retrospective analysis of data of patients with MEC (n = 108) treated with surgery plus postoperative 125 I seed brachytherapy between 2004 and 2016. Overall survival (OS), disease-free survival (DFS), local control rate (LCR), distant metastasis, and radiation-associated toxicities were analyzed, and factors affecting outcomes were evaluated. RESULTS The 5- and 10-year OS were 98.8% and 95.8%, respectively. The DFS and LCR at 5 and 10 years were all 91.4%. Age ≥ 60 years (hazard ratio [HR] = 6.86, 95% confidence interval [CI]: 1.54-30.55) and T4 disease (HR = 7.15, 95% CI: 1.40-36.52) were poor prognostic factors. Acute radiation-associated toxicities were minor. CONCLUSION Surgery plus 125 I seed brachytherapy appears to be an effective treatment for parotid gland MEC, capable of providing satisfactory outcomes with few complications.
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Affiliation(s)
- Zhi-Yuan Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen-Jie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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24
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Buccal Myomucosal Flap Reconstruction After Resection of Palatal Mucoepidermoid Carcinoma. Ann Plast Surg 2019; 83:538-541. [PMID: 31021844 DOI: 10.1097/sap.0000000000001949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Salivary gland tumors are rare, constituting approximately 0.5% of pediatric malignancies, yet account for over 50% of malignant salivary gland neoplasms, of which a majority are mucoepidermoid carcinomas (MECs). We present a case of MEC involving the palatal minor salivary gland of an adolescent patient successfully reconstructed using buccal myomucosal flap. The subject presented as a 17-year-old male with a painless left hard palatal mass found to have imaging suspicious for minor salivary gland tumor and punch biopsy consistent with a low-grade MEC. The subject underwent wide local excision of a 1.0 × 1.2 cm mass with 1.0 cm margins down to hard palate nasal mucosa excluding the abutting first and second molars of the ipsilateral maxilla. Pathology confirmed low-grade MEC confined to hard palate. Two weeks, thereafter, the subject underwent buccal myomucosal flap reconstruction inset into the palatal defect and divided 2 weeks thereafter. Postoperative course was complicated by a pinpoint oronasal fistula at the posterior aspect of the flap-palate junction requiring reelevation and advancement. The subject subsequently recovered without complication. Mucoepidermoid carcinomas represent rare, malignant minor salivary gland tumors with nonspecific presentations that require multidisciplinary workup and management. The authors recommend reconstruction of resultant palatal defects to prevent progression to oronasal fistulae or speech and swallow impairment.
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25
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Zenga J, Yu Z, Parikh A, Chen JX, Lin DT, Emerick KS, Faquin WC, Varvares MA, Deschler DG. Mucoepidermoid Carcinoma of the Parotid: Very Close Margins and Adjuvant Radiotherapy. ORL J Otorhinolaryngol Relat Spec 2019; 81:55-62. [PMID: 30939481 DOI: 10.1159/000497438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS The importance of adjuvant radiotherapy in patients with close margin resections for mucoepidermoid carcinoma of the parotid gland remains unclear. METHODS Patients who underwent parotidectomy for mucoepidermoid carcinoma with or without adjuvant radiotherapy at a single academic tertiary care center from 2000 to 2014 were identified. Included patients had negative but close (≤2 mm) surgical margins without other high-risk histopathological factors including advanced T-stage, positive nodal disease, lymphovascular or perineural invasion, or high-grade histology. RESULTS Nineteen patients were identified, of whom 15 (79%) were observed postoperatively, while 4 (21%) underwent adjuvant radiotherapy. There were no significant differences in extent of parotidectomy, elective neck dissection, T staging, or tumor size between patients who were observed and those undergoing adjuvant radiation. There were no locoregional or distant recurrences in any patients at a mean follow up 74.3 months. Patients undergoing adjuvant radiation, however, had significantly more intermediate-grade as compared to low-grade histology (75% vs. 13%, difference 62%, 95% CI 4% to 100%). CONCLUSIONS Patients with negative but close (≤2 mm) surgical margins without other high-risk histopathological factors have excellent long-term locoregional control with surgery alone. The effects of adjuvant radiotherapy for those who have intermediate-grade disease remain uncertain.
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Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zizi Yu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - William C Faquin
- Department of Pathology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA,
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26
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Lubin D, Song S, Zafar HM, Baloch Z. The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland. Diagn Cytopathol 2019; 47:617-636. [PMID: 30912629 DOI: 10.1002/dc.24175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022]
Abstract
Oncocytic and oncocytoid lesions represent a distinct subset of salivary gland lesions. True oncocytic lesions of the salivary gland are entirely composed of oncocytes. These are characterized by the presence of abundant eosinophilic granules due to the presence of abundant cytoplasmic mitochondria. Oncocytic lesions of the salivary gland include oncocytosis, oncocytoma, and oncocytic carcinoma. In addition to the true oncocytic lesion, there exists another group of salivary gland lesions, which demonstrate cells with abundant and occasionally granular cytoplasm. These are often termed as "oncocytoid" lesions. The recently proposed Milan System for reporting salivary gland cytology clearly states that fine-needle aspiration specimens representing oncocytic/oncocytoid lesions of salivary gland cannot effectively distinguish between a nonneoplastic lesion, benign and malignant neoplasms. Therefore, most lesions lacking classic cytomorphologic features will be classified under the umbrella diagnostic term of "Salivary Gland Neoplasm of Uncertain Malignant Potential" (SUMP). In this review, we discuss and illustrate key clinicopathologic and radiologic features that can help the practicing cytopathologist narrow down the differential and provide the best management based diagnosis.
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Affiliation(s)
- Daniel Lubin
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sharon Song
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology & Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Mantravadi AV, Moore MG, Rassekh CH. AHNS series: Do you know your guidelines? Diagnosis and management of salivary gland tumors. Head Neck 2018; 41:269-280. [PMID: 30548929 DOI: 10.1002/hed.25499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022] Open
Abstract
This article is the next installment of the series "Do you know your guidelines" presented by the Education Committee of the American Head and Neck Society. Guidelines for the workup and management of tumors of the major and minor salivary glands are reviewed.
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Affiliation(s)
- Avinash V Mantravadi
- Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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HIF-1α, NOTCH1, ADAM12, and HB-EGF are overexpressed in mucoepidermoid carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e8-e17. [PMID: 30415904 DOI: 10.1016/j.oooo.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Intratumoral hypoxia (IH) occurs during cellular proliferation of malignant tumors. This phenomenon is characterized by a decrease in oxygen levels in the neoplastic microenvironment. Throughout this condition, the proteins HIF-1α, NOTCH1, ADAM12, and HB-EGF can be activated, triggering signaling pathways associated with tumor invasiveness through invadopodia formation. This study aimed to evaluate the immunostaining of HIF-1α, NOTCH1, ADAM12, and HBEGF in 19 cases of mucoepidermoid carcinoma (MEC) and 10 samples of salivary glands (control group). STUDY DESIGN The immunoperoxidase technique was employed to detect the proteins of interest. The Student t test was used to compare immunoexpression between MEC samples and the control group. RESULTS Protein immunostaining was statistically significantly higher in MEC samples than in the control group (P < .01), and the proteins were especially overexpressed in epidermoid cells of MEC. CONCLUSIONS We suggest that there is an association between the NOTCH1 signaling pathway activated by IH and the biologic behavior of MEC.
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29
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Rajasekaran K, Stubbs V, Chen J, Yalamanchi P, Cannady S, Brant J, Newman J. Mucoepidermoid carcinoma of the parotid gland: A National Cancer Database study. Am J Otolaryngol 2018; 39:321-326. [PMID: 29559174 DOI: 10.1016/j.amjoto.2018.03.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe the demographics, tumor characteristics, and prognostic features of mucoepidermoid carcinoma of the parotid gland. MATERIALS AND METHODS A retrospective study of the National Cancer Database was reviewed for all mucoepidermoid carcinomas of the parotid gland between 2004 and 2012). Patient demographics and tumor characteristics were abstracted and analyzed. Univariate and multivariate Cox multivariate regression models were used to identify predictors of survival. RESULTS A total of 4431 patients met inclusion criteria. Average age at diagnosis was 57 years (median 62, SD 19), with no overall sex preference (52% female), and majority white (78%). The 1-year overall survival was 92.9% (95% CI [92.1-93.6]) and 5-year overall survival was 75.2% (95% CI [73.8-76.7%]). Median overall survival was not reached at 5 years. Factors associated with decreased survival were increasing age, comorbidities, high tumor grade, advanced pathologic group stage, and positive surgical margins. Female sex was the only factor associated with improved survival. Controlling for either histopathologic grade or pathologic stage to determine how patient demographics and tumor characteristics affected overall survival yielded similar results. Of note, intermediate grade tumors, although not independently associated with worse survival, when seen in conjunction with tumors ≥T2 and/or ≥N2, a negative impact on overall survival was seen. CONCLUSION Although mucoepidermoid carcinoma of the parotid gland is the most common parotid gland malignancy, it is still a rare tumor with a lack of large population-based studies. Advanced stage and high-grade tumors are significant predictors of decreased survival. Females have improved survival compared to males.
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Affiliation(s)
- Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Vanessa Stubbs
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Jinbo Chen
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
| | - Pratyusha Yalamanchi
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Steven Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Jason Brant
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Jason Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States
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30
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Janet-Ofelia GC, Rafael MV, Guillermo GA, Carlos-Enrique CV, José-Martín RM, Henry GM, Jaime-Enrique MG. Mucoepidermoid Carcinoma of the Salivary Glands: Survival and Prognostic Factors. J Maxillofac Oral Surg 2017; 16:431-437. [PMID: 29038625 PMCID: PMC5628063 DOI: 10.1007/s12663-016-0946-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/21/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to establish global survival rates and potential prognostic factors for mucoepidermoid carcinoma (MC) of the salivary glands in patients diagnosed at the Dr. Eduardo Cáceres Graziani National Institute for Neoplastic Diseases (INEN), Lima, Peru, between 2002 and 2012. MATERIALS AND METHODS This was an observational, analytical and longitudinal (information reconstructed in time) retrospective cohort study. Data were obtained from clinical records and used to determine the overall survival (OS) rate at 2 and 5 years, and the individual percentage survival for each prognostic factor using the actuarial technique. We also performed univariate analysis for each possible prognostic factor using log-rank analysis, and multivariate analysis using Cox's regression model. The study was approved by the institutional review board at Dr. Eduardo Caceres Graziani INEN and conducted in accordance with the 1964 Declaration of Helsinki. For this type of study formal consent was not required. RESULTS The OS rate of the 51 patients enrolled in the study was 81 % at 2 years and 78 % at 5 years. In the multivariate analysis, the equation that best explained the survival result contained the variable, clinical stage (p = 0.063). CONCLUSIONS The results revealed the importance of clinical stage regarding the survival of patients with a primary diagnosis of MC of the salivary glands.
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Mosconi C, Arantes DAC, Gonçalves AS, Alencar RDCG, Oliveira JC, Silva TA, Mendonça EF, Batista AC. Immunohistochemical investigations on the expression of programmed cell death ligand 1, human leukocyte antigens G and E, and granzyme B in intraoral mucoepidermoid carcinoma. Arch Oral Biol 2017; 83:55-62. [PMID: 28711734 DOI: 10.1016/j.archoralbio.2017.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify the expression of nonclassical human leukocyte antigen G and E (HLA-G and -E), programmed cell death ligand-1 (PD-L1) and granzyme B (GB) in intraoral mucoepidermoid carcinomas (MECs), and to assess whether such expressions are related to metastasis, survival, staging, tumor grade and number of GB-positive cells. DESIGN For this cross-sectional study, samples of MEC (n=30) were selected and classified as low-grade (LG), intermediate-grade (IG) or high-grade (HG), according to the WHO grading system. HLA-G, -E and PD-L1 were identified by immunohistochemistry and quantified as the proportion of positive neoplastic cells. The density of GB+ cells was also evaluated. The Kruskal-Wallis test was used with a 5% significance level. RESULTS Expressions of HLA-G, -E and PD-L1 were identified in the majority of epidermoid, intermediate and clear cells, but not in the mucous cells of the MECs. The quantitative analysis of the total percentage of positive neoplastic cells showed overexpression of this set of proteins in all MEC samples. The expression of these proteins and histological grading were positively correlated [HLA-G (LG=79% positive cells, IG=96%, HG=99%; p=0.0004), HLA-E (LG=70%, IG=96%, HG=99%; p<0.0001) and PD-L1 (LG=34%, IG=79%, HG=80%; p=0.01)]. No relationship was observed between the immunosuppressive proteins and other clinicopathological parameters. Low GB density was found in all MEC samples. CONCLUSIONS The augmented expression of HLA-G, -E and PD-L1 in the intraoral MEC might suggest a role of these molecules in the scape of neoplastic cells from immunosurveillance.
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Affiliation(s)
- Carla Mosconi
- Federal University of Goiás, Faculty of Dentistry, Department of Stomatology (Oral Pathology), Goiânia, Brazil.
| | - Diego Antônio Costa Arantes
- Federal University of Goiás, Faculty of Dentistry, Department of Stomatology (Oral Pathology), Goiânia, Brazil.
| | - Andréia Souza Gonçalves
- Federal University of Goiás, Faculty of Dentistry, Department of Stomatology (Oral Pathology), Goiânia, Brazil.
| | | | - José Carlos Oliveira
- Araújo Jorge Hospital, Association of Cancer Combat of Goiás, Division of Head and Neck, Goiânia, Brazil.
| | - Tarcília Aparecida Silva
- Federal University of Minas Gerais, Faculty of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, Brazil.
| | | | - Aline Carvalho Batista
- Federal University of Goiás, Faculty of Dentistry, Department of Stomatology (Oral Pathology), Goiânia, Brazil.
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Granic M, Suton P, Mueller D, Cvrljevic I, Luksic I. Prognostic factors in head and neck mucoepidermoid carcinoma: experience at a single institution based on 64 consecutive patients over a 28-year period. Int J Oral Maxillofac Surg 2017; 47:283-288. [PMID: 28969884 DOI: 10.1016/j.ijom.2017.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/19/2017] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
Abstract
Mucoepidermoid carcinoma (MEC) is the most common malignancy of the salivary glands. The clinical behaviour of MEC is largely unpredictable, ranging from indolent tumour growth to highly aggressive metastatic spread. The objective of this study was to determine the clinicopathological predictors of recurrence and survival in patients with head and neck MEC. The medical records of 64 patients who underwent surgical treatment for head and neck MEC between 1982 and 2010 were reviewed. The main outcome measures were disease-free survival (DFS) and overall survival (OS). Clinicopathological parameters evaluated were age, sex, anatomical subsite, histological grade, tumour stage, tumour size, adjuvant therapy, and nodal and margin status. For the entire cohort, the 5-year DFS was 82.8% and the 5-year OS was 67.2%. Histological grade and tumour subsite were statistically significant predictors of OS. Furthermore, tumour stage and nodal status were statistically significant predictors with respect to OS. Advanced tumour stage, high histological grade, submandibular/sublingual localization, and positive nodal status were independent predictors of the prognosis in patients with head and neck MEC. Further studies into the molecular biology of MEC are needed in order to provide new therapeutic strategies for patients with locally aggressive and highly metastatic carcinomas.
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Affiliation(s)
- M Granic
- Department of Oral Surgery, University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - P Suton
- Department of Radiotherapy and Medical Oncology, Division of Radiation Oncology, University Hospital for Tumours, University Hospital Centre "Sisters of Mercy", Zagreb, Croatia
| | - D Mueller
- Department of Pathology, University Hospital Dubrava, Zagreb, Croatia
| | - I Cvrljevic
- Department of Maxillofacial Surgery, University of Zagreb School of Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - I Luksic
- Department of Maxillofacial Surgery, University of Zagreb School of Medicine, University Hospital Dubrava, Zagreb, Croatia.
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Rubin A, Davis J, Jreije K, Wu H, Oppenheimer R. Case Report: Recurrent Mucoepidermoid Carcinoma of the Tongue in Adult Female Patient With Lung Cancer. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2017; 10:1179550617720462. [PMID: 28757800 PMCID: PMC5513522 DOI: 10.1177/1179550617720462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
There is a steady rise in incidence of malignant salivary gland tumors in the United States, with mucoepidermoid carcinoma (MEC) the most frequent. Although 40% of MECs are found in the parotid gland, these lesions possess the capacity to develop anywhere along the aerodigestive tract. Here, we present a case of recurrent tongue MEC in a young adult female patient with history of lung malignancy and multiple brain metastases. Without a universally accepted management protocol for recurrent MECs, the current clinical practice uses tumor grade, location, and clinical progression to determine both prognosis and goals of care. The patient had transoral laser excision of the first MEC lesion in 2013. Her tongue MEC recurred 3 years later with 2 distinct lesions. One was discovered on physical examination and computed tomography and the other diagnosed intraoperatively 1 month later. These lesions were located on a previously unaffected portion of dorsal tongue base. These lesions were completely excised in the operating room. The patient currently remains on chemotherapy. This underscores the importance for developing a guideline that delineates the most efficacious surveillance and treatment plans for recurrent MECs.
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Affiliation(s)
- Arielle Rubin
- Otolaryngology Section, Department of Surgery, Maricopa Medical Center, Maricopa Integrated Health System (MIHS), Phoenix, AZ, USA
| | - John Davis
- Otolaryngology Section, Department of Surgery, Maricopa Medical Center, Maricopa Integrated Health System (MIHS), Phoenix, AZ, USA
| | - Karim Jreije
- Otolaryngology Section, Department of Surgery, Maricopa Medical Center, Maricopa Integrated Health System (MIHS), Phoenix, AZ, USA
| | - Henry Wu
- Otolaryngology Section, Department of Surgery, Maricopa Medical Center, Maricopa Integrated Health System (MIHS), Phoenix, AZ, USA
| | - Randy Oppenheimer
- Otolaryngology Section, Department of Surgery, Maricopa Medical Center, Maricopa Integrated Health System (MIHS), Phoenix, AZ, USA
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Margin Analysis: Malignant Salivary Gland Neoplasms of the Head and Neck. Oral Maxillofac Surg Clin North Am 2017; 29:315-324. [PMID: 28551337 DOI: 10.1016/j.coms.2017.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There are no established protocols for the optimum surgical margin required for salivary gland malignancies. Factors including histologic diagnosis and TNM stage have been shown to be important in prognosis and survival outcome and mandate special consideration of margin size. Salivary cancers are treated differently at different anatomic sites, and different histologic types show a propensity for major or minor glands. Low-grade malignancies are treated with soft tissue margins of 1 cm or less. The facial nerve is preserved unless infiltrated and encased. Adenoid cystic carcinoma and carcinoma ex pleomorphic adenoma require more complex planning to obtain negative margins.
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Birkeland AC, Foltin SK, Michmerhuizen NL, Hoesli RC, Rosko AJ, Byrd S, Yanik M, Nor JE, Bradford CR, Prince ME, Carey TE, McHugh JB, Spector ME, Brenner JC. Correlation of Crtc1/3-Maml2 fusion status, grade and survival in mucoepidermoid carcinoma. Oral Oncol 2017; 68:5-8. [PMID: 28438292 DOI: 10.1016/j.oraloncology.2017.02.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/15/2017] [Accepted: 02/22/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands. Tumor stage and grade have historically been important predictors of survival. An oncogenic CRTC1- or CRTC3-MAML2 gene fusion has been identified in a number of MECs. Historically, these gene fusions have been associated with lower grade tumors and better survival. However, reported gene fusion rates and prognosis varies widely across studies, and have not controlled for tumor grade. We sought to identify gene fusion rates and outcomes in our cohort of MEC patients. MATERIALS AND METHODS An IRB-approved retrospective cohort of patients with MEC was identified at the University of Michigan. Clinical, histologic, and outcome data was collected from medical records. RNA was isolated from formalin fixed paraffin-embedded tumor sections, and qRT-PCR was performed to identify CRTC1/3-MAML2 gene fusions. Sanger sequencing of qRT-PCR products was used to confirm gene fusions. RESULTS Overall, 90 patient MEC tumors were collected (58 low-grade, 25 intermediate-grade, and 7 high-grade). Gene fusions were identified in 59% (53/90) of tumors. On univariate and bivariate analysis, fusion status did not significantly associate with grade or survival. CONCLUSION We have identified a high rate of CRTC1/3-MAML2 gene fusions in a large cohort of MEC. We do not identify any correlation between fusion status with tumor grade or survival. These findings suggest further characterization of MECs is needed before considering the CRTC1/3-MAML2 gene fusion as a prognostic biomarker. Additional genetic drivers may account for survival and grade in MECs.
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Affiliation(s)
- Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Susan K Foltin
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Nicole L Michmerhuizen
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States; Department of Pharmacology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Rebecca C Hoesli
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Serena Byrd
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University, 3635 Vista Ave, St. Louis, MO 63110, United States
| | - Megan Yanik
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Jacques E Nor
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States; Comprehensive Cancer Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States; Comprehensive Cancer Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Thomas E Carey
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States; Comprehensive Cancer Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States; Comprehensive Cancer Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States; Comprehensive Cancer Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
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Xu W, Wang Y, Qi X, Xie J, Wei Z, Yin X, Wang Z, Meng J, Han W. Prognostic factors of palatal mucoepidermoid carcinoma: a retrospective analysis based on a double-center study. Sci Rep 2017; 7:43907. [PMID: 28262804 PMCID: PMC5338264 DOI: 10.1038/srep43907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) of the palate is a common malignancy of minor salivary glands. This study was designed to identify the prognostic factors for MEC of the palate. The medical records of patients diagnosed with MEC of the palate who visited the Department of Oral and Maxillofacial Surgery at Nanjing Stomatological Hospital and the Department of Stomatology at Central Hospital of Xuzhou were retrospectively studied. The prognostic factors were determined using a Cox proportional hazards model. Furthermore, the expression of cancer stem cell (CSC) markers CD44, CD133, Nanog and Sox2 were detected in neoplastic samples of these patients by immunohistochemistry. As a result, both univariate analysis and multivariate analysis proved a high histological grade and an advanced tumor stage as negative prognostic factors for overall survival. By immunohistochemistry staining and survival analysis, a combination of CD44/CD133/SOX2 was found to have the strongest prognostic value for palatal MEC patients. In conclusion, the proposed nomogram which include histological grade and tumor stage along with cancer stem cell markers provides a more accurate long-term prediction for palatal MEC patients.
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Affiliation(s)
- Wenguang Xu
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Yufeng Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Xiaofeng Qi
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Junqi Xie
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Zheng Wei
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Xiteng Yin
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Zhiyong Wang
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
| | - Jian Meng
- Department of Stomatology, Xuzhou Central Hospital, Affiliated Hospital of Medical College of Southeast University, Xuzhou 221009, People’s Republic of China
| | - Wei Han
- Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
- Central Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, No 30 Zhongyang Road, Nanjing, P.R. China
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Lanzel E, Robinson RA, Zimmerman MB, Pourian A, Hellstein JW. The use of immunohistochemistry in detection of perineural invasion in mucoepidermoid carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:636-42. [DOI: 10.1016/j.oooo.2016.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/22/2016] [Accepted: 01/24/2016] [Indexed: 11/25/2022]
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Jeba J, Suryawanshi M, Gaikwad P, Backianathan S. Colonic metastasis in mucoepidermoid carcinoma of the parotid: a rare occurrence. BMJ Case Rep 2016; 2016:bcr-2015-213932. [PMID: 26823365 DOI: 10.1136/bcr-2015-213932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of intermediate-grade mucoepidermoid carcinoma of the parotid with late local recurrence and colonic metastasis. A 69-year-old man who had undergone right total conservative parotidectomy followed by adjuvant radiotherapy for intermediate-grade mucoepidermoid carcinoma 10 years prior, presented with a recurrent swelling in the postoperative site and cardiac failure. On evaluation, he was found to have severe anaemia with positive stool occult blood. Colonoscopic evaluation revealed a globular submucosal bulge with erosion 40 cm from the anal verge, the biopsy of which was consistent with mucoepidermoid carcinoma. The presentation, diagnostic details and management of this rare case are discussed.
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Affiliation(s)
- Jenifer Jeba
- Department of Radiotherapy, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Mayur Suryawanshi
- Department of General Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Pranay Gaikwad
- Department of General Surgery Unit 1, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Selvamani Backianathan
- Department of Radiotherapy, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Ata-Ali J, Zurriaga O, Alberich C. Incidence and survival rates for malignant salivary gland tumors. J Oral Sci 2016; 58:67-73. [DOI: 10.2334/josnusd.58.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Javier Ata-Ali
- Public Dental Health Service, Arnau de Vilanova Hospital
- Department of Dentistry, European University of Valencia
| | - Oscar Zurriaga
- Department of Preventive Medicine and Public Health, Medical and Dental School, University of Valencia
- Department of Health, General Directorate of Public Health
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)
- Spanish Biomedical Research Consortium for Epidemiology and Public Health (CIBERESP)
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Assessing the histological type and grade of primary parotid carcinoma by fine-needle aspiration and frozen section. Auris Nasus Larynx 2015; 42:463-8. [PMID: 26065980 DOI: 10.1016/j.anl.2015.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/12/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study is to compare preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section (FS) for the correct identification of malignancy, histological grade, and histological type. METHODS FNAC was performed on all 105 patients and FS on 71 patients with parotid carcinoma. RESULTS The rate of correctly determining the histological grade by FNAC and FS was 32% and 73%, respectively. The correct diagnosis rate for both the histological type and grade by FNAC and FS was 20% and 48%, respectively. CONCLUSIONS The correct grading of both high and low/intermediate grade carcinoma is possible in 70-80% of patients by FS. If the histological grade is identified correctly, the extent of resection can usually be decided appropriately. Therefore, we should put emphasis on determining the histological grade.
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Postoperative radiation therapy for parotid mucoepidermoid carcinoma. Case Rep Oncol Med 2015; 2014:345128. [PMID: 25580323 PMCID: PMC4279126 DOI: 10.1155/2014/345128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 11/18/2022] Open
Abstract
Salivary gland cancers are rare and represent approximately 5% of all head and neck cancers and only 0.3% of all malignancies. The majority (75%) of salivary gland tumors occur in the parotid gland, and while benign lesions are more common, mucoepidermoid carcinoma (MEC) makes up 40–50% of malignant parotid gland tumors. No randomized controlled trials exist regarding the role of adjuvant radiation for patients who undergo surgical resection of low-grade MECs. Herein, we report two cases of successful postoperative radiation therapy in low-grade, pT2N0 MEC of the parotid gland. The role of adjuvant radiation therapy for patients with MEC of the parotid gland is based on data from institution reviews and lacks data from randomized controlled trials. Per our review of the literature, the pathological findings of positive surgical margins and/or perineural invasion in two patients with low-grade MEC of the parotid gland warranted adjuvant radiation for improved local control after partial parotidectomy. Both patients tolerated postoperative radiation therapy with only mild side effects and, at last follow-up, five years after completion of therapy, had no clinical or radiographic evidence of either local recurrence or distant metastasis.
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Vingerhoedt SI, Hauben E, Hermans R, Vander Poorten VL, Nuyts S. Elevated carcinoembryonic antigen tumour marker caused by head and neck cancer: a case report and literature study. Cancer Radiother 2014; 19:106-10. [PMID: 25457791 DOI: 10.1016/j.canrad.2014.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/16/2014] [Accepted: 09/25/2014] [Indexed: 11/26/2022]
Abstract
Carcinoembryonic antigen is a tumour marker commonly increased in gastrointestinal and pulmonary cancers. We report a case of a 46-year-old man with a mucoepidermoid carcinoma of the base of tongue with an elevated and traceable serum carcinoembryonic antigen level. This antigen proved to be a valuable marker in the treatment follow-up. When a raised carcinoembryonic antigen level is found, salivary gland malignancies should be taken into the differential diagnosis and clinical examination of the head and neck region should not be overlooked.
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Affiliation(s)
- S I Vingerhoedt
- Department of Radiation Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
| | - E Hauben
- Department of Pathology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - R Hermans
- Department of Radiology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - V L Vander Poorten
- Department of Otorhinolaryngology, Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Nuyts
- Department of Radiation Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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Patel TD, Vázquez A, Patel DM, Baredes S, Eloy JA. A comparative analysis of sinonasal and salivary gland mucoepidermoid carcinoma using population-based data. Int Forum Allergy Rhinol 2014; 5:78-84. [DOI: 10.1002/alr.21422] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 08/11/2014] [Accepted: 08/23/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Tapan D. Patel
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Alejandro Vázquez
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Dhruv M. Patel
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
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Katabi N, Ghossein R, Ali S, Dogan S, Klimstra D, Ganly I. Prognostic features in mucoepidermoid carcinoma of major salivary glands with emphasis on tumour histologic grading. Histopathology 2014; 65:793-804. [PMID: 25040772 DOI: 10.1111/his.12488] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/30/2014] [Indexed: 12/21/2022]
Abstract
AIMS To compare the different grading systems of mucoepidermoid carcinoma (MEC) and identify the most reliable and objective histopathologic features predictive of outcome. METHODS AND RESULTS Seventy-two cases diagnosed as MEC were subjected to a meticulous histopathologic re-review. 20 of 72 (28%) cases were originally misdiagnosed as MEC including 16 as high grade (HG). Among the 52 confirmed MEC, median follow up (FU) was 59 months. Mitosis (≥4/10 High Power Fields), necrosis, pleomorphism, focal keratinization, desmoplasia, and lymph node metastasis were associated with adverse disease specific survival (DSS) and recurrence free survival (RFS) (P < 0.002). In all grading systems, low and intermediate grade had similar DSS and RFS but much better outcome than HG (P < 0.007). All patients with tumour harboring low mitotic rate and no necrosis did not recur except for one patient with a positive margin. All cases with high mitotic rate and necrosis died or recurred. CONCLUSIONS The majority of previously diagnosed HG MEC cases are misclassified. There is no difference in outcome between low and intermediate grade in all grading schemes. Consideration should be given to stratify MEC based on relatively objective criteria such as mitosis and necrosis.
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Affiliation(s)
- Nora Katabi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Biron VL, Lentsch EJ, Gerry DR, Bewley AF. Factors influencing survival in acinic cell carcinoma: a retrospective survival analysis of 2061 patients. Head Neck 2014; 37:870-7. [PMID: 24623677 DOI: 10.1002/hed.23686] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/13/2014] [Accepted: 03/07/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Acinic cell carcinoma is an uncommon salivary neoplasm with clinical and histologic features known to influence prognosis. The purpose of this study was to further describe variables influencing survival in a large cohort of patients with acinic cell carcinoma. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) registry, we obtained demographic, clinicopathologic, and treatment data pertaining to patients diagnosed with acinic cell carcinoma. Kaplan-Meier and Cox regression analyses were performed to compare survival with various clinical and pathological parameters. RESULTS We identified 2061 patients with acinic cell carcinoma from 1973 to 2009. Sex, staging, grade, subsite, and treatment were significant predictors of disease-specific survival (DSS). Patients who received surgery alone had the highest 20-year DSS (92.4%), followed by those treated with surgery and radiation (71.9%) or radiation alone (62.3%). CONCLUSION Our results suggest that histologic grade is a stronger predictor of survival than TNM classification, survival after surgical resection alone is excellent, and adjuvant radiation may be of limited benefit
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Affiliation(s)
- Vincent L Biron
- Department of Otolaryngology, University of California Davis, Sacramento, California
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel R Gerry
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Mercer University School of Medicine, Savannah, Georgia
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California Davis, Sacramento, California
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Fok TC, Lapointe H, Tuck AB, Chambers AF, Jackson-Boeters L, Daley TD, Darling MR. Expression and localization of osteopontin, homing cell adhesion molecule/CD44, and integrin αvβ3 in mucoepidermoid carcinoma and acinic cell adenocarcinoma of salivary gland origin. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:320-9. [PMID: 25151586 DOI: 10.1016/j.oooo.2014.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/03/2014] [Accepted: 05/07/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Osteopontin (OPN) plays a role in tumor progression. This study aimed to determine the expression of OPN, CD44, and integrin αvβ3 in pleomorphic adenoma (PA), acinic cell adenocarcinoma (ACA), and mucoepidermoid carcinoma (MEC). STUDY DESIGN Immunohistochemistry was used to semiquantify the levels of expression of OPN and its receptors in normal salivary glands (NSG) (n = 20), PA (n = 20), ACA (n = 11), and MEC (n = 29). RESULTS OPN expression was increased in ACA and MEC compared with PA and NSG (median scores, 6, 6, 4, and 4, respectively). CD44 expression was increased in ACA and reduced in MEC and PA compared with NSG (median scores, 8, 4, 3, and 5, respectively). Integrin αvβ3 median scores were 5 in ACA, 1 in MEC, and 0 in PA and NSG. CONCLUSIONS OPN is expressed in salivary gland tumors and is at higher levels in ACA and MEC.
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Affiliation(s)
- T C Fok
- Oral and Maxillofacial Surgery Resident, Division of Oral Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - H Lapointe
- Professor, Division of Oral Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A B Tuck
- Professor, Department of Pathology and Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A F Chambers
- Professor, Department of Pathology and Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - L Jackson-Boeters
- Medical Technologist, Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - T D Daley
- Professor, Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - M R Darling
- Associate Professor, Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Salivary mucoepidermoid carcinoma revisited. Eur Arch Otorhinolaryngol 2014; 272:799-819. [PMID: 24771140 DOI: 10.1007/s00405-014-3053-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/07/2014] [Indexed: 12/29/2022]
Abstract
Clinicopathological features, prognosis and therapeutic strategies for mucoepidermoid carcinoma originating in salivary and salivary-type glands of the head and neck are reviewed. We emphasise histopathological aspects, appraise the value of histochemistry, electron microscopy, immunohistochemistry and cytophotometry, and discuss histogenesis and characteristic gene translocations. We additionally consider possible diagnostic difficulties, problems related to histological grading and accuracy of existing literature, and areas of controversy or uncertainty which may benefit from further investigations.
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