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Zhang ES, Hair BB, Lamarre ED, Koyfman SA, Burkey BB. Occult Nodal Metastases in Individuals with Clinically Node-Negative Salivary Gland Malignancies. Laryngoscope 2024; 134:1705-1715. [PMID: 37847121 DOI: 10.1002/lary.31119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/03/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Salivary gland malignancies comprise a heterogeneous group of pathologies, for which treatment of the clinically negative neck may vary depending on numerous factors. Herein we present data on occult nodal metastases (ONM) as well as survival and recurrence from a large series of cN0 salivary gland malignancies. METHODS Retrospective chart review was conducted on 532 patients, with 389 patients with major salivary gland cancers and 143 patients with minor salivary gland cancers. Demographic and treatment data were included and rates of ONM, overall survival, local recurrence, regional recurrence, and distant recurrence were analyzed. RESULTS We found that the overall rate of ONM for parotid was 27% (63/235), for submandibular/sublingual was 35% (18/52), and for minor was 15% (4/26). Analysis of ONM rate at each nodal level was also performed, finding higher rates of level IV and V ONM than prior studies. Submandibular/sublingual and minor salivary gland malignancies showed a predominance of ONMs at levels I-III. Our survival and recurrence rates were similar to those found in previous studies. CONCLUSION Our data also demonstrate a predominance of ONM in levels I-III for submandibular/sublingual and minor salivary gland cancers, suggesting elective dissection in these levels. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1705-1715, 2024.
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Affiliation(s)
- Emily S Zhang
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Bryan B Hair
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, Cleveland, Ohio, U.S.A
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Brian B Burkey
- Department of Otolaryngology, Cleveland Clinic Florida, Vero Beach, Florida, U.S.A
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2
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Kalaitsidou I, Pasteli N, Venetis G, Poulopoulos A, Antoniades K. Immunohistochemical Expression of Epithelial Cell Adhesion Molecule (EpCAM) in Salivary Gland Cancer: Correlation with the Biological Behavior. Diagnostics (Basel) 2023; 13:2652. [PMID: 37627911 PMCID: PMC10453306 DOI: 10.3390/diagnostics13162652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Salivary gland neoplasms comprise a diverse group of tumors with different biological behaviors and clinical outcomes. Understanding the underlying molecular alterations associated with these malignancies is critical for accurate diagnosis, prognosis, and treatment strategies. Among the many biomarkers under investigation, epithelial cell adhesion molecule (EpCAM) has emerged as a promising candidate in salivary gland cancer research. This article aims to provide a comprehensive overview of the differential expression of EpCAM in salivary gland cancer and its potential correlation with the biological behavior of these tumors. The clinical characteristics of 65 patients with salivary gland malignancy of different histopathological subtypes were included. We report the differential expression of EpCAM and the relationship between the clinical and histopathologic features of these tumors. Regarding the evaluation of the effect of EpCAM expression on survival, in our study, we showed that tumors with high EpCAM expression had reduced disease-free survival (DFS) and overall survival (OS) (p < 0.001) compared to patients with cancers with low EpCAM expression. In addition, the concurrent presence of perineural invasion and positive EpCAM expression appeared to be associated with shorter disease-free survival and overall survival. In conclusion, our study confirmed the prognostic value of detecting perineural invasion and EpCAM expression.
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Affiliation(s)
- Ioanna Kalaitsidou
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.V.)
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Nikoleta Pasteli
- Pathology Department, G. Papanikolaou Hospital, 57010 Thessaloniki, Greece
| | - Gregory Venetis
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.V.)
| | - Athanasios Poulopoulos
- Department of Oral Medicine and Maxillofacial Pathology, Aristotle University, 54124 Thessaloniki, Greece;
| | - Konstantinos Antoniades
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (G.V.)
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3
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Liu F, Fan L, Lu L, Guo H, Nan J, Han F. Comprehensive diagnosis and treatment of ductal carcinoma of the submandibular gland: case report and literature review. Int J Clin Exp Pathol 2023; 16:67-75. [PMID: 37033394 PMCID: PMC10076972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/13/2023] [Indexed: 04/11/2023]
Abstract
Salivary duct carcinoma (SDC) is a rare malignant tumor of the salivary gland and is most commonly found in the parotid gland, followed by the submandibular gland. Due to its rarity, there is no consensus on its treatment. Surgical resection is currently the only curative treatment. Considering its high degree of malignancy, extensive tumor resection and postoperative adjuvant radiotherapy are recommended. We report a rare case of SDC of the submandibular gland. A 62-year-old man presented to our hospital with complaints of swelling in the right submaxillary area for 4 months, rapidly growing, with pain for 10 days. After admission, fine needle aspiration (FNA) revealed right submandibular gland ductal carcinoma. Considering its aggressiveness, large size, and invasion of parapharyngeal and oral floor soft tissues, the patient received two cycles of neoadjuvant chemotherapy followed by extended surgical resection. Postoperatively, the patient received four cycles of concurrent chemoradiotherapy, followed by afatinib targeted therapy. No recurrence or metastasis was observed in a 45-month follow-up. Thus we present a comprehensive treatment for salivary duct carcinoma combining neoadjuvant chemotherapy with surgery, postoperative concurrent radiotherapy, and chemotherapy followed by afatinib targeted therapy.
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Affiliation(s)
- Feng Liu
- Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital, Cancer Hospital of Chinese Academy of Medical Sciences Taiyuan 030013, Shanxi, China
| | - Li Fan
- Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital, Cancer Hospital of Chinese Academy of Medical Sciences Taiyuan 030013, Shanxi, China
| | - Lifang Lu
- Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital, Cancer Hospital of Chinese Academy of Medical Sciences Taiyuan 030013, Shanxi, China
| | - Hongyi Guo
- Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital, Cancer Hospital of Chinese Academy of Medical Sciences Taiyuan 030013, Shanxi, China
| | - Jie Nan
- Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital, Cancer Hospital of Chinese Academy of Medical Sciences Taiyuan 030013, Shanxi, China
| | - Fei Han
- Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital, Cancer Hospital of Chinese Academy of Medical Sciences Taiyuan 030013, Shanxi, China
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4
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Yan W, Huang L, Jiang J, Shen C, Ou X, Hu C. Postoperative Chemoradiotherapy versus Radiotherapy Alone in Major Salivary Gland Cancers: A Stratified Study Based on the External Validation of the Distant Metastasis Risk Score Model. Cancers (Basel) 2022; 14. [PMID: 36428676 DOI: 10.3390/cancers14225583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The role of additional chemoradiotherapy (CRT) for distant metastasis (DM) on the resected malignancy of the major salivary gland (SGM) remained unknown. We conducted this study to externally validate a recently reported DM risk score model and compare the survival outcome between adjuvant CRT and RT alone. MATERIALS We retrospectively reviewed the patients with SGM following postoperative radiotherapy (PORT). The cumulative incidence of DM was assessed using a competing risk method. Multivariate analysis was performed with Cox proportional-hazards regression to identify significant predictors for DM. Patients were classified as high- and low-risk subgroups with the cutoff value of the DM risk score model. The inverse probability of treatment weighting (IPTW) was conducted to minimize the bias of the groups. RESULTS A total of 586 eligible patients were analyzed and 67 cases underwent adjuvant CRT. The 5-year incidence of DM was 19.5% (95% CI 16.0-23.0%). The model reasonably discriminated the DM risk between the high- and low-risk subgroup in our cohort, and the c-index was 0.75. No survival benefit was observed for the CRT group compared with RT alone in the entire cohort after IPTW (p = 0.095). After subgroup analysis, increased mortality was identified with the administration of CRT in the low-risk subset (p = 0.002) while no significant difference in OS was illustrated in the high-risk subgroup (p = 0.98). CONCLUSIONS This external validation provides further exploration of the DM risk score model in major SGM. Our results demonstrated no support for the utility of additional chemotherapy to PORT in the major SGM, especially in the low-risk subgroup of patients with DM.
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Imamura Y, Kiyota N, Tahara M, Hanai N, Asakage T, Matsuura K, Ota I, Saito Y, Sano D, Kodaira T, Motegi A, Yasuda K, Takahashi S, Yokota T, Okano S, Tanaka K, Onoe T, Ariizumi Y, Homma A. Systemic therapy for salivary gland malignancy: current status and future perspectives. Jpn J Clin Oncol 2022; 52:293-302. [PMID: 35134985 DOI: 10.1093/jjco/hyac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/15/2022] Open
Abstract
Salivary gland malignancies are rare neoplasms that have a broad histological spectrum and a variety of biologic behaviors. Salivary gland malignancies are known as chemo-resistant tumors, which render optimal treatment challenging. This review summarizes the role of systemic therapy for salivary gland malignancies. To date, the advantage of adding concurrent chemotherapy has remained undefined for both postoperative and inoperable locally advanced salivary gland malignancy patients undergoing radiotherapy. For recurrent/metastatic disease, local and/or systemic treatment options should be discussed in a multidisciplinary setting with consideration to both patient needs and tumor factors. For symptomatic patients or those who may compromise organ function, palliative systemic therapy can be a reasonable option based on the results of phase II studies. Platinum combination regimens as first-line therapy have been widely accepted. Personalized therapies have become established options, particularly for androgen receptor-positive, HER2-positive and NTRK fusion-positive salivary gland malignancies (i.e. androgen receptor and HER2 in salivary duct carcinoma and NTRK3 in secretory carcinoma). For patients with adenoid cystic carcinoma, multi-targeted tyrosine kinase inhibitors have also been developed. Anti-PD1 checkpoint inhibitors have shown limited activity to date. Investigation of active systemic treatments for salivary gland malignancy remains a significant unmet need. Future directions might include a more comprehensive genomic screening approach (usually next-generation sequencing-based) and combination strategies using immune checkpoint inhibitors. These are rare malignancies that require ongoing effort in the conduct of high-quality clinical trials.
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Affiliation(s)
- Yoshinori Imamura
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan.,Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ichiro Ota
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Yuki Saito
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Daisuke Sano
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Atsushi Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Japan
| | - Susumu Okano
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Japan
| | - Takuma Onoe
- Department of Medical Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Yosuke Ariizumi
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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6
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Yan F, Lao WP, Nguyen SA, Sharma AK, Day TA. Elective neck dissection in salivary gland malignancies: Systematic review and meta-analysis. Head Neck 2021; 44:505-517. [PMID: 34862810 DOI: 10.1002/hed.26923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022] Open
Abstract
We defined the occult nodal metastasis (ONM) rate of clinical node-negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta-analysis querying four databases, from inception of databases to March 25th, 2020. Fifty-one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex-pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High-grade tumors had a 3.8 times increased risk of ONM than low/intermediate-grade tumors. ONM rates were exceedingly high for T3/T4, high-grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Wilson P Lao
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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7
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Seo GT, Xing MH, Mundi N, Matloob A, Khorsandi AS, Urken ML. Adenoid Cystic Carcinoma of the Gingiva: A Case Report and Literature Review. Ann Otol Rhinol Laryngol 2021; 131:1151-1157. [PMID: 34706573 DOI: 10.1177/00034894211055591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Adenoid cystic carcinoma (ACC) is a commonly encountered salivary gland malignancy. However, it rarely occurs in the gingiva, an area generally thought to be devoid of minor salivary glands. We present a case occurring in this unusual site and review other reported cases. METHODS A 56 year-old male presented with a right-sided mandibular toothache for 1 year and underwent dental extraction. Due to persistent pain, follow up examination revealed a large gingival lesion. A biopsy was positive for adenoid cystic carcinoma. RESULTS The patient underwent a complete right segmental mandibulectomy and was reconstructed with a fibular osteocutaneous free flap. Three months postoperatively, during the planning for adjuvant radiation therapy, the patient developed pain in the left mandible. Imaging revealed extensive involvement of the left native mandible. Deep bone biopsies in several areas of the left mandible revealed ACC. He then underwent a complete left hemi-mandibulectomy and reconstruction with a fibular osteocutaneous free flap. Tensor fascia lata suspension slings were placed due to concern for an open mouth deformity attributable to disruption of bilateral masticator slings. He will undergo adjuvant radiation therapy. Our review of the literature revealed 50 cases of gingival ACC published since 1972. Disease recurrence and distant metastases were noted in several patients, occurring at the latest after 30 years follow-up. CONCLUSIONS Given its indolent behavior, high proclivity for late recurrence and metastasis, and overall infrequency, ACC represents a pathology that requires early diagnosis and comprehensive long-term surveillance. While ACC is well described in oral cavity sites with high densities of minor salivary glands, it is not commonly seen in the gingiva. As such, gingival ACC may display a unique biological and/or clinical character. We offer the first literature review of this rare entity.
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Affiliation(s)
- Gabriella T Seo
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ammar Matloob
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, NY, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Gotmare SS, Babu C, Shetty S, Pereira T. Adenoid Cystic Carcinoma - A Case of an Aggressive Ulcerated Lesion of the Upper Lip. J Microsc Ultrastruct 2021; 10:143-145. [PMID: 36504591 PMCID: PMC9728091 DOI: 10.4103/jmau.jmau_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is an unusual slow growing salivary gland malignancy with higher chances of recurrence. It is characterized by the proliferation of ductal (luminal) and myoepithelial cells in cribriform, tubular, solid, and cystic forms. Standard treatment, including surgery with postoperative radiation therapy, has attained reasonable local control rates, but distant metastases do not allow any improvement in the survival rate. We present a case of a 50-year-old female diagnosed with ACC involving almost the whole of the upper lip, with an aim to highlight its histologic evolution from it being clinically seen as severely ulcerated and necrotised upper lip mimicking a case of squamous cell carcinoma and its prognosis.
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Affiliation(s)
- Swati Shrikant Gotmare
- Department of Oral and Maxillofacial Pathology, D Y Patil University School of Dentistry, Navi Mumbai, Maharashtra, India,Address for correspondence: Dr. Swati Shrikant Gotmare, Department of Oral and Maxillofacial Pathology, D Y Patil University School of Dentistry, Sector 7, Nerul, Navi Mumbai - 400 0706, Maharashtra, India. E-mail:
| | - Cathy Babu
- Department of Oral and Maxillofacial Pathology, D Y Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Subraj Shetty
- Department of Oral and Maxillofacial Pathology, D Y Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Treville Pereira
- Department of Oral and Maxillofacial Pathology, D Y Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
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9
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Kerns A, Ross A, Sugihara EM, Bathula SS. Tumors of Atypical Carcinoma of the Parotid Gland and Papillary Thyroid Carcinoma: A Case Report. Cureus 2020; 12:e10496. [PMID: 32963922 PMCID: PMC7500745 DOI: 10.7759/cureus.10496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lymphoepithelial carcinoma (LEC) is a variant of anaplastic carcinoma usually found in the nasopharynx. It is a rare, aggressive malignant tumor in the salivary glands, which is usually associated with Epstein-Barr virus (EBV), and often presents with facial nerve paralysis when in the parotid gland. This case report is unique in that our patient had EBV-negative LEC, with facial nerve involvement and a concurrent primary papillary thyroid carcinoma (PTC). We successfully managed this patient with surgery and adjuvant chemoradiotherapy. The patient has responded well to the treatment and she showed no evidence of disease at the 24-month follow-up.
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Affiliation(s)
- Aileen Kerns
- Department of Otolaryngology-Head and Neck Surgery, Detroit Medical Center, Detroit, USA
| | - Andrew Ross
- Department of Otolaryngology-Head and Neck Surgery, Detroit Medical Center, Detroit, USA
| | - Eric M Sugihara
- Department of Otolaryngology-Head and Neck Surgery, Detroit Medical Center, Detroit, USA
| | - Samba Siva Bathula
- Department of Otolaryngology-Head and Neck Surgery, Detroit Medical Center/Michigan State University, Detroit, USA
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10
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Garrett SL, Trott K, Sebastiano C, Wolf MJ, Rao NK, Curry JM, Cognetti DM, Luginbuhl AJ. Sensitivity of Fine-Needle Aspiration and Imaging Modalities in the Diagnosis of Low-Grade Mucoepidermoid Carcinoma of the Parotid Gland. Ann Otol Rhinol Laryngol 2019; 128:755-759. [PMID: 30991829 DOI: 10.1177/0003489419842582] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of fine-needle aspiration (FNA) and imaging modalities for low-grade mucoepidermoid carcinoma (MEC) of the parotid gland. METHODS Retrospective chart review of patients diagnosed with low-grade MEC of the parotid gland following surgical excision between January 2010 and June 2018. Imaging from patients with MEC were randomly mixed with imaging from patients with benign pathology and reviewed in a blinded fashion. Main outcome measure was sensitivity. RESULTS A total of 24 patients were confirmed to have had low-grade MEC on final pathology, with a total of 31 FNAs performed between them. Twelve of 31 FNAs were positive for low-grade MEC, with a sensitivity of 39%. A total of 27 imaging studies were reviewed, which included 16 patients with low-grade MEC and 11 patients with benign pathology. Of these 27 imaging studies, 10 were declared indeterminate. Of the remaining 17 imaging studies, 13 were reviewed as malignant (11 true positive and 2 false positive) and 4 as benign (4 true negative). Overall magnetic resonance imaging (MRI) sensitivity for low-grade MEC was 100% (9/9) with 95% CI (0.66-1.0) when considering indeterminate results as positive for malignancy. CONCLUSION This study reaffirms that for low-grade MEC, sensitivity of FNA is poor. MRI provides an important diagnostic tool in the evaluation of salivary gland neoplasms, due to its increased sensitivity for low-grade MEC when considering indeterminate results as positive. This provides confidence in the diagnosis of benign tumors and allows appropriate counseling of all options to the patient, including observation. Imaging and low threshold of excision should be considered despite an inflammatory or benign FNA.
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Affiliation(s)
- Samuel L Garrett
- 1 Department of Otolaryngology-Head and Neck Surgery, BS, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kiley Trott
- 1 Department of Otolaryngology-Head and Neck Surgery, BS, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Sebastiano
- 2 Department of Pathology, Anatomy, & Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J Wolf
- 3 Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neeta K Rao
- 3 Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph M Curry
- 1 Department of Otolaryngology-Head and Neck Surgery, BS, Thomas Jefferson University, Philadelphia, PA, USA
| | - David M Cognetti
- 1 Department of Otolaryngology-Head and Neck Surgery, BS, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam J Luginbuhl
- 1 Department of Otolaryngology-Head and Neck Surgery, BS, Thomas Jefferson University, Philadelphia, PA, USA
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11
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Abstract
Necrotizing sialometaplasia (NSM) is a benign, reactive metaplastic condition of the minor salivary gland tissue typically seen in the setting of injury, chemical or traumatic, and is nonneoplastic and self-limited. The diagnosis may be challenging as it may clinically mimic malignancy. We present the case of a 74-year-old male with a 1 pack per day smoking history for 60 years who presented with a reported 20-pound weight loss, dysphagia, and dysphonia progressing over the course of 6 months and found to have a 3.5-cm hypopharyngeal mass on computed tomography imaging and fiberoptic laryngoscopy. Initial frozen section of the mass was concerning for squamous cell carcinoma in situ, but permanent specimens returned as nondiagnostic. Repeat biopsy established a diagnosis of NSM. Two-month follow-up showed complete resolution of the mass. Clinicians should be aware that NSM may present in unusual locations when considering differential diagnoses for laryngeal masses and evaluating for malignancy.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jennifer C Fuller
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Peter M Sadow
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel G Deschler
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jeremy D Richmon
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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12
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Thompson JD, Avey GD, Wieland AM, Harari PM, Glazer TA, McCulloch TM, Hartig GK. Auriculotemporal Nerve Involvement in Parotid Bed Malignancy. Ann Otol Rhinol Laryngol 2019; 128:647-653. [PMID: 30894024 DOI: 10.1177/0003489419837574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify and evaluate patients with parotid bed malignancy demonstrating radiographic findings of auriculotemporal (AT) nerve involvement. METHODS A retrospective review of patients with parotid bed malignancy was performed to identify patients with imaging findings of AT nerve involvement and record associated clinical findings, symptoms, and pathology information. Independent, blinded review of radiographic images by a senior neuroradiologist was performed to identify imaging characteristics and categorize patients into highly likely or possible involvement groups. RESULTS Of 547 patients identified with parotid bed malignancy, 23 patients exhibited radiographic findings suggestive of AT nerve involvement. Thirteen patients met criteria for highly likely involvement, and 10 patients met criteria for possible involvement. Cutaneous malignancy with metastasis to the parotid bed accounted for 11 of 23 patients, and the most common histology was squamous cell carcinoma (9 patients). Primary parotid malignancy accounted for 12 of 23 patients, and the most common histology was salivary ductal carcinoma (3 patients). All 13 highly likely patients reported periauricular pain, and 11 of 13 demonstrated facial weakness. Features suggesting advanced disease included radiographic findings of intracranial involvement (10/23 patients), nonsurgical primary treatment (13/23 patients), and positive margins on pathology report (7/10 patients). CONCLUSION AT nerve involvement is an uncommon but important phenomenon that often occurs in the setting of advanced disease and is commonly associated with periauricular pain and coexisting facial weakness. Awareness of the associated clinical features and imaging patterns can allow for appropriate identification of this pattern of spread and help to optimize treatment planning.
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Affiliation(s)
- James D Thompson
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory D Avey
- 2 Department of Radiology-Division of Neuroradiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron M Wieland
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul M Harari
- 3 Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tiffany A Glazer
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Timothy M McCulloch
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory K Hartig
- 1 Department of Surgery-Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Abstract
Objectives To investigate the clinical predictors and survival implications of perineural invasion (PNI) in parotid gland malignancies. Study Design Case series with chart review. Setting Tertiary care medical center. Subjects and Methods Patients with parotid gland malignancies treated surgically from 2000 to 2015 were retrospectively identified in the Head and Neck Cancer Registry at a single institution. Data points were extracted from the medical record and original pathology reports. Results In total, 186 patients with parotid gland malignancies were identified with a mean follow-up of 5.2 years. Salivary duct carcinoma (45), mucoepidermoid carcinoma (44), and acinic cell carcinoma (26) were the most common histologic types. A total of 46.2% of tumors were found to have PNI. At the time of presentation, facial nerve paresis (odds ratio [OR], 64.7; P < .001) and facial pain (OR, 3.7; P = .002) but not facial paresthesia or anesthesia (OR, 2.8, P = .085) were predictive of PNI. Malignancies with PNI were significantly more likely to be of advanced T and N classification, be high-risk pathologic types, and have positive margins and angiolymphatic invasion. PNI positivity was associated with worse overall (hazard ratio, 2.62; P = .001) and disease-free survival (4.18; P < .001) on univariate Cox regression analysis. However, when controlling for other negative prognosticators, age, and adjuvant therapy, PNI did not have a statistically significant effect on disease-free or overall survival. Conclusions PNI is strongly correlated with more aggressive parotid gland malignancies but is not an independent predictor of worse survival. Facial paresis and pain were predictive of PNI positivity, and facial paresis correlated with worse overall and disease-free survival.
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Affiliation(s)
- Phillip Huyett
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonas T Johnson
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barry M Schaitkin
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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14
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Chen DW, Lewin JS, Xu L, Lai SY, Gunn GB, Fuller CD, Mohamed ASR, Kanwar A, Sturgis EM, Hutcheson KA. Feeding Tube Utilization in Patients with Salivary Gland Malignancies. Otolaryngol Head Neck Surg 2016; 156:109-117. [PMID: 27576681 DOI: 10.1177/0194599816666038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate feeding tube utilization in patients with salivary gland malignancies (SGMs). Study Design Case series with planned data collection. Setting The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Subjects and Methods Patients (N = 287) were sampled from an epidemiologic SGM registry during a 12-year period. Feeding tube history was retrospectively reviewed. Patients with outside locoregional therapy or palliative treatment were excluded. Enteral feeding and length of dependence were analyzed as a function treatment modality and site of SGM. Results Of 287 patients, 79 (28%) required temporary nasogastric tube feeding (median duration: 13 days, interquartile range: 6-21). Among those 79, 30 (10% of total cohort) required conversion to percutaneous gastrostomy tube (G-tube). Median G-tube duration was 4.8 months (interquartile range: 3.7-13.1). G-tube placement was necessary only in patients receiving multimodality therapy ( P < .001), and among those, 50% with SGMs arising from pharyngeal/laryngeal sites required G-tube, as compared with 8% to 19% of SGMs arising from all other sites ( P < .01). At a median follow-up of 2.4 years, 9 (3%) of all SGM patients were G-tube dependent, but 14% (3 of 22) with laryngeal/pharyngeal sites treated with multimodality therapy remained chronically G-tube dependent. Conclusion While almost 30% of SGM survivors require a temporary nasogastric tube, G-tube utilization is uncommon, in roughly 10% of SGM overall. G-tube utilization appears exclusive to patients treated with multimodality therapy, and chronic gastrostomy remains high (14%) in patients with minor gland cancers arising in the pharynx/larynx, suggesting impetus for dysphagia prophylaxis in these higher-risk subsets, similar to patients treated for squamous cancers.
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Affiliation(s)
- Diane Wenhua Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan S Lewin
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Li Xu
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brandon Gunn
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton David Fuller
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abdallah S R Mohamed
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,4 Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt
| | - Aasheesh Kanwar
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,5 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katherine A Hutcheson
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hindocha N, Wilson MH, Pring M, Hughes CW, Thomas SJ. Mammary analogue secretory carcinoma of the salivary glands: a diagnostic dilemma. Br J Oral Maxillofac Surg. 2017;55:290-292. [PMID: 27527989 DOI: 10.1016/j.bjoms.2016.07.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/29/2016] [Indexed: 01/30/2023]
Abstract
Mammary analogue secretory carcinoma (MASC) is a recently identified salivary gland neoplasm that can mimic other salivary gland tumours such as acinic cell carcinoma and cystadenocarcinoma. It is distinguished from these by differences in immunohistochemical profile and the identification of an ETV6-NTRK3 translocation (12;15)(p13;q25), which is also found in secretory carcinomas of the breast. Previous publications have suggested that MASC tumours have similar biological behaviour to acinic cell carcinoma. We report two cases of MASC that affected the upper lip, and showed an infiltrative and locally aggressive growth pattern that required several operations to ensure clearance of microscopic tumour cells.
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Abstract
Primary intraosseous mucoepidermoid carcinoma (PIOC) is an infrequent malignancy of the head and neck that exhibits diverse biological behavior. The rareness of the location for a salivary gland tumor and the clinical and radiographic manifestations, suggestive of an odontogenic lesion often pose a diagnostic challenge. We hereby report such a unique case of central mucoepidermoid carcinoma that presented in an ambiguous manner, developing in the maxilla and intruding into the adjacent vital structures, adding a literature review.
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Affiliation(s)
- S M Nallamilli
- Department of Oral Medicine and Radiology, Drs. Sudha and Nageswara Rao Siddhartha Institute of Denta Sciences, Chinaoutapalli, Gannavaram Mandalam, Andhra Pradesh - 521286
| | - R Tatapudi
- Department of Oral medicine and Radiology, Vishnu Dental College, Vishnupur Bhimavaram, Andhra Pradesh - 534202
| | - R S Reddy
- Department of Oral medicine and Radiology, Vishnu Dental College, Vishnupur Bhimavaram, Andhra Pradesh - 534202
| | - M Ravikanth
- Department of Oral and Maxillofacial Pathology,Vishnu Dental College, Vishnupur Bhimavaram, Andhra Pradesh - 534202
| | - N Rajesh
- Department of Oral medicine and Radiology, Vishnu Dental College, Vishnupur Bhimavaram, Andhra Pradesh - 534202
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Pushpanjali M, Sujata DN, Subramanyam SB, Jyothsna M. Adenoid cystic carcinoma: An unusual presentation. J Oral Maxillofac Pathol 2014; 18:286-90. [PMID: 25328314 PMCID: PMC4196302 DOI: 10.4103/0973-029x.140796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 07/09/2014] [Indexed: 11/20/2022] Open
Abstract
The adenoid cystic carcinoma is a relatively rare epithelial tumor of the major and minor salivary glands, accounting for about 1% of all malignant tumor of the oral and maxillofacial regions. Peak incidence occurs between the 5th and 6th decades of life. The clinical and pathological findings typical of this tumor include slow growth, peri-neural invasion, multiple local recurrences and distant metastasis. Herein, we report a case of adenoid cystic carcinoma of oropharynx with unusual clinical presentation. The diagnosis of this case and importance of cytology in diagnosing such cases is discussed.
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Affiliation(s)
- M Pushpanjali
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
| | - D Naga Sujata
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
| | - S Bala Subramanyam
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
| | - M Jyothsna
- Department of Oral Pathology, Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
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McRackan TR, Fang TY, Pelosi S, Rivas A, Dietrich MS, Wanna GB, Labadie RF, Haynes DS, Bennett ML. Factors associated with recurrence of squamous cell carcinoma involving the temporal bone. Ann Otol Rhinol Laryngol 2014; 123:235-9. [PMID: 24671478 DOI: 10.1177/0003489414524169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to better identify factors associated with recurrence of squamous cell carcinoma (SCC) involving the temporal bone. METHODS A retrospective study was conducted at a tertiary hospital. Sixty patients who were diagnosed over a 10-year period with SCC involving the temporal bone and underwent surgical resection were analyzed. All patients were staged based on the University of Pittsburgh staging system. Demographic, intraoperative, and pathologic data were analyzed with respect to recurrence. RESULTS Thirteen (21.7%) patients were T1, 8 (13.3%) T2, 7 (11.7%) T3, and 32 (53.3%) T4. Eighteen patients (30.0%) recurred in the study period. The mean time to recurrence was 5.8 months. Tumors originating in the skin overlying the parotid gland and the external auditory canal had higher recurrence rates than those from the auricle/postauricular skin and temporal bone (P = .05). Direct parotid and perineural spread accounted for 15.0% of all routes of temporal invasion but resulted in 22.2% of all recurrences (P = .04). Increased N stage was statistically associated with increased risk of recurrence (P = .01). Cervical, as compared to perifacial and parotid, lymph node involvement was associated with increased risk of recurrence (odds ratio = 6.91; 95% confidence interval, 1.11-42.87). CONCLUSION We have identified multiple factors that are associated with increased recurrence of SCC involving the temporal bone.
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Affiliation(s)
- Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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