Carcinoma ex pleomorphic adenoma: a case report and review of literature

Background

Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CAex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma.

Objective

Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor.

Case Report

54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion.

Conclusion

Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.

The endocytic pathways of carbon dots in human adenoid cystic carcinoma cells

OBJECTIVES

This study aimed at investigating cellular uptake pathways of carbon dots (CDs) in human adenoid cystic carcinoma cell line ACC-2.

MATERIALS AND METHODS

We synthesized CDs using a hydrothermal method with citric acid and polyethylenimine (PEI, Mw = 25 000). The CDs incubated with the ACC-2 cells showed their bioimaging capabilities using a confocal microscopy test. Flow cytometry was used to analyse cellular uptake pathways of CDs in ACC-2 cells.

RESULTS

Our findings indicated that CDs possessed good biocompatibility in ACC-2 cells. CDs were endocytosed mainly via micropinocytosis and energy-dependent pathways.

CONCLUSIONS

In general, these findings suggested that CDs had excellent biomedical imaging properties for ACC-2 cells and there was a potential opportunity to develop biomedical applications.

Salivary duct carcinoma of the supraglottis with a distinct presentation: A case report and literature review

RATIONALE

Salivary duct carcinoma (SDC) is a rare and aggressive subtype of salivary gland carcinoma that histologically resembles in situ and invasive ductal carcinoma of the breast. We present the first case of advanced SDC of the minor salivary gland arising from the supraglottis and review the literature on the clinicopathologic characteristics and prognosis of SDC.

PATIENT CONCERNS

A 59-year-old male patient with progressive difficulty in swallowing and a muffled voice for 2 months.

DIAGNOSES

The patient was diagnosed with SDC arising from the supraglottis with extensive tumor invasion into the subsites of the larynx and pharynx.

INTERVENTIONS

Due to impending airway obstruction, the patient underwent CO2 laser debulking surgery. In addition to local disease, lymph node and distant metastases were also noted at diagnosis and concurrent chemoradiation therapy was arranged.

OUTCOMES

Laryngeal function was preserved and tracheostomy was avoided. The patient has survived for >1 year after the initial diagnosis.

LESSONS

SDC is a rare and aggressive subtype of salivary gland carcinoma that histologically resembles in situ and invasive ductal carcinoma of the breast. Here we presented the first case of advanced SDC of the minor salivary gland arising from the supraglottis that was treated with CO2 laser debulking surgery followed by concurrent chemoradiation therapy. Due to their rarity, further studies are required to establish the most effective treatment protocol for advanced SDC.

[A difficult case of the differential diagnosis of focal infiltrative lung changes in phthisiatric practice]

Errors occur rather commonly in the differential diagnosis of respiratory diseases accompanied by X-ray lung tissue changes as foci and infiltration. Infiltrative and disseminated pulmonary tuberculosis, lung cancer, and pneumonia constitute a high proportion among the detected concurrent lung diseases. The rate of diagnostic discordance for these lung abnormalities accounts for more than 30%; and the diagnosis period for an infiltrative lung process lasts 2–3 weeks in 20% of cases and above 1–3 months in 80%. In particular, clinicians are faced with great difficulties in diagnosing aspiration pneumonia; this is due to that its X-ray manifestations are not purely specific and they are characterized by the parenchymal (alveolar) infiltration of lung tissue with a varying extent of lung inflammation. This paper describes a clinical case of a patient with salivary gland adenocarcinoma and focal infiltrative lung changes. Diagnostic difficulties have emerged in establishing the genesis of the changes in the lung.

RBE and OER within the spread-out Bragg peak for proton beam therapy: in vitro study at the Proton Medical Research Center at the University of Tsukuba

There are few reports on the biological homogeneity within the spread-out Bragg peak (SOBP) of proton beams. Therefore, to evaluate the relative biological effectiveness (RBE) and the oxygen enhancement ratio (OER), human salivary gland tumor (HSG) cells were irradiated at the plateau position (position A) and three different positions within a 6-cm-wide SOBP (position B, 26 mm proximal to the middle; position C, middle; position D, 26 mm distal to the middle) using 155-MeV/n proton beams under both normoxic and hypoxic conditions at the Proton Medical Research Center, University of Tsukuba, Japan. The RBE to the plateau region (RBE(plateau)) and the OER value were calculated from the doses corresponding to 10% survival data. Under the normoxic condition, the RBE(plateau) was 1.00, 0.99 and 1.09 for positions B, C and D, respectively. Under the hypoxic condition, the RBE(plateau) was 1.10, 1.06 and 1.12 for positions B, C and D, respectively. The OER was 2.84, 2.60, 2.63 and 2.76 for positions A, B, C and D, respectively. There were no significant differences in either the RBE(plateau) or the OER between these three positions within the SOBP. In conclusion, biological homogeneity need not necessarily be taken into account for treatment planning for proton beam therapy at the University of Tsukuba.

Rapidly progressive and metastatic mucoepidermoid carcinoma: application of serological tumor markers

Mucoepidermoid carcinoma (MEC) of the salivary gland is a rare entity. A distinction of 2 variants has been proposed: the low-grade tumor with a favourable prognosis and the high-grade tumor with a poor prognosis. Indeed, MEC is a cancer with a relative favourable outcome and more than 90% of patients survive for more than 5 years after diagnosis, reduced to about 70% after 10 years. This excellent prognosis might contribute to the unacceptable retention of the term "mucoepidermoid tumor" in the medical terminology, even in current medical textbooks. However, the distinction of MEC by grading is a guideline only and it is not appropriate to use this histological term as a prediction for individual cases. We describe the rapid fatal outcome of a patient with MEC in order to emphasize the malignant characteristics of this tumor and the possible application of tumor markers for the diagnosis of metastasizing MEC.

Diagnosis of pleomorphic adenoma in a heterotopic salivary gland: a case report

BACKGROUND

The histologic diversity encountered in pleomorphic adenoma may cause diagnostic difficulty in fine needle aspiration cytology (FNA) due to limited and selective sampling.

CASE

A 40-year-old woman presented with a mass in the anterior aspect of the neck along the sternocleidomastoid muscle. FNA revealed a cellular tumor with a chondrimyxoid background and epithelial cells intermingled with a few mesenchymal cells. The diagnosis of pleomorphic adenoma was confirmed on histopathology.

CONCLUSION

Primary ectopic pleomorphic adenoma can confidently be diagnosed by FNA. This technique is a useful tool in the initial assessment of the tumor.

Biological role of estrogen receptor beta in salivary gland adenocarcinoma cells

PURPOSE

This study is intended to investigate the biological role of estrogen receptor (ER) nongenomic signaling in salivary gland adenocarcinoma cells that predominantly express ERbeta.

EXPERIMENTAL DESIGN

Salivary gland adenocarcinoma cell lines HSG and HSY were used to study the effect of diarylpropionitrile and estrogen on the nongenomic signaling of ERbeta, cytoskeletal remodeling, and cell motility.

RESULTS

We found that diarylpropionitrile and estrogen triggered rapid activation of the extracellular signal-regulated kinase 1/2 (ERK), Src, and focal adhesion kinase signaling pathways. Estrogen stimulation also induced long cytoplasmic extensions, filopodia formation, and abnormal outgrowths in both HSG and HSY cells. We further observed that ligand-induced migration of these cells was blocked by the pure antiestrogen ICI 182780 and the mitogen-activated protein/ERK kinase inhibitor PD98059, indicating that estrogen-induced cell migration is mediated by the activation of ERbeta nongenomic signaling.

CONCLUSION

These results clearly showed that ERbeta nongenomic signaling is active in salivary gland cells and has a biological role in migration, presumably via the stimulation of ERK1/2. In future, the findings of this study might have clinical importance as several ERbeta-selective agonists are currently being available, and these could potentially be used for therapeutic targeting of ERbeta-positive salivary tumors.

Expression of the urokinase receptor regulates focal adhesion assembly and cell migration in adenoid cystic carcinoma cells

Adenoid cystic carcinoma (AdCC) cell lines (ACCS and ACCT) showed higher migration responses and adhesion to the extracellular matrix (ECM), especially types I and IV collagen, than did the oral squamous cell carcinoma (SCC) lines (NA and TF). The response to collagens was largely and exclusively inhibited by anti-alpha(2) integrin antibody. Moreover, AdCC cell lines expressed higher surface levels of urokinase-type plasminogen activator receptor (uPAR) than did SCC cell lines. When AdCC cells were plated on collagen, the surface level of uPAR was increased, and numerous focal adhesions consisting of uPAR, vinculin, and paxillin were assembled; whereas collagen-stimulated SCC cell counterparts or AdCC cells plated on other types of ECM, such as fibronectin, failed to assemble such definite focal adhesions. In order to elucidate the association of uPAR with collagen-induced events, an ACCS-AS cell line transfected with a vector expressing antisense uPAR RNA was established and shown to have reduced uPAR (about 10% that of parental ACCS at both the protein and mRNA levels). ACCS-AS showed a strong reduction of collagen-stimulated migration and focal adhesion assembly of alpha(2) integrin, vinculin, and paxillin. These findings suggest that AdCC has a proclivity for migrating to types I and IV collagens due to the overexpression of uPAR, which plays a key role in focal adhesion assembly and migration.

[The relationship of abnormal expression of cell glucoprotein with recurrence of pleomorphic adenoma in salivary gland]

OBJECTIVE

To study the relationship of expression of mucin 1 and E-cadherin with recurrence of pleomorphic adenoma in salivary gland, and to investigate the signal to predict the recurrence potential of the tumor.

METHODS

; The capsule of tumor was observed by microscope. The expression of mucin 1 and E-cadherin in 33 cases of primary adenoma, 12 cases of recurrent pleomorphic adenomas and 7 cases of malignant pleomorphic adenomas were detected by immunohistochemistry.

RESULTS

There was no significant difference about the status of capsule and the positive rate of mucin 1 expression between primary and recurrent pleomorphic adenoma (P > 0.05). The abnormal distribution of mucin 1 expression was observed in recurrent pleomorphic adenoma (6/8), which was characterized by the positive staining of the whole cytomembrane. On the other hand, positive staining of the primary pleomorphic adenoma was observed on the top of the membrane (19/21). The difference was statistically significant (P < 0.05). The staining pattern in malignant pleomorphic adenoma was similar with the recurrent ones except higher ratio of positive expression. No significant different was observed among the three kind of tumors on the expression rate of E-cadherin (P > 0.05).

CONCLUSION

The status of capsule didn't have much actual usage in predicting the recurrence of pleomorphic adenoma. There was no significant relationship between the expression of E-cd and the recurrence of the tumor. The abnormal distribution of mucin 1 expression contributes to the invasiveness of the tumor and can be used as the predictive signal for recurrence of pleomorphic adenoma.

[Lymphoproliferative disorders in Sjögren's syndrome]

INTRODUCTION

Sjögren's syndrome [SS] is an autoimmune disease that mainly affects the exocrine glands. B-cell lymphoproliferation is a characteristic feature of this syndrome and the lesion may range from benign to malignant.

MATERIAL AND METHODS

After a systematic search of Pubmed we reviewed literature regarding the histopathology, pathophysiology and clinics of lymphoproliferation in SS.

RESULTS

Patients with Sjögren's syndrome [SS] have over 40-fold increased risk of the development B-cell non-Hodgkin's lymphoma. Most cases of lymphomas complicating the course of SS arise in mucosal extranodal sites, especially in the salivary gland, and are classified as low grade marginal zone B-cell lymphoma with long-term survival. The main problem in salivary lymphoproliferation in Sjögren's syndrome consists in the difficulties in the differential diagnosis of lymphoma. Genotypic studies have documented the rearrangement of immunoglobulin genes across the full spectrum of lymphoid infiltrates in the salivary gland including cases regarded as reactive lymphoepithelial sialadenitis [LESA], borderline cases with halos of monocytoid cells surrounding epimyoepithelial islets, and cases with fully developed marginal zone lymphoma [MZL]. Thus, the simple detection of B-cell clonality cannot be used as a criterion for the diagnosis of B-cell malignancy. Broad strands of monocytoid B-cells that surround and invade epimyoepithelial islets and monotypic immunoglobulin expression detected by immunohistochemistry are an essential feature for the histopathological diagnosis of MZL. The pathophysiology of lymphoma in SS remains still unknown. Viral infection, hyperstimulation of B cells, disregulation in the process of apoptosis, and unknown oncogenes are suspected to initiate the start of lymphoma. The main clinical features associated with the development of lymphoma in SS include persistent major salivary gland enlargement (> 2 months), persistent lymphadenopathy or splenomegaly, monoclonal gammapathy and type II mixed cryoglobulinemia. The treatment and prognosis of lymphoma associated with SS depend on the type and stage of lymphoma.

CONCLUSION

Patients with SS develop a variety B lymphoproliferative disorders. The nature of these must be determined by multiparameter analysis including clinical, histopathological, immunohistochemical and genotypic studies.

Mutations in components of the Wnt signaling pathway in adenoid cystic carcinoma

The Wnt signaling pathway is essential for normal development and organogenesis. However, inappropriate activation of Wnt signaling, which results in the nuclear translocation of beta-catenin, is associated with the development of various types of neoplasm. In this study, we investigated possible mutations in the genes for components of this pathway, namely, CTNNB1 (the gene for beta-catenin), AXIN1, and APC, in adenoid cystic carcinoma, by PCR, analysis of single-strand conformational polymorphism, and sequencing. Among a total of 20 cases of adenoid cystic carcinoma, seven cases (35%) were associated with mutations in one or more of these three components. A mutation in CTNNB1 was detected in one case. Five cases, including the case with a mutation in CTNNB1, were associated with missense mutations in AXIN1. An aberration in the mutation cluster region of APC was detected in two cases. Mutations trended to be detected more frequently in adenoid cystic carcinoma with solid growth pattern than that with tubular and cribriform growth pattern. In the cases in which we detected mutations, it is possible that the presence of the abnormal products of the mutated genes resulted in the inappropriate activation of the Wnt signaling pathway to tumorigenesis and the growth of adenoid cystic carcinoma.

Skin and salivary gland carcinogenicity of 7,12-dimethylbenz[a]anthracene is equivalent in the presence or absence of aryl hydrocarbon receptor

7,12-Dimethylbenz[a]anthracene (DMBA) is a well-known polycyclic aromatic hydrocarbon (PAH) that causes a variety of tumors in exposed animals. Although PAH carcinogenicity is primarily mediated by the aryl hydrocarbon receptor (AhR) through induction of P450, it is not precisely determined whether AhR regulates the DMBA carcinogenesis in vivo. In this context, we examined the frequency of DMBA-induced tumors and the expressions of mRNAs of P450-CYP1 subfamily and microsomal epoxide hydrolase (mEH) in the skin and submandibular gland using AhR-deficient mice. After DMBA exposure, AhR-/- and AhR+/+ mice showed the same tumor incidences and latency. CYP1A1 was absent in these tissues but was slightly induced in DMBA-treated AhR+/+ mice. In AhR-/- and AhR+/+ mice, constitutive expression of CYP1B1 was evident at equivalent levels, whereas CYP1A2 was not detectable, irrespective of DMBA treatment. mEH was expressed in both tissues of all animals. Collectively, the constitutive levels of CYP1B1 and mEH in the skin and submandibular gland maintain DMBA response in these tissues of AhR-/- mice.

Detection of photodynamic therapy-induced early apoptosis in human salivary gland tumor cells in vitro and in a mouse tumor model

We studied the detection of apoptosis of malignant human salivary gland tumor cells induced by photodynamic therapy (PDT) using the photosensitizer mono-L-aspartyl chlorin e6 (NPe6) in vitro and in vivo in mice receiving transplanted human salivary gland tumor (HSG) cells. An immunohistocytochemical method using a monoclonal antibody (MoAb), M30, which reacts with the product resulting from the cleavage of cytokeratin (CK) 18 by activated caspase, was applied to detect the apoptosis of HSG cells induced by PDT. Significant amounts of immunoreactive products were observed in the cytoplasm of HSG cells after PDT. In vitro, M30-positive cells increased from 2 h after PDT, increased rapidly from 8 h and reached a peak 24 h after PDT. In vivo, a peak of early apoptosis was confirmed two hours after PDT. In comparison with DNA fragmentation detected by the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method, the destroyed tumor cells were observed sporadically 24 h after PDT. These results suggest that immunohistocytochemical staining with the MoAb M30 may be useful for detecting early apoptosis induced by PDT. Futhermore, PDT using NPe6 is effective in inducing apoptosis of HSG cells at an early stage, which suggests the possibility of the therapy being ideal for treatment of human malignant neoplasms.

Brefeldin-A induces apoptosis in human adenoid cystic carcinoma cultured cells

Adenoid cystic carcinoma (ACC) of salivary glands is characterized by a high rate of local recurrences, neurotropism and metastasis. ACC long-term survival rate is not promising. Thus, different chemotherapeutical approaches had been proposed for this neoplasm, including apoptosis induction by different drugs. This work evaluates the efficacy of Brefeldin-A (BFA), a potent apoptosis inducer, on ACC cultured cells (CAC2 cell line). CAC2 cells were treated with a 375 microM BFA solution in serum-free medium during 18 h. CAC2 cells grown in DMEM supplemented with 10% fetal bovine serum served as controls. Apoptotic cell recognition and counting were carried out through Hoechst staining. Transmission electron microscopy and immunofluorescence assessed the effect of BFA on CAC2 cells phenotype. Treated cultures showed a high apoptotic index presenting +/-30% of cells in evident apoptosis, when compared to controls. Apoptotic CAC2 cells also exhibited different alterations such as cytoplasmic vesicles formation and mitochondrial changes. Cultured ACC cells are strongly susceptible to apoptosis induction under BFA treatment, which may constitute a promising tool in further chemotherapeutical approaches.

Gamma radiation-induced apoptosis, G2 delay, and the risk of salivary and thyroid carcinomas?a preliminary report

BACKGROUND

While radiation has been the only well-established risk factor for salivary and thyroid cancers, the exact mechanisms remain unknown. We hypothesized that individuals with altered apoptotic response to gamma irradiation may be susceptible to salivary and thyroid cancers.

METHODS

We tested our hypothesis in a pilot case-control study of 29 patients with neoplasms of the salivary and thyroid glands and 29 cancer-free control subjects. Patients and control subjects were matched on age, sex, and ethnicity. In vitro gamma radiation-induced apoptosis in lymphocytes was quantified utilizing the TUNEL assay and flow cytometry.

RESULTS

The mean apoptotic capacity was 13.55 +/- 10.54 for control subjects, 5.75 +/- 4.96 for patients with salivary gland carcinomas (p =.003), and 6.87 +/- 4.45 for patients with thyroid carcinomas (p =.006). These differences were associated with a 10-fold increased risk of salivary gland carcinoma (odds ratio [OR] = 10.71; 95% confidence interval [CI], 1.21-94.86) and a four-fold increased risk of thyroid carcinoma (OR = 3.93; 95% CI, 0.90-17.08).

CONCLUSIONS

Our data suggests that gamma radiation-induced apoptosis may serve as a biomarker of genetic susceptibility to salivary and thyroid carcinoma, and further confirmatory studies with larger sample size are warranted.

[Molecular techniques lead to the first insights into the pathophysiology of salivary gland adenomas]

Pleomorphic adenomas are the most common type of salivary gland tumours. Activation of the PLAG1 gene on chromosome 8q12 is the most frequent mutation found in these tumours. This results from chromosomal translocations leading to promoter substitution between PLAG1, mainly expressed in fetal tissue, and more broadly expressed genes. The replacement of the PLAG1 promoter, inactive in adult salivary glands, by a strong promoter derived from the translocation partner, leads to ectopic expression of PLAG1 in the tumor cells. This abnormal PLAG1 expression results in deregulation of PLAG1 target genes causing salivary gland tumorigenesis. PLAG1 binds to promoter 3 of the Insulin-like growth factor 2 gene (IGF2) and stimulates its activity. IGF2 is highly expressed in salivary gland adenomas overexpressing PLAG1 while no IGF2 expression is found in adenoma without abnormal PLAG1 expression nor in normal salivary gland tissue, indicating a perfect correlation between PLAG1 and IGF2 expression. These results provide us with the first clue for understanding the role of PLAG1 in salivary gland tumor development. IGF2 perfectly fits in the picture of a restarted developmental program with concomitant loss of differentiation, the typical hallmark for any tumour. Salivary gland genesis provides a system for studying the development of glandular organs having many basic features in common with the salivary gland, such as breast, kidney, lung, pancreas and prostate. With a unique salivary gland organ culture system we now can study principles of epitheliogenesis, tubulogenesis and branching morphogenesis. Genes expressed at the spot where during tumourigenesis proliferation overrules differentiation constitute new targets for reverting the proliferative, tumour-specific stage. By elucidating molecular mechanisms involved in human cancer, we will hence contribute at the level of fundamental cancer research (oncogenesis) and normal organ development (organogenesis).

Loss of p21WAF1/CIP1 accelerates Ras oncogenesis in a transgenic/knockout mammary cancer model

Upregulation of the cyclin-dependent kinase inhibitor p21WAF1/CIP1 and subsequent cell growth arrest or senescence is one mechanism by which normal cells are believed to respond to stress induced by the constitutively activated GTPase Ras. We hypothesize that in the absence of p21, the onset of Ras-dependent oncogenesis is accelerated. To test this hypothesis, we crossed MMTV/v-Ha-ras transgenic mice into a p21-deficient background. By 63 days of age, all 8 ras/p21-/- mice developed either malignant (mammary and/or salivary adenocarcinomas) or benign (Harderian hyperplasia) tumors. In contrast, by the same age, only one out of nine of the ras/p21+/+ mice developed a tumor. Furthermore, by 94 days of age, half of the ras/p21-/- mice, but none of the ras/p21+/+ mice, developed mammary tumors. p21-deficiency also accelerated the development of salivary (T50=66 days for ras/p21-/- vs T50=136 days for ras/p21+/+) and Harderian (T50=52 days for ras/p21-/- vs T50>221 days for ras/p21+/+) tumors. Furthermore, two out of the eight ras/p21-/- mice had metastatic lesions, one in its lungs, the other in its abdomen. None of the nine ras/p21+/+ mice had metastatic lesions. By 4 months of age, the mammary tumor multiplicity was 10-fold greater in ras/p21-/- (average 3.40 tumors/mouse) than in ras/p21+/+ (average 0.33 tumor/mouse) mice. However, once the tumors appeared, their growth rate, apoptosis level, and mitotic index were not affected by the loss of p21, suggesting that loss of p21 is critical in early but not late events of Ras oncogenesis. Altogether, the results show that tumor onset in MMTV/v-Ha-ras mice is p21-dependent with loss of p21 associated with earlier tumor appearance and increased tumor multiplicity and aggressiveness.

Influence of environmental and nutritional factors on salivary gland tumorigenesis with a special reference to dietary lipids

Salivary gland cancer is a rare condition whose incidence varies according to different geographical regions. Several environmental factors, such as ionizing radiation and some occupational aspects, as well as habits like smoking and alcohol consumption, are related to salivary tumorigenesis. Both acinar and ductal cells may be involved in the origin of salivary gland tumours. Even though laboratory and epidemiological evidence indicates that diet and nutritional habits may modulate the tumorigenesis at different sites, little is known about this effect on salivary glands, mainly in regard to dietary lipids. However, the fact that monounsaturated fatty acids behave as protumorigenic and, on the contrary, certain polyunsaturated fatty acids exert beneficial effects, demonstrated on breast, colon and even oral cancer, gives support to our hypothesis. The suggested relationship between environmental and nutritional factors, mainly dietary lipids, and salivary gland cancer constitutes the aim of the present work.

Fine-needle aspiration cytology of malignant hemangiopericytoma of the salivary gland: A case report

A 79-yr-old woman presented with a 5-yr history of swelling of the left cheek. The fine-needle aspiration (FNA) smear showed a spindle-cell neoplasm with capillaries and benign endothelial cells. The spindle cells possessed pleomorphic, hyperchromatic elongated nuclei and a moderate amount of ill-defined cytoplasm. They also showed papillary arcades surrounded and encased by relatively small ovoid to short spindle cells. Subsequent surgical excision confirmed the presence of malignant hemangiopericytoma (HP). Immunohistochemical studies on the histologic section using vimentin were strongly positive, consistent with HP. To the best of our knowledge, this is the second published report of FNA cellular features of malignant HP of the salivary gland. Besides delineating the FNA cellular features of HP of the salivary gland, the present case illustrates the value of using immunohistochemical approaches. Diagn. Cytopathol. 1999;21:398-401.

Decrease in gamma-actin expression, disruption of actin microfilaments and alterations in cell adhesion systems associated with acquisition of metastatic capacity in human salivary gland adenocarcinoma cell clones

In order to clarify how cytoskeletons and adhesion systems change through acquisition of metastatic capacity in a cancer cell, we examined the expressions of beta- and gamma-actin, the morphology of actin microfilaments and focal contacts, and also the expression of vinculin in a salivary gland adenocarcinoma cell clone cl-1, which acquired metastatic capacity, in comparison with its original clone HSGc lacking metastatic ability. Two-dimensional gel electrophoresis of Triton-insoluble fractions and combined Western blot analysis by immunostaining with anti actin-isoform antibodies showed that the expression of gamma-actin was somewhat lower than that of beta-actin in HSGc, and cl-1 expressed a comparable amount of beta-actin to HSGc, whereas gamma-actin expression by cl-1 was far less than that by HSGc. Northern blot analysis demonstrated that there was little difference in the level of beta-actin mRNA between HSGc and cl-1, while the level of gamma-actin was markedly decreased in cl-1 as compared with HSGc. In terms of morphology, cl-1 cells showed disruption of actin microfilaments and a decrease in the size and number of focal contacts on the cell surface. Furthermore, cl-1 showed decreased expression of vinculin, which became obscured even at the end of actin microfilaments. These results demonstrated that a decrease in gamma-actin, disruption of actin microfilaments, and suppression of focal contacts as well as vinculin take place in the transformation from a non-metastatic condition to a metastatic one in the human salivary gland adenocarcinoma cell clones. Thus, it was strongly suggested that these changes contribute to a decrease in cell adhesiveness and an increase in cell motility, which is probably a major cause for acquisition of metastatic potential.

Management of malignant tumors of the salivary glands

Results of treatment for patients with salivary gland carcinoma have improved in recent years, most likely due to earlier diagnosis and the use of more effective locoregional therapy. Salivary gland tumors are treated surgically, often in conjunction with postoperative radiation therapy when the tumor is malignant. Good results rest strongly on the performance of an adequate, en bloc initial resection. Radical neck dissection in indicated in patients with obvious cervical metastasis, and limited neck dissection may be appropriate in patients with clinically negative nodes in whom occult nodal involvement is likely. Postoperative radiation therapy should be administered when the tumor is high stage or high grade, the adequacy of the resection is in question, or the tumor has ominous pathologic features. Neutron beam therapy shows promise in controlling locoregional disease but requires further study. No single chemotherapeutic agent or combination regimen has produced consistent results. At present, chemotherapy is clearly indicated only for palliation in symptomatic patients with recurrent and/or unresectable cancers. Patients with salivary gland carcinomas must be followed for long periods, as recurrence may occur a decade or more following therapy. Distant metastasis appears to occur in approximately 20% of patients.

Major salivary gland lesions: correlation of MR findings with flow cytometric DNA analysis and prognosis

OBJECTIVE

We correlated MR imaging findings with those from flow cytometry and determined prognostic factors of patients with major salivary gland lesions.

SUBJECTS AND METHODS

DNA ploidy (11 aneuploid, 35 diploid lesions) and S-phase fraction (SPF) (12 high-SPF, 28 low-SPF lesions) percentages as determined by flow cytometric technique in 46 major salivary gland lesions were correlated with MR findings and signal-intensity ratios of lesion to muscle on fast spin-echo T2-weighted images, unenhanced spin-echo T1-weighted images, and gadolinium-enhanced fat-suppressed spin-echo T1-weighted images. SPF percentages were correlated with the three signal-intensity ratios by stepwise regression analysis. Prognostic indicators of disease-free survival were assessed with Cox multivariate analysis (range of follow-up, 2-50 months; mean, 16.6 months).

RESULTS

Signal-intensity ratios for all pulse sequences were significantly smaller in aneuploid lesions than in diploid lesions. Incidence of ill-defined margins (p < .001), invasion (p = .014), and hypointensity to the gland on T2-weighted images (p = .047) was significantly higher in aneuploid lesions than in diploid lesions. Of these, signal-intensity ratios on enhanced T1-weighted images were most accurate for predicting aneuploidy. A threshold of 1.55 for signal-intensity ratios on enhanced T1-weighted images yielded the highest accuracy (86%) for aneuploidy. Signal-intensity ratios on T2-weighted images (p = .025) and enhanced T1-weighted images (p < .001) were significantly smaller in high-SPF lesions than in low-SPF lesions. A threshold of 1.73 for signal-intensity ratios on enhanced T1-weighted images yielded 73% accuracy for high-SPF lesions, which was inferior to the prediction possible from ill-defined margins (80% accuracy). Aneuploidy (p = .008), ill-defined margins (p = .036), and signal-intensity ratios on unenhanced T1-weighted images (p = .008), related significantly and negatively to disease-free survival. A signal-intensity ratio of 1.22 or less for unenhanced T1-weighted images indicated a high risk of developing recurrence (100% sensitivity).

CONCLUSION

MR findings and signal-intensity ratios can reflect DNA ploidy and SPF status and can predict prognoses for patients with major salivary gland lesions.

Pleomorphic adenoma and adenoid-cystic carcinoma of salivary glands: immunohistochemical assessment of proliferative activity in comparison with flow-cytometric study

In this study, 32 pleomorphic adenomas (PAs) and seven adenoid cystic carcinomas (ACCs) were analysed for the evaluation of proliferating cell nuclear antigen (PCNA) indices and flow cytometric variables. Our aim was to assess any possible relationship between these parameters and the clinico-pathological variables and to clarify their histogenesis and reasons for their biological differences. The tumours were divided into three groups, mainly epithelial (E), myxoid (M) and chondroid (C); PCNA labelling index (LI) and weighted mean index (WI) and the WI/LI ratio were analysed in the predominant components; a single PCNA index, weighted by the percentage of each component, was also calculated. Only WI/LI was found to be significantly different in the three components, while PCNA single index did not show either significant differences by sex, age, site and size, or any correlation with the S phase fraction. A significant difference was found between PAs and ACCs by site (P < 0.01) and DNA ploidy (P < 0.05); furthermore, all PCNA indices (single index) were significantly lower in PAs than in ACCs.

Salivary duct carcinoma. Clinicopathologic and immunohistochemical review of 26 cases

BACKGROUND

Salivary duct carcinoma (SDC) is a high grade aggressive malignancy of the major salivary glands. Clinical and pathologic features that may be predictive of survival are not well delineated. The microscopic features of SDC are remarkably similar to those of mammary ductal carcinoma, raising the question of whether these tumors share antigenic or hormonal features.

METHODS

We reviewed the clinical and pathologic characteristics of 26 cases of SDC treated at the Mayo Clinic from 1960 to 1989. Immunoperoxidase studies and flow cytometry were performed in 25 and 24 cases, respectively.

RESULTS

The study population consisted of 22 men and 4 women (mean age, 66 years). The parotid gland was involved in 23 patients and the submaxillary gland in 3. Five of 24 tumors studied were diploid (21%), and 19 (79%) were nondiploid. Nine tumors (35%) recurred locally and 16 (62%) metastasized distantly; 20 patients (77%) died of disease at a mean interval of 3 years after diagnosis. Female sex was the only significant negative prognostic factor analyzed, but positive nodal status approached significance. Paraffin-section immunostaining showed positive reactions for epithelial membrane antigen (100%), keratin (AE1/AE3) (88%), alpha-lactalbumin (88%), GCDFP-15 (76%), and carcinoembryonic antigen (72%); S-100 protein was rarely detected (4%). Stains for estrogen receptor were uniformly negative, but one tumor was positive for progesterone receptors.

CONCLUSIONS

The prognosis for SDC is dismal, and clinically useful prognostic factors were not found. Our results do not confirm hormonal concordance between SDC and breast carcinoma.

Salivary gland tumours in Zimbabwe: report of 282 cases

Tumours of the salivary glands are relatively uncommon. In a review of 282 black patients seen at Harare Central Hospital, Zimbabwe, the relative incidence of various tumour types and the age and sex distribution were similar to those reported in other series. There were more tumours of the minor salivary glands than in reported Western series. There were more tumours of the minor salivary glands than in reported Western series. Pain and rapid growth were significant in distinguishing malignant from benign tumours. Malignant tumours were more common in elderly than in young patients.

Synergistic interaction of transforming growth factor alpha and c-myc in mouse mammary and salivary gland tumorigenesis

The c-myc oncogene is commonly amplified in breast cancer and is known to interact synergistically with transforming growth factor alpha (TGF alpha) in vitro to promote phenotypic transformation of mammary epithelial cells. In addition, both genes are under sex steroid hormone regulation in breast cancer. We have used a bitransgenic mouse approach to test the relevance of Myc-TGF alpha interaction in mammary gland tumorigenesis of virgin animals in vivo. We mated single transgenic TGF alpha and c-myc mouse strains to yield double transgenic offspring for TGF alpha and c-myc. All (20 of 20) double transgenic TGF alpha/c-myc animals developed synchronous mammary tumors at a mean age of 66 days. An unexpected finding was that tumor latency and frequency in males and virgin females were identical. Thus, two gene products that are known to be coinduced in breast cancer by the sex hormones estrogen and progesterone strongly synergize to induce synchronous mammary tumors, independent of sex. The tumors, despite being estrogen receptor positive, were readily transplanted as highly malignant s.c. cancers in ovariectomized nude mice. Although approximately one-half of single transgenic c-myc virgin females also eventually developed mammary gland tumors, these were stochastic and arose after a long latency period of 9-12 months. Single transgenic virgin TGF alpha females and males, c-myc males, and transgene-negative littermates did not develop tumors (ages up to 15 months). The salivary glands of double transgenic animals also coexpress the two transgenes and show pathological abnormalities ranging from hyperplasias to frank adenocarcinomas. In contrast, the salivary glands of single transgenic and wild-type animals showed only mild hyperplasias or metaplasias, but tumors were not observed. In situ hybridization analysis of mammary and salivary glands revealed that hyperplastic and tumorous areas colocalize with regions that overexpress both the TGF alpha and c-myc transgenes. This indicates that there is a requirement for the presence of both proteins for transformation of these glands. In summary, TGF alpha and c-Myc synergize in an extremely powerful way to cause breast and salivary gland tumorigenesis in males and virgin females without a requirement for pregnancies.

Histocytologic grading of mucoepidermoid carcinoma of major salivary glands in prognosis and survival: a clinicopathologic and flow cytometric investigation

BACKGROUND

Controversy exists regarding the role of a 3-tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3-tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades.

METHODS

Forty-eight patients with 7 low-grade (LG), 23 intermediate-grade (IG), and 18 high-grade (HG) MECs of parotid (n = 43) and submandibular (n = 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal-Wallis and Chi-squared tests where appropriate).

RESULTS

Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p = 0.02). Gender ratio (p < 0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 IG, and 3.6 HG (p < 0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p = 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p < 0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p < 0.001). DNA aneuploidy (DNA index < 0.9 or > 1.1) was present in 0% LG, 13% IG, and 28% HG (p = 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p = 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p = 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p = 0.009). Survival was decreased significantly (p < 0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG).

CONCLUSION

Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3-tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals.

Prognostic significance of cell proliferation in mucoepidermoid carcinomas of the salivary gland: clinicopathological study using MIB 1 antibody in paraffin sections

Mucoepidermoid carcinomas of salivary gland origin have an uncertain clinical course not directly predictable by histomorphology. The MIB 1 antibody, which detects Ki-67 antigen in formalin-fixed, paraffin-embedded tissues, was used to study cell proliferation in these tumors. An MIB 1 index was developed to express the percentage of MIB 1-positive proliferating cells, and the results were compared with histomorphological tumor grade and clinical outcome. All patients with MIB 1 indices lower than 10% in their primary tumors had a favorable clinical outcome. Most patients with MIB 1 indices higher than 10% developed a recurrent or metastasizing disease. All patients who died of their tumor or who had persistent tumor had MIB 1 indices higher than 10%. Thus, the MIB 1 index defines two virtually nonoverlapping forms of the disease, an indolent one and an aggressive one. Cell proliferation in mucoepidermoid carcinomas, assessed with the MIB 1 antibody, thus represents a significant prognostic factor for improving the accuracy of conventional histological grading.

Radiation therapy and pain in patients with head and neck cancer

Pain is commonly present at the time of diagnosis of head and neck cancer. Pain occurs in all patients treated for oropharyngeal cancer. This study examined the prevalence, severity and characteristics of pain in patients treated with radiation therapy for cancer involving the head and neck and oral cavity. Pain increases throughout the course of radiation and persists following treatment and in some patients continues for 6-12 months. Pain frequently requires systemic analgesics in addition to oral rinses.

An experimental study of chondrogenesis and osteogenesis in rat submandibular gland induced by implantation of demineralized dentin

Demineralized dentin pieces were implanted in 18 rat submandibular glands to examine the chondrogenesis and osteogenesis in pleomorphic adenoma of the salivary gland. After 7 days of implantation, a large amount of cartilage tissue was found next to the inner portions of the implanted pieces, and small amounts of the osteoid and cartilage tissues were detected next to the outer portions. A small amount of bone tissue was found in contact with the cartilage 10 days after the implantation. In the inner portions, invasions of capillaries and a small amount of osteoid tissue were noted. These histological findings resembled those of endochondral ossification. Large amounts of bone tissue and resorption of the implant were observed after 14 days. It has been suggested that cartilage and bone are produced by bone morphogenetic proteins (BMP) in demineralized dentin resulting in chondrogenesis followed by osteogenesis in submandibular gland. Apparently, undifferentiated mesenchymal cells are produced by implantation, undergo dedifferentiation, and are redifferentiated into chondroblasts and osteoblasts in the presence of BMP. These results suggest that chondrogenesis and osteogenesis in the submandibular gland are induced by BMP. It is possible that the chondroid tissues in pleomorphic adenoma of the salivary glands are induced by proteins such as BMP.

[Importance of determining halo-formation in comprehensive diagnosis of neoplasms in the large salivary glands]

An original diagnostic test in study of the functional state of segmented neutrophils, based on the halo-formation phenomenon, was investigated in patients with neoplastic and non-neoplastic diseases of the large salivary glands. Donors formed the control group. Analysis of the results showed a marked increase of the number of halo forming cells in patients with various forms of malignant new growths of these organs. The suggested test is recommended for use as an index of the functional activity of segmented neutrophils in malignant growth.

Sex hormone involvement in the development of experimental virally induced murine salivary gland tumors

Mice were given a single inoculation of polyoma virus at birth and then orchidectomised or oophorectomised. Unoperated groups received polyoma virus alone whilst further males received testosterone, and females received oestradiol thrice-weekly in addition to polyoma virus inoculation. All groups were then observed over the succeeding 370 days for the development of tumors of the submandibular and parotid salivary glands. Polyoma virus inoculation selectively induced salivary gland tumors in 70% of male animals and 30% of female animals given polyoma virus alone. Testosterone therapy increased the salivary tumor frequency from 69-90% whilst orchidectomy reduced the tumor frequency to 50%. Oophorectomy or oestrogen therapy did not significantly alter the salivary gland tumor frequency in females but oestrogen therapy did result in the development of second primary tumors of breast in 60% of female animals bearing salivary gland tumors. The role of androgens in the development of virally induced salivary gland tumors is discussed as are the possible mechanisms responsible for the development of second primary tumor of breast.

Effects of 5-fluorouracil and the combination of 5-fluorouracil and human leukocyte interferon on human salivary gland adenocarcinoma cell line in culture

The growth inhibitory effects of 5-fluorouracil (5-Fu) and the combination of 5-Fu and human leukocyte interferon (HuIFN-alpha) on the human salivary gland adenocarcinoma cell line HSG in culture were examined by measuring colony formation in the semi-solid agar medium and cell proliferation in the monolayer culture. As a consequence, the colony-forming ability of HSG cells in the agar medium containing 5-Fu was found to be markedly inhibited as compared with the untreated control. The concentration of 5-Fu yielding 50% inhibition of colony-forming ability of HSG cells under the presence of 5-Fu was 0.08 micrograms/ml. When the growth inhibitory effects of the combination of 5-Fu and HuIFN-alpha on HSG cells were examined, the colony forming ability of HSG cells was synergistically inhibited, whereas effects of the combined treatment on HSG cells in the monolayer culture were less sensitive than those on the colony formation. These findings strongly suggest that the combination of 5-Fu and HuIFN-alpha or 5-Fu alone is selectively effective on the neoplastic cells of HSG cell population but not on the non-neoplastic cells.

Colony-forming assay of human salivary gland tumors. Applications for chemosensitivity and histogenetic studies

Eight malignant and nine benign salivary gland neoplasms were cultured using a soft agar technique. Eleven of these tumors were successfully grown, two were contaminated, and only four demonstrated no growth. Cloning efficiency varied from 0.004% to 0.225%. These efficiencies and the 65% successful growth rate are much higher than those reported for head and neck squamous cell carcinomas. Single cell disaggregation with resultant clonal growth can be accomplished with salivary gland neoplasms. Ultrastructural study of colonies from three mixed tumors did not demonstrate distinct epithelial and mesenchymal populations of cells, the expected finding if mixed tumors were composed of two independent cell lines. Rather, mixed tumors invariably consisted of a monoclonal population of cells with evidence of ambivalent, mesenchymal, and epithelial differentiation. Myoepithelial cells were not present.

Prelymphoma, early lymphoma, and manifest lymphoma in immunosialadenitis (Sjögren's syndrome)--a model of lymphomagenesis

The development of malignant lymphoma in myoepithelial sialadenitis with and without Sjögren's syndrome was investigated. At first, prelymphomatous proliferation areas showing a polytypic immunoglobulin (Ig) pattern were seen. These transformed into malignant lymphoma with a monotypic Ig pattern, at first in small, circumscribed proliferation areas ("early lymphoma") and later in large, confluent proliferation area ("manifest lymphoma"). The lymphomas were classified as LP immunocytoma. In some cases they transformed into high-grade malignant lymphomas of the same category, namely, B-immunoblastic lymphoma. The same types of lymphoma have been found in NZB mice and chronic graft-versus-host reactions. "Primary" malignant lymphomas of salivary glands that did not show myoepithelial sialadenitis were also studied. These lymphomas were mostly germinal center cell tumors and probably developed primarily in lymph nodes within parotid glands in most, if not all, cases.

Management of recurrent salivary gland tumors

The management of 129 patients with recurrent tumors of the salivary glands is analyzed, Principles of approaching recurrent tumors and guidelines for their management are outlined in detail. Age distribution, symptoms, time to recurrence, cases that showed possible malignant degeneration, and complications are reviewed. The surgical procedures, recurrence rate, and survival rates are recorded.