Histologic-Prognostic Correlations in Adenoid Cystic Carcinoma of Major and Minor Salivary Glands of the Oral Cavity

Thirty-four cases of adenoid cystic carcinoma (ACC) of the major and minor salivary glands of the oral cavity, treated by wide surgical excision, were studied. The relationship between prognosis of the neoplasm and various morphologic factors were evaluated. Among the morphologic parameters previously studied, which according to various authors may be linked to the evolution of this tumor, we confirmed correlations for both histologic patterns and perineural invasion. In addition, the authors propose neoplastic growth type as a new parameter prognostically significant in ACC. In fact, none of the patients with the pushing type growth pattern died during the study period (p = 0.007). These same patients presented disease-free periods (mean 56 months, median 58 months) significantly longer than those with the infiltrating type growth pattern (mean 28 months, median 24 months).

Adenoid Cystic Carcinoma of the Submandibular Gland: A 35-Year Review

OBJECTIVES: To evaluate the treatment results of adenoid cystic carcinoma (ACC) of the submandibular gland at a single institution during a 35-year period.

STUDY DESIGN & SETTING: A retrospective review was performed by examining the records and reviewing the pathology of 22 patients with ACC of the submandibular gland treated at UCLA Medical Center from June 1963 to December 1997.

RESULTS: Seven men and 15 women with an age range of 23 to 85 years (median, 48 years) were treated. Surgical intervention was performed in 21 patients. All patients with advanced tumor size, perineural invasion, microscopically positive surgical margins, or regional neck metastases received postoperative adjunctive therapy, primarily radiotherapy. Follow-up varied from 6 months to 181 months (median, 67 months). Disease-free survival at 3, 5, and 10 years was 66%, 57%, and 41% respectively, whereas overall survival was 76%, 70%, and 37%, respectively (note: 5- and 10-year survival rates are not statistically conclusive due to the small sample size).

CONCLUSIONS: We report fairly high disease-free survival rates in this patient population and a number of prognostic trends are evident. Early diagnosis, wide surgical intervention, and postoperative radiation are associated with a favorable prognosis. Advanced tumor size, positive surgical margins, perineural invasion, and local recurrence of the tumor are associated with an unfavorable prognosis. EBM rating: C.

Results in the management of malignant submandibular tumours and guidelines for elective neck treatment

BACKGROUND

Malignant submandibular gland tumours are rare tumours treated primarily with surgery.

PURPOSE

This retrospective study was done to determine the effectiveness of adjuvant radiation therapy (RT), to document the patterns of failure, and to define the prognostic variables for treatment outcome.

MATERIALS AND METHODS

Between 1960 and 2002, 74 patients diagnosed as having malignant submandibular gland tumours were treated with radical surgery. The surgery included neck dissection in 37 patients and adjuvant RT in 50 patients with high-risk features.

RESULTS

Forty-one (54%) patients experienced disease relapse. The local recurrence rates were 35% in those treated only with surgery and 21% in patients who underwent postoperative RT (p  =  .20). The risk of subclinical nodal metastases in the clinical N0 neck was 21%.

CONCLUSIONS

The American Joint Committee on Cancer stage approached statistical significance for cause-specific survival. Although not statistically significant, RT probably reduced local recurrence. All patients with malignant submandibular tumours except T1 need elective neck treatment.

[Prognostic analysis of adenoid cystic carcinoma of major salivary glands of 64 cases]

BACKGROUND & OBJECTIVE

Adenoid cystic carcinoma of salivary glands is a kind of highly malignant tumor, and researches on the tumors originated from major salivary glands are rare. This study was to investigate prognostic factors of adenoid cystic carcinoma of major salivary glands.

METHODS

Clinical records of 64 patients with adenoid cystic carcinoma of major salivary glands followed up for more than 7 years were reviewed. Cumulative survival rate was analyzed by the Kaplan-Meier method. The log-rank test was applied to compare survival rates, and the comparison of the percentage of subjects between two groups was conducted with Chi2 test.

RESULTS

The overall death rate was 57.8%; the cause-specific death rate was 46.9%; the 5-and 10-year cumulative survival rates were 65.63% and 54.52%, respectively; the relapse rate was 34.4%; and the metastasis rate was 45%. Univariate analysis revealed that the factors impacting the prognosis were age, presence or absence of nerve invasion, histological subtypes, clinical stage, positive or negative surgical margin. Patients aged > or = 50, presence of nerve invasion, solid/tubular subtype, advanced clinical stage (stages III and IV), and positive surgical margin had poorer prognosis than those aged < 50, absence of nerve invasion, cribriform subtype, early clinical stage (stages I and II), and negative surgical margin. Multivariate analysis showed that the presence of nerve invasion, solid histological subtype, advanced clinical stage (stages III and IV), and positive surgical margin were independently associated to poor prognosis.

CONCLUSION

Presence or absence of nerve invasion, histological subtype, clinical stage, and positive or negative surgical margin are the independent factors affecting the prognosis of patients with adenoid cystic carcinoma of salivary glands.

[Salivary duct carcinoma of the submandibular gland]

BACKGROUND

Salivary duct carcinoma (SDC) is a rare adenocarcinoma of the salivary glands which usually occurs in the parotid gland (approx. 80%), but is also found in the submandibular gland (approx. 12%) and the minor salivary glands. Due to the low incidence of this tumour-particularly in terms of involvement of the submandibular and minor salivary glands-only limited clinical data is available.

PATIENTS/METHOD

In a retrospective investigation, follow-ups of six patients with a SDC of the submandibular gland were analysed and the surgical measures evaluated for their efficiency.

RESULTS

At the time of diagnosis, varying tumor stages were present (2xT1, 3xT2, 1xT1). Initial lymph node metastasis was observed in four (66.6%) of the six patients. In all patients, the submandibular gland was resected and neck dissection performed, in two cases (33,3%) this was followed by radiotherapy. Four patients developed a life-threatening local recurrence. Only one patient developed distant metastasis. Two thirds of the patients died due to tumor-related disease after an average of 35.5 months.

CONCLUSION

The clinical course of patients with SDC of the submandibular gland exhibits a high (66.6%) rate of local recurrence, crucial for the following clinical course. The treatment of these patients, therefore, must include radical tumor resection as well as tissue resection with a wide margin.

Tumors of the submandibular gland: Clinicopathologic analysis of 23 patients

PURPOSE

Tumors of the submandibular gland are rare, comprising less than 2% of head and neck neoplasia. Both benign and malignant lesions show a mild symptomatology, resulting in late presentation and in advanced stage of disease. The purpose of this article was to report our experience in treating submandibular gland neoplasia during the last 10 years.

PATIENTS AND METHODS

The medical records of all patients with histologically confirmed epithelial tumors of the submandibular gland were retrospectively reviewed. This review found 23 patients with 9 benign and 14 malignant tumors. The collection of data included demographic data, diagnostic procedures, operative and pathology reports, complications, additional treatment, and follow-up.

RESULTS

There were 10 men and 13 women with a mean age of 60 years. Pleomorphic adenoma was the most frequently encountered benign tumor; adenocarcinoma and adenoid cystic carcinoma had an equal presentation in the malignant group of patients. Eleven of the 14 patients with malignant tumors presented in advanced stages of disease (stage III and IV). Surgery was the sole treatment for the benign tumors. There were no recurrences. In the majority of cases, patients with malignant tumors were treated with surgery and postoperative radiotherapy. Eight patients died during the follow-up period, giving a mortality rate of 61.5%.

CONCLUSION

Benign submandibular gland tumors manifest a mild course of disease, and local excision along with the gland is a safe and effective method of treatment. Malignant tumors have a poor symptomatology that results in late diagnosis. Radical surgery and postoperative radiotherapy is the treatment of choice. Prognosis depends on the histopathology and biologic behavior of the specific type of malignant tumor.

Survival and prognosis for cancer of the submandibular gland

PURPOSE

We sought to determine survival and factors affecting survival for patients with cancer of the submandibular gland.

METHODS

All cases of surgically treated cancer of the submandibular gland were extracted from the Surveillance, Epidemiology and End Results database for the time period 1988 to 1998. After tabulation of demographic, tumor-specific, and survival data, Kaplan-Meier survival analysis was conducted according to histopathologic results. Cox regression analysis stratified for histopathology was conducted to determine factors that influenced survival.

RESULTS

A total of 370 cases of submandibular gland cancer were analyzed. Adenoid cystic carcinoma accounted for 42.2% of cases followed by mucoepidermoid carcinoma (22.2%). Overall mean, median, and 5-year survival times and rate were 82 months, 97 months, and 59.7% for the entire cohort, respectively. Adenoid cystic carcinoma exhibited the best mean survival (99 months), whereas squamous cell carcinoma exhibited the poorest mean survival (52 months). Younger age, decreased tumor grade, and radiation therapy were found to improve survival (P <.001,.005, and.015, respectively). Gender, tumor size, extraglandular extension, and nodal positivity did not statistically influence survival.

CONCLUSIONS

Significantly different survival can be expected depending on individual tumor histopathology in submandibular gland cancer. Tumor grade and radiation therapy have important effects on prognosis.

Metastasis to the submandibular gland in head and neck carcinomas

BACKGROUND

The purpose of this retrospective chart review was to determine whether and how the submandibular gland is involved in metastases of squamous cell carcinoma of the head and neck.

METHODS

We reviewed the records of all patients for whom pathology specimens were available after neck dissection for primary head and neck cancers at two institutions.

RESULTS

One hundred sixty-nine patients were included in the study, 27 underwent bilateral neck dissections, and 196 submandibular glands were resected and sent for pathology. One hundred forty-four glands had normal histologic findings. Normal or benign histologic changes were present in 187 glands. Three submandibular glands showed invasion from a locally involved lymph node, and six had direct extension from a primary lesion. The primary lesions were all ipsilateral to the involved gland and originated from cancers of the floor of the mouth, alveolar ridge, and tongue. No submandibular glands showed pathologic evidence of metastases.

CONCLUSIONS

Because the submandibular gland has no intraparenchymal lymph nodes, its involvement in upper aerodigestive tract carcinomas must be through extension from a locally involved lymph node or the primary tumor. Previous work has demonstrated that the submandibular gland can undergo transplantation out of the neck with subsequent reimplantation, as a possible means of protection from the effects of radiation. We demonstrated the submandibular gland to be involved only in cases of ipsilateral oral cavity tumors or metastasis to ipsilateral level I lymph nodes. We conclude that it is oncologically sound to consider transplantation and replantation of the contralateral submandibular gland for patients with head and neck squamous cell carcinoma when level I lymph nodes are unlikely to be involved.

Carcinoma of the parotid and submandibular glands--a study of survival in 2465 patients

Salivary gland carcinomas demonstrate a wide diversity of histopathological types and biological behavior. The aim of this study was to analyze relative survival of patients with major salivary gland carcinomas with special reference to histopathology, gender and age. All new carcinomas of the major salivary glands reported to the National Swedish Cancer Registry 1960-1995 were searched for and the vital status of the cases was updated by record linkage to the Swedish Population Registry through December 31 1996. The study comprised 2465 patients with carcinoma of the parotid or submandibular glands. Relative survival differed markedly according to histopathological typing (P<0.001). For parotid tumors, acinic cell carcinomas had the best prognosis with a 10-year relative survival of 88%. The corresponding figures for mucoepidermoid carcinomas, adenoidcystic carcinomas and carcinoma ex pleomorphic adenoma were 80, 74 and 73%. Adenocarcinoma NOS and undifferentiated carcinoma had worse prognosis, with 10-year relative survival of 55 and 44%. Patients with submandibular gland cancer had similar relative survival to those with parotid cancers, besides those with mucoepidermoid cancer and adenocarcinoma NOS, who carried worse prognosis. Age and gender had an impact on relative survival for patients with mucoepidermoid carcinoma, adenocarcinoma and undifferentiated cancer of the parotid.

[Clinical presentation, therapy and prognosis of non-Hodgkin lymphomas of the major salivary glands]

INTRODUCTION

About 5 - 10 % of all Non-Hodgkin-Lymphomas (NHL) present within the major salivary glands. Two etio-pathologically different groups, the (extranodal)-parenchymal NHL and NHL of intra- or periglandular lymphnodes (nodal lymphomas) have to be distinguished. It was the aim of this study to evaluate the clinical presentation, therapy and biological behaviour of these etiopathologically different lymphoma-groups.

MATERIAL AND METHOD

In a retrospective study, therapy and course of disease of 26 patients with a NHL of the major salivary glands were examined (diagnosis and treatment between 1988 and 1996).

RESULTS

Staging results in the group of parenchymal lymphoma always showed the disease limited to the effected gland, whereas nodal NHL presented with a stadium II to IV (Ann-Arbor) at time of diagnosis. Local recurrencies were five times higher in nodal NHL compared to parenchymal NHL. In only one case (7.7 %) of the patients with parenchymal NHL, dissemination was observed. In the group of nodal NHL, a dissemination was observed in 6 patients (46.2 %). 7 of 13 patients (53.8 %) with a nodal NHL died due to lymphoma dissemination, compared to one patient (7.7 %) with a parenchymal NHL.

CONCLUSION

Based on the presented data, the histopathological diagnosis, under special recognition of the particular lymphoma-pathogenesis, constitutes an important prognostic factor in patients with NHL of the major salivary glands.

Postoperative radiotherapy for malignant tumors of the submandibular gland

PURPOSE

This retrospective study assessed the outcome and patterns of failure for patients with malignant submandibular tumors treated with surgery and postoperative radiation.

METHODS AND MATERIALS

Between 1965 and 1995, 83 patients aged 11-83 years old received postoperative radiotherapy after resection of submandibular gland carcinomas. The most common radiation technique was an appositional field to the submandibular gland bed using electrons either alone or mixed with photons. Primary tumor bed doses ranged from 50 to 69 Gy (median, 60 Gy). Regional lymph nodes (ipsilateral Levels I-IV) were irradiated in 66 patients to a median dose of 50 Gy. Follow-up time ranged from 5 to 321 months (median, 82 months).

RESULTS

Actuarial locoregional control rates were 90%, 88%, and 88% at 2, 5, and 10 years, respectively. The corresponding disease-free survival rates were 76%, 60%, and 53%, because 27 of 74 patients (36%) who attained locoregional control developed distant metastases. Adenocarcinoma, high-grade histology, and treatment during the earlier years of the study were associated with worse locoregional control and disease-free survival. The median survival times for patients with and without locoregional control were 183 months and 19 months, respectively. Actuarial 2-, 5-, and 10-year survival rates were 84%, 71%, and 55%, respectively. Late complications occurred in 8 patients (osteoradionecrosis, 5 patients).

CONCLUSIONS

High-risk cancers of the submandibular gland have a historic control rate of approximately 50% when treated with surgery alone. In the current series, locoregional control rates for high-risk patients with submandibular gland cancers treated with surgery and postoperative radiotherapy were excellent, with an actuarial locoregional control rate of 88% at 10 years.

Prognostic factors in major salivary gland cancer

OBJECTIVE

To identify features of major salivary gland cancers that are prognostic for disease-free survival.

STUDY DESIGN

A retrospective study of 78 patients with major salivary gland cancer (64 parotid and 14 submandibular gland) who underwent surgery for definitive treatment from 1976 to 1996. A select group of patients also received adjuvant radiation (56%) and/or chemotherapy (13%).

METHOD

Clinical and pathological risk factors were obtained from patients' charts and pathology reports. Age, gender, tumor site, T-stage, facial paralysis, histologic neck involvement, perineural invasion, and cancer grade were analyzed with respect to disease-free survival. The role of adjuvant treatment in terms of clinical outcome was also investigated.

RESULTS

In our series, the 5-year disease-free survival was 65%. Examining clinical and histologic features one at a time, we found poorer prognosis was associated with submandibular tumors compared with parotid (P =.02), higher T-stage (P =.001), positive cervical nodes (P <.001), perineural invasion (P =.002), and high-grade or adenoid cystic tumors (P =.002). A multivariable analysis indicated that positive lymph nodes (P =.07) and perineural invasion (P =.03) were important histologic predictors of shorter disease-free survival. Receipt of both adjuvant radiation and cisplatin-based chemotherapy (P =.05) was an independent predictor of longer disease-free survival.

CONCLUSION

Our study indicated that the presence of positive lymph nodes and perineural invasion is important independent predictors of disease-free survival. Our limited data also suggest that adjuvant chemotherapy and radiation therapy may improve disease-free survival.

Submandibular gland carcinoma; an audit of local control and survival following adjuvant radiotherapy

Carcinoma of the submandibular gland is a rare diagnosis, accounting for less than 2% of cases of salivary gland tumours. We have examined the treatment and outcome of a total of 30 patients treated with radiotherapy at the Christie Hospital, Manchester between 1980 and 1993. In most cases this followed radical surgery, though 12 patients were referred following either incomplete excision or biopsy only. Adenoid-cystic histology accounted for 19 cases (63%). Standard radiotherapy was delivered using a beam directed technique to treat the whole submandibular compartment. Doses prescribed were most commonly from 50 to 55 Gy in 16 fractions over three weeks. Cancer specific survival was 79% and 57% at 5 and 10 yr respectively, the continued fall at 10 yr reflected late recurrence seen in patients with adenoid-cystic histology. Local control was 85% and 73%, respectively. Nine of twelve patients with incomplete excision or biopsy only had local control with radiotherapy. Six patients developed lung metastases, all of whom had adenoid-cystic histology. Radiotherapy was well-tolerated acutely, and only one patient experienced osteoradionecrosis requiring surgical intervention. The incidence of adenoid-cystic carcinoma is higher in the submandibular than the parotid gland. This typically results in late recurrence, and a high incidence of lung metastases and this was confirmed in our study. However, overall survival was very similar to that of parotid carcinoma.

Mucoepidermoid carcinoma of the major salivary glands: clinical and histopathologic analysis of 234 cases with evaluation of grading criteria

BACKGROUND

The authors had previously conducted an investigation of minor salivary gland mucoepidermoid carcinoma, in which they demonstrated that certain clinical and histopathologic features were useful in predicting biologic outcome. The current study investigated the usefulness of these features in determining the prognoses of patients with mucoepidermoid carcinomas of the major salivary glands.

METHODS

Clinical data and 15 histopathologic features were compared in 4 patient groups based on outcome after initial treatment. The outcome groups were 1) survival without disease, 2) survival with tumor recurrence only, 3) survival with metastasis, and 4) death related to tumor. A numeric score was assigned to each unfavorable histopathologic feature. Low grade tumors had scores of 0-4. Intermediate grade tumors scored 5 or 6. High grade tumors had scores higher than 6.

RESULTS

Most patients (75%) were tumor free after the initial treatment. Twenty-one patients (9%) had local recurrence only, 12 (5%) demonstrated metastasis and survived, and 25 patients (11%) died of their disease.

CONCLUSIONS

Clinical features associated with metastasis or death were more advanced age, tumor size, and preoperative symptoms. Histopathologic features that correlated with poor outcome were cystic component less than 20%, 4 or more mitotic figures per 10 high-power fields, neural involvement, necrosis, and anaplasia. All five of these histopathologic features demonstrated statistical prognostic significance when parotid gland tumors from Groups 1 and 4 were compared (P < 0.001). The point-based grading system demonstrated a statistically significant correlation with outcome for parotid tumors but not for submandibular tumors. The authors' findings indicate that patients with tumors of equal histopathologic grade have a better prognosis when their tumors are in the parotid gland than when their tumors are in the submandibular gland. Six of eight submandibular tumors that metastasized or resulted in death were low grade lesions, and none were high grade.

Submandibular gland excision: a five-year review

Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes. This retrospective study of 93 consecutive patients who underwent excision of the submandibular gland in the Department of Otolaryngology, Singapore General Hospital over a five-year period was undertaken to study the indications of surgery, the pathology of the excised submandibular gland and the demographic profile of patients. Fifty-six (60.2 per cent) patients underwent submandibular gland excision for non-neoplastic salivary gland disease while 37 (39.8 per cent) had neoplastic submandibular gland disorders. The commonest pathology encountered was sialadenitis/sialolithiasis (53.76 per cent) followed by pleomorphic adenoma (33.33 per cent). Fine needle aspiration cytology (FNAC) was a valuable pre-operative investigation with a sensitivity and specificity of 94.7 per cent and 100 per cent respectively for neoplastic disease. The morbidity rate for this surgery was 4.3 per cent.

[Tumors of the submandibular gland]

The authors have analyzed 148 cases with submandibular gland tumors treated surgically in ENT Department of County Hospital Nr 1 in Rzeszów from 1974 to 1994. Inflammatory tumors occurred in 123 (83%) patients, in this number non-specific inflammation caused by calculi occurred in 120 (97.5%) patients and specific inflammations (tuberculosis) in 3 (2.5%) ones. Neoplastic tumors occurred in 14 (56.0%) patients and non-malignant in 11 (44.0%) patients. Among malignant tumors adenoid cystic carcinoma occurs most frequently (8 cases, 57%), whereas among non-malignant ones pleomorphic adenoma is most frequent (10 cases, 91%).

[Effects of TNM extension and histopathological type of the tumor on long-term survival rates of parotid and submandibular gland cancer]

The effects of TNM extension and histopathological type of the tumor on 5 and 10-year survival rates were analysed in 1,147 cases of parotid cancer and 271 cases of submandibular gland cancer which had been registered from 152 institutes throughout Japan since 1978. Advance of stage decreased the prognosis significantly, and the decrease was more pronounced in submandibular gland cancer. Facial paralysis also decreased the prognosis of parotid cancer significantly. The prognosis was also affected significantly by the histopathological type of the tumor. The 5-year survival rates of adenocarcinoma, epidermoid carcinoma and undifferentiated carcinoma were only about 30% in parotid cancer and about 20% in submandibular gland cancer. In treatment of salivary gland cancer, the therapeutic approach should be individualized in accordance with the tumor extension and its histopathological type. Improvement of accuracy in preoperative diagnosis of salivary gland cancer is of the utmost importance.

Salivary duct carcinoma: clinical characteristics and treatment strategies

BACKGROUND

Salivary duct carcinoma (SDC) is a highly malignant tumor of the salivary gland.

METHODS

Twenty-six cases observed during the period 1975 to 1994 were selected from the pathology archives of the Instituto Nazionale Tumori of Milan. A review of all the similar cases published in the literature and comparison with the present series was performed.

RESULTS

SDC was mainly a parotid gland tumor diagnosed at an advanced stage. Lymphatic involvement seems to be related to T stage. Distant spread was evidently related to the presence of lymph node metastasis. Surgery with radiotherapy was the standard treatment. The only demonstrable negative prognostic factor was the presence of node metastases (p = 0.01).

CONCLUSIONS

Most patients died of disseminated disease in spite of an aggressive and often successful local-regional treatment. The role of a prophylactic ipsilateral neck dissection and adjunctive systemic treatment should be investigated.

[Relationship between c-erbB-2 oncoprotein expression and prognosis in salivary gland malignant pleomorphic adenoma]

A monoclonal antibody AB-3 has been used immunohistochemically in a retrospective study of formalin-fixed paraffin embedded tissues of the salivary gland malignant pleomorphic adenomas (MPA). Positive staining was found in 25/60 (41.67%) of MPA. c-erbB-2 oncoprotein expression of the postoperative recurrent MPA group was higher than that of non-recurrent MPA group (P < 0.05). The postoperative 5-year survival rate of MPA with c-erbB-2 expression was considerably lower than that of without expression (P < 0.01). This observation indicates that c-erbB-2 oncoprotein expression may be an useful prognostic indicator in MPA.

[TNM classification system in cancer of the submandibular gland--a comprehensive retrospective study of 271 primary cases]

A total of 271 patients with submandibular gland cancer, treated in 149 hospitals in Japan in the period from 1958 to 1991, were retrospectively studied with regard to age, sex, TNM classification (UICC 1987, Geneva), histological diagnosis, therapeutic method and prognosis. The results were the following: 1. 157 males and 114 females 2. Stage I: 52 cases (19%); stage II: 64 cases (24%); stage III: 52 cases (19%) and stage IV: 103 cases (38%). 3. T1: 29 cases (11%); T2:116 cases (43%); T3: 93 cases (30%) and T4: 43 cases (16%). 4. Cervical lymph node involvement: 40%, ranging 25% in adenoid cystic carcinoma and acinic cell tumor, to 62% in undifferentiated carcinoma. 5. Distant metastasis: 11% 6.

HISTOLOGY

adenoid cystic carcinoma 37%, adenocarcinoma 20%, mucoepidermoid tumor 16%, carcinoma in pleomorphic adenoma 10%, epidermoid carcinoma 10%, undifferentiated carcinoma 3%, acinic cell tumor 3%. 7. Treatment method: Surgical procedure alone; 51%, Combination of surgery and postoperative radiation; 18%. 8. 5-year and 10-year survival rates were 36% and 11%, respectively. 9. 5-year and 10-year survival rates varied according to the stages, being 76% and 38%, respectively, for stage I, 68% and 20%, respectively, for stage II, 15% and 10%, respectively, for stage III, and 14% and 4%, respectively for stage IV.

Flow cytometric DNA content of adenoid cystic carcinoma of submandibular gland. Correlation of histologic features and prognosis

Flow cytometric analysis of nuclear DNA content was performed in 26 adenoid cystic carcinomas of the submandibular gland using archived, paraffin-embedded tissues. The DNA content was compared with multiple histologic parameters and clinical course. Ten carcinomas (38%) were aneuploid and 16 (62%) diploid. Aneuploid carcinomas demonstrated a higher frequency of solid cytoarchitecture, lymph node metastases, and advanced clinical stage, as compared with diploid carcinomas. Other histologic features predicting aggressive clinical behavior also correlated with abnormal DNA content and included invasion of nerves larger than 0.25 mm and intravascular extension. Our data suggest that DNA content analysis can be an effective objective parameter in the clinicopathologic assessment of adenoid cystic carcinoma.

Submandibular gland tumors. Adverse histologic factors and therapeutic implications

We reviewed our 41-year experience with tumors of the submandibular gland to determine what factors influence outcome and their implications for treatment. The most common benign neoplasm was pleomorphic adenoma (21), while among malignant tumors the adenoid cystic variety (37) predominated. For the 86 patients who had malignant tumors, the 2- and 5-year survivals by the life table method were 82% and 69%, respectively. For patients with malignant tumors, histology, size, perineural invasion, and prior treatment did not affect overall survival. Factors adversely affecting outcome were extraglandular soft-tissue extension and lymph node metastasis. Local-regional control was enhanced in patients with soft-tissue extension if they were treated by surgery followed by radiotherapy rather than by surgery alone.

[Radiotherapy in the treatment of carcinoma of the major salivary glands]

The authors conducted a retrospective study on 99 patients with malignant tumors of the major salivary glands, who had been treated by radiotherapy between 1976 and 1986: 86 cases of parotid tumors and 13 cases of submandibular gland tumors. Only 28 tumors (28%) were T1-T2, N0-N1. Local control, 3-5 and 8-year survival rates, and complications were considered. Radiation therapy alone was performed on 19 patients (19%), while combined surgical and radiation therapy was performed on 80 patients (80%). The results of radiation therapy alone and combined with surgery are discussed. Loco-regional disease control was obtained in 9 out of 19 patients (47%) by irradiation alone, and by combined irradiation and surgery in 60 out of 80 cases (75%). Distant metastases developed in 23 out of 99 patients (23%). Loco-regional metastases were the most frequent cause of death (20 out of 55 cases: 36%). Severe complications were extremely rare. The results demonstrate not only the advantages of combined treatment but also the value of radiotherapy alone in the treatment of tumors of the major salivary glands.

Small cell carcinoma of the major salivary glands

Small cell carcinoma is primarily a pulmonary neoplasm that rarely arises in extrapulmonic sites including salivary glands of the head and neck. Twelve cases of small cell carcinoma of salivary gland origin were retrieved from the Armed Forces Institute of Pathology files. Six tumors occurred in the parotid gland and six in the submandibular gland. Tumors were classified into two categories: those with areas of histologically typical small cell carcinoma (7 cases) and those with areas of typical small cell carcinoma with foci of ductal differentiation (5 cases). Follow-up information was available in all 12 cases. Electron microscopy was done on eight tumors; only one demonstrated round electron dense intracytoplasmic neurosecretory granules. These observations further support evidence in the literature suggesting most of the small cell carcinomas of salivary gland origin are not true neuroendocrine ("oat cell") carcinomas, but actually are small cell ductal carcinomas. These tumors appear to have a better prognosis than small cell carcinoma of the lung or nonsalivary gland sites in the head and neck region, with an estimated 2- and 5-year survival of 70 and 46%, respectively.

Lymphomas of salivary glands

Primary lymphomas arising in salivary glands are very uncommon. The histologic classification of 40 cases of lymphomas in salivary gland tissue submitted to the British Salivary Gland Tumour Panel is reported, and, for 30 of the patients for whom adequate information was available, the clinical presentation, management, and outcome have been analyzed. Lymphomas in salivary glands represented 1.7% of all reported salivary neoplasms. The majority developed in the parotid glands of patients aged between 50 and 70 years. Only four cases gave a premorbid history compatible with sicca syndrome. In this series, non-Hodgkin's lymphomas predominated; 23 were Grade I, and 13 were Grade II. Treatment regimens were not uniform, but are outlined. Survival ranged from 5 to 111 months. Median survival for the group was 49 months. Prognosis was not influenced by the clinical stage of disease at presentation. Four cases of lymphoma arising in benign lymphoepithelial lesions are included. None had clinical symptoms of sicca complex. Prognosis for this group was found to be as favorable as the others.

Salivary neoplasms: overview of a 35-year experience with 2,807 patients

We have reviewed a 35-year experience with 2,807 patients treated for salivary tumors which arose in the parotid gland (1,695 patients; 70%), submandibular gland (235 patients; 8%), and seromucinous glands of the upper aerodigestive tract (607 patients; 22%). Pleomorphic adenomas comprised 45% of the total, most of which occurred in the parotid gland. The clinical findings and the distribution of patients according to the histology and the site of origin are summarized. Treatment was surgical and the resection was conservative when possible, depending upon the extent of the tumor. The impact of site, histology, grade, and tumor stage on the results is shown.

Childhood rhabdomyosarcomas of the head and neck. 2 Case reports on salivary glandular and paraglandular involvement

Rhabdomyosarcoma is an uncommon, aggressive soft tissue malignant tumor, more often seen in children than in adults. During the past 32 years (1949-1980), 48 cases have been diagnosed at the Montreal Children's Hospital of which 20 have involved the head and neck. Recently, two cases involving the salivary glandular and paraglandular tissue were treated. At the present time, the combination of surgery, radiation therapy, and chemotherapy are proving superior to any one modality by itself and have eliminated the necessity of mutilating surgery. Recently, five year survival rates of 75% have been reported.