Primary salivary gland-type tumor of the lung and bronchoscopic therapy. A valid option for lung parenchyma preservation? Case report

Primary pulmonary salivary gland-type tumours are rare neoplasms that are thought to arise from seromucinous glands that are located in the submucosa of large airways. These neoplasms have clinical and pathologic features that are distinct from other pulmonary neoplasms. The majority of primary pulmonary salivary gland-type tumours are malignant, with the most common entities being mucoepidermoid carcinoma, adenoid cystic carcinoma, and epithelial-myoepithelial carcinoma. Less commonly seen are myoepithelial carcinoma, hyalinizing clear cell carcinoma, acinic cell carcinoma, secretory carcinoma, salivary duct carcinoma, intraductal carcinoma, and polymorphous adenocarcinoma. Benign salivary gland-type tumours of the lung include pleomorphic adenoma and sialadenoma papilliferum. Morphologic, immunophenotypic, and molecular features of these neoplasms are largely similar to salivary gland tumours elsewhere, and therefore the exclusion of metastatic disease requires clinical and radiologic correlation. However, the differential diagnostic considerations are different in the lung. The distinction of salivary gland-type tumours from their histologic mimics is important for both prognostication and treatment decisions. Overall, salivary gland type-tumours tend to have a more favourable outcome than other pulmonary carcinomas, although high-grade variants exist for many of these tumour types. Recent advances in our understanding of the spectrum of salivary gland-type tumours reported in the lung and their diversity of molecular and immunohistochemical features have helped to refine the classification of these tumours and have highlighted a few differences between salivary gland-type tumours of the lung and those primary to other sites.

AN UNEXPECTED CAUSE OF HEMOPTYSIS: RARE TRACHEAL TUMOR

Introduction: Salivary gland tumors are a heterogeneous group of neoplasms that are relatively rare but represent a wide variety of both benign and malignant histopathologic subtypes. The aim of this study was to find out the histopathological distribution of primary salivary gland tumors and correlate fine needle aspiration cytology reports with histological findings.Materials and Methods: A total of 83 patients attending the otorhinolaryngology department with salivary gland tumors were enrolled in our study. The histopathological findings were reported and correlated with cytological findings.Results: The mean age of the patient with salivary tumors was 43.11 ± 13.02 years. Out of 83 cases, 3 (3.6%) patients were diagnosed as inflammatory lesions, 64 (77.1%) patients had benign salivary gland tumors and 16 (19.3%) of patients had malignant salivary glands tumors in histopathology. The sensitivity and specificity of FNAC in this series for detecting salivary gland malignancy were 68.8% and 98.5% respectively with an overall diagnostic accuracy of 92.8%. The most common salivary gland tumor was found to be pleomorphic adenoma (56.6%) and the most common malignant salivary gland tumor was found to be mucoepidermoid carcinoma (19.3%). The comparison of the incidence of salivary gland tumors in various age groups showed a statisticallysignificant difference (p=0.009). 
 Conclusions: Benign salivary tumors are more common than malignant tumors with the most common occurrence in parotid glands. Pleomorphic adenoma is the most common benign tumor whereas; mucoepidermoid carcinoma is the most common malignant tumor in patients visiting Nobel medical college.

Salivary gland tumors include a wide spectrum of histological subtypes and clinical behavior, which we aim to evaluate. We performed a retrospective study of all salivary gland tumors diagnosed and treated at the Centro HospitalarSão João, Porto, between 2005 and 2015. Histological re- evaluation was performed in all cases and patient files were reviewed andboth clinical and follow-up data were collected. Disease-free survival and overall survival were evaluated using Kaplan-Meier survivalcurves and compared using the Mantel-Cox log-rank test. The significance threshold was set at 0.05. We selected 295 cases, 150 males with a mean age at diagnosis of 50.4 (± 16.4) years. Primary benign epithelial tumors [n =228 (77.3%)] were mostly pleomorphic adenomas [n = 148 (64.9%)] and Warthin tumors [n = 61 (26.8%)]. Primary malignant epithelialtumors [n = 43 (14.8%)] included mucoepidermoid [n = 16 (37.2%)], adenoid cystic [n = 6 (14.0%)] and acinic cell [n = 5 (11.6%)]carcinomas; 32 (74.4%) in parotid, 2 (4.6%) in submandibular and 9 (21%) in minor salivary glands. Primary epithelial tumors weremore frequently malignant in minor (33.3%) than in major (13.9%) salivary glands. Local recurrence occurred in 30.2% and distantmetastases in 25.6% tumors. The mean disease-free interval was 26 (± 37.5) months; most metastases were in lung and centralnervous system. The 5 and 10 year disease-free survival rates were 63.4% and 50.1%, respectively; the 5 and 10 year disease-specificsurvival rates were 76.9% and 57.9%, respectively. Primary salivary tumors included also lymphomas [n = 8 (2.7%)] and soft tissuetumors [n = 5 (1.7%)]. Secondary tumors included metastases of carcinomas [n = 7 (2.4%)] and involvement by lymphoma [n = 1(0.3%)]. Our results concerning age, gender, histological subtype, frequency and clinical behavior of salivary tumors concurwith European studies. Divergence with Portuguese studies might be related with the inclusion criteria, clinical referral and time lagvariations. Although uncommon, salivary gland tumors occur in a wide age range and include histological subtypes with diverseprognosis.

Introduction:Natural killer (NK) cells, of which CD56 is a specific marker, play an important role in host defense against tumors. Cancer stem cells, of which aldehyde dehydrogenase isoform 1 (ALDH1) is an immunohistochemical marker, are a group of tumorigenic cells which are involved in migration and tumor recurrences. We aimed to evaluate the expression of ALDH1 and CD56 in common salivary gland tumors, as well as their relationship with each other and with a number of clinicopathologic factors.Materials and Methods:Forty-five paraffin blocks of salivary gland tumors (pleomorphic adenoma, mucoepidermoid carcinoma and adenoid cystic carcinoma, 15 samples each) were selected. Malignant tumors were classified into two groups: low-grade (including mucoepidermoid carcinoma grade I) and high-grade (including mucoepidermoid carcinoma grade III and adenoid cystic carcinoma). Immunohistochemical staining for ALDH1 and CD56 markers was performed. Data were analyzed using SPSS (20) and the Chi-square test.Results:CD56 expression was significantly higher in benign and high-grade malignant tumors (P=0.01). ALDH1 overexpressed in all three salivary tumors, but not to statistically significant degree (P=0.54). There was no statistically significant correlation between ALDH1 and CD56 expression with demographic factors (age, gender, or location of tumor; P>0.05).Conclusion:It appears that the number of NK cells and their function change in different types of salivary gland tumors (benign/malignant) and stroma. NK cells are important components of the anti-tumor system; therefore immune dysfunction is associated with tumor progression in tumors of the salivary gland. ALDH1 overexpression suggests its role in tumorogenesis, but ALDH1 is not involved in the morphogenesis of salivary gland tumors.

Primary salivary gland-type tumors of the tracheobronchial tree are rare; their cytologic features have been seldom reported. We aim to describe the clinical and cytomorphologic features of tracheobronchial salivary gland-type tumors diagnosed by transbronchial fine needle aspiration (TBNA) at our institution, and correlate the findings with a corresponding surgical specimen. We searched our laboratory information system to identify patients with a primary salivary gland-type neoplasm of the tracheobronchial tree diagnosed by TBNA and with a corresponding surgical pathology specimen, over 10 years. The study cohort consisted of 11 patients (7F/4M; mean age 58 years, range 41-78). Presenting symptoms included hemoptysis (4), cough (3), dyspnea (1), stridor (1), and shoulder pain (1). Most had a tracheal mass (5), while 3 had mainstem bronchi masses and 3 had lung masses. Radiographically, the masses were lobulated, rounded, or polypoid in six patients. All underwent TBNA with a 21- or 22-gauge needle and endobronchial biopsy. The most frequent diagnosis was adenoid cystic carcinoma (4/11, 36%), followed by mucoepidermoid carcinoma (3/11, 27%), epithelial-myoepithelial carcinoma (2/11, 18%), oncocytoma (1/11, 9%), and hyalinizing clear cell carcinoma, salivary gland type (1/11, 9%). The surgical pathology specimens confirmed the diagnosis in all cases. To our knowledge, this is one of the largest cytomorphologic studies of primary salivary gland tumors of the tracheobronchial tree in the literature. Salivary gland tumors of the tracheobronchial tree are rare, and recognizing cytomorphologic changes that occur in salivary gland-type tumors is important for establishing a definitive diagnosis.

Salivary gland-like tumors are extremely unusual in the breast, and their histology is very similar to primary salivary gland neoplasms. Mucoepidermoid carcinoma (MEC), a common salivary gland tumor, displays an infrequent occurrence in the breast, accounting for a mere 0.2-0.3% incidence. Given its rarity, it is critical to accurately distinguish it from metastatic cases before diagnosing it as a primary breast MEC for appropriate treatment. Currently, there is no consensus on the treatment of MEC, and there is a paucity of literature highlighting the ideal treatment modality, especially for estrogen receptor (ER)-positive cancers. Therefore, the aim of our case report was to underscore the diagnostic process, surgical and adjunctive treatments for our patient with ER-positive, progesterone receptor (PR)-negative and human epidermal growth factor receptor 2 (HER2)-negative MEC while also conducting a literature review to contribute to the limited existing data. A 67-year-old African American woman presented with a lobulated 3.1-cm left breast mass on mammography, for which she underwent ultrasound-guided core needle biopsy that revealed invasive carcinoma with squamous differentiation. The carcinoma was ER-positive, PR-negative and HER2-negative. Subsequently, she underwent a lumpectomy with sentinel lymph node biopsy. Her final pathology revealed an intermediate-grade MEC with negative lymph nodes. She had a past medical history of benign salivary gland tumor, as well as a family history of BReast CAncer gene 1 (BRCA1)-associated breast cancer in her daughter. MEC of the breast is a rare tumor with a relatively favorable overall prognosis. The early and precise diagnosis of this condition plays a pivotal role in formulating effective treatment strategies and ensuring positive survival rates. Nonetheless, future studies are recommended to further explore the role of surgical approaches and adjuvant therapy to improve treatment outcomes.

External Urethral Orifice Metastasis of Cervical Cancer Treated With Intraluminal Urethral Brachytherapy Using a Lumencath Applicator: The First Case Report

Our aim was to examine the outcome of patients treated with a planned gamma knife boost after completion of neutron radiotherapy for salivary gland neoplasms involving the base of skull. Thirty-four patients with salivary gland neoplasms involving the base of skull were treated from 2001 to 2005 at our institution. These results were compared with a similar historical group treated at our institution from 1984 to 2000. The patients had the following characteristics: median age: 54 years (range, 23-80); median follow-up period: 20.5 months (range, 4-55); women-to-men patient ratio: 1.1:1; histology: 29 adenoid cystic, 3 adenocarcinoma, 1 acinic cell, 1 mucoepidermoid; primary sites of disease: 6 nasopharyngeal, 14 paranasal sinuses, 4 parotid gland, 8 oral cavity, 1 lacrimal gland, and 1 auditory canal. All patients had gross residual disease at the time of treatment. The median neutron dose prescribed to isocenter was 19.2 nGy and the median dose to the effected temporal tip was 11.98 nGy. The median prescribed gamma knife dose was 12 Gy to the 50% isodose line. The median number of isocenters was 17. The median target volume treated was 12.4 cm3 (range, 1.9-28.9) with a median total volume treated of 18.3 cm3 (range, 5.9-53.9). The 24-month and 40-month Kaplan-Meier estimated local control was 82% versus 81% (24 months) and 82% versus 39% (40 months; p = .04) for the gamma knife treated group versus historical controls (n = 61). Two of the 4 failures in the gamma knife-treated group occurred outside the boosted area. Complications were no greater in the gamma knife-treated group than in those treated with neutron radiotherapy alone. Patients with primary salivary gland neoplasms that involve the base of skull and are treated with neutron radiotherapy alone are at high risk of local recurrence. A gamma knife boost improves local control and adds little additional toxicity. These preliminary results suggest that all patients with salivary neoplasms and base of skull invasion should be considered for a gamma knife boost after primary treatment with neutron radiotherapy.

A RIDDLE WRAPPED IN A MYSTERY: MUCOEPIDERMOID CARCINOMA (MEC) FOUND DURING EVALUATION OF PERSISTENT LUNG COLLAPSE

Introduction:Primary salivary gland-type tumors of the lung (PSGTTL) are rare intrathoracic malignant neoplasms. Their description in literature is largely limited to a few case series and case reports. A systematic review and pooled analysis of the previously reported cases of PSGTTL is presented here.Methods:Electronic database of PubMed using keywords “lung neoplasm” AND “salivary gland tumors” was used to identify the papers documenting the PSGTTL. Filters (publication date from January 1, 1900–-December 31, 2015, Humans and English) were applied to refine the search. A pooled analysis of clinical, pathological, treatment, and survival data was performed.Results:The present systematic review included 5 studies and a total of 233 patients. Mean age of the patients was 41 years (range 6–80 years) and there was a male preponderance (1.3:1). Common pathological types were mucoepidermoid (MEC) (56.6%), adenoid cystic (ACC) (39.5%), and epithelial-myoepithelial cancer (3.8%). Tumors were located in the central airways (trachea and major bronchi) in 43.3% of patients. Weighted median tumor size was 4.2 cm. Surgery was the primary treatment undertaken in 82.4% of the patients, while radiotherapy and chemotherapy were also used in 15.9% and 9.4% of the patients. Lymph node involvement was seen in 15.2% of the patients. Disease recurrences were observed in 21.1% of the patients (12.9% and 37.5% in MEC and ACC, respectively). Three-, 5-, and 10-year weighted overall survival was 86.4%, 81.4%, and 73.6% (93.8%, 90.0%, and 85.0%, respectively, for MEC and 76.7%, 62.8%, and 50.5%, respectively, for ACC).Conclusion:Surgery is the primary treatment of PSGTTL to achieve long-term survival. Role of chemotherapy and radiotherapy in the management of PSGTTL warrants further studies.

Primary Malignant Cardiac Tumors: A Rare Disease With an Adventurous Journey

P2.04-033 Primary Salivary Gland Tumors of the Lung: A Systematic Review and Pooled Analysis: Topic: Esophageal Cancer and Other Malignancies

Malignant salivary gland neoplasms are rare, representing approximately 3% to 7% of all head and neck cancers. Contrasting from the more common mucosal head and neck cancers, which, in general, are ascribed to excessive tobacco, alcohol use, and more recently to viral infection, specific carcinogenic factors for malignant salivary gland growths have not been as clearly identified. Histologically, they represent a heterogeneous group of tumors. Forty histologic types of epithelial tumors of the salivary glands have been reported; some are exceedingly rare and may be the topic of only a few case reports. Salivary tumors can arise in the major salivary glands or in one of the minor salivary glands (predominantly mucus secreting glands), which are distributed throughout the upper aerodigestive. Most patients who develop malignant salivary gland tumors are in the sixth or seventh decade of life. FNA should be considered as part of the diagnostic evaluation but due to its varying sensitivities and specificities imaging modalities such as ultrasound, CT scans, and MRI should also be used as diagnostic adjuncts. Surgery is the primary modality for management of these tumors, nontraditional surgical approaches and instrumentation, as well as facial nerve monitoring, can be selectively utilized to try and decrease the morbidity associated with these surgical procedures. Adjuvant treatment is primarily achieved with radiation therapy. Chemotherapy continues to have a palliative role in the management of salivary gland tumors; however, research in this field is trying to identify a therapeutic role for chemotherapy in order to improve overall survival.

Background: Studies on the incidence of salivary tumors around the world showed variations, including in Iraq. This study was intended to evaluate the relative incidence of these tumors among the Iraqi population. Materials and methods: The current retrospective study encompassed 109 cases retrieved from the file records of the pathology laboratory of Baghdad Medical City over a five-year period from January 2017 to December 2021. Information regarding age, gender, site, and tumor type was assembled and analyzed using a statistical package for social sciences (SPSS version 20). Results: The present study documented that salivary gland tumors represent 1.35% of the total sample studied. Approximately 56% were benign and 44% were malignant, with a ratio of benign to malignant was 1.27/1. The male-to-female ratio was 1/1. The prevalent benign tumor was pleomorphic adenoma, followed by Warthin's tumor. Warthin's tumor showed a predilection for male patients. The most common sites were the parotid gland (50%), palate (29%), and submandibular gland (10%), respectively. Regarding malignant tumors, adenoid cystic carcinoma ranked first followed by mucoepidermoid carcinoma. Conclusions: Salivary gland tumors chiefly arise in major salivary glands without sex predilection, with pleomorphic adenoma and adenoid cystic carcinoma being the most common salivary tumors.