Benign Pleomorphic Adenoma Research Articles

Benign metastasizing tumor or benign epithelial inclusion in the node: A diagnostic dilemma

Generally metastasis implies malignancy, but there are some benign tumours which can also metastasize to lymph nodes, bone, and kidney. The benign tumours which can metastasize includes pleomorphic adenoma, leiomyoma, giant cell tumour of bone and meningioma. A 27 years old female presented to the cytology clinic with the submandibular swelling for past 3 months. Patient is a known case of pleomorphic adenoma post-surgery in the same region 6 years back. On examination two nodular swelling each measuring 1 x 1 which is firm mobile near scar site and left level III lymph node region. A non-guided fine needle aspiration cytology was performed from both the swelling. The Papanicolaou- and May-Grünwald Giemsa-stained smears from both sites showed features of pleomorphic adenoma. The interesting aspect of this article is cytological diagnosis of benign pleomorphic adenoma metastasizing to lymph nodes which is a rare entity.

Multispectral optoacoustic tomography of benign parotid tumors in vivo: a prospective observational pilot study

Parotid lumps are a heterogeneous group of mainly benign but also malignant tumors. Preoperative imaging does not allow a differentiation between tumor types. Multispectral optoacoustic tomography (MSOT) may improve the preoperative diagnostics. In this first prospective pilot trial the ability of MSOT to discriminate between the two most frequent benign parotid tumors, pleomorphic adenoma (PA) and Warthin tumor (WT) as well as to normal parotid tissue was explored. Six wavelengths (700, 730, 760, 800, 850, 900 nm) and the parameters deoxygenated (HbR), oxygenated (HbO2), total hemoglobin (HbT), and saturation of hemoglobin (sO2) were analyzed. Ten patients with PA and fourteen with WT were included (12/12 female/male; median age: 51 years). For PA, the mean values for all measured wave lengths as well as for the hemoglobin parameters were different for the tumors compared to the healthy parotid (all p < 0.05). The mean MSOT parameters were all significantly higher (all p < 0.05) in the WT compared to healthy parotid gland except for HbT and sO2. Comparing both tumors directly, the mean values of MSOT parameters were not different between PA and WT (all p > 0.05). Differences were seen for the maximal MSOT parameters. The maximal tumor values for 900 nm, HbR, HbT, and sO2 were lower in PA than in WT (all p < 0.05). This preliminary MSOT parotid tumor imaging study showed clear differences for PA or WT compared to healthy parotid tissue. Some MSOT characteristics of PA and WT were different but needed to be explored in larger studies.

Expression of FOXI1 and POU2F3 varies among different salivary gland neoplasms and is higher in Warthin tumor

PurposeSalivary gland tumors are histologically diverse. Ionocytes and tuft cells, rare epithelial cells found in normal salivary glands, might be associated with salivary tumors. Here, we explored the expression of FOXI1 and POU2F3, master regulators of ionocytes and tuft cells, respectively, for common salivary neoplasms using immunohistochemistry.MethodsWe analyzed normal salivary tissues and nine salivary gland tumors; Warthin tumors (WT), pleomorphic adenomas (PA), basal cell adenomas, and oncocytomas were benign, whereas mucoepidermoid, adenoid cystic, acinic cell, salivary duct carcinomas, and polymorphous adenocarcinomas were malignant.ResultsNormal salivary glands contained a few FOXI1- and POU2F3-positive cells in the ducts instead of the acini, consistent with ionocytes and tuft cells, respectively. Among the benign tumors, only WTs and PAs consistently expressed FOXI1 (10/10 and 9/10, respectively). The median H-score of WTs was significantly higher than that of PAs (17.5 vs. 4, P = 0.01). While WTs and PAs harbored POU2F3-positive cells (10/10 and 9/10, respectively), the median H-score was higher in WTs than in PAs (10.5 vs 4, respectively). Furthermore, WTs exhibited a unique staining pattern of FOXI1- and POU2F3-positive cells, which were present in luminal and abluminal locations, respectively. Whereas none of the malignant tumors expressed FOXI1, only adenoid cystic carcinoma consistently expressed POU2F3 (5/5), with a median H-score of 4.ConclusionThe expression patterns of the characteristic transcription factors found in ionocytes and tuft cells vary among salivary gland tumor types and are higher in WT, which might be relevant for understanding and diagnosing salivary gland neoplasms.

Never too young for a salivary gland carcinoma ex-pleomorphic adenoma

BackgroundCarcinoma ex-pleomorphic adenoma (CXPA) can either arise primarily as a de novo or from the malignant transformation of a benign pleomorphic adenoma (PA). CXPA mostly occurs in adults aged 50 to 70 years; hence, the occurrence of CXPA in younger ages is not common.Case presentationWe report a 27-year-old female who had a history of submandibulectomy for pleomorphic adenoma, and presented with recurrent left submandibular swelling for 4 months. The mass was rapidly increasing in size and was associated with occasional throbbing pain. Examination showed a multilobulated, firm left submandibular swelling with no overlying skin changes. FNAC was performed twice, by conventional and ultrasound-guided techniques, and both concluded as benign salivary gland tumours. CT scan and MRI revealed a well-demarcated tumour with an area of necrosis within, with no obvious invasion into surrounding soft tissue and no significant lymphadenopathy. Having high suspicion of a malignant transformation, the tumour was resected with a concurrent modified radical neck dissection. The histopathological examination confirmed a carcinoma ex-pleomorphic adenoma with the myoepithelial malignant component. The patient subsequently received adjuvant radiotherapy. This case demonstrated that CXPA, although rare, can occur in young adults. Pre-operative FNAC and radiological imaging may mimic a pleomorphic adenoma.ConclusionThe presence of recurrent tumours with rapid growth should alarm the clinician about a possible malignant transformation of a benign parotid tumour.

Risk of Carcinoma in Pleomorphic Adenomas of the Parotid

Surgery is the mainstay of treatment for pleomorphic adenomas (PAs) of the parotid to prevent further growth and potential future malignant transformation. While historical case series have reported transformation rates as high as 10%, there is a lack of contemporary methodologically sound data. To examine the rate of carcinoma ex pleomorphic adenoma (CXPA) detection in untreated PAs and investigate factors associated with malignant neoplasm. This cohort study reviewed all cases of primary PAs managed at a quaternary referral center between December 1990 and January 2015. Patients whose clinical presentation was compatible with a primary benign PA and whose history indicated tumor duration of over 1 year were included. Data were analyzed from January to April 2023. Untreated PA. Rate of CXPA detection among untreated PAs and association of tumor duration with rates of CXPA detection. Pathology slides of patients who underwent surgery were reviewed by a single expert pathologist for the presence of CXPA. Univariable logistic regression was performed to evaluate possible factors associated with CXPA. A total of 260 patients (median age, 47 years [IQR, 38-60 years]; 174 [66.9%] female) had a median tumor duration of 3.2 years (range, 1-30 years; mean [SD], 5.7 [5.5] years). Patients were divided into 4 groups by tumor duration: 1 to 4 years (158 [60.7%]), 5 to 9 years (47 [18.1%]), 10 to 14 years (27 [10.4%]), and 15 to 30 years (28 [10.8%]). In 156 of 170 patients who underwent preoperative fine-needle aspiration (91.8%), a benign tumor was diagnosed; 5 of these patients (3.2%; 95% CI, 1.4%-7.3%) were later diagnosed with CXPA on pathology after eventual excision, and the rate of high grade CXPA was 1.3%. None of the patients had permanent facial nerve paralysis. Tumor size at presentation (odds ratio [OR], 1.66; 95% CI, 1.22-2.24) and incremental (per year) increase in age (OR, 1.04; 95% CI, 1.01-1.08) were found to be associated with CXPA, whereas tumor duration was not (OR, 1.00; 95% CI, 1.00-1.01). In this study, the rate of malignant neoplasm detection among initially untreated PA was 3.2%. The results suggest that tumor size and older age are associated with the development of CXPA, while tumor duration is not. Observation of PA for longer periods was not associated with serious permanent complications.

Basal cell adenoma and pleomorphic adenoma of the parotid gland: a single center experience.

Basal cell adenoma (BCA) and pleomorphic adenoma (PA) are among the most common benign neoplasms of the salivary glands. The aim of this study was to analyze and compare the diagnosis, treatment, and recurrence rate of these two different types of parotid benign tumors. A retrospective analysis of all cases of parotid gland BCA and PA surgically treated between January 1, 1990, and December 31, 2019, was performed at our university. A total of 349 patients were enrolled in the present study, 311 of which (89.1%) were affected by PA, and 38 patients (10.9%) by BCA. The most frequently performed surgery was partial parotidectomy for both groups (85.9% in PA and 65.8% in BCA). Perioperative complications - often transient and of short duration - occurred within 48 hours of surgery and were observed in 30.6% of PA patients and in 18.4% of BCA patients; furthermore, recurrences were noticed in 19 PA patients (6.2%) and in 3 BCA patients (7.9%) (rates in range with the available literature data). To the best of our knowledge, this study is one of the largest single-center series in the literature comparing diagnosis, treatment, recurrence rate and clinical-pathological features of two different types of benign parotid gland tumors, BCA, and PA.

Extracellular matrix remodelling and stiffening contributes to tumorigenesis of salivary carcinoma ex pleomorphic adenoma——A study based on patient-derived organoids

BackgroundSalivary carcinoma ex pleomorphic adenoma (CXPA) is defined as a carcinoma that develops from benign pleomorphic adenoma (PA). Abnormally activated Androgen signaling pathway and amplification of HER-2/neu(ERBB-2) gene are known to be involved in CXPA tumorigenesis. Recent progress in tumour microenvironment research has led to identification that extracellular matrix (ECM) remodelling and increased stiffness act as critical contributing role in tumour carcinogenesis. This study examined ECM modifications to elucidate the mechanism underlying CXPA tumorigenesis.ResultsPA and CXPA organoids were successfully established. Histological observation, immunohistochemistry (IHC), and whole-exome sequencing demonstrated that organoids recapitulated phenotypic and molecular characteristics of their parental tumours. RNA-sequencing and bioinformatic analysis of organoids showed that differentially expressed genes are highly enriched in ECM-associated terms, implying that ECM alternations may be involved in carcinogenesis. Microscopical examination for surgical samples revealed that excessive hyalinized tissues were deposited in tumour during CXPA tumorigenesis. Transmission electron microscopy confirmed that these hyalinized tissues were tumour ECM in nature. Subsequently, examination by picrosirius red staining, liquid chromatography with tandem mass spectrometry, and cross-linking analysis indicated that tumour ECM was predominantly composed of type I collagen fibers, with dense collagen alignment and an increased level of collagen cross-linking. IHC revealed the overexpression of COL1A1 protein and collagen-synthesis-related genes, DCN and IGFBP5 (p < 0.05). Higher stiffness of CXPA than PA was demonstrated by atomic force microscopy and elastic imaging analysis. We utilized hydrogels to mimic ECM with varying stiffness degrees in vitro. Compared with softer matrices (5Kpa), CXPA cell line and PA primary cells exhibited more proliferative and invasive phenotypes in stiffer matrices (50Kpa, p < 0.01). Protein-protein interaction (PPI) analysis of RNA-sequencing data revealed that AR and ERBB-2 expression was associated with TWIST1. Moreover, surgical specimens demonstrated a higher TWIST1 expression in CXPA over PA. After knocking down TWIST1 in CXPA cells, cell proliferation, migration, and invasiveness were significantly inhibited (p < 0.01).ConclusionDeveloping CXPA organoids provides a useful model for cancer biology research and drug screening. ECM remodelling, attributed to overproduction of collagen, alternation of collagen alignment, and increased cross-linking, leads to increased ECM stiffness. ECM modification is an important contributor in CXPA tumorigenesis.

Transcervical Approach in a Thrice Recurrent Parapharyngeal Space Tumor.

Parapharyngeal space tumors are rare and account for 0.5% of all head and neck tumors. Most of them are benign (95%), of which pleomorphic adenomas of the salivary gland are the most common. Due to their anatomical location, gaining surgical access while avoiding postoperative morbidity is the main limitation. We present the case of a 35-year-old male with a history of three transcervical resections of benign pleomorphic adenomas in the parapharyngeal space within the deep lobe of the parotid gland. The patient has been followed for more than ten years and maintains an adequate quality of life.

Modified transoral approach for excision of parapharyngeal pleomorphic adenoma

Parapharyngeal space (PPS) tumours are rare, usually benign pleomorphic adenomas (PSA),1,2 which can arise from the deep lobe of the parotid or minor salivary glands. Their surgical management is often challenging owing to difficulty of access and proximity of vital structures. Options for the approach include transoral, transcervical, transparotid, and combined methods with or without mandibulotomy, robotic, or endoscopic techniques.

Modern Outcomes of Pediatric and Young Adult Patients with Parotid Gland Tumors Treated with Highly-Conformal Radiation Therapy

<h3>Purpose/Objective(s)</h3> Parotid tumors in the pediatric and young adult (PYA) population are a rare entity with a paucity of data available regarding treatment outcomes and toxicities. Most reports are long-term results of small series of patients treated with a wide variety of historical techniques. We aim to report our experience with modern highly-conformal radiation techniques for this unique population. <h3>Materials/Methods</h3> IRB approved retrospective review of 9 PYA patients (defined as age 0-25 at diagnosis) with parotid tumors treated with radiation therapy (RT) at one institution. Tumor characteristics, treatment modality, disease status, dosimetry, and acute and late toxicities were collected from the medical record. <h3>Results</h3> Nine PYA patients (5 female, 4 male) with received RT for parotid gland tumors from 2015-2022. The median age at diagnosis was 22 years (range 12-24). Median follow up was 34.4 months from RT completion. No patient had metastasis at diagnosis. Tumor histologies were: 4 mucoepidermoid carcinomas (n=1 sclerosing subtype); 1 acinic cell carcinoma, 1 adenocarcinoma, 1 NUT midline carcinoma, and 2 benign recurrent pleomorphic adenomas. All underwent total parotidectomy before RT. Three had disease involving only the deep lobe, 3 had only superficial involvement, and 3 had multifocal disease. Six patients underwent unilateral neck dissection at the time of parotidectomy; only 1 patient with a malignant tumor did not. Three patients had lymph node positive disease. The median time from surgery to RT was 6.7 weeks (range 4.7-10.7). Seven patients were treated using intensity modulated proton RT (IMPT), 1 started with intensity modulated RT (IMRT) for the first 20 of 30 fractions (fx) and transitioned to IMPT, and 1 was treated with IMRT alone. The most common dose and fractionation was 60 Gy in fx (n=7). One patient was treated using 66 Gy in 33 fx and n=1 with recurrent unresected gross disease received 69.96 Gy in 33 fx. The most common acute toxicities were grade 1-2 xerostomia, RT dermatitis, mucositis, alopecia, dysgeusia, and fatigue. No patient required a feeding tube or hospitalization during RT. One patient with NUT midline carcinoma histology received concurrent chemotherapy with cisplatin and etoposide. The most common late toxicities were grade 1-2 trismus, RT fibrosis, alopecia, lymphedema, and hearing loss. Two patients required thyroid supplementation after completing treatment – both received IMRT. There were no reported instances of osteoradionecrosis or extensive dental caries. All patients were alive at the time of data collection. There were no locoregional recurrences, and one patient (NUT midline carcinoma) developed distant metastatic disease. <h3>Conclusion</h3> Highly conformal proton/IMRT following surgical resection provides excellent local control with an acceptable toxicity profile for PYA patients with parotid gland tumors.

Distinct histone H3 modification profiles correlate with aggressive characteristics of salivary gland neoplasms

Post-translational modification of histones is the crucial event that affect many tumor-specific traits. A diverse type of histone modifications had been reported in different cancers with prognostic implications. This study aimed to examine the degree of histone H3 modifications in salivary gland neoplasms and their associations with tumor pathologic characteristics and proliferative activity. The expression of H3K9Ac, H3K18Ac, H3K9Me3 and Ki-67 in 70 specimens of salivary gland neoplasms, consisting of 30 mucoepidermoid carcinoma (MEC), 20 adenoid cystic carcinoma (ACC) and 20 pleomorphic adenoma (PA), were investigated immunohistochemically. The immunohistochemical scoring of 3 histone modification types and Ki-67 labeling index were determined. Overall, MEC demonstrated elevated H3K9Ac level compared with benign PA. Increased H3K9Me3 in MEC was positively correlated with small nest invasion at tumor front, advanced pathologic grade, and elevated proliferative index. In addition, the significant upregulation of all 3 types of histone H3 modification was noted in solid subtype of ACC and associated with increased cell proliferation. This study indicates that salivary gland neoplasms differentially acquire distinct patterns of histone H3 modification, which impact prognostically relevant cancer phenotypes. The hyperacetylation and methylation of histone H3 could be underpinning the prognostically worsen solid type of ACC, and the trimethylation of H3K9 may be involved in aggressive characteristics of MEC.

CARCINOMA EX PLEOMORPHIC ADENOMA FROM PALATAL MINOR SALIVARY GLAND: A CASE REPORT

Carcinoma ex pleomorphic adenoma is a high-grade salivary gland cancer in which malignant transformation occurs in a previously benign pleomorphic adenoma. A 56-year-old woman attended the Hospital Dental Center presenting an exophytic sessile nodule on the hard palate. She had been diagnosed with a pleomorphic adenoma in this region a year prior. Computed tomography revealed a hypodense image in the left region of the hard palate. Microscopic examination demonstrated a neoplasm composed of epithelial and myoepithelial cells, organized in ductal structures, cords, and nests. Islands with epithelial cells, presenting nuclear pleomorphism, clear cells, and cystic spaces bounded by mucous cells characterized the malignant component. Keratin pearls were also present in the center of some islands. The specimen's margins were compromised. A final diagnosis of carcinoma ex pleomorphic adenoma was obtained. The patient was referred for removal of surgical margins and remains to undergo clinical follow-up.

Proteomics Study of Mesenchymal Stem Cell-Like Cells Obtained from Tumor Microenvironment of Patients with Malignant and Benign Salivary Gland Tumors.

Objective Salivary gland tumors (SGTs) show some aggressive and peculiar clinicopathological behaviors that might be related to the components of the tumor microenvironment, especially mesenchymal stem cells (MSCs)-associated proteins. However, the role of MSCs-related proteins in SGTs tumorigenesis is poorly understood. This study aimed to isolate and characterize MSCs from malignant and benign tumor tissues and to identify differentially expressed proteins between these two types of MSCs. Materials and Methods In this experimental study, MSC-like cells derived from benign (pleomorphic adenoma, n=5) and malignant (mucoepidermoid carcinoma, n=5) tumor tissues were verified by fluorochrome antibodies and flow cytometric analysis. Differentially expressed proteins were identified using two-dimensional polyacrylamide gel electrophoresis (2DE) and Mass spectrometry. Results Results showed that isolated cells strongly expressed characteristic MSCs markers such as CD44, CD73, CD90, CD105, and CD166, but they did not express or weakly expressed CD14, CD34, CD45 markers. Furthermore, the expression of CD24 and CD133 was absent or near absent in both isolated cells. Results also discovered overexpression of Annexin A4 (Anxa4), elongation factor 1-delta (EF1-D), FK506 binding protein 9 (FKBP9), cytosolic platelet-activating factor acetylhydrolase type IB subunit beta (PAFAH1B), type II transglutaminase (TG2), and s-formylglutathione hydrolase (FGH) in MSCs isolated from the malignant tissues. Additionally, heat shock protein 70 (Hsp70), as well as keratin, type II cytoskeletal 7 (CK-7), were found to be overexpressed in MSCs derived from the benign ones. ConclusionMalignant and benign SGTs probably exhibit a distinct pattern of tissue proteins that are most likely related to the metabolic pathway. However, further studies in a large number of patients are required to determine the applicability of identified proteins as new targets for cancer therapy.

A Clinicopathological Analysis of 75 Salivary Gland Tumors at Mayo Hospital, Lahore

Aim: To describe the clinic-o-pathological pattern of patients presented with salivary gland tumors at Department of Maxillofacial surgery Mayo hospital Lahore during time period of one year from 1st January 2019 to 31st December 2019. Methods: This was a retrospective cross-sectional study conducted at Department of Oral and Maxillofacial Surgery, Mayo Hospital Lahore. 75 cases of Salivary gland tumors in the head and neck region were identified. Patient’s medical record and pathology reports were retrieved and carefully reviewed by a senior doctor to collect basic demographic data as well as tumor related information. Data entry and analysis was done with the help of SPSS version-26. Chi Square Test/Fisher exact test was applied to see the association between qualitative variables. Results: In this study Mean age of patients in this study was 40.45±13.18. Male patients were predominant as compared to female patients; Male 53.3% &amp; Female 46.7%.The most frequent tumor among patients was Pleomorphic Adenoma (61.3%) followed by Adenoid Cystic Carcinoma (17.3%), Mucoepidermoid Carcinoma (13.3%), Warthin’s Tumor (4%), Squamous cell Carcinoma of Parotid (2.7%) and adenocarcinoma (1.3%) respectively. However no significant association was seen between salivary gland tumors with age and gender of patients (p-value=0.521). Conclusion: Among the benign salivary gland tumors pleomorphic adenoma is the most common tumor whereas among malignant salivary gland tumors adenoid cystic carcinoma is the most frequent occurring tumor. Keywords: Salivary gland Tumors, Maxillofacial Surgery, Pathological Pattern,

Clinical Diagnostic Application of Contrast-Enhanced Ultrasound in Focal Lesions of the Salivary Glands.

To evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for focal benign and malignant lesions of the salivary glands, as well as for common benign lesions. A total of 91 patients with focal lesions of the salivary glands were included in this study. In this study, CEUS was used to study the differential diagnosis of focal benign and malignant lesions of the salivary gland and the most common benign tumors, that is, pleomorphic adenoma (PA) and adenolymphoma. The differences between focal benign and malignant lesions in the salivary glands were statistically significant (P <.05) in terms of qualitative CEUS indicators, enhancement pattern, enhancement homogeneity, enhancement margin, and enhanced lesion size, whereas the differences were not statistically significant (P >.05) in terms of wash-in and wash-out pattern, enhancement degree. Blurred margins and increased size of the lesion after enhancement are two CEUS features independently associated with focal malignant lesions of the salivary gland. The differences between salivary gland PA and adenolymphoma were statistically significant (P < .05) in terms of wash-in pattern, enhancement degree, enhancement homogeneity, and enhancement pattern, but not in terms of wash-out pattern, enhancement margin, and enhanced lesion size (P > .05). As an economical, convenient, and safe imaging method, CEUS has important clinical value in distinguishing benign and malignant salivary glands.

Characteristics and Outcomes of Parotid Gland Tumors in Adolescents.

Parotid tumors are rare neoplasms in adults but are exceedingly infrequent in adolescents. We aimed to determine the clinical characteristics and outcomes of parotid tumors in adolescents under 20years old. Between 1999 and 2020, 979 cases of benign parotid tumors and 236 cases of malignant parotid tumors were treated surgically in our department. Of these, 12 benign cases (1.2%) and 9 malignant cases (3.8%) were in adolescents. There were no benign or malignant cases for those aged under 10years. Regarding the histological type, all benign tumors were pleomorphic adenomas. About half of malignant tumors were mucoepidermoid carcinomas, and excluding one high-grade case, the grade of malignancy was all low/intermediate. The accuracy of fine-needle aspiration cytology among adolescents showed no significant difference with that of adults. In contrast to adults, adolescent benign tumor cases showed a markedly high rate of pleomorphic adenomas and no postoperative facial nerve palsy. Malignant tumors in adolescents had a different trend than adults; low/intermediate-grade malignancies were common and thus few symptoms/signs of malignancy could be observed. As well, the accuracy of fine-needle aspiration cytology was poor. All cases had a good prognosis and are disease-free survival. Parotid tumors in adolescents are rare but have several characteristics that are distinct from adults. As long-term observation is required posttreatment in adolescent patients, recurrence in benign pleomorphic adenomas and poor long-term prognosis in malignant tumors, especially for those with low/intermediate-grade malignancy, are more likely to be observed.

Extensive Sclerosis ("mummification") in Lacrimal Gland Pleomorphic Adenoma May Indicate Neighboring Malignant Transformation.

Salivary gland pleomorphic adenomas not uncommonly show extensive sclerosis ("dense hyalinization," "coagulative necrosis," or "mummification"), which arise spontaneously or after prior surgery, and this change is considered a high-risk factor for malignant transformation of benign salivary adenomas. While minor hyalinization is common in lacrimal gland adenomas, massive sclerosis-where almost all (90% or more) of the tumor is replaced by an amorphous hyaline material-is extremely rare. Four patients (2 males) are described in whom, despite not having an acute inflammatory episode, their lacrimal gland tumor showed marked sclerotic necrosis within the majority of either the benign or malignant parts of the tumor. Three tumors had evidence of malignant change, 2 to adenocarcinoma, and 1 to mucoepidermoid carcinoma, but none of the malignant areas showed perineural or endovascular invasion. Extensive sclerosis in association with a lacrimal gland pleomorphic adenoma (LGPA) is rare (4/110 of the cases) and-as with salivary adenomas-appears to be associated with a high chance of associated malignant change. Both the surgeon and the histopathologist should regard extensive sclerotic necrosis as a harbinger for malignant change in association with benign pleomorphic adenomas of the lacrimal gland.

The presence of herpesviruses in malignant but not in benign or recurrent pleomorphic adenomas.

The etiology of salivary gland tumors is mainly unknown. The anatomical location of the salivary glands, with the mucosal pathway to the oral cavity and its rich microbiome, raises the question of potential viral background. This study focuses on the potential presence of herpes-, polyoma- and parvoviruses in pleomorphic adenoma (PA), recurrent pleomorphic adenoma (RPA) and carcinoma ex pleomorphic adenoma (CaxPA). Thirty different viruses were analyzed by PCR-based assays in 68 formalin-fixed paraffin-embedded salivary gland tumors (25 PA, 31 RPA and 12 CaxPA). Virus DNA was detected altogether in 19/68 (28%) tumor samples. Human herpesviruses 6B and 7 (HHV-6B and HHV-7) and Epstein-Barr virus (EBV) were frequently and almost exclusively found in CaxPA (5/12, 7/12, and 3/12, respectively). Within the 7 CaxPA that were virus-positive, 3 samples contained 3, and 1 sample even 4, different viruses. Infrequent viral positivity was shown for parvovirus B19 and cutavirus, as well as Merkel cell and Malawi polyomaviruses. Our unexpected finding of herpesvirus DNA almost exclusively in CaxPA tissues deserves further in-depth studies.

Parapharyngeal carcinosarcoma treated with an endoscopic-assisted transcervical approach: a case report

: Primary tumors of the parapharyngeal space (PPS) are very rare, accounting for approximately 0.5–1.5% of all head and neck tumors. Most of them are benign lesions (80%) and pleomorphic adenoma is the most common, followed by neurogenic tumors. Multiple surgical approaches have been described, each one offering various functional outcomes, and the transcervical approach still represents the workhorse for head and neck surgeons confronting the PPS. Large tumors, or those located in the upper part of PPS, often require greater mobilization of neural and vascular structures, or combined routes with a mandibulotomy or an infratemporal fossa approach, therefore associated with considerable morbidity. In the present study we report the case of an 81-year-old woman with persistence of a PPS malignant tumor, after radiation treatment. A surgical resection via an endoscopic-assisted transcervical approach was performed. Complete tumour removal was obtained. No intra-, peri- or post-operative complications were reported. Histopathological findings were consistent with salivary carcinosarcoma. Routinely, PPS tumors are removed through the transcervical approach. Recently, several surgical minimal invasive approaches to PPS have been described, employing endoscopic and robotic assistance via transnasal and transoral windows. The endoscopic-assisted transcervical approach PPS allowed us to remove the tumor in conditions of good visualization, preventing neurovascular injuries and tumor spillage.

UNUSUAL LIP TUMORS: A CASE SERIES

<h3>Background</h3> The majority of isolated persistent lip swellings are attributed to mucoceles. However, minor salivary gland neoplasm must be included in the differential diagnosis, particularly with upper lip swellings. Benign pleomorphic adenomas are the most frequent labial mucosa neoplasm; however, other benign and malignant tumors may also develop in the lips. <h3>Objective</h3> To demonstrate the rare and unusual neoplasms that may present in this area. <h3>Methods</h3> Our 5-year retrospective review of oral pathology reports identified 8 unusual neoplasms within the labial mucosa. Clinical case note review was conducted to identify patient demographics, presenting complaints, medical and social histories, diagnoses, and treatment. <h3>Results</h3> The patients were aged from 8 to 73 years old. Clinically, all lesions were described as well-defined submucosal swellings; however, their sizes ranged from 2 mm to 15 mm. Common clinical differential diagnoses included mucocele and lipoma. The histopathologic diagnoses included 2 cases of schwannoma and 1 case each of basal cell adenoma, papillary cystadenoma, canalicular adenoma, granular cell tumor, and myxoid neurothekeoma. One malignant secretory carcinoma was also identified in a child. All lesions were excised and monitored postoperatively, with the malignant neoplasm requiring a second surgery to gain complete excision. <h3>Conclusions</h3> This review demonstrates the interesting and unusual pathologies that may arise within the labial mucosa. It highlights the importance of performing biopsy of persistent swellings in both adult and pediatric patients to confirm the diagnosis. Although rare, malignant minor salivary gland tumors can occur within labial mucosa, and early histopathological diagnosis and surgical removal can significantly improve prognosis.