Benign Salivary Gland Tumors Research Articles

LIPOMA IN THE MENTAL REGION: CASE REPORT

A 57-year-old male patient was referred with an asymptomatic swelling on the left-side lower labial mucosa for 3 years. He reported smoking 20 cigarettes per day for 17 years, with no other comorbidities. Clinical examination revealed a well-defined sessile nodule on the left side of the lower labial mucosa, with a soft consistency and a slightly yellowish color. Panoramic radiography showed no evidence of lesion. Diagnostic hypotheses included benign mesenchymal neoplasms and benign salivary gland neoplasms. Excisional biopsy of the lesion was performed, with histopathologic diagnosis of lipoma. After 6 months of follow-up the patient showed no signs of recurrence of the lesion. A 57-year-old male patient was referred with an asymptomatic swelling on the left-side lower labial mucosa for 3 years. He reported smoking 20 cigarettes per day for 17 years, with no other comorbidities. Clinical examination revealed a well-defined sessile nodule on the left side of the lower labial mucosa, with a soft consistency and a slightly yellowish color. Panoramic radiography showed no evidence of lesion. Diagnostic hypotheses included benign mesenchymal neoplasms and benign salivary gland neoplasms. Excisional biopsy of the lesion was performed, with histopathologic diagnosis of lipoma. After 6 months of follow-up the patient showed no signs of recurrence of the lesion.

CANALICULAR ADENOMA: REPORT OF TWO CASES WITH UNUSUAL FINDINGS

Canalicular adenoma (CA) is a benign salivary gland tumor that most commonly affects the upper lip of older patients. We report 2 additional cases of CA with unusual clinical and microscopic findings. Case 1 is a 76-year-old woman presenting a painless bluish nodule of fibrous consistency and 3-month duration, covered by a smooth surface with telangiectatic small vessels and located in the buccal mucosa. Case 2 is a 65-year-old woman referred for evaluation of an asymptomatic normal-colored nodule of 6 months' duration in the upper lip mucosa. Excisional biopsy was performed and microscopically both cases showed monomorphic epithelial ductal cells arranged in anastomosing cords within vascular stroma, confirming the diagnosis of CA. Interestingly, the second case exhibited exuberant secretory areas and clusters of foam cells. No recurrence was observed after 6 months of follow-up. Buccal mucosa location, bluish coloration, and exuberant secretory areas are unusual findings occasionally observed in CA.

CLINICO-EPIDEMIOLOGICAL ASPECTS OF 562 SALIVARY GLAND TUMORS: A RETROSPECTIVE STUDY FROM A SINGLE BRAZILIAN INSTITUTION

<h3>Objectives</h3> The aim of this study was to review cases of benign and malignant salivary gland tumor (SGT) and correlate it with clinical and epidemiologic characteristics of affected patients. <h3>Study Design</h3> Clinical and epidemiologic data were obtained from medical records from 1993 to 2019 and tabled in a spreadsheet of the Microsoft Office Excel. <h3>Results</h3> Five hundred sixty-two SGTs were identified, among which most were classified as benign neoplasms. In general, tumors were more frequent in women than in men, with the parotid gland being the most affected site. The mean age of patients affected by malignant tumors was higher than that of patients with benign tumors. Pleomorphic adenoma (PA) and mucoepidermoid carcinoma were the most prevalent tumors in the benign and malignant groups, respectively. PA was the most common SGT. <h3>Conclusions</h3> Our results corroborate the literature and show that SGTs are rare, and benign tumors are more common than malignant tumors. The parotid gland remains the most affected gland and pleomorphic adenoma is the most prevalent neoplasm.

POLYMORPHOUS LOW-GRADE ADENOCARCINOMA: CASE REPORT

A 62-year-old White female patient presented to the stomatology clinic with a submucosal nodular lesion in a region of the lower right labial mucosa, asymptomatic, well delimited, circumscribed, movable, with a fibrous consistency, measuring 1 cm in diameter, with approximately 1 year of evolution. With the hypothesis of benign salivary gland neoplasm and benign mesenchymal neoplasm, an excisional biopsy was performed. Histologically, proliferation of cells organized in nests, ducts, and cords was observed, showing pale nuclei and evident nucleoli. The presence of mucous cells and cribriform areas and extracellular matrix, sometimes fibrous and other times hyaline, was noted. Immunohistochemically, cells were positive for cytokeratins 7 and 14, S-100, and p63 and focally positive for smooth muscle actin. The cell proliferation index measured by Ki-67 was less than 5%. In view of the clinical and microscopic characteristics, the diagnosis of low-grade polymorphous adenocarcinoma was closed. The patient was referred to the head and neck surgeon.

AN UNUSUAL INTRAORAL LIPOMA: A CASE REPORT

Intraoral lipoma is a relatively rare painless benign tumor derived from mesenchymal connective tissue. A 58-year-old White male patient in good health was examined for a slow growing painless nodule on the palate which had been present for 6 years. There were no changes in the extraoral clinical examination. The intraoral examination revealed a sessile nodule of soft consistency on the right side of the hard palate covered by an intact mucosa and measuring approximately 2 × 2 cm. Radiographic examination showed no signs of bone changes. The clinical differential diagnosis included benign salivary gland tumor and mesenchymal tumor. Excisional biopsy was performed under local anesthesia, and the surgical specimen was sent to an anatomic pathology laboratory. Microscopic examination showed collections of mature adipocytes and scarce fibrous connective tissue stroma. The diagnosis of lipoma was established. After 5 months of follow-up, satisfactory wound healing and no recurrences were detected.

APPROACH TO DIAGNOSIS OF A SALIVARY GLAND TUMOR OF THE HARD PALATE: CASE REPORT

Pleomorphic adenoma is a benign salivary gland tumor commonly found in the palate. The diagnosis may be challenging once the tumor exhibits a wide range of microscopic features. A 30-year-old man with a history of attention deficit and hyperactivity was referred for evaluation of a lesion on the right side of the hard palate with 11 months of evolution. Intraoral examination revealed a painless submucosal nodule of fibroelastic consistency measuring about 1.5 × 1.0 cm. Computed tomography showed a well-defined hypodense image suggestive of benign tumor lesion, which caused slight erosion of the palatine bone. A biopsy was performed under local anesthesia and the histopathologic diagnosis was pleomorphic adenoma. The patient was then evaluated for conservative surgical excision of the tumor. Imaging and histopathologic findings are pivotal for the correct diagnosis and management of minor salivary gland tumors.

Serum metabolomics reveals an innovative diagnostic model for salivary gland tumors

An early diagnosis of salivary gland tumors (SGTs) and determination of their malignancy are conducive to developing individualized therapeutic strategies and thus improving prognosis. The aim of this study was to investigate the difference of serum metabolic profiles in patients with SGTs to better understand the mechanism of this disease and disease risk stratification. We used ultrahigh-performance liquid chromatography Q Exactive mass spectrometry and multivariate statistical analyses to conduct a comprehensive analysis of serum metabolites in a population with normal control and SGTs. 32 differentially expressed metabolites were identified, while the level of serine and lactic acid were investigated to gradually upregulate in benign SGTs and malignant SGTs. Then, the expression of serine and lactic acid were assessed in validation cohort using multiple reaction monitoring (MRM) based targeted metabolite analysis. A risk score formula based on the amount of serine and lactic acid was developed and explored to be significantly related to benign SGTs and malignant SGTs in discovery and validation cohort. Our work highlights the possible use of the risk score assessment based on the serum metabolites not only reveal in the early diagnosis of SGTs but also assist in enhancing current therapeutic strategies in the clinic.

Submandibular Gland Oncocytoma: A Rare Tumor Case Series-Its Diagnosis and Treatment Based on Clinicopathology.

Submandibular oncocytomas are rare benign salivary gland neoplasms, normally involves the parotid gland and few instances are stated in the submandibular gland region. As the clinical and histopathological features are overlapping to another salivary gland tumor like pleomorphic adenoma or warthin tumour, they are often misdiagnosed. They are typically found in patients aged 50-70years with no gender preference. The aim of this paper is to assess the clinicopathological functions, diagnostic standards and treatment of submandibular gland oncocytomas via a series of three case reports. We report a three case series of unilateral submandibular gland oncocytoma with female to male ratio 2:1, Size of tumor ranged from 1.8 to 10cm, 2 cases have painless swelling and one involved tender mass. FNAC and CT scan confirmed the presence of an oncocytoma. The patient underwent unilateral submandibular gland resection and on follow up no evidence of any recurrence was identified. Submandibular oncocytomas often present as solitary slow growing painless masses, which are firm on clinical examination. CT followed by fine-needle aspiration cytology (FNAC) would be the preferred diagnostic modalities. Due to its low rate of malignant transformation and recurrence, the best treatment is local resection with follow-up as necessary.

Ultrasonographic prediction model for benign and malignant salivary gland tumors: a preliminary study

To establish an ultrasonographic (US) prediction model for benign and malignant salivary gland tumors. We retrospectively analyzed the clinical data of 575 patients with salivary gland tumors. Patients were divided into benign (N=420) and malignant (N=155) tumor groups based on histopathologic results. The clinical and US features of the tumor groups were statistically compared. With histopathologic findings as the dependent variable and clinical and US features as independent variables, a multiple logistic regression model was established. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate its diagnostic efficacy. Statistically significant differences between tumor groups were discovered for patient age, tumor site, and the US features of tumor size, shape, and margins; posterior echo pattern; microcalcification, abnormal lymph nodes, and tumor vascularity. Individual US features had limited diagnostic value. The AUC, sensitivity, specificity, and accuracy values of the logistic regression equation were 0.893, 84.3%, 80.0%, and 83.1%, respectively. The diagnostic performance of the predictive model was significantly better than that of any single US factor. This suggests that establishment of multiple models based on US features can improve the accuracy of diagnosis of benign and malignant salivary gland tumors and can be applied clinically.

Clinicopathological Study of Salivary Gland Tumours

Background: Salivary gland tumours are relatively uncommon and constitute 3% to 10% of all head &amp; neck neoplasms. The majority of salivary gland tumours arise in the parotid gland.&#x0D; Objectives: To search the clinicopathological presentation of salivary gland tumours.&#x0D; Methods: This was a cross sectional study.&#x0D; Results: The highest incidence of benign tumors was in the 3rd and 4th decade, whereas for malignant tumor it was the 5thdecade of life. Among 47 male patients, 72.3% had benign and 27.7% cases had malignant tumours. Out of 40 female patients 45% cases had benign and 55% cases had malignant tumours. With overall male: female ratio was 1.2:1. Among parotid gland tumours 62.32% had benign and 37.68% cases had malignant tumours. Out of 12 submandibular gland tumours 41.67% cases had benign and 58.33% cases had malignant tumours. Among 35 malignant tumours, 12 Mucoepidermoid carcinoma, the majority occurred in the parotid gland 10(83.3%) followed by submandibular gland 1(8.3%) and minor salivary glands 1(8.3%). Out of 11 cases reported as Adenoid cystic carcinoma, the majority involved submandibular gland 6(54.5%) followed by parotid gland 4(36.4%).&#x0D; Conclusion: Benign salivary gland tumours are more common than malignant ones. There is male preponderance in the incidence of salivary gland tumours. Pleomorphic adenoma is the most frequently encountered tumour among all salivary gland tumours.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 96-102

Evaluating the results of the surgery of benign parotid tumors

Background: Benign tumors account for 80% of parotid salivary gland tumors, early diagnosis and effective treatment will contribute to reducing complications of surgery. Objective: To evalutate surgical results of benign parotid tumors on facial paralysis and other complications. Research Methodology: including 51 patients with benign parotid salivary gland tumors at Hue University of Medicine and Pharmacy Hospital from June 2019 to October 2021 were operated on and monitored for facial paralysis after 1 week, 1 month, 3 months, and 6 months according to the House-Brackmann facial nerve grading system and noted other complications. Results: Pleomorphic adenoma and Warthin tumors are the two most common types of benign tumors. The rate of facial paralysis at the time points after 1 week, 1 month, 3 months, and 6 months gradually decreased by 56.9%, 35.3%, 19.6%, 0%, respectively. Most temporary facial paralysis grade II (mild) and grade III (moderate) (classification of House - Brackmann). The surgical method was significantly related to facial paralysis (p &lt; 0.05). Other complications such as numbness around the ear, hemorrhage, sialocele, salivary fistula, depression of facial contour, bad scars. Nevertheless, no cases of tumor recurrence and Frey’s syndrome were recorded after 6 months. Conclusion: Surgery is an effective and safe treatment for benign parotid salivary gland tumors. Facial paralysis accounts for a high incidence after surgery, but it will fully recover after 6 months. Choosing the appropriate treatment method helps to minimize complications and recurrence after surgery of parotid salivary gland tumors. Key words: benign parotid tumors, facial paralysis, parotidectomy.

PLEOMORPHIC ADENOMA OF SUBMANDIBULAR SALIVARY GLAND - A CASE REPORT

Pleomorphic adenoma is a benign salivary gland neoplasm with its most common site of origin being the parotid gland, usually involving the superficial lobe of the parotid gland. Pleomorphic adenoma is a painless swelling which gradually increases in size if left untreated. It has a female predilection and occurs within the age range of 30-60 years. Here we report a rare case of a pleomorphic adenoma of the right submandibular gland presented by a 33 years old that was diagnosed using cytology, histopathology and managed by surgical excision.

Pleomorphic Adenoma of Palpebral Part of Lacrimal Gland: A Case Report

Pleomorphic adenoma is a benign salivary gland neoplasm most commonly seen in major salivary glands. It’s composed of several epithelial and myoepithelial tissue elements. Pleomorphic adenoma of the lacrimal gland is a rare entity and accounts for approximately 12–25% of all lacrimal tumours. Of these 90% are seen in the orbital part and only 10% are present in the palpebral part of the lacrimal gland. We present a case report of a 33 years old female with a complaint of painless swelling in the right upper eyelid which was gradually increasing in size. A provisional diagnosis of a lacrimal gland neoplasm was made. The lacrimal mass was resected with enbloc enucleation via supratarsal fold approach. On histopathaological evaluation it showed typical morphological features of pleomorphic adenoma. After 12 months of enucleation, patient recovery was satisfactory without any signs of recurrence. This case is presented for its rarity and it highlights the need for proper diagnosis and treatment plan in the cases of benign lacrimal gland tumours.

Pleomorphic Adenoma of the Palate: A Rare Case in an Adolescent With Cleft lip and Palate.

Benign salivary gland tumors are rarely found in children and adolescents compared with adults. Pleomorphic adenomas (PAs), the most common benign salivary gland tumor, account for only 1% of all head and neck lesions and fewer than 5% of all salivary gland tumors in individuals under the age of 16 years. The data on palatal PA in the first 2 decades of life is confined to published case reports and case series. To date, there has never been a report of palatal PA in a patient with cleft lip and palate. Here we describe an adolescent female with bilateral cleft lip and palate with PA of the hard and soft palate who underwent wide local excision and reconstruction with a buccal fat pad and buccal myo-mucosal flap.

Unusual Clinical Morphology of Bilateral Pleomorphic Adenoma with Unilateral Cystic Degeneration; a Consequence of Delay in Consent for Treatment: A Case Report

Background: Pleomorphic adenoma is the most common benign tumour of the salivary glands with majority found in the parotid gland. It accounts for 3% of all head and neck tumours and 70-80% of benign salivary gland tumours. The clinical features depend on the size, location and in some cases the potential to undergo malignant transformation. They are usually solitary, unilateral, firm and mobile, painless and slow growing, hence the long duration before presentation for treatment.&#x0D; Purpose: To present an 84-year-old female who first presented 16 years ago with a 4-year history of bilateral swellings at the left and right parotid regions, measuring 8.0 cm by 10.0 cm and 3.0 cm by 5.0 cm respectively. Due to fear of surgery, the patient gave consent for the excision of only the left lesion whose histology report came out to be pleomorphic adenoma. The right swelling was left in-situ. The time lapse of 16years resulted in gradual increase in size of the right lesion now measuring 12.0 cm by 8.0 cm with no clinical symptoms but aesthetically unpleasant to patient. With consent, the right lesion was excised and pathological examination showed a benign lesion composed of ovoid and spindle-shaped epithelial cells arranged in sheets and ducts, some of which contain eosinophilia coagulum and cystic degeneration in other foci. No evidence of malignancy. No post-operative recurrence on the left side16 years after and on the right side 24 months after treatment&#x0D; Conclusion: Pleomorphic adenoma can grow to enormous size, and with a potential to undergo cystic degeneration if left untreated. Early presentation for treatment is of high importance to prevent complications associated with delay.

Salivary gland organoid culture maintains distinct glandular properties of murine and human major salivary glands

Salivary glands that produce and secrete saliva, which is essential for lubrication, digestion, immunity, and oral homeostasis, consist of diverse cells. The long-term maintenance of diverse salivary gland cells in organoids remains problematic. Here, we establish long-term murine and human salivary gland organoid cultures. Murine and human salivary gland organoids express gland-specific genes and proteins of acinar, myoepithelial, and duct cells, and exhibit gland functions when stimulated with neurotransmitters. Furthermore, human salivary gland organoids are established from isolated basal or luminal cells, retaining their characteristics. Single-cell RNA sequencing also indicates that human salivary gland organoids contain heterogeneous cell types and replicate glandular diversity. Our protocol also enables the generation of tumoroid cultures from benign and malignant salivary gland tumor types, in which tumor-specific gene signatures are well-conserved. In this study, we provide an experimental platform for the exploration of precision medicine in the era of tissue regeneration and anticancer treatment.

Mucoepidermoid carcinoma: Analysis of 76 cytologic cases and correlation with histologic grade

Mucoepidermoid carcinoma (MEC) is the most common salivary gland (SG) malignancy. In this study, the author undertook analysis of a large collection of MEC cytologic cases. Cytopathology files were searched for MEC cases with histopathologic confirmation. Fine-needle aspiration (FNA) smears used standard technique. Seventy-six cases (63 patients [M:F=1:1; age range, 23-87 years; mean age, 58 years]) met inclusion criteria. Aspirates were primary (54 [71%]), metastatic (18 [24%]), and locally recurrent (4 [5%]). FNA sites included parotid gland (49 [64%]), regional lymph nodes (11 [14%]), submandibular gland (5 [7%]), inner canthus of eye (2 [3%]), and lung (2 [3%]); and single specimens from palate, jaw, shoulder, paranasal sinus, floor of mouth, ear canal, and effusion. Cytologic diagnoses included MEC (30 cases [39%]), suspicious for MEC (16 [21%]), non-MEC carcinoma (9 [12%]), suspicious for malignancy (SM) (2 [3%], malignant (M) (1 [1%]), SG and/or suspicious SG neoplasm (7 [8%]), atypical (3 [5%]), nonneoplastic (5 [6%]), nondiagnostic (2 [3%]), and benign SG neoplasm (1 [1%]). A total of 26% of low-grade (LG) cases were diagnosed as malignant in contrast to 87% malignant in high-grade (HG) cases. Cytomorphology depended on tumor grade. LG MEC contained intra- and/or extra-cellular mucin and more uniform cell and/or nuclear morphology, whereas cytologic atypia, anisonucleosis, and keratotic cells were more typical of HG tumors. A malignant (M) or suspicious for malignancy (SM) cytologic interpretation was made in 76% of mucoepidermoid carcinoma (MEC) cases. In contrast to high-grade MEC (97% identified as M/SM), only 59% of low-grade (LG) MEC cases were interpreted as such, illustrating the continued diagnostic challenge posed by LG MEC using fine-needle aspiration biopsy.

Pleomorphic adenoma of lip: An uncommon case presentation

Salivary gland neoplasms are infrequent, with a worldwide annual incidence of 1.0–6.5 cases per 100,000 people. Although pleomorphic adenoma (PA) is the commonest amongst the benign salivary gland tumors and makes half of all salivary gland tumors. Its presence on the lip is quite rare. Here, we present a case of 39 years old gentleman who presented with a complaint of right upper lip gradual swelling for last two years. The lesion was excised, and histopathology revealed it to be a pleomorphic adenoma. The epithelial component was arranged in the form of tubules and nests surrounded by sheets and nests of myoepithelial cells. The stroma was myxoid and focally showed cartilaginous differentiation. No evidence of malignancy was seen. Hence, the diagnosis of Pleomorphic adenoma was made. It is recommended to excise widely but chances to recur even after several years therefore long-term follow-up is important.

Global DNA Methylation Profiling Reveals Differentially Methylated CpGs between Salivary Gland Pleomorphic Adenomas with Distinct Clinical Course.

Pleomorphic adenomas (PAs) are the most frequently diagnosed benign salivary gland tumors. Although the majority of PAs are characterized by slow growth, some develop very fast and are more prone to recur. The reason for such differences remains unidentified. In this study, we performed global DNA methylation profiling using the Infinium Human Methylation EPIC 850k BeadChip Array (Illumina) to search for epigenetic biomarkers that could distinguish both groups of tumors. The analysis was performed in four fast-growing tumors (FGTs) and four slow-growing tumors (SGTs). In all, 85 CpG dinucleotides differentiating both groups were identified. Six CpG tags (cg06748470, cg18413218, cg10121788, cg08249296, cg18455472, and cg19930657) were selected for bisulfite pyrosequencing in the extended group of samples. We confirmed differences in DNA methylation between both groups of samples. To evaluate the potential diagnostic accuracy of the selected markers, ROC curves were constructed. We indicated that CpGs included in two assays showed an area under the curve with an acceptable prognostic value (AUC > 0.7). However, logistic regression analysis allowed us to indicate a more optimal model consisting of five CpGs ((1) cg06748470, (2) cg00600454, (3) CpG located in chr14: 77,371,501–77,371,502 (not annotated in GRCh37/hg19), (4) CpG2 located in chr16: 77,469,589–77,469,590 (not annotated GRCh37/hg19), and (5) cg19930657) with AUC > 0.8. This set of epigenetic biomarkers may be considered as differentiating factors between FGT and SGT during salivary gland tumor diagnosis. However, this data should be confirmed in a larger cohort of samples.

Evaluation of HER2/neu expression in different types of salivary gland tumors: a systematic review and meta-analysis.

This study is a systematic review and meta-analysis to assess the overexpression rate of HER2 in patients with salivary gland tumors. We included peer-reviewed publications from 1995 to 2020, indexed in medical databases, using search terms such as “human epidermal growth factor receptor 2 (HER2)” and “salivary gland tumors”, and extracted relevant data. The extracted data were analyzed with RevMan 5.3 software. Intra-and intergroup post hoc analyses of outcome variables were performed using t-tests, and the rates of HER2 positivity among studies were evaluated. 80 studies were included in the analysis. The positive rates of HER2 ranged from 3.3% to 84.0% and 1% to 9% in malignant and benign subtypes, respectively. The highest HER2 overexpression rate among malignant tumors was in salivary ductal carcinomas (SDC), with a 45% positive rate (CI 95%: 21.9–70.3%). Mucoepidermoid carcinoma (MEC) had the highest positive rate of 84% (CI 95%: 74.1–90.0%). Among benign salivary gland tumors, the highest rate was found in myoepithelioma, with a positive rate of 9% (CI 95%: 1.7–33.6%). The highest rate of HER2 overexpression is present in malignant subtypes of salivary gland tumors, more specifically in salivary ductal carcinoma, mucoepidermoid carcinomas, salivary duct carcinoma in situ, and carcinoma ex pleomorphic adenoma.