Benign Salivary Gland Tumors Research Articles

Warthinův tumor nosohltanu – kazuistika a přehled literatury

Papillary cystic adenolymphoma, usually called Warthin’s tumour (WT), is the second most common benign salivary gland tumour with a relative incidence of up to 25%. Typically, it is localized in the parotid gland or in its proximity where it arises from salivary inclusions entrapped in the intra- and paraparotic lymph nodes. In the upper aerodigestive tract, the WT occurs very rarely. In the postnasal space, only 11 cases have been published in the literature so far. In this case, we bring a case report of a 61-year-old woman, a smoker, in whom the tumour was located at the nasopharyngeal ostium of the left Eustachian tube. Based on our case and review of relevant literature, we discuss clinical aspects of this extraordinary rare neoplasia. Key words Warthin’s tumour – nasopharynx – head and neck neoplasms

HISTOPATHOLOGICAL STUDY OF SALIVARY GLAND LESION

Objective: The objective of this study was to evaluate various histopathological patterns of salivary gland lesions. Methods: The hospital-based retro-prospective observational study was conducted at the Department of Pathology, Sardar Patel Medical College and associated group of hospitals, Bikaner. This study included salivary gland biopsies/tissue following surgical resection, submitted, processed routinely, and stained with H&E stain, histopathologically diagnosed salivary gland lesions in the department of pathology. Histopathological study was carried out as records available of the previous 5 years (2017–2022). Results: We observed the number of male patients was higher than the female patients. Most of the patients in this study enrolled in 2021 followed by 2018, 2019, 2017, 2020, and 2022. The proportion of patients with poor oral hygiene was significantly higher than the proportion of patients with good oral hygiene. Pleomorphic salivary gland adenoma was the most prevalent morphological spectrum of lesions, followed by chronic sialadenitis and Warthin tumor. The frequency of benign lesions was significantly higher than malignant lesions also, the majority of parotid gland and sub-mandible gland lesions were benign. The frequency of neoplastic lesions and non-neoplastic lesions was almost similar. Conclusion: Salivary gland tumors (SGTs) are relatively more in males. The principal site for SGTs is the parotid gland in both benign and malignant tumors. PA was the most common benign SGT, and adenoid cystic carcinoma was the most frequent malignant neoplasm.

Ultrasonography characteristics of cystic components in primary salivary gland tumors

ObjectivesThe present study aimed to characterize the ultrasonography (US) features of cystic components in salivary gland tumors (SGTs).Materials and methodsA total of 207 patients (218 lesions) with pathologically confirmed primary SGTs were analyzed. Preoperative US revealed the presence of cystic components in lesions. Lesion size, shape, margin, and US findings of the cystic components, including number, distribution, margin, occupying rate, and internal characteristics, were evaluated.ResultsSimilarities were observed between the US performance of benign SGTs (B-SGTs) and malignant SGTs (M-SGTs) with cystic components. Differences in sex and age of patients, number, distribution, and internal characteristics of cystic components were statistically significant. For SGTs with cystic components, the proportions of M-SGTs to ill-defined margins (P = 0.002), eccentric distribution (P = 0.019), and none of the internal characteristics (P = 0.019) were significantly higher than those of B-SGTs. Younger age (P = 0.001), eccentric distribution (P = 0.034) and ill-defined margin (P < 0.001) were risk factors for diagnosing M-SGTs. Cystic component features needed to be combined with lesion indicators (border and shape) to improve diagnostic sensitivity.ConclusionsUS features of the B-SGTs and M-SGTs were significantly different. Cystic component is of interest in the US-related differential diagnosis of B-SGT and M-SGT.Clinical relevanceCystic components are potentially valuable in the differential diagnosis of B-SGTs and M-SGTs on US.

Malignant and Benign Tracheobronchial Neoplasms: Comprehensive Review with Radiologic, Bronchoscopic, and Pathologic Correlation.

Tracheobronchial neoplasms are much less common than lung parenchymal neoplasms but can be associated with significant morbidity and mortality. They include a broad differential of both malignant and benign entities, extending far beyond more commonly known pathologic conditions such as squamous cell carcinoma and carcinoid tumor. Airway lesions may be incidental findings at imaging or manifest with symptoms related to airway narrowing or mucosal irritation, invasion of adjacent structures, or distant metastatic disease. While there is considerable overlap in clinical manifestation, imaging features, and bronchoscopic appearances, an awareness of potential distinguishing factors may help narrow the differential diagnosis. The authors review the epidemiology, imaging characteristics, typical anatomic distributions, bronchoscopic appearances, and histopathologic findings of a wide range of neoplastic entities involving the tracheobronchial tree. Malignant neoplasms discussed include squamous cell carcinoma, malignant salivary gland tumors (adenoid cystic carcinoma and mucoepidermoid carcinoma), carcinoid tumor, sarcomas, primary tracheobronchial lymphoma, and inflammatory myofibroblastic tumor. Benign neoplasms discussed include hamartoma, chondroma, lipoma, papilloma, amyloidoma, leiomyoma, neurogenic lesions, and benign salivary gland tumors (pleomorphic adenoma and mucous gland adenoma). Familiarity with the range of potential entities and any distinguishing features should prove valuable to thoracic radiologists, pulmonologists, and cardiothoracic surgeons when encountering the myriad of tracheobronchial neoplasms in clinical practice. Attention is paid to any features that may help render a more specific diagnosis before pathologic confirmation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Recurrent pleomorphic adenoma of submandibular gland — a rare entity

BackgroundAmong benign salivary gland tumors, pleomorphic adenoma is one of the most common tumor involving submandibular gland, but it is rare to encounter recurrent pleomorphic adenoma in submandibular gland after submandibular gland excision.Case presentationWe present a case of 22-year-old female patient who presented to us with recurrent pleomorphic adenoma of submandibular gland region after 10 years of removal of submandibular gland, diagnosis was established with the help of ultrasound and fine-needle aspiration cytology, and thereafter, patient was taken up for surgical excision under general anesthesia. Histopathology confirmed the diagnosis.ConclusionsThis case report highlights the importance of special caution in removal of submandibular gland along with its capsule especially in pediatric population where due to small facial structures, chances of capsular breech are high, which can result in tumor seedling and future recurrence of tumor.

Fine-Needle Aspiration Cytology in the Diagnosis of Salivary Gland Tumors Before the Milan System: A Ten-Year Experience From a Tertiary Care Center in Greece.

Objective The objective of this study was to determine the diagnostic value of fine-needle aspiration cytology (FNAC) for salivary gland tumors. Methodology A retrospective file analysis of patients with salivary gland pathology, attending the Department of Oral and Maxillofacial Surgery of a tertiary care center in Athens, Greece, over a 10-year-long period, was conducted. Sensitivity, specificity, accuracy, positive prognostic value (PPV), and negative prognostic value (NPV) of FNAC for benign and malignant tumors separately were assessed and compared with histology. Results A total of 82 patients (46 male and 36 female) with salivary gland tumors, submitted to both FNAC and histology, were included. The mean age was 55 years. A total of 73 tumors were histologically diagnosed as benign and nine as malignant. FNAC identified 62 benign and seven malignant tumors but was inconclusive in 13 cases. The most common diagnosis of both histology and FNAC was pleomorphic adenoma. FNAC sensitivity, specificity, accuracy, PPV, and NPV were 98.3% and 100%, 87.5% and 100%, 97.1% and 100%, 98.3% and 100%, and 87.5% and 100% for benign and malignant tumors, respectively. Conclusions FNAC is highly sensitive but moderately specific for the preoperative identification of benign salivary gland tumors. Its use as an initial diagnostic modality is warranted, thanks to its safeness, rapidity, and lack of pain.

Modifiable factors for benign salivary gland neoplasms: AMendelian randomization study.

Observational studies have found associations between smoking, alcohol, radiation, body mass index (BMI), periodontitis, and the hazard of benign salivary gland neoplasms (BSGNs). Nevertheless, the etiology of BSGNs remains unclear. This study aims to assess the causal association between these modifiable factors and the BSGNs. Genetic instruments associated with exposures at the genome-wide significance level were selected from corresponding genome-wide association studies. The summary statistics for BSGNs were obtained from the FinnGen consortium (2445 cases and 340,054 controls). The inverse variance-weighted method was used as the primary analysis, and several sensitivity analyses were performed to test the reliability. Genetically predicted higher lifetime smoking index (odds ratio [OR] = 2.10, p = 0.012) and BMI (OR = 1.58, p = 2.29 × 10-5) were associated with elevated risk of BSGNs, whereas other exposures do not. Sensitivity analyses showed consistency. The causal effect of the lifetime smoking index became more significant after adjusting for BMI (OR = 2.89, p = 0.005) and alcohol consumption (OR = 2.49, p = 0.002). A slight negative association emerged for alcohol consumption with adjustment for cigarettes per day (OR = 0.53, p = 0.034) but disappeared when adjusting for cigarettes per day and BMI. This study supports the independent causal role of lifetime smoking index and BMI in BSGNs risk.

Surgical management of a large palatal pleomorphic adenoma by intra oral route: a difficult case

Despite being the most common benign tumor of salivary glands, pleomorphic adenoma in hard palate is a rare site. Such tumors are a challenge to remove surgically. These tumors usually require an extensive resection with wide margins and removal of surrounding mucoperiosteum. There is also usually requirement of removal of a number of teeth or portion of maxilla, especially if the size is huge. The resulting disfigurement can be a problem for young females. We present a case of successful treatment of pleomorphic adenoma of the hard palate in a 15-year old female patient, which was achieved through an enbloc removal technique with clear margins, without the need for partial maxillectomy or bone removal. This approach played a pivotal role in preventing any potential disfigurement and preserving the aesthetic appearance of the patient. The personalized approach towards patient care was instrumental in tailoring the surgical strategy to meet the specific needs of the individual.

A Review of the Current Literature on Pleomorphic Adenoma.

Pleomorphic adenomas (PA) are the most common benign salivary gland tumors. They arise from the major salivary glands, as well as the minor salivary glands. They may arise rarely from the palate, oral cavity, neck, and nasal cavityalso. Yet, the fourth, fifth, and sixth decades of life are the most common for them to manifest. Forty percent of them occurin males and 60% in females.It is a benign mixed tumor, whichhas three components: an epithelial component, a myoepithelial cell component, and a mesenchymal component.A fibrous capsule separates these cells from the surrounding tissues. Itgenerally presents as a slowly progressingpainlessswelling, which is well-delineated, nonsymptomatic, and not involving the facial nerve. Salivary gland tumors can be accurately diagnosed before surgery using fine-needle aspiration (FNA), ultrasonography (USG), and computed tomography (CT) scan. Calponin, cluster of differentiation 9 (CD9), glial fibrillary acidic protein (GFAP), Mcl-2, metastasis suppressor gene (NM23), p63, S-100, smooth muscle actin (SMA), and SRY-box transcription factor 10 (SOX10) exhibit the majority of the positive reactions in pleomorphic adenomas. The diagnostic marker pleomorphic adenoma gene 1 (PLAG1) is frequently employed since it is specific for pleomorphic adenoma.Although benign, these epithelial tumors have a propensity to recur and undergo malignant transformation if incompletely excised, leading to increased morbidity in these patients. A review of the consensus guidelines and literature was conducted, and the online literature on the subject from 2002wasincluded. This article is not a complete review of all the available literature; rather, it is a comprehensive review of the topic.

Pattern of Salivary Gland Tumours among Patients Attending Otorhinolaryngology and Maxillofacial Services at Tertiary Hospital in Tanzania, A Cross-Sectional Study

The proportion of neoplasms of the salivary gland in the study population accounted for 10% of all head &amp; neck and 3% of all neoplasms in the body. There is a scarcity of information regarding salivary gland tumours in Tanzania; therefore, this study addresses important issues in prevalence, histological, demographic characteristics, co-morbidities and treatment of salivary gland tumours. This study aimed to determine the pattern of salivary gland tumours among patients attending Otorhinolaryngology and Maxillofacial services at a tertiary hospital. This was a cross-sectional study done on patients diagnosed with salivary gland tumours. A total of 276 patients were recruited. Pre-tested coded questionnaires were used to collect data which were later analysed using SPSS statistical computer software version 20.0. Of the studied 276 participants, 156 (56.5%) were males, and 120 (43.5%) were females. Their age group ranged between 0 to 90 years with a mean age of 49.47 years, SD ±15.7. Most of them, 69 (28.6 %) aged above 60 years, and 31 (26.1 %) were in the age group of 40-49 and 60+ years. Mostly affected were males, 64 (55.1%) and 52 (44.8%) were females, P=0.76. The most commonly affected site was the parotid gland (75%), and the least affected sites were submandibular and sublingual (7.5%). Among 116 patients, malignant and benign types accounted for 76 (66%) and 40 (34%), respectively. Both benign and malignant salivary gland tumours (SGT) had male preponderance. Pleomorphic adenoma was high in males (28.1%) compared to females (25.0%); mucoepidermoid carcinoma was commonly found, accounting for 23.4% in males and 28.9% in females. More males were commonly affected, particularly the 40-49 age group, although the differences were statistically insignificant (p-value= 0.07). In conclusion, the majority of salivary gland tumours were malignant type and mucoepidermoid carcinoma being the most common histological type, while pleomorphic adenoma was the most frequently encountered benign type, and both had male preponderance, mostly seen at the age of 40 years and above. The majority of patients with malignant tumours presented late to the hospital; therefore, there is a need for advocacy for early health-seeking behaviour to the community and early detection of the disease by health personnel in the primary health centres.

Canalicular adenoma of parotid gland: A case report and review of literature

Canalicular adenoma is a rare benign salivary gland neoplasm affecting predominantly the minor salivary gland. We present a case of a 55 year female who presented with a mucosal nodule in the left cheek and was diagnosed as Canalicular adenoma based on the morphology and immunohistochemistry findings. Our case is rare in that, it is a case of Canalicular adenoma affecting the major salivary gland – Parotid gland, and is the 7 case reported in literature to the best of our knowledge.

The convoluted conduit-striated duct adenoma

Striated duct adenoma is an exceptionally encountered, benign salivary gland neoplasm. Tumefaction is constituted of ductal articulations coated with mono-layered epithelial cells and a cytological resemblance to normal striated ducts. Striated duct adenoma may recapitulates normal configuration of salivary ducts. Striated duct adenoma was initially scripted by Dardick wherein the neoplasm was designated as ‘ductal adenomas with no visible myoepithelial cells’ in 1996.

Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations.

(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.

Pleomorphic Adenoma of the Hard Palate:A Multidisciplinary Approach

Pleomorphic adenoma is the most common salivary gland tumor accounting for 80% of all major salivary gland tumors. It is a benign salivary gland neoplasm that constitutes 3% to 10% of the neoplasms in the head and neck region.1 Salivary gland neoplasms represents less than 1% of all tumors. This article is being showcased as a special case due to the fact it was done at a Taluk Hospital and also because ENT and oromaxillofacial surgeons were involved during the surgery.

Warthin cyst of lacrimal sac: A rare presentation of a common tumor!

Warthin tumor is a common and benign salivary gland tumor comprising of 2-15% of all epithelial tumors of the parotid gland. The extra-parotid presentation is seen to be rare at sites like the eyelid, caruncle, and the lacrimal gland. In this study, we have reported an extremely rare case of Warthin cyst of the lacrimal sac in an 82-year-old male patient with swelling over the medial canthal region since the past 2 years.

PLEOMORPHIC ADENOMA IN PARAPHARYNGEAL SPACE – A CASE REPORT AND REVIEW LITERATURE

INTRODUCTION Parapharyngeal tumours account for 0.5% of all head and neck masses and vast majority are b e n i g n . P l e o m o r p h i c a d e n o m a s o f t h e parapharyngeal space arise from the deep lobe of parotid gland present in oropharynx. MATERIAL AND METHOD A case of benign tumor of Parapharyngeal Space was admitted in the Otorhinolaryngology department of a tertiary care centre. The patient was a 26yr old female presented with chief complaints of difficulty in swallowing and swelling in the oral cavity since 2 months. On examination there was a firm swelling on right submandibular region and upper side of neck and uvula was deviated towards left side. CTscan revealed a heterogenous mass in the parapharyngeal space. Provisional diagnosis of benign salivary gland tumor of the parapharyngeal space was made. Tumour was surgically excised and tissue send for histopathological examination, which confirmed the tumour as Pleomorphic adenoma. CONCLUSION Pleomorphic adenoma in parapharyngeal space is of rare occurrence. An adequate clearance of the tumor with a cuff of surrounding dispensable normal tissues is the key to successful treatment of such tumors. Keywords: Pleomorphic Adenoma; Parapharyngeal Space;

Mucinous Cystadenoma of Parotid Gland: A Rare Entity

&lt;p&gt;Cystadenoma is a benign salivary gland tumor that develops very infrequently. The commonest site for their occurrence is minor salivary glands, where these present as cystic growths with papillary projections. Cystadenomas are often interpreted as mucous retention cysts. Therefore, histopathological confirmation is essential for further treatment and follow-up of the patients, even after the surgery, to keep a check on the recurrence and, in the long run, the exclusion of the possibility of malignant transformation. We report a case of mucinous cystadenoma of the salivary gland occurring in a 44-year-old male who presented with a painless mass, gradually increasing in size over the period of 3 years. The radiological evaluation reported it as a retention cyst. Fine needle aspiration cytology was performed, followed by complete surgical excision of the lesion. Diagnosis of mucinous cystadenoma in the parotid gland was made. There are only a few cases of mucinous cystadenoma of the parotid gland reported so far from the world, and to the best of author&amp;rsquo;s knowledge, it is the first case of its kind reported from Pakistan.&lt;/p&gt;

Detection of salivary gland and sinonasal fusions by a next-generation sequencing based, ligation-dependent, multiplex RT-PCR assay.

The discovery of tumour type-specific gene fusion oncogenes in benign and malignant salivary gland and sinonasal (SGSN) tumours has significantly increased our knowledge about their molecular pathology and classification. We developed a new targeted multiplexed next-generation sequencing (NGS)-based method that utilizes ligation dependent reverse-transcriptase polymerase chain reaction (LD-RT-PCR) to detect oncogenic fusion transcripts involving 116 genes, leading to 96 gene fusions known to be recurrently rearranged in these tumours. In all, 180 SGSN tumours (formalin-fixed, paraffin-embedded samples, 141 specimens and 39 core needle biopsies) from the REFCORpath (French network for rare head and neck cancers) with previously identified fusion genes by fluorescent in situ hybridisation (FISH), RT-PCR, or molecular immunohistochemistry were selected to test its specificity and sensitivity and validate its diagnostic use. Tested tumours encompassed 14 major tumours types, including secretory carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary gland intraductal carcinoma, clear cell carcinoma, pleomorphic adenoma, adamantinoma-like Ewing Sarcoma, EWSR1::COLCA2 sinonasal sarcoma, DEK::AFF2 sinonasal carcinoma, and biphenotypic sinonasal sarcoma. In-frame fusion transcripts were detected in 97.8% of cases (176/180). Gene fusion assay results correlated with conventional techniques (immunohistochemistry [IHC], FISH, and RT-PCR) in 176/180 tumours (97.8%). This targeted multiplexed NGS-based LD-RT-PCR method is a robust, highly sensitive method for the detection of recurrent gene fusions from routine clinical SGSN tumours. It can be easily customized to cover new fusions. These results are promising for implementing an integrated NGS system to rapidlydetect genetic aberrations, facilitating accurate, genomics-based diagnoses, and accelerate time to precision therapies in SGSN tumours.

Tubarial Salivary Gland – The New Member of Nasopharynx

Tubarial Salivary Gland – The New Member of Nasopharynx

Analysis of ultrasonography and cytology potential in differential diagnosis of major salivary gland neoplasms

Background: Salivary gland tumors account for up to 5% of all head and neck neoplasms. Ultrasonography is one of the main diagnostic modalities for the salivary gland pathology; however, its diagnostic potential is under scrutiny. Fine needle aspiration cytology is considered the main diagnostic method, although its role in the differential diagnosis is disputable.Objective: To identify, based on morphology results, the effectiveness of the main ultrasonographic signs indicating major salivary gland neoplasms in the differential diagnosis and study these signs, to evaluate the effectiveness of fine needle aspiration in the diagnosis of benign and malignant major salivary gland neoplasms.Materials and methods: This retrospective study evaluated a group of 220 patients. We calculated sensitivity, specificity, and accuracy of qualitative ultrasonographic signs of salivary gland neoplasms, analyzed the fine needle aspiration effectiveness, and compared results accuracy by calculating Pearson’s empirical χ-square.Results: Common ultrasonographic signs of benign salivary gland neoplasms included a clear contour (97.5%) and decreased echogenicity (72.7%). Malignant tumors frequently presented with a clear contour (76.7%), uneven contour (72.1%), and decreased echogenicity (69.8%). Fine needle aspiration sensitivity and specificity in the diagnosis of benign neoplasms were 75.5% and 53.6%, respectively. Fine needle aspiration sensitivity and specificity in respect of malignant tumors were 50% and 94%, respectively. Pearson’s χ-square value for the clear contour had significant differences in favor of benign neoplasms.Discussion: Benign and malignant salivary gland neoplasms often have a similar ultrasonographic pattern. A significant diagnostic sign of malignant tumors is the uneven contour. We compared the effectiveness of cytological differentiation between benign and malignant neoplasms and found high rates of specificity and accuracy for malignant tumor diagnosis.Conclusions: Clear contour and decreased echogenicity are significant ultrasonographic signs in the differentiation of benign neoplasms. Uneven contour is a significant differentiating factor for malignant neoplasms. Cytology can be used for initial morphology in diagnosing major salivary gland neoplasms, but in half of the cases it fails to identify the nature and type of the tumor.