Carcinoma In Pleomorphic Adenoma Research Articles

舌根部に生じたcarcinoma in pleomorphic adenomaの一例

舌根部に生じたcarcinoma in pleomorphic adenomaの一例

Nucleolar organizer regions in malignant salivary gland tumors.

Proliferative activity of carcinomas arising from salivary glands was analyzed by enumeration of argyrophilic nucleolar organizer regions (AgNORs). The mean numbers of AgNORs in the various tumors were as follows: mucoepidermoid carcinoma, 2.20; acinic cell carcinoma, 2.51; adenoid cystic carcinoma (ACC), 2.57; carcinoma in pleomorphic adenoma, 1.00 (benign component) and 3.99 (cancer-bearing area); salivary duct carcinoma, 4.49; polymorphous low-grade adenocarcinoma, 3.37; sebaceous carcinoma, 2.57; oncocytic carcinoma, 4.63; adenocarcinoma, 4.53. Cells of most tumors showed heterogeneous activity within the same tumor. In mucoepidermoid carcinoma, the mucous cells had suppressed activity in comparison with the epidermoid cells and intermediate cells. In ACC, the activity of the tumor cells increased according to growth pattern in the order tubular, glandular and solid. In carcinoma in pleomorphic adenoma, vigorous proliferative activity was observed in the malignant component, whereas less active cells were seen in the myxoid or chondroid matrix. AgNOR staining was useful for distinguishing benign from malignant regions in carcinoma in pleomorphic adenoma. Our results suggest that mucoepidermoid carcinoma, acinic cell carcinoma and ACC, except for that with a solid growth pattern, may be considered as low-grade malignancies, whereas solid-type ACC, the cancer component in carcinoma in pleomorphic adenoma and some of the other carcinomas have high-grade malignant behavior.

Immunohistochemical study of c-erbB-2 oncoprotein overexpression in human major salivary gland carcinoma: an indicator of aggressiveness.

In order to analyze the correlation between immunohistochemical positivity for c-erbB-2 oncoprotein and prognosis in patients with malignant salivary gland tumors, 59 cases of malignant tumors of the major salivary glands, including 35 parotid gland, 20 submaxillary gland and 4 sublingual gland tumors, were studied immunohistochemically using a polyclonal antibody against c-erbB-2 oncoprotein. Positive staining was observed in 13 (22%) of the 59 cases. Interestingly, positive results were obtained only in adenocarcinoma (6/20) and carcinoma in pleomorphic adenoma (7/15), and not in any other histological types such as adenoid cystic carcinoma, mucoepidermoid tumor, and squamous cell carcinoma. There was no correlation between the degree of differentiation of adenocarcinoma and c-erbB-2 positivity. Since the carcinoma in pleomorphic adenoma positive for c-erbB-2 oncoprotein was adenocarcinoma, adenocarcinoma and adenocarcinoma in pleomorphic adenoma were placed together (n = 33), and the presence or absence of c-erbB-2 oncoprotein in this group was examined for correlation with patients' survival and other clinicopathological features, including clinical stage, tumor size, surgical margins, and lymph node status. The c-erbB-2-positive tumors tended to be more advanced and larger than negative tumors. Similarly, c-erbB-2-positive tumors were difficult to resect completely, were associated with lymph node metastasis more frequently, and showed lower disease-free survival than negative cases (P less than .05). We conclude that immunohistochemical positivity for c-erbB-2 is an indicator of aggressiveness in both adenocarcinoma and adenocarcinoma in pleomorphic adenoma of the major salivary glands.

Histopathology of malignant salivary gland tumours.

This report is based upon the Salivary Gland Register in Hamburg and on the second revised edition of the WHO Histological Typing of Salivary Gland Tumours. The group of malignant salivary gland tumours contains carcinomas, malignant non-epithelial tumours, malignant lymphomas and secondary tumours. The various carcinomas are classified in a continuous separate listing because the different types are distinguished not only by histopathology, but also by differences in prognosis and treatment. The term "tumour" is replaced by "carcinoma" in two entities: acinic cell carcinoma and mucoepidermoid carcinoma. New entities are: polymorphous low-grade adenocarcinoma, basal cell adenocarcinoma, salivary duct carcinoma and malignant myoepithelioma. Carcinoma in pleomorphic adenoma can be distinguished as non-invasive and invasive carcinoma, and carcinosarcoma. Malignant non-epithelial tumours are mostly malignant fibrous histiocytoma, malignant schwannoma and rhabdomyosarcoma. The large majority of malignant lymphomas are non-Hodgkin-lymphomas with high differentiation. Many lymphomas are associated with chronic immunosialadenitis (Sjögren's syndrome). Secondary tumours are mostly metastases from primary squamous cell carcinomas or from melanomas of the skin (head and neck area). Haematogeneous metastases are very rare (mainly from lung, kidney or breast).

涙腺に原発した多形腺腫内癌腫の１例 捺印細胞診について

患者は75歳の女性で, 6年前から進行する左眼球突出と復視を訴えて来院した.左眼窩外上側に弾性硬の腫瘤を触知し, 切除手術が行われ, 涙腺由来の多形腺腫内癌腫の病理診断を得た.腫瘍の捺印細胞診では, 結合性の弱い, 多角形～紡錘形の腫瘍細胞の集塊がみられ, 一部の細胞には細胞異型が目立った.組織学的には, 粘液または線維性基質中に, 未分化癌または低分化腺癌が増殖しており, 先行して存在していた多形腺腫の癌化に由来していると考えられた.電子顕微鏡的所見では, 腫瘍細胞には腺上皮性細胞内器官が主に認められたが, 中間フィラメントが目立つ細胞も混在していた.

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

A total of 271 patients with submandibular gland cancer, treated in 149 hospitals in Japan in the period from 1958 to 1991, were retrospectively studied with regard to age, sex, TNM classification (UICC 1987, Geneva), histological diagnosis, therapeutic method and prognosis. The results were the following: 1. 157 males and 114 females 2. Stage I: 52 cases (19%); stage II: 64 cases (24%); stage III: 52 cases (19%) and stage IV: 103 cases (38%). 3. T1: 29 cases (11%); T2:116 cases (43%); T3: 93 cases (30%) and T4: 43 cases (16%). 4. Cervical lymph node involvement: 40%, ranging 25% in adenoid cystic carcinoma and acinic cell tumor, to 62% in undifferentiated carcinoma. 5. Distant metastasis: 11% 6. adenoid cystic carcinoma 37%, adenocarcinoma 20%, mucoepidermoid tumor 16%, carcinoma in pleomorphic adenoma 10%, epidermoid carcinoma 10%, undifferentiated carcinoma 3%, acinic cell tumor 3%. 7. Treatment method: Surgical procedure alone; 51%, Combination of surgery and postoperative radiation; 18%. 8. 5-year and 10-year survival rates were 36% and 11%, respectively. 9. 5-year and 10-year survival rates varied according to the stages, being 76% and 38%, respectively, for stage I, 68% and 20%, respectively, for stage II, 15% and 10%, respectively, for stage III, and 14% and 4%, respectively for stage IV.

副咽頭間隙多形腺腫内癌の３症例

Three cases of carcinoma in pleomorphic adenoma of the parapharyngeal space are reported. All cases were resected surgically through the lateral cervical approach. The histological diagnosis made at the time of transoral biopsy before operation in two cases was benign, but postoperative diagnosis was malignant. According to recent reports, cases of malignant parapharyngeal tumors are increasing.If the tumor is suspected malignant, surgical resection should be performed immediately without transoral biopsy

Ｃａｒｃｉｎｏｍａ ｉｎ ｐｌｅｏｍｏｒｐｈｉｃ ａｄｅｎｏｍａの１例 免疫組織化学的検索，文献的考察

Carcinoma in pleomorphic adenoma is a relatively rare lesion, and a case of which is reported in this article.A 52-year-old man had become aware of painless swelling in the right parotid gland about 15 years before. Because the swelling became larger, the patient was admitted to Tokyo Dental College Ichikawa Hospital. The Surgically removed tumor was examined using a light microscope and immunohistochemistry. Light microscopically, the tumor revealed that atypical epithelial cells infiltratively proliferated in the fibrous connective tissue, part of which had mucous degeneration. The immunohistochemical study suggested that EMA was useful as an diagnosis of carcinoma in pleomorphic adenoma.

Intraoral minor salivary gland tumors: A demographic and histologic study of 200 cases.

In a demographic and histologic study of 200 intraoral minor salivary gland tumors seen in Japan (Nagasaki and Miyagi prefectures), 127 cases (63.5%) were classified as benign, comprising 124 pleomorphic adenomas and 3 monomorphic adenomas. The other 73 cases (36.5%) were malignant tumors, represented by 33 adenoid cystic carcinomas, 16 mucoepidermoid carcinomas, 10 carcinoma in pleomorphic adenomas, 6 acinic cell carcinomas, 5 adenocarcinomas, one polymorphous low-grade adenocarcinoma, one undifferentiated carcinoma and one clear cell carcinoma. There was an overall female preponderance (1.78/1). The mean age for females was 47.2 years and for males was 50.6 years. The mean age for patients with malignant tumors was 10 years greater than for patients with benign tumors and was statistically significant. The palate was the most common site for intraoral minor salivary gland tumors followed by the lip and buccal mucosa. These three sites accounted for 83% of all cases. Tumors arising in these three sites were predominantly benign. In contrast, those located in the gingiva, floor of the mouth and tongue were predominantly malignant. The results of this study were compared with other recent studies.

Glial fibrillary acidic protein and desmin in salivary neoplasms

The presence of intermediate filament proteins (IFP) in normal salivary gland tissue and investigated by immunohistochemical techniques on frozen sections. Cytokeratins (CKs) were seen in almost all normal epithelial cells. In the parotid gland and in palatal gland tissue, a co-expression of cytokeratin and glial fibrillary acidic protein (GFAP) was seen in some myoepithelial cells, but this was not apparent in the submandibular gland. In some pleomorphic adenomas, carcinomas in pleomorphic adenomas, one mucoepidermoid carcinoma, one mucus-producing adenopapillary carcinoma and one adenoid cystic carcinoma, cells expressing three different IFP classes were found (CKs, vimentin, GFAP). These cells were most often situated peripherally in the tumour cords or ducts. The cytokeratin pattern in these cells, as revealed by mAbs PKK1-3, was similar to that in normal myoepithelial cells. Furthermore, reactivity for a fourth class of IFP, desmin, could be seen in this cell type in two carcinomas in pleomorphic adenomas, and also in a few cells in a pleomorphic adenoma and an adenoid cystic carcinoma. Thus the pattern of IFP expression in salivary gland neoplasms, is very complex, and cannot always be related to the normal tissue.

耳下腺部に生じたＣａｒｃｉｎｏｍａ ｉｎ ｐｌｅｏｍｏｒｐｈｉｃ ａｄｅｎｏｍａの１例とその免疫組織化学的観察

A case of carcinoma in pleomorphic adenoma which developed in the deep lobe of the left parotid gland of a 75-year-old Japanese man is described.The case was clinically prediagnosed as a benign salivary gland tumor; however, examination of excised tissue revealed small areas of adenoid cystic carcinoma invading the capsule and of pleomorphic adenoma comprising almost all the tumor tissue. The surgical procedure choice included complete excision of the tumor tissue with lobectomy of the superficial part of the left parotid gland.Recurrence or metastasis has not been noted in the one year and 8 months since operation.The excised material was also examined from an immunohistochemical aspect, using the peroxidase-antiperoxidase method. The staining of S-100 protein, lysozyme, transferrin, secretary component, and keratin showed similar findings as have been already reported.

STUDY OF OPERATIVE SALIVARY GLAND LESIONS DURING 27 YEAR PERIOD

Preoperative diagnosis of saivary gland tumor is important for determining of operative procedure. During 27 year period from Jan. 1960 to Dec. 1986, we experienced a total of 178 cases of salivary gland tumors, which included 104 cases of parotid lesions, 65 of submandibular, 3 of sulingual, and 6 of others. The malignancy accounted 22% for the parotid gland and 15% for the submandibular gland. While in view of only tumor lesions, these figures were 26% and 32% respectively. Mean ages were 39 years for benign and 53 years for malignant lesions. Frequently encountered benign lesions were pleomorphic adenoma (67%) and sialolithiasis & inflammations (9%) in the parotid gland, while sialolithiasis & inflammation (53%) and pleomorphic adenoma (35%) in the submandibular gland. Among malignant diseases mucoepidermoid carcinoma (29%) was the most common followed by carcinomas in pleomorphic adenoma (18%) and adenocarcinoma (18%).

耳下腺に発生したＣａｒｃｉｎｏｍａ ｉｎ ｐｌｅｏｍｏｒｐｈｉｃ ａｄｅｎｏｍａの１症例 特に手術後の顔面神経麻ひについて

A 33-year old woman with carcinoma in pleomorphic adenoma of the parotid gland was reported. Carcinoma in pleomorphic adenoma is relatively rare. Our case was treated with surgical resection, postoperative irradiation (50Gy) and 5-fluorouracil administration (2, 500mg).Facial palsy following this operation was treated with nerve repairing and acupuncture. Recovery was enough to retain face symmetry at rest. Postoperative course was uneventful during the past four and A half years

Ｃａｒｃｉｎｏｍａ ｉｎ ｐｌｅｏｍｏｒｐｈｉｃ ａｄｅｎｏｍａ 腫ようマーカーに関する免疫組織化学的研究

Carcinoma in pleomorphic adenoma (Ca in PA) is a rare lesion which is composed of a malignant tumor or is transformed from a benign pleomorphic adenoma. We describe immunohistochemical investigations of tumor markers in 5 cases of carcinoma in pleomorphic adenoma; keratin (polyclonal; TK: 41-65 kDa, monoclonal: KL1: 55-57 kDa; PKK1: 40, 45 and 52.5 kDa), vimentin, desmin, involucrin (Inv), S-100 protein, lysozyme (LZ), lactoferrin (LF), α1-antitrypsin (α1-At), α1-antichymotrysin (α1-Ach), carcinoembryonic antigen (polyclonal; CEA (P), NCA-absorbed polyclonal; CEA (N), monoclonal; CEA (M)), and epithelial membrane antigen (EMA).1) Keratin which is an intermediate sized filament protein and an epithelial marker, is not a specific marker for this tumor. It showed both malignant and benign tumor cells, and did not discriminate the two lesions. Inv is lackeing in the tumor, but is detected in squamous metaplasia or keratinizing of the changed area.2) S-100 proteins showed great variations for staining in tumor cells. Normal myoepithelial cells do not always show positive reactions.3) LZ, LF, α1-At, and α1-Ach showed mostly negative in the cells of Ca in PA. They were associated with bacteriostatic mechanisms as a focal defence mechanism.4) Polyclonal CEA reaction is not specific, and the reaction product appeared in both carcinoma and pleomorphic adenoma. True CEA reaction between cancer and pleomorhic adenoma tissues was unexpected.5) EMA is a more useful and suspected tumor markers in correlation with histologic malignancy, grading and/or possibility.

口蓋に発生したｃａｒｃｉｎｏｍａ ｉｎ ｐｌｅｏｍｏｒｐｈｉｃ ａｄｅｎｏｍａの１例

口蓋に発生したｃａｒｃｉｎｏｍａ ｉｎ ｐｌｅｏｍｏｒｐｈｉｃ ａｄｅｎｏｍａの１例

Undifferentiated Tumours of Salivary Glands: Immunocytochemical Investigations and Differential Diagnosis of 22 Cases

22 undifferentiated tumours of the Salivary Gland Register (University of Hamburg) were studied by conventional light microscopical and immunocytochemical methods to elucidate the heterogeneity of this tumour group. The following observations were made in this collective: 18 tumours displayed one or more markers for the epithelial character and were classified as carcinomas. 10 carcinomas were considered as primary ones and 8 were considered as secondary ones (metastatic or invasive "per continuitatem"). Primary carcinomas were subclassified as poorly differentiated variants of a distinctive type of salivary gland tumours, as follows: 6 cases of carcinoma in pleomorphic adenoma, and one case each of mucoepidermoid tumour, adenocarcinoma, salivary duct carcinoma and epidermoid carcinoma. Secondary carcinomas were subclassified as follows: 3 epidermoid carcinomas, 3 nasopharyngeal carcinomas and 2 bronchial carcinomas. One tumour positive for S-100 protein and NSE (Neuron-specific enolase) was classified as a metastatic melanoma. Another tumour positive for vimentin and actin was classified as a rhabdomyosarcoma of the periglandular tissue. Two tumours lacked any markers studied here and were regarded as a malignant paraganglioma and an undifferentiated lymphoma, respectively. The differential diagnosis of the undifferentiated tumours of salivary glands and the special problems of this tumour group are discussed.

過去１５年間の耳下腺腫ようの臨床統計

Between 1971 and 1985 123 patients with parotid tumors were treated in the Department of Otolaryngology of Kobe Central Municipal Hospital. Of the 123 tumors, 103 (83.7%) were benign and 20 (16.3%) were malignant. Pleomorphic adenoma was present in 61 cases, adenolymphoma (Warthin's tumor) in 18, muco-epidermoid tumor in four, acinic cell tumor in three, adenoid cystic carcinoma in two, adenocarcinoma in five, undiferenciated carcinoma in two and carcinoma in pleomorphic adenoma in three.For diagnosis, we usually use sialography, CT, echography and RI-scintigraphy. We stress, however, that the clinical history and physiological findings are more important for the diagnosis than other examinations.During surgery, we first identify the main trunk of the facial nerve near the stybid process and follow the branches of the facial nerve distally. After that, the tumor is resected with a little parotid tissue.

Immunohistochemical expression of monoclonal antibody against epithelial membrane antigen in salivary gland tumors.

A total of 154 cases of salivary gland tumors were studied by an indirect method with the use of monoclonal antibody to epithelial membrane antigen (EMA) from human milk fat globule membrane. Normal salivary glands displayed positive reaction of EMA staining in the luminal and lateral borders of serous acinar cells, and in the luminal border of ducts. Immunohistochemical expression of EMA in salivary gland tumors was chiefly classified into two types: one is the luminal surface-positive type and the other is the whole cellpositive type. Pleomorphic adenoma was usually positive for EMA staining in luminal borders of tubular, duct-like and cystic structures, and occasionally positive in the cytoplasm of the cells comprising these structures. Warthin's tumor was positive for EMA staining on the luminal surface of eosinophilic tumor epithelial cells, or EMA-positive reaction was evident in various areas scattered throughout the epithelial structures. Acinic cell tumor, carcinoma in pleomorphic adenoma (carcinoma cell), and mucoepidermoid tumor showed positive reaction of EMA staining throughout their cytoplasm depending on histological malignancy. No positive reaction to EMA staining was given by either normal myoepithelial cells, and transformed or neoplastic myoepithelial cells.

Ultrastructural and immunohistochemical aspects of carcinoma in mixed tumors

Four cases of malignant mixed tumor (carcinoma in pleomorphic adenomas) were studied for ultrastructural appearance and for the presence of cytokeratins and vimentin. Ultrastructurally, both squamous and glandular epithelial differentiation were found not only in the same tumor but also within the same cell. One tumor showed mainly mesenchymal differentiation with fibroblast-like cells. The intermediate filament expression of benign mixed tumors (i.e., both cytokeratin and vimentin content) were found in two of the three malignant tumors investigated. In the third tumor, only cytokeratins were found. Thus, the filament content of mixed tumors may change when the tumor becomes malignant. This change does not always parallel a change in morphology. Although one tumor was clearly epithelial ultrastructurally and another mostly mesenchymal, both did contain both cytokeratins and vimentin.

Immunohistochemical localization of carcinoembryonic antigen in carcinoma in pleomorphic adenoma of salivary gland: use in the diagnosis of benign and malignant lesions.

The localization of carcinoembryonic antigen (CEA) and lysozyme (LZM) was immunohistochemically studied in 34 carcinomas arising in benign pleomorphic adenomas and 25 normal salivary glands in order to assess its potential diagnostic value. CEA in the normal salivary gland was located in luminal cell membranes of intercalated duct cells and serous acinar cells. Strongly positive cell surface and intraluminal staining of CEA appeared in the areas of gland-forming pattern in pleomorphic adenoma. CEA activity was detected in 7/9 cases (78%) of adenocarcinoma, 10/11 cases (91%) of epidermoid carcinoma, 3/8 cases (38%) of anaplastic carcinoma, 5/5 cases (100%) of mucoepidermoid carcinoma, and 1/1 case (100%) of adenoid cystic carcinoma. CEA was always present in the cytoplasm of epithelial cells and luminal contents of neoplastic glands. CEA in epidermoid carcinoma may occasionally react strongly in the cytoplasm. Lysozyme-immunoreactivity was detected in the cytoplasm of intercalated duct cells and serous acinar cells of the normal salivary gland but little or no LZM was observed in any of the tumors. These results suggest that the presence of CEA could be a useful marker that provides valuable information for the differential diagnosis between benign and malignant areas of carcinoma in pleomorphic adenoma of the salivary gland. Moreover, LZM could be of valuable use for discriminating neoplastic from non-neoplastic tissue of salivary glands.