Carcinoma Of Minor Salivary Glands Research Articles

Minor salivary gland carcinoma involving the oral cavity or oropharynx.

Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980-2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner. A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22-86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low-grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow-up 83 per cent of patients were alive and disease free. Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.

Salivary duct carcinoma of minor salivary gland

Salivary duct carcinoma (SDC) is an uncommon aggressive malignancy seen predominantly in the parotid gland. Intra oral cases of SDC arising from minor salivary glands are rare and only a few have been reported in literature. This malignancy is well known for its cestructive behaviour, metastasis to distant sites and high mortality rate. In this article, we present a case of salivary duct carcinoma of palate of a 44-year-old male patient.

Signet-ring cell (mucin-producing) adenocarcinomas of minor salivary glands.

We report seven cases of minor salivary gland carcinomas characterized by the marked presence of mucin-containing signet-ring cells. These tumors were distinctive in their microscopic appearance and displayed features not seen in any other type of salivary gland malignancy. They typically exhibited invasive growth by narrow parallel strands, randomly scattered small nests, or individually infiltrating cells. Solid, cribriform, or targetoid areas were absent, as well as papillary components. Ductal differentiation was minimal, and seen in only four cases. Degrees of cellularity varied from one area to another. The tumors were cytologically bland. We think that these tumors represent a unique subset of intraoral minor salivary gland carcinomas.

HER2/neu and Ki-67 as prognostic indicators in mucoepidermoid carcinoma of salivary glands.

Mucoepidermoid carcinoma is the most common salivary gland malignancy, representing up to 30% of all cases. Despite attempts to correlate histopathologic grades to clinical outcomes, some histologically "low"-grade lesions continue to behave aggressively despite appropriate treatment. This preliminary study will attempt to evaluate the use of immunohistochemical markers HER2/neu and Ki-67 as prognostic markers of biologic aggressiveness for mucoepidermoid carcinoma of the salivary glands. A retrospective chart review of 42 patients with mucoepidermoid carcinoma of major and minor salivary glands treated between 1970 and 1995 was conducted. A combination of primary resection with or without postoperative irradiation was used. Histologic grading and correlation with outcome analyses are provided. In the current study, positive HER2/neu staining and strong Ki-67 staining occurred in patients with high-grade mucoepidermoid carcinoma, whereas low-grade carcinoma was correlated with negative or weak staining. These preliminary results indicate that, overall, the overexpression of both the HER2/neu and the Ki-67 oncoproteins may serve as prognostic markers for poor outcome in salivary gland mucoepidermoid carcinoma.

Prognostic Significance of p27 and Ki-67 Expression in Mucoepidermoid Carcinoma of the Intraoral Minor Salivary Gland

p27 and Ki-67, a universal cyclin-dependent kinase inhibitor and a proliferative cell marker, respectively, have been useful in predicting clinical aggressiveness in various human tumors. We studied clinicopathologic significance of these molecules in mucoepidermoid carcinoma of the intraoral minor salivary gland. Expression of p27 and Ki-67 was assessed immunohistochemically in primary mucoepidermoid carcinomas from 31 patients without distant metastasis at surgery. Correlation each of p27 and Ki-67 expression was analyzed with various clinicopathologic parameters including age, sex, primary tumor site, tumor size, nodal metastasis, clinical stage, and histologic grade. The latter was evaluated using a point-scoring scheme of Auclair et al. that consists of five histologic factors (intracystic component, neural invasion, necrosis, mitosis, and anaplasia). p27 expression was correlated inversely with histologic grade (P = .007), but with none of other factors. When the correlation of p27 expression was further examined with each of the histologic factors, it was correlated significantly with intracystic component, but not with neural invasion, necrosis, mitosis, or anaplasia. Ki-67 expression was correlated significantly with histologic grade only in the clinicopathologic factors (P < .0001), and in the histologic factors, with necrosis, mitosis, and anaplasia. Multivariate prognostic analyses were performed to identify independent risk factors for both disease-free and overall survivals. Large tumor size (P = .031, relative risk = 5.5) and low p27 expression (P = .012, relative risk = 5.2) were risk factors for worse disease-free survival. Low p27 expression (P = .015, relative risk = 15.2) was selected as a risk factor for worse overall survival. Other factors including age, sex, tumor site, nodal status, clinical stage, histologic grade, and Ki-67 did not emerge as independent risk factors in either prognostic analysis. These data suggest that p27 may be useful in estimating prognosis of the patients who have mucoepidermoid carcinoma of the intraoral minor salivary gland.

Stage as major long term outcome predictor in minor salivary gland carcinoma

BACKGROUND The myriad of histologic types and anatomic sites of occurrence make minor salivary gland carcinomas the most heterogeneous group of carcinomas of the upper aerodigestive tract. Many publications addressing this group consider different subsections, making it hard to get a clear picture of long term treatment results and of modifying prognostic factors. METHODS Overall survival, disease specific survival, and percentage rates for no recurrence in all 55 patients with a minor salivary gland carcinoma, treated at the Netherlands Cancer Institute from 1973 to 1994, were calculated and compared to the results in major salivary gland carcinoma patients. Major prognostic factors were univariately analyzed. The median period of follow-up time for patients alive at the end of follow-up was 134 months. RESULTS The overall 5- and 10-year survival rates were 66% and 57%, respectively. The 5- and 10-year disease specific survival rates (DSS) were 76% and 74%, respectively; and the 5- and 10-year recurrence-free rates were 63% and 60%, respectively. Prognostic for overall survival were age (P = 0.0005), site of occurrence (P = 0.0001), and the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) Tumor, Node, and Metastases (TNM) classification and stage regrouping system (P = 0.0001). Factors predicting DSS were site of occurrence (P < 0.0001) and the UICC/AJCC TNM classification and stage regrouping (P < 0.0001). In surgical patients, histologic evidence for metastatic lymph nodes (P = 0.0037) and vascular invasion (P = 0.0051) conferred a lower DSS. Tumor recurrence was predicted by the UICC/AJCC TNM classification and stage regrouping (P = 0.0001). In surgical patients, soft tissue invasion (P = 0.0085) predicted tumor recurrence. CONCLUSIONS Sixty percent of patients treated for minor salivary gland carcinoma were free of tumor ten years later. This equals the result in major salivary gland carcinoma patients. The recent UICC/AJCC TNM classification and stage regrouping are confirmed as major predictors of outcome. Cancer 2000;89:1195–204. © 2000 American Cancer Society.

Stage as major long term outcome predictor in minor salivary gland carcinoma.

The myriad of histologic types and anatomic sites of occurrence make minor salivary gland carcinomas the most heterogeneous group of carcinomas of the upper aerodigestive tract. Many publications addressing this group consider different subsections, making it hard to get a clear picture of long term treatment results and of modifying prognostic factors. Overall survival, disease specific survival, and percentage rates for no recurrence in all 55 patients with a minor salivary gland carcinoma, treated at the Netherlands Cancer Institute from 1973 to 1994, were calculated and compared to the results in major salivary gland carcinoma patients. Major prognostic factors were univariately analyzed. The median period of follow-up time for patients alive at the end of follow-up was 134 months. The overall 5- and 10-year survival rates were 66% and 57%, respectively. The 5- and 10-year disease specific survival rates (DSS) were 76% and 74%, respectively; and the 5- and 10-year recurrence-free rates were 63% and 60%, respectively. Prognostic for overall survival were age (P = 0.0005), site of occurrence (P = 0.0001), and the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) Tumor, Node, and Metastases (TNM) classification and stage regrouping system (P = 0.0001). Factors predicting DSS were site of occurrence (P < 0.0001) and the UICC/AJCC TNM classification and stage regrouping (P < 0.0001). In surgical patients, histologic evidence for metastatic lymph nodes (P = 0.0037) and vascular invasion (P = 0.0051) conferred a lower DSS. Tumor recurrence was predicted by the UICC/AJCC TNM classification and stage regrouping (P = 0.0001). In surgical patients, soft tissue invasion (P = 0. 0085) predicted tumor recurrence. Sixty percent of patients treated for minor salivary gland carcinoma were free of tumor ten years later. This equals the result in major salivary gland carcinoma patients. The recent UICC/AJCC TNM classification and stage regrouping are confirmed as major predictors of outcome.

Apoptosis and apoptotic-related factors in mucoepidermoid carcinoma of the oral minor salivary glands.

The oncoproteins Bcl-2 and Bax, the tumor suppressor gene product p53, TUNEL (TdT [terminal deoxynucleotidyl transferase] dUTP nick end-labeling) and the cell-cycle antigen Ki-67 were studied in 71 cases of mucoepidermoid carcinoma originating in the oral minor salivary glands. Grade I tumors had higher expression of Bcl-2 than Grade II and III tumors (chi2 test, 0.01<P<0.025) and the Bcl-2-positive group had a higher survival rate than the Bcl-2-negative group (generalized Wilcoxon, P = 0.00051). Patients with strong TUNEL positivity had a higher survival rate than those with either weak positivity or negativity (generalized Wilcoxon, P = 0.047). The expression of p53 and TUNEL had a positive correlation (P = 0.0315). Grade II and III tumors had a higher frequency of positive Ki-67 expression than Grade I tumors (chi2 test, 0.01<P<0.025) and patients with Ki-67-negative tumors had better survival than patients with Ki-67-positive tumors (generalized Wilcoxon, P = 0.000099). This study showed that Bcl-2 proteins, p53 protein, TUNEL and Ki-67 are potentially useful prognostic markers for survival in patients with mucoepidermoid carcinoma of the oral minor salivary glands.

Expression of the c-kit protein is associated with certain subtypes of salivary gland carcinoma

The c-Kit protein, a receptor type tyrosine kinase that plays an important role in the development of hematopoietic cells, melanocytes, and germ cells, is expressed in mastocytosis, gastrointestinal stromal cell tumors (GISTs), germ cell tumors, and several other tumors. Gain-of-function mutations in exon 11 and exon 17 have been shown as a mechanism of c-kit activation in some tumors. To study the role of c-kit in salivary gland carcinomas, we analyzed the c-kit protein expression in 79 carcinomas of major and minor salivary glands by immunohistochemistry. Although varying in intensity of staining, c-kit expression was identified very often in adenoid cystic carcinomas (20/25), lymphoepithelioma-like carcinomas (6/6) and myoepithelial carcinomas (2/2), but not in other types of salivary gland carcinoma (0/46), P<0.00001. By DNA sequencing, genetic alteration of c-kit juxtamembrane domain (exon 11) and tyrosine kinase domain (exon 17) was not found in all the three types of salivary carcinoma that had c-kit protein expression. In conclusion, c-kit protein overexpression is involved in the pathogenesis of certain types of salivary gland carcinoma, but mutation of the gene is not the mechanism of c-kit activation.

中咽頭粘表皮癌例

A comparatively rare case of a primary minor salivary gland mucoepidermoid carcinoma in the radix linguae is reported. A 21 year-old woman visited our hospital complaining of pain during swallowing. A smooth mass spreading to the lateral wall of the oropharynx from the left side of the radix linguae was found. CT showed a Gd enhanced homogenous mass 2cm in size on the left side of the oropharynx. The mass was suspected to be a benign tumor, and we attempted to remove it by oral approach. However, it was adherent to the lateral wall of the oropharynx. It was suspected to be a mucoepidermoid carcinoma after analyzing a frozen section. Therefore, it was removed during second operation. A median incision of the pharynx spread the range of vision sufficiently. A free radial forearm flap improved the postoperative functional disorders. The mass was a well differentiated mucoepidermoid carcinoma. There has been no evidence of recurrence for 8 months. A mucoepidermoid carcinoma is considered rare in primary minor salivary gland carcinomas and it is believed to be more rare finding a well differentiated mucoepidermoid carcinoma in the radix linguae of a young woman.

Postoperative irradiation of minor salivary gland malignancies of the head and neck

Objectives: (1) To review the Stanford experience with postoperative radiotherapy for minor salivary gland carcinomas of the head and neck. (2) To identify patterns of failure and prognostic factors for these tumors.Materials and methods: Fifty-four patients with localized tumors were treated with curative intent at Stanford University between 1966 and 1995. The 1992 AJCC staging for squamous cell carcinomas was used to retrospectively stage these patients. Thirteen percent had stage I, 22% stage II, 26% stage III, and 39% stage IV neoplasms. Thirty-two patients (59%) had adenoid cystic carcinoma, 15 (28%) had adenocarcinoma, and seven (13%) had mucoepidermoid carcinoma. Thirty (55%) had positive surgical margins and seven (13%) had cervical lymph node involvement at diagnosis. The median follow-up for alive patients was 7.8 years (range: 25 months–28.9 years).Results: The 5- and 10-year actuarial local control rates were 91 and 88%, respectively. Advanced T-stage (T3-4), involved surgical margins, adenocarcinoma histology, and sinonasal and oropharyngeal primaries were associated with poorer local control. The 5- and 10-year actuarial freedom from distant metastasis were 86 and 81%, respectively. Advanced T-stage (T3-4), lymph node involvement at diagnosis, adenoid cystic and high-grade mucoepidermoid histology were associated with a higher risk of distant metastases. The 10-year cause-specific survival (CSS) and overall survival (OS) were 81% and 63%, respectively. On multivariate analysis, prognostic factors affecting survival were T-stage (favoring T1-2), and N-stage (favoring NO). When T- and N-stage were combined to form the AJCC stage, the latter became the most significant factor for survival. The 10-year OS was 86% for stage I-II vs. 52% for stage III-IV tumors. Late treatment-related toxicity was low (3/54); most complications were mild and no cranial nerve damage was noted.Conclusions: Surgical resection and carefully planned post-operative radiation therapy for minor salivary gland tumors is well tolerated and effective with high local control rates. AJCC stage was the most significant predictor for survival and should be used for staging minor salivary gland carcinomas.

Multivariate survival analysis of 128 cases of oral cavity minor salivary gland carcinomas.

Minor salivary gland carcinomas are uncommon tumors of the oral cavity. The decision regarding treatment remains controversial. The main objective of this paper is to report on the survival results of 128 patients treated in a single institution. Tumor sites were: hard palate (62 cases), tongue (16 cases), buccal mucosa (13 cases), soft palate (12 cases), and other sites (25 cases). The most common histology was mucoepidermoid carcinoma (76 cases). Clinically metastatic lymph nodes were palpable in 21 patients. Cox regression technique was used to construct the mathematical-statistical models, aiming to predict the risks of recurrence and of death as functions of the different variables under study. The 5-year overall survival rates were, respectively, 85.9% and 87.7% in the groups of patients treated by surgery or combined therapy. There were significant differences in survival rates according to N stage, bone involvement, tumor histology, sex, and type of surgery. Most of the recurrences were at the site of primary tumor; neck metastases were rare at presentation and after initial treatment. Prognosis involves several factors related to stage, histology, and treatment.

Immunohistochemical study of acinic cell carcinoma of minor salivary gland.

Acinic cell carcinoma (ACC) is a rare salivary gland tumour, making up 4% of all minor salivary gland tumors. Typically, it is composed of acinic cells although transitional and duct-like cells are also identified. In the present study, a panel of antibodies was applied to eight minor salivary gland ACCs. Antibodies tested were: cytokeratins 7, 8, 13, 14, 18, 19, vimentin and actin (HHF35). Immunohistochemical staining revealed that cytokeratin 8, among the tested antibodies, was the more specific to neoplastic cells with a pattern of distribution quite variable and peculiar. This staining may be useful in the recognition of neoplastic acinic cells.

Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands

Purpose : To examine the efficacy of fast neutron radiotherapy for the treatment of patients with locally advanced, adenoid cystic carcinoma of minor salivary glands and to identify prognostic variables associated with local control, overall survival, and cause specific survival. Methods and Materials : Eight-four patients having adenoid cystic carcinoma of minor salivary glands were treated with fast neutron radiotherapy during the years 1985–1994. All patients had either unresectable disease or gross disease remaining after attempted surgical extirpation. Seventeen patients had previously received conventional radiotherapy and their subsequent treatment fields and doses for neutron radiotherapy were modified for critical sites (brainstem, spinal cord, brain). Although the median doses (tumor maximum and tumor minimum) only varied by ≤10%, treatment portals were substantially smaller in these patients because of normal tissue complication considerations. Twelve patients (13%) had distant metastases at the time of treatment and were only treated palliatively with smaller treatment portals and lower median tumor doses (≤80% of the doses delivered to curatively treated patients). Seventy-two patients were treated with curative intent, with nine of these having recurrent tumors after prior full-dose radiotherapy. The median duration of follow-up at the time of analysis was 31.5 months (range 3–115). Sites of disease and number of patients treated per disease site were as follows: paranasal sinus—; oral cavity—20; oropharynx—12; nasopharynx—11; trachea—6; and other sites in the head and neck—4. Results : The 5-year actuarial local-regional tumor control rate for all patients treated with curative intent was 47%. Patients without involvement of the cavernous sinus, base of skull, or nasopharynx (51 patients) had a 5-year actuarial local-regional control rate of 59%, whereas local-regional control was significantly lower (15%) for patients with tumors involving these sites ( p < 0.005). In the latter cases, normal tissue injury considerations precluded delivery of the full dose to the entire tumor. Patients with no history of prior radiotherapy (63 patients) had an actuarial local control rate of 57% at 5 years compared to 18% for those (9 patients) who had been previously irradiatde with conventional photons ( p = 0.018). Eliminating the dose-limiting factors of prior radiation therapy and/or high risk sites of involvement, the 5-year actuarial local-regional control rate of these 46 patients was 63%, with an actuarial cause specific survival rate of 79%. Lymph node status was a predictor of distant metastasis; 57% of node positive patients developed distant metastases by 5 years compared to 15% of patients with negative nodes ( p < 0.0005), and patients who had nodal involvement developed distant metastases sooner than node negative patients ( p < 0.0001). The 5-year actuarial overall survival and cause specific survival for the 72 patients treated with curative intent were 59% and 64%, respectively. Conclusions : Fast neutron radiotherapy offers high local-regional control and survival rates for patients with initial primary treatment for these patients, as well as for other patients in whom surgical extirpation would cause considerable morbidity.

Apocrine carcinoma of the lip: A case report including immunohistochemical and ultrastructural study, discussion of differential diagnosis, and review of the literature

The light microscopic, immunohistochemical, and ultrastructural features of a case of apocrine carcinoma of the upper lip of a 54-year-old white man are described. The neoplasm had a cribriform intraductal component resembling apocrine carcinoma of the breast. The tumor had irregular borders and infiltrated skeletal muscle. The neoplastic cells had abundant eosinophilic granular cytoplasm and showed apical decapitation secretion characteristic of apocrine differentiation. The differential diagnosis is discussed with particular reference to distinction of the tumor from oncocytic carcinoma and ductal carcinoma of minor salivary gland.

Management of minor salivary gland carcinomas

Purpose : To assess the role of radiotherapy alone or in combination with surgery in the treatment of patients with malignant minor salivary gland carcinomas. Methods and Materials : Between October 1964 and November 1992, 95 patients with minor salivary gland carcinomas of the head and neck received radiotherapy with curative intent. Eighty-seven patients were previously untreated, and 8 were treated for postsurgical recurrence. Fifty-one patients were treated with radiotherapy alone, and 44 were treated by surgical resection plus radiotherapy. Patients were staged according to the 1983 American Joint Committee on Cancer (AJCC) staging criteria for squamous cell carcinomas. Results : The 20-year actuarial rate of local control was 57% with no significant difference according to histologic type. When tumor stage was taken into consideration, there were no significant differences in local control according to tumor site. The 12-year actuarial probability of distant metastases was 40% (19% as the only site of failure). In multivariate analyses, local control was significantly affected only by tumor stage and treatment type (combined therapy better than radiotherapy alone); tumor stage was a significant predictor of cause-specific survival and freedom from relapse. Freedom-from-relapse rates were higher for patients who received combined treatment ( p = 0.068). Conclusions : Treatment of minor salivary gland carcinomas is usually by combined surgery and radiotherapy, but there are situations where surgery alone or radiotherapy alone may be used. The ability to control these tumors with radiotherapy alone is not widely recognized. In the present series, the tumor was locally controlled in 20 patients with previously untreated primary lesions after radiotherapy alone (2.5 to 21 years) and in 4 other patients who were treated by radiotherapy alone for postsurgical recurrent tumor (3.5 to 14 years after radiotherapy). Contrary to the widely held belief that local recurrence after radiotherapy eventually develops in all patients with adenoid cystic carcinoma, local control has been maintained in 13 patients after radiotherapy alone; 5 of the 13 patients have been observed for 10 to 17 years.

Carcinoma of the minor salivary glands: Results of surgery and combined therapy

aPurpose This article reports the results of treatment of 7 histologic types of minor salivary gland carcinoma.Patients and Methods Of 256 cases, local excision was used in 194, extended excision in 62, excision accompanied by neck dissection in 98, and surgery with adjunctive radiation therapy or chemotherapy in 101. Forty-five of the 98 neck dissection cases had cervical node metastases.Results Survival rates were analyzed for 233 patients. The 3-year survival rate was (167 of 215) (77.67%), the 5-year survival rate was 134 of 187 (71.76%), and the 10-year survival rate was 79 of 113 (69.91%).Conclusions These data confirm that surgery is still the mode of choice in the treatment of minor salivary gland carcinoma, but a combination with radiation therapy or chemotherapy is advisable in some patients.

A mucoepidermoid carcinoma of minor salivary gland with t(11;19)(q21;p13.1) as the only karyotypic abnormality

We present the cytogenetic analysis of a mucoepidermoid carcinoma of the minor salivary gland with t(11,19)(q21;p13.1) as the sole karyotypic abnormality. Our findings, along with those of previous reports, indicate that this translocation is an early and most likely a primary event in the development of at least a subset of these neoplasms.

108 Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands

108 Neutron radiotherapy for adenoid cystic carcinoma of minor salivary glands

小唾液腺悪性腫瘍37例の検討

小唾液腺悪性腫瘍37例の検討