Carcinoma Of Parotid Gland Research Articles

Survival in patients with parotid gland carcinoma – Results of a multi-center study

BackgroundParotid gland carcinoma is a rare malignancy, comprising only 1–4% of head and neck carcinomas; therefore, it is difficult for a single institution to perform meaningful analysis on its clinical characteristics. The aim of this study was to update the clinical knowledge of this rare disease by a multi-center approach. MethodsThe study was conducted by the Kyoto University Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group (Kyoto-HNOG). A total of 195 patients with parotid gland carcinoma who had been surgically treated with curative intent between 2006 and 2015 were retrospectively reviewed. Clinical results including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control rate (LCR), regional control rate (RCR), and distant metastasis-free survival (DMFS) were estimated. Univariate and multivariate analyses were performed to identify prognostic factors. ResultsThe median patient age was 63years old (range 9–93years), and the median observation period was 39months. The OS, DFS, DSS, LCR, RCR, and DMFS at 3years were 85%, 74%, 89%, 92%, 88%, and 87%, respectively. Univariate analysis showed age over 74, T4, N+, preoperative facial palsy, high grade histology, perineural invasion, and vascular invasion were associated with poor OS. N+ and high grade histology were independent factors in multivariate analysis. In subgroup analysis, postoperative radiotherapy was associated with better OS in high risk patients. ConclusionNodal metastases and high grade histology are important negative prognostic factors for OS. Postoperative radiotherapy is recommended in patients with advanced high grade carcinoma.

Iodine-125 brachytherapy alone for advanced primary parotid gland carcinoma

This study aimed to evaluate the efficacy of iodine-125 (125I) brachytherapy alone for the treatment of advanced parotid gland carcinoma and to identify predictors of tumour control and patient survival. Primary parotid gland carcinoma patients (n=23) treated with 125I brachytherapy alone between 1 October 2005 and 31 July 2013 at Peking University Stomatology Hospital were enrolled in this retrospective study. All had clinical stage IV disease. The prescribed dose was 60–160Gy. The local control rate, survival rate, and predictors of the prognosis were evaluated. Adverse events related to treatment were also noted. The average follow-up time was 29 months (range 9–74 months). Among the 23 patients, six had local failure and 11 died during the follow-up period. The 1-, 3-, and 5-year overall survival rates were 87.0%, 55.4%, and 47.5%, respectively. The 1-, 3-, and 5-year progression-free survival rates were 73.9%, 47.0%, and 39.2%, respectively. The 1-, 3-, and 5-year local control rates were 82.1%, 73.9%, and 73.9%, respectively. Age and distant metastasis were independent predictors of survival, while the preoperative duration of the disease was an independent predictor of local control. The use of 125I seed brachytherapy alone for the treatment of primary parotid gland carcinoma can provide good short-term results without causing any severe side effects.

Success of preventive approach to mandibular osteoradionecrosis in an adolescent: case report.

AbstractOsteoradionecrosis (ORN) is defined as the presence of ulceration or necrosis of the mucosa with exposure of necrotic bone that does not heal within a 2‐month period after radiotherapy in patients with head and neck tumours. The mandible presents a higher risk of developing ORN than the maxilla and extraction of teeth is also considered a risk factor for the development of ORN. The aim of this article was to present a clinical case where a protocol was used to prevent the development of ORN after the extraction of lower molars in an adolescent who had undergone surgical removal and radiotherapy for a mucoepidermoid carcinoma in the left parotid gland. The results showed that the protocol used was efficient in the prevention of osteoradionecrosis in this adolescent. One year after the extractions, no clinical or radiographic signs of any pathological alteration were observed in the region; the patient remains under periodical clinical and radiographic follow‐up.

Abstract 1757: Spectrum of BAP1 mutations identified in diverse cancer lineages

Abstract Background: Germline mutations in the tumor suppressor gene, BAP1, a deubiquitylase that regulates key cellular pathways, are associated with a recently-described tumor predisposition syndrome characterized by early onset benign melanocytic skin tumors, and a significant risk of cancers that include mesothelioma, cutaneous and uveal melanoma, renal cell carcinoma (RCC) and cholangiocarcinoma. Somatic or germline BAP1 mutations have been associated with an aggressive course and a poor prognosis in RCC and cholangiocarcinoma and may render the cancer cells more sensitive to HDAC inhibitors or Parp inhibitors. We investigated types and frequencies of BAP1 mutations in a large cohort of diverse malignancies and their associations with other molecular/genomic characteristics. Methods: A total of 9782 tumor samples from over 40 cancer types were molecularly profiled at Caris Life Sciences by next generation sequencing (Illumina NextSeq platform and Agilent SureSelect XT panel, 592 genes). Microsatellite instability (MSI) was tested by PCR and fragment analysis (Promega MSI Analysis System). Results: A pathogenic somatic or germline BAP1 mutation was identified in 20 cancer types, with a total of 129 tumors with mutations found (1.3% prevalence). As expected, BAP1 mutations were frequently seen in uveal melanoma (50% or 24 in 48), malignant pleural mesothelioma (29% or 6 in 21), RCC (8% or 12 in 150), cholangiocarcinoma (6.6% or 13 in 196), and cutaneous melanoma (2.2% or 7 in 319). In addition, pathogenic BAP1 mutations were detected in carcinomas arising in parotid gland (10.3% or 3 in 29), anus (8.3% or 3 in 36), cervix (3.4% or 4 in 117), stomach (3.3%, or 6 in 180), head and neck (1 in 97 or 1%), lung (14 in 1590 or 0.9%), and breast (0.8% or 7 in 887). A mutation was also noted in a meningioma (1 in 43) and a uterine sarcoma (1 in 96). Variants of BAP1 (pathogenic, presumed pathogenic, and variants of unknown significance) were more often seen in MSI-high tumors (compared to MSS) in both colorectal (12/61 vs. 18/1003) and endometrial carcinomas (5 of 69 vs. 5 of 321; both p<0.01). It was not determined whether the BAP1 mutations were somatic or germline in origin. Conclusions: The study confirmed the presence of pathogenic BAP1 mutations in carcinomas commonly associated with BAP1 germline and somatic mutations. It also identified BAP1 mutations in additional cancer types (parotid gland, anal and cervical carcinomas), as well as its association with MSI-H cancers (colon and endometrium). Evaluation of mutations in non-cancerous tissues is underway to determine if these novel cancer associations are related to germline predisposition. Citation Format: Zoran Gatalica, Joanne Xiu, Jeffrey Swensen, Wangjuh Chen. Spectrum of BAP1 mutations identified in diverse cancer lineages [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1757. doi:10.1158/1538-7445.AM2017-1757

Comparing the RTOG/EORTC and LENT-SOMA scoring systems for the evaluation of late skin toxicity after 125I seed brachytherapy for parotid gland cancer

PurposeThe Radiation Therapy Oncology Group (RTOG) and Late Effects Normal Tissue Task Force-Subjective, Objective, Management and Analytic (LENT-SOMA) scoring systems were compared for grading late skin effects after iodine-125 seed brachytherapy in parotid gland cancer patients. Methods and MaterialsA total of 109 patients diagnosed with parotid gland carcinoma were treated postoperatively with iodine-125 seed brachytherapy at a dose of 100–120 Gy. After 6–24 months of followup, telangiectasia, skin pigmentation, atrophy, fibrosis, and ulceration were scored according to both RTOG and LENT-SOMA scale criteria. The strength of correlation between the scores and the interobserver variability were calculated. ResultsOf 109 patients, 22.9% had telangiectasia; 78.9%, pigmentation; 28.4%, fibrosis; 4.6%, edema; 0.9%, ulceration; 37.6%, retraction and/or atrophy; 22.9%, sensation change; and 11%, scaliness and/or roughness. Compared with RTOG, LENT-SOMA criteria resulted in the upgrading of pigmentation in 17% of cases, the downgrading of all instances of telangiectasia and the downgrading of one instance of Grade 4 ulceration to Grade 3. Between the two scales, fibrosis and atrophy correlated well (Spearman ρ, 0.992, 0.986). An additional 229 side effects were observed using LENT-SOMA criteria. ConclusionsThe LENT-SOMA scale was more accurate than the RTOG scale for the evaluation of late skin and subcutaneous toxicity. The downgrading of telangiectasia and upgrading of pigmentation with the LENT-SOMA scale reflected the patients' conditions better than the scores obtained with the RTOG scale. The assessment of fibrosis and atrophy correlated well between the two scales. The use of the sum of the individual scores of the LENT-SOMA is therefore advocated. The addition of decreased sweating and the removal of the alopecia (scalp) metric should be considered to standardize the reporting of late radiation morbidity.

Parotid adenoid cystic carcinoma: Retrospective single institute analysis

PurposeAdenoid cystic carcinoma (ACC) is a uncommon salivary malignant tumor. Our aim was to review our experience with parotid ACC, to identify clinical-pathological parameters predictive for outcome. Materials and methodsWe retrospectively reviewed 228 patients affected by parotid gland carcinomas surgically treated at our Institution. Forty-four ACC were included in this study. Multivariate analysis risk models were built to predict recurrence free probability (RFP), distant recurrence free probability (DRFP), overall survival (OS) and disease free survival (DFS). ResultsTwenty-one patients (47.7%) died from ACC and 2.3% for other causes. The 41% presented local-regional recurrence, with a regional-RFP rate of 93%, and the 34% reported distant metastases (DM). The five and ten-year OS rates were 74% and 50%, respectively. ConclusionsRecurrences were mainly influenced by the presence of perineural invasion and nerve paralysis, whilst female gender and age<50 were predictors for good prognosis.

耳下腺脱分化癌例

耳下腺脱分化癌例

Primary lymphoepithelial carcinoma of parotid gland in a patient from a nonendemic area

Primary lymphoepithelial carcinoma (LEC) of salivary gland is very rare and accounts for 0.4% of all malignant salivary gland tumors. LEC occurs more commonly in parotid. It is endemic in certain regions of world and has a racial predilection for Eskimos, Southeastern Chinese, and Japanese. Incidence is slightly more in females. We herewith report a case of LEC of the parotid gland in a 54-year-old male from a nonendemic area (Central Kerala, India).

Perineural spread of mucoepidermoid carcinoma of parotid gland involving V, VI, and VII cranial nerves demonstrated on positron emission tomography/computed tomography

Perineural spread (PNS) in head and neck malignancies has been associated with extremely poor prognosis. Through this interesting case, we demonstrate the PNS of a mucoepidermoid carcinoma of parotid gland with simultaneous involvement of V, VI, and VII cranial nerves identified on positron emission tomography/computed tomography.

Treatment and problem of parotid gland carcinoma

Treatment and problem of parotid gland carcinoma

Outcomes and prognostic factors for surgery followed by modern radiation therapy in parotid gland carcinomas.

To evaluate the outcomes and prognostic factors in patients with parotid gland cancers treated with adjuvant radiotherapy with or without chemotherapy. Eighty-five patients with parotid gland cancers were identified between October 2001 and September 2011. The median radiation dose was 66 Gy (range, 9-76 Gy). The outcomes assessment included overall survival, locoregional control, distant metastasis-free survivaland disease-free survival. The stage distribution was 20 patients(23.5%) in stage I, 28 (32.9%) stage II, 14 (16.5%) stage III and 23 (27.1%) stage IV. Fifty-five patients (64.7%) had positive margins and 23 patients (27.1%) had close margins (<0.5 cm). Lymph node extracapsular spreading occurred in nine patients. The adjuvant therapy included radiotherapy alone in 47 patients (55.3%) and concurrent chemoradiotherapyin 38 patients (44.7%). With a median follow-up of 4.5 years (range, 0.4-11 years), the 5-year overall survival, locoregional control, distant metastasis-free survival and disease-free survival were 82.0, 88.4, 82.4 and 77.5%, respectively. Based on multivariate analysis, N1/N2 was a significant negative prognostic factor for distant metastasis-free survival, disease-free survival and overall survival. Perineural invasion was a significant negative prognostic factor for locoregional control, distant metastasis-free survival and disease-free survival. Patients 50 years or older had significantly worse distant metastasis-free survival, disease-free survival and overall survival. Surgery and radiotherapy treatment could achieve excellent outcomes in a modern cohort. However, N1/N2, perineural invasion and age ≥50 years, but not positive margins, are significant factors associated with a worse prognosis.

403. Lymphoepithelial carcinoma of parotid gland as an example of very rare malignancy

Introduction: Lymphoepithelial carcinoma (LEC) is an uncommon tumor, histologically characterized by malignant epithelial cells with dense lymphoid stroma. LEC constitutes for 0.4% of invasive salivary gland tumors and has unique demographic specification with very low incidence rate in Europe. According to RARECARE Surveillance there are only 18 cases documented in Europe with an incidence rate 0.003/100000.

A rare presentation of Adenoid cystic carcinoma of parotid gland as metastatic Endobronchial growth during Bronchoscopy with multiple ‘Bilateral Cannon ball’ lung metastasis in chest radiograph

Adenoid cystic carcinoma are relatively less common type of salivary gland tumour including parotid gland, and is the only histological type having propensity to spread distantly by lympho-hematogenous and other ‘classical perineural’ spread. Adenoid cystic carcinoma as a primary salivary gland tumor arising in bronchus is known entity although is exceptionally rare. In this case report, 43 year male with past history of adenoid cystic carcinoma of left parotid gland which was operated 4 years back and received post-operative radiotherapy presented with shortness of breath clinically. We observed ‘cannon ball opacities bilaterally’ over chest radiograph and Endobronchial growth during bronchoscopy. Histopathology confirmed as a metastatic lung cancer. We recommend bronchoscopy of all the cases with bilateral cannon ball metastasis as it will help in diagnosis endobronchial growth.

Clinicopathological characteristics of head and neck Merkel cell carcinomas

There are still controversies about the therapeutic strategies and subsequent outcome in head and neck Merkel cell carcinoma. Clinicopathological data of 23 Merkel cell carcinomas, 93 cutaneous head and neck squamous cell carcinomas (HNSCCs), 126 malignant melanomas, and 91 primary parotid gland carcinomas were comprehensively analyzed. Merkel cell carcinomas were cytokeratin 20 (CK20)/neuron-specific enolase (NSE)/chromogranin A (CgA)/synaptophysin (Syn)/thyroid transcription factor-1 (TTF-1)/MIB1 immunostained. All Merkel cell carcinomas underwent wide local excision. Parotidectomy/neck dissection was performed in 40%/33% cutaneous Merkel cell carcinoma and 100%/100% in parotid gland Merkel cell carcinoma. Five-year recurrence-free interval (RFI)/overall survival (OS) was significantly higher in malignant melanoma (81/80%) than in cutaneous Merkel cell carcinoma/HNSCC. Interestingly, 5-year RFI/OS was significantly higher in Merkel cell carcinoma (61%/79%) than in HNSCC (33%/65%; p < .0001) despite comparable TNM classifications and treatment regimens. There were neither differences of RFI/OS between parotid gland Merkel cell carcinoma and parotid gland carcinomas, nor in the immunohistochemical profile. Five-year RFI/OS was significantly better in cutaneous Merkel cell carcinoma when compared with TNM classification matched HNSCC. Five-year RFI/OS was comparable in parotid gland Merkel cell carcinoma and other primary parotid gland malignancies. © 2016 Wiley Periodicals, Inc. Head Neck 39: 92-97, 2017.

Histological reclassification of parotid gland carcinomas: importance for clinicians.

Reassessment of histological specimens of salivary gland carcinomas is associated with a change of primary diagnosis in a significant number of patients. The authors evaluated the relation between reclassification/verification of histological diagnosis and the clinical course of parotid gland carcinomas. Histological and immunohistochemical examinations of 111 specimens of parotid gland carcinomas operated on during the years 1992–2010 were revised and in some cases supplemented with cytogenetic tests (FISH), to verify the diagnosis and potentially reclassify the tumours. Analysis of the clinical documentation and follow-up data of patients whose diagnosis was changed was then carried out. The prognostic factors taken into account in the evaluation of the clinical course included the T and N stage, the tumour grade and the extent of resection. The primary diagnosis was changed on review in 28 patients (25.2 %). In 16 patients, the change involved a different histological type of cancer. In six cases, what was thought to be a primary salivary gland cancer was reclassified as a secondary tumour. In four other cases, the change was made from a malignant to a benign tumour and in one case to a non-neoplastic lesion (necrotizing sialometaplasia). Additionally, in two patients with carcinoma ex pleomorphic adenoma, the malignant component was found to be of in situ type. A potentially atypical clinical course was observed in 4 out of 28 patients whose diagnosis was changed. In the case of 2 patients, the course of disease was more aggressive (dissemination, death) than predicted and less aggressive in rest of the patients. Histological reclassification/verification of parotid gland carcinomas can explain the cause of an atypical clinical course in some patients and sometimes enables doctors to implement a change in therapy.

The Trojan Horse Tale Revisited: An Eye on Metastatic Spread of Carcinoma Cells

The metastatic spread of carcinoma cells is not fully understood. Here, we compare the peripheral blood mononuclear cells (PBMC) and intraocular metastatic cells in parotid gland carcinoma with the PBMCs of healthy donors by immunohistochemistry and flow cytometry. We found Ber-EP4 tumor marker-positive carcinoma cells in the aqueous humor of the patient's right eye and a CD45 and Ber-EP4-expressing PBMC population in his blood. These Ber-EP4-expressing cells exhibited a monocytic-myeloid phenotype with coexpression of CD11b, CD115, and the macrophage marker CD172a (SIRP-α). Uptake of pHrodogreen revealed their phagocytic activity. Our findings suggest that the tumor cells in the anterior chamber originally derived from cell fusions between tumor cells and myeloid cells in the peripheral blood. Thus, metastases of a solid malignancy could use monocytes-macrophages as the Trojan horse to enter the eye.

Clinicopathological features and treatment outcomes of the rare, salivary duct carcinoma of parotid gland.

BackgroundSalivary ductal carcinoma (SDC) of parotid gland is a rare and aggressive entity; accounting for 1–3 % of all malignant salivary gland tumors, 0.2 % of epithelial salivary gland neoplasms, 0.5 % of salivary gland carcinomas, and 1.1 % of parotid gland carcinomas. Here in we aimed to evaluate the clinico-pathological features and treatment outcomes of parotid gland SDC in Saudi population.MethodsAmong 38 patients with parotid malignancies, who were treated in two major tertiary care referral cancer centers between December 2007 and December 2014, seven cases (18.4 %) were found to have SDC, which were investigated for clinicopathological features, locoregional recurrences (LRRs), distant metastasis (DM) and survival rates.ResultsMean age of cohort was 62.3 years (range: 41–83) and female predominant (71.4 %). All patients underwent total parotidectomy and ipsilateral neck dissection. Mean tumor size was 3.4 cm (range: 2.1–5.3); perineural invasion (85.8 %); lymph node involvement (42.9 %); and HER-2 neu overexpression (28.6 %). Postoperative radiation therapy (PORT) was given to six patients (dose: 50–66 Gy). Median follow-up was 20.2 months (range: 11–48). LRRs were seen in five (71.4 %) patients (base of skull, 3 patients; cervical nodes, one patient; parotid bed, one patient). LRRs were salvaged with resection (two patients) and re-irradiation (one patient with base of skull). DM in lungs was seen in three patients (42.8 %); one treated with carboplatin/paclitaxel based chemotherapy. The 4-year disease free and overall survival rates were 16.7 % and 40 % respectively.ConclusionSDC of parotid gland is a rare and aggressive entity, and most of LRRs were seen in the base of skull, which warrants inclusion of base of skull in clinical target volume in PORT planning. Role of anti HER-2 targeted therapy in SDC with HER-2 neu overexpression needs further investigations.

Epstein-Barr Virus Positive Primary Lymphoepithelial Carcinoma of the Parotid Gland with Hot Uptake of the Nasopharynx at Positron Emission Tomography-Computed Tomography

림프상피암종(lymphoepithelial carcinoma)은 림프 모양 조직배경에 미분화된 악성종양세포가 침윤하는 특징이 있는 종양으로 대부분 비인강에 발생한다. 비인강 외에는 이하선 에서 가장 많이 발생하며, 타액선에서 발생하는 종양 중에서 는 0.4%를 차지하는 드문 종양으로 알려져 있다. 림프상피 암종은 Hilderman 등에 의해 1962년 최초로 보고되었으 며, 현재까지 소수의 증례보고가 있어 왔다. 최근 여러 연구에서 림프상피암종은 Epstein-Barr virus (EBV)와 관련성이 높으며, 인종지형학적으로 에스키모인, 중 국인, 일본인, 대만인에서는 EBV와 관련이 있으나 서양인에 서는 큰 관련이 없다는 결과가 보고되었다. 이에 본 저자 들은 positron emission tomography-computed tomography (PET-CT)에서 비인두의 이상섭취 소견이 동반된 EBV 양성 원 발성 이하선 림프상피암종을 수술적 절제 후 방사선 조사로 치 료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Epithelial myoepithelial carcinoma of parotid gland-a case report

Epithelial-Myoepithelial Carcinoma is a rare malignant salivary gland neoplasm. It is also known as adenomyoepithelioma. It accounts for less than 1% of all salivary gland neoplasms. This unusual salivary gland tumors is first described by Donath et al in 1972. This tumor occurs in sixth decade and beyond having a female predominance. Parotid gland is the most commonly involved followed by submandibular gland and palate. Herein we are presenting a rare case of Epithelial-myoepithelial carcinoma of parotid gland.

Adenoid cystic carcinoma of the accessory parotid gland

Accessory parotid gland is a small salivary gland tissue separated from main part of parotid gland. It is located on the masseter muscle anterior to the Stensen's duct. Tumors of accessory parotid gland are rare. In this article, we report an unusual case of adenoid cystic carcinoma involving accessory parotid gland. The patient presented with a progressively growing mass in the middle portion of her cheek. She underwent a partial parotidectomy including both the superficial and accessory lobes. The histopathologic diagnosis was adenoid cystic carcinoma of cribriform type.