Cases Of Salivary Gland Tumors Research Articles

唾液腺腫ようの穿刺吸引細胞診

Clinical observations in 123 cases of salivary gland tumors (carcinoma: 11, pleomorphic adenoma: 81, warthin's tumor: 31) between 1991 and 2000 are reported and the cytodiagnosis of fine needle aspirated cytological materials from 114 cases (carcinoma: 10, pleomorphic adenoma: 78, warthin's tumor: 30) are discussed.Results and conculusions were as follows:1. In warthin's tumor, possible cytological classification diagnosis of benign tumor (class II) was made in 90% (27 cases), histological type suspicious diagnosis of warthin's tumor in 90% (27 cases) and 3 cases yielded unsatisfactory materials.2. In pleomorphic adenoma, we were possible classification diagnosis of benign tumor (class IIIa-II) was made in 91.9% (68 cases), histological diagnosis of pleomorphic adenoma in 90.5% (67 cases) and 6 cases yielded unsatisfactory material.3. In carcinoma cases, possible cytological classification diagnosis (class V-IIIb) of malignannt tumor was made in 50% (5 cases), histological type diagnosis of carcinoma in only 30% (adeno carcinoma: 2 cases, sucamous cell ca: l case) and 2 cases yielded unsatisfactory materials.4. Overall cytological results showed a sensitivity of 62.5%, specifity of 100%, false negative findings in 37.5%, false positive findings in 0% and unsatisfactory materials in 9.6%.5. When reexamination of malignant 10 cases was attemped postoperatively, it confirmed correct cytological diagnosis in 2 cases of adenoidcystic ca and a case of mucoepidermoid ca. Thus the cytological sesitivity rate rose from 62.5% to 75.0%.6. FNAC (Fine Needle Aspiration Cytology) for salivary gland tumor is a useful diagnostic method, becase the differential diagnosis of benign or malignant tumor and suspicious diagnosis of histologic type are possible.

Dendritic interstitial and myofibroblastic cells at the border of salivary gland tumors.

CD34-positive dendritic interstitial cells may be associated with the regulation of tumor growth. This association has been studied in various human neoplasms, especially skin tumors. In this study, we evaluated the distribution of dendritic interstitial cells and myofibroblastic cells at the tumor periphery of various benign and malignant salivary gland neoplasms. Forty-nine cases of salivary gland tumors were selected: 16 pleomorphic adenomas, 12 Warthin tumors, 8 polymorphous low-grade tumors, 5 adenoid cystic carcinomas, 6 acinic cell carcinomas, and 2 mucoepidermoid carcinomas. Immunohistochemical analysis was performed by using antibodies for CD34 (dendritic cells) and alpha-smooth muscle actin (myofibroblast) on formalin-fixed, paraffin-embedded archival tissue. Staining intensity was graded as marked (3+), moderate (2+), weak (1+), and absent (0). Staining intensity for CD34 was 3+ in 24 (86%) of 28 benign tumors (pleomorphic adenomas and Warthin tumors) and 6 (29%) of 21 malignant tumors (polymorphous low-grade tumors, acinic cell carcinomas, adenoid cystic carcinomas, and mucoepidermoid carcinomas) and 2+ in 4 (19%) of 21 malignant tumors. None of the benign tumors displayed 2+ staining with CD34. Three (11%) of 28 benign and 11 (52%) of 21 of malignant tumors failed to stain with CD34. alpha-Smooth muscle actin staining was 3+ in 10 (36%) of 28 benign tumors and 6 (29%) of 21 malignant tumors, and 2+ in 11 (39%) of 28 benign and 2 (9%) of 21 malignant tumors. Five (18%) of 28 benign and 11 (52%) of 21 malignant tumors failed to stain with alpha-smooth muscle actin. We conclude that the dendritic interstitial cells and myofibroblastic cells may be associated with the regulation of tumor growth in salivary gland tumors.

Dendritic Interstitial and Myofibroblastic Cells at the Border of Salivary Gland Tumors

Abstract Objective.—CD34-positive dendritic interstitial cells may be associated with the regulation of tumor growth. This association has been studied in various human neoplasms, especially skin tumors. In this study, we evaluated the distribution of dendritic interstitial cells and myofibroblastic cells at the tumor periphery of various benign and malignant salivary gland neoplasms. Methods.—Forty-nine cases of salivary gland tumors were selected: 16 pleomorphic adenomas, 12 Warthin tumors, 8 polymorphous low-grade tumors, 5 adenoid cystic carcinomas, 6 acinic cell carcinomas, and 2 mucoepidermoid carcinomas. Immunohistochemical analysis was performed by using antibodies for CD34 (dendritic cells) and α-smooth muscle actin (myofibroblast) on formalin-fixed, paraffin-embedded archival tissue. Staining intensity was graded as marked (3+), moderate (2+), weak (1+), and absent (0). Results.—Staining intensity for CD34 was 3+ in 24 (86%) of 28 benign tumors (pleomorphic adenomas and Warthin tumors) and 6 (29...

The clinical relevance of ploidy and S-phase fraction in salivary gland tumors. A flow cytometric study of 97 cases

The authors studied a series of 97 consecutive cases of salivary gland tumors to investigate the correlation between the biologic parameters DNA ploidy and S-phase fraction (SPF) and the presumptive behavior of the neoplasms, as well as the potential clinical utility of these parameters. Histopathologic classification and grading of the tumors were evaluated according to 1991 World Health Organization criteria. DNA analysis was performed by flow cytometry in fresh material after propidium iodide staining. Clinical data and follow-up information were obtained from the clinical charts. All the 71 benign salivary tumors showed a DNA diploid pattern. Seven carcinomas (7.2%) exhibited DNA aneuploidy. Eleven (42.3%) of 26 malignant tumors were considered low grade carcinomas, all of them being DNA diploid. Of the remaining 15 tumors, classified as high grade carcinomas, 7 showed DNA aneuploidy. SPF values ranged from 0.6% to 27.7%. A statistically significant difference was found between the mean SPF values of benign and malignant tumors, diploid and aneuploid tumors, and low grade and high grade carcinomas. When a cutoff value of 3% was used to discriminate histopathologic subgroups with prognostic impact, a significant difference was found between benign and malignant salivary tumors, high grade and low grade carcinomas, and high grade and benign tumors (P<0.001). The data from this study confirm the low incidence of DNA aneuploidy in salivary gland tumors and provide evidence for the potential utility of SPF estimation in evaluating the clinical behavior of these neoplasms. H. Tideman

Submandibular gland carcinoma; an audit of local control and survival following adjuvant radiotherapy.

Carcinoma of the submandibular gland is a rare diagnosis, accounting for less than 2% of cases of salivary gland tumours. We have examined the treatment and outcome of a total of 30 patients treated with radiotherapy at the Christie Hospital, Manchester between 1980 and 1993. In most cases this followed radical surgery, though 12 patients were referred following either incomplete excision or biopsy only. Adenoid-cystic histology accounted for 19 cases (63%). Standard radiotherapy was delivered using a beam directed technique to treat the whole submandibular compartment. Doses prescribed were most commonly from 50 to 55 Gy in 16 fractions over three weeks. Cancer specific survival was 79% and 57% at 5 and 10 yr respectively, the continued fall at 10 yr reflected late recurrence seen in patients with adenoid-cystic histology. Local control was 85% and 73%, respectively. Nine of twelve patients with incomplete excision or biopsy only had local control with radiotherapy. Six patients developed lung metastases, all of whom had adenoid-cystic histology. Radiotherapy was well-tolerated acutely, and only one patient experienced osteoradionecrosis requiring surgical intervention. The incidence of adenoid-cystic carcinoma is higher in the submandibular than the parotid gland. This typically results in late recurrence, and a high incidence of lung metastases and this was confirmed in our study. However, overall survival was very similar to that of parotid carcinoma.

The clinical relevance of ploidy and S-phase fraction determination in salivary gland tumors: A flow cytometric study of 97 cases

The authors studied a series of 97 consecutive cases of salivary gland tumors to investigate the correlation between the biologic parameters DNA ploidy and S-phase fraction (SPF) and the presumptive behavior of the neoplasms, as well as their potential clinical utility. Histopathologic classification and grading of the tumors were evaluated according to 1991 World Health Organization criteria. DNA analysis was performed by flow cytometry in fresh material after propidium iodide staining. Clinical data and follow-up information were obtained from the clinical charts. All the 71 benign salivary tumors showed a DNA diploid pattern. Seven carcinomas (7.2%) exhibited DNA aneuploidy. Eleven (42.3%) of 26 malignant tumors were considered low grade carcinomas, all of them being DNA diploid. Of the remaining 15 tumors, classified as high grade carcinomas, 7 showed DNA aneuploidy. SPF values ranged from 0.6% to 27.7%. A statistically significant difference was found between the mean SPF values of benign and malignant tumors, diploid and aneuploid tumors, and low grade and high grade carcinomas. When a cutoff value of 3% was used to discriminate histopathologic subgroups with prognostic impact, a significant difference was found between benign and malignant salivary tumors, high grade and low grade carcinomas, and high grade and benign tumors (P < 0.001). The data from this study confirm the low incidence of DNA aneuploidy in salivary gland tumors and suggest the potential utility of SPF estimation in evaluating the clinical behavior of these neoplasms.

Flow cytometric DNA analysis and MR imaging of salivary gland tumors

We correlated the histopathology of 32 cases of salivary gland tumors with MR imaging and flow cytometric DNA analysis. All malignant tumors were invasive and/or had an ill-defined margin. Fifty-seven percent of the pleomorphic adenomas were shown as a high signal intensity area on T2 weighted images. Fifty-six percent of Warthin tumors were shown as a low or iso signal intensity area on T2 weighted images associated with the cystic portion. Sixty-seven percent of malignant tumors were characterized by DNA aneuploidy and/or a total percentage of the S-phase fraction plus the G2 + M fraction higher than 10%. It was less than 10% and the Ki-67 positive fraction was higher than 20% in all pleomorphic adenomas. The Ki-67 positive fraction was less than 20% in 78% of Warthin tumors. The histopathology of all malignant tumors, 86% of the pleomorphic adenomas, and 89% of Warthin tumors was correctly predicted by the combination of MR images and flow cytometry. We suggest that the MR images combined with flow cytometric analysis of fine needle aspiration-derived materials is useful in the pre-operative histopathologic diagnosis of salivary gland tumors.

IMMUNOHISTOCHEMICAL DETECTION OF P53 PROTEIN AND PROLIFERATING CELL NUCLEAR ANTIGEN (PCNA) IN SALIVARY-GLAND TUMORS

The expression of p53 protein and PCNA was immunohistochemically examined in 161 cases of salivary gland tumors. The p53 protein was positive in 23.8% (24/101) of malignant salivary gland tumors, while only one case of 60 pleomorphic adenomas was positive. p53 protein was frequently detectable in salivary duct carcinoma (60%), basal cell adenocarcinoma (66.7%), acinic cell carcinoma (53.3%) and undifferentiated carcinoma (50%), but was rarely seen in adenoid cystic carcinoma (17.2%) and mucoepidermoid carcinoma (0%). p53 protein was more frequently detectable in PCNA positive cases than in negative cases (p=0.0074).

타액선 종양의 임상적 고찰

The salivary glands are divided into major salivary glands, consisting of the paired parotid, submandibular, and sublingual glands, and the minor salivary glands, composed of the 600 to 1000 glands distributed throughout the upper aerodigestive tract. Because of the diversity of tumor types and the relative rarity of salivary gland neoplasm, exact diagnosis and treatment decision have been difficult. Treatment was surgical and the resection was conservative when possible, depending upon the extent of the tumor. Seventy cases of salivary gland tumors which were diagnosed at our hospital from January 1987 to December were reviewed according to age, sex, site, presenting symptoms, staging, histology, and outcome, retrospectively. The following results were obtained; There were 27 males(38% ) and 43 females(62% ). The male to female ratio was 1 : 1.5 in benign tumors, and 1 : 2 in malignant tumors. Of all salivary gland tumors, 35 cases(50%) arose in the parotid gland, 16 cases(23%) in the submandibular gland, and 19 cases(27%) in the minor salivary glands. Among the benign tumors, size of 1 ∼3cm was 31 cases(56% ). There were 55(79%) benign tumors, and 15(21%) malignant tumors. The most frequent benign tumor was pleomorphic adenoma(89% ), and malignant tumor was adenoid cystic carcinoma(400. The incidence of malignancy was 11% in parotid gland, 31% in submandibular gland, and 32% in minor glands. The symptoms varied in duration from several weeks to 26 years. 29 cases(41%), had symptoms for one to five years. The most common presenting symptom was asymptomatic slowly growing mass(54%) followed by pain, rapidly growing mass, rhinorrhea, nasal obstruction, and facial nerve paralysis. The incidence of neck node involvement was 27% (4 cases). According to TNM system of AJC, 3, 5, 2, and 5 cases had stages I through IV. Superficial parotidectomy was performed 21 cases(60%) of parotid tumor. Among the submandibular and minor salivary glands, wide excision was performed 13 cases(81%) and 14 cases(74%). Among the parotid and submandibular glands, postoperative facial nerve paralysis was occurred 9 cases(18%). Recurrence was seen in 4 cases(6%).

Epithelial salivary gland tumors of children and adolescents in southern Portugal: A clinicopathologic study of twenty-four cases

During a 30-year period 24 epithelial salivary gland tumors were diagnosed in children and adolescents less than 18 years of age. The cases were retrieved from a series of 759 consecutive cases of salivary gland tumors (3.2%) from the area corresponding to southern Portugal during the same period of time. The mean age of the patients was 13.4 years, and one case was congenital. There was a slight female predominance (male/female ratio 1:1.7). The parotid gland was affected in most cases (70.8%). Seventeen neoplasms were benign, and the remaining seven were malignant. As in the adult group, pleomorphic adenoma was the most frequent benign tumor (66.6%), with similar histologic findings and clinical course. Mucoepidermoid carcinoma was the prevalent malignant tumor (20.8%), had a high grade of differentiation, and had a favorable outcome. The histologic pattern of the congenital neoplasm was similar to that of adult epithelial-myoepithelial carcinoma.

唾液腺腫よう１６０症例の臨床統計的検索

One hundred and sixty cases of salivary gland tumors histologically diagnosed at the Department of Oral Surgery, Faculty of Dentistry, Kyusyu University during the period from 1966 to 1987 were reviewed and clinically analysed. The results are:1. They were composed of 70.0% of benign tumors and 30.0% of malignant tumors.2. Pleomorphic adenoma were most common, which comprised 66.3% of all tumors and 94.6% of benign tumors.3. Adenoid cystic carcinoma and mucoepidermoid tumor were equally common in malignant tumors. They comprised about 20% of all tumors and more than two thirds of malignant tumors.4. Benign tumors occurred more frequently in women (66.1%) than men (33.9%) and malignant tumors occurred more frequently in men (54.2%) than women (45.8%).5. The average age of the patients affected by malignant tumors was higher than that of benign tumors (malignant tumors 53.0 years old, benign tumors 44.9 years old), and benign tumors were distributed evenly in all generation, but most malignant tumors occurred in middle or high generation.6. They occurred almost equally in major salivary glands (50.6%) and minor salivary glands (49.4%).7. Palatal gland tumors were most common, and comprised 36.3% of all tumors.8. The incidence of malignant tumors in minor salivary glands was higher than that of major salivary glands.

唾液腺腫よう６０例の臨床統計的観察

Sixty cases of salivary gland tumors at the Department of Dentistry and Oral Surgery of Wakayama Medical College during a 22-year period are reviewed. The diagnosis of individual tumors was based on the World Health Organization classification.1) 28 cases were benign tumors, and pleomorphic adenoma (27 cases) was the lesion most frequently encountered. In the group of malignant tumors (32 cases), mucoepidermoid tumor (12 cases) was the most frequently encountered lesion.2) Malignant tumors occurred most frequently in the sixth decade of life, although benign tumors were equally common in all decades.3) The palate was the site of most often involved. The next most common site of involvement for benign tumors was the parotid gland. For malignant tumors, the next common sites were the floor of the mouth and the retromolar region.4) The average duration from onset of benign tumors and malignant tumors were 5.4 years and 2.2 years.5) Painless swelling was the most common symptom presented. Pain and ulcer formation were presented with much greater frequency in cases of malignant tumors.6) From the clinical behavior and end results, mucoepidermoid tumor of low-grade malignancy does not tend to recur or metastasize. Those of high-grade malignancy frequently recurred and metastasized.7) Adenoid cystic carcinoma exhibits a marked tendency to metastasize to lungs 7-8 years after primary treatments.

Immunohistochemical expression of MAM-3 and MAM-6 antigens in salivary gland tumours

MAM-3 and MAM-6 antigens of human milk fat globule membrane were detected immunohistochemically in 93 cases of salivary gland tumours as well as in normal glands. The antigens were visualized in 10% formalin-fixed paraffin sections. MAM-3 (MoAbs 115G3, 67D11) antigen was distributed in intercalated and striated duct cells of the normal salivary glands, and in luminal tumour cells and squamous metaplastic cells of pleomorphic adenomas. In pleomorphic adenomas the frequency of positive staining with MoAb 67D11 (54/67; 80.6%) was higher than that with MoAb 115G3 (36/67; 53.7%). MAM-6 (MoAbs 115D8, 115F5) antigen was expressed in luminal and lateral borders of serous acinar cells and ductal of the normal glands, and also in luminal borders of tubulo-ductal and glandular structures of salivary gland tumours. Ductal basal cells were characterized by existence of positive staining for MAM-6 antigen, in adenolymphomas MAM-6 antigen was restricted to the basal tumour cells. Some mucous cells of mucoepidermoid tumours were stained specifically with MoAb 115G3, and epidermoid cells of mucoepidermoid carcinomas manifested MAM-6 antigen staining. Immunohistochemical localization of MAM-6 antigen resembled that of epithelial membrane antigen (EMA) detected with MoAb.

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%).

唾液腺腫ようの病理組織学的研究 特に多形性腺腫の亜分類と被膜との関係について

One hundred and forty-seven cases of salivary gland tumors were studied, composed of 107 cases of benign tumors (72.8%) and 40 cases of malignant tumors (27.2%). Pleomorphic adenomas were the most common tumor (94 cases) and occurred more frequently in females than in males. Mucoepidermoid tumors were the most common tumors among the malignant ones.Most of the pleomorphic adenomas were composed of three main patterns: epithelial, myoepithelial, and myxomatous. According to the kind of the predominant pattern, we classified the tumors into four types, the adenomatous, the myoepitheliomatous, the intermediate, and the myxomatous type in order of frequency. Incomplete encapsulation and capsular invasion were found most frequently in the cases of adenomatous type. The presence of adipose tissue within the tumor tissue was found more frequently in the minor salivary gland tumors.

Salivary gland tumours—Analysis of 162 cases

The clinical records of 162 cases of salivary gland tumours were studied. Parotid gland was the commonest site for origin of tumour (110 cases.) Commonest benign tumour was pleomorphic adenoma (42 cases) and the commonest malignant tumour was mucoepidermoid carcinoma (26 out of 162 cases). The next common tumours were adenoidcystic and undifferentiated carcinoma which constituted 23 and 20 cases respectively. Surgery or surgery with radiotherapy were the main modalities of treatment for the primary tumours. Twenty patients had recurrence within three years after the treatment. These patients were treated with either revision surgery or external radiations. Chemotherapy was given to one patient of soft tissue sarcoma. Twenty nine patients had post-operative complications like facial paralysis, parotid fistula, skin necrosis and Frey’s syndrome.

A note on the histochemical and morphological characterization of the asbestoid degeneration of cartilage.

Using only one histologic preparation and under the light microscope, the simple Picrosirius-polarization method permitted the histochemical characterization of the collagenous nature of amianthoid fibers in file cases of salivary gland tumors. In this regard the foregoing results agree with the electron microscopic and X-ray diffraction observations recorded in the literature. Not only did the Picrosirius-polarization method permit the precise characterization of the collagenous nature of asbestoid change but it was also useful for studying the degree of collagen polymerization in the lesion. Collagen molecules in the amianthoid fibers showed hyperpolymerization whereas the molecules in the compact areas were disoriented. Since the foregoing results demonstrate that the Picrosirius-polarization method is a simple and sensitive procedure for detecting asbestoid change in cartilage sections obtained from paraffin-embedded tissues, the usefulness of this technique for studying file cases is evident.

Clinicopathological and immunohistological study of salivary gland tumors

A total of 126 cases of salivary gland tumors were studied from clinicopathological view point. A particular attention was paid to the reason for the recurrence in pleomorphic adenoma and to the prognosis of adenoid cystic carcinoma. Immunohistological reaction for many markers including lysozyme, lactoferrin, Al-p, keratin, S-100, actin, vimentin, CEA, etc., using PAP method was performed to investigate the origin of tumor cells and to obtain an indicator for malignancy.In recurrent cases with plemorphic adenoma, myxochondromatous pattern was more frequently observed than other patterns, even if no correlation to the numbers of atypical cells and of mitotic figures. A relation between the recurrence and proliferation of tumor cells was not speculated because of an equal frequency of Ki-67 positive cells irrespectively histological subtypes of pleomorphic adenoma. In adenoid cystic carcinoma, the cases with solid pattern, occupying only a part of tumor, had poor prognosis. It was presumably considered that the solid pattern in adenoid cystic carcinoma might reflect high grade malignancy.Immunohistologically, salivary gland tumors, benign or malignant, are composed of lines of ductal epithelial cells. In malignant tumors, however, it was rather difficult to determine the cell origin because of a poor immunohistological reaction. A localization of CEA was different in benign tumors from malignant tumors, showing that it was positive for luminar border of ductal epithelium in former and positive for cytoplasma of tumor cells in latter, particalurly in mucoepidermoid carcinoma and acinic cell carcinoma. CEA might be useful for differential diagnosis in certain histologic types. Ki-67 is known as antigen positive for nuclei of proliferating cells, but there has been no report on salivary gland tumors. In this study, Ki-67 positive cells in malignant tumors were higher than those of normal gland benign tumors. A high frequency of Ki-67 positive cells in salivary gland tumors may give a clue for malignancy.

唾液腺腫瘍の臨床病理学的検討

The 142 cases of salivary gland tumors treated in our department during the past ten years were reviewed clinicopathologically. Major salivary gland tumors were found in 124 cases with 110 cases of parotid tumors and 14 cases of submandibular gland tumors. Minor salivary gland tumors were found in only 18 cases. Pleomorphic adenoma was the most predominant tumor in the salivary glands accounting for 59%of all cases. There were malignant tumors in 15% and 56% of major and minor salivary glands respectively, indicating the high incidence of malignancy in the minor salivary gland. Among the malignant tumors of the minor salivary were 3 gland cases of adenoid cystic carcinoma which was found only in one case of the major salivary gland. Compared to the benign tumors, more malignant tumors which were larger were found in elderly males. Malignant tumors were accompanied by facial palsy and pain with a high incidence only in the parotid gland. In the submandibular and minor salivary glands, the small number of cases did not reveal any differences in rates of these complications.

Immunohistochemical distribution of human epidermal growth factor in salivary gland tumours

Immunohistochemical identification of human epidermal growth factor (hEGF) was carried out in a total of 152 cases of salivary gland tumours, consisting 107 pleomorphic adenomas and their variants, 13 adenolymphomas and 32 adenoid cystic carcinomas. A high percentage of pleomorphic adenomas revealed markedly positive hEGF staining of the luminal surface cells of tubuloductal structures and of modified or neoplastic myoepithelial cells. Clear cells of the tumour showed various reactivities from very slight to strong. Eosinophilic epithelial cells of adenolymphoma gave a positive reaction for hEGF in all the cases, whereas most adenoid cystic adenoma lacked hEGF staining; however some cases showed positive staining of the tumour cells. The immunohistochemical detection of hEGF in most salivary gland tumours suggests this factor to be a possible new marker of salivary glands tumours, and to have a biological role in tumour proliferation.