Intraglandular Lymph Node Research Articles

The Emerging Theoretical Framework of Two-Person Neuroscience

Whether the submandibular gland (SMG) can be preserved during neck dissection in the surgical treatment of oral squamous cell carcinoma (OSCC) is controversial. This study investigated the SMG involvement rate and provides a basis for preserving the SMG during neck dissection in appropriate cases of OSCC.A comprehensive systematic review was conducted on the PubMed and MEDLINE, Embase, and Cochrane Library databases for studies on SMG involvement in OSCC published before December 2017 with a data analysis technique. Predictor variables were numbers of patients and resected SMGs, primary site, and tumor, node, and metastasis stage. Outcome variables were the number of involved SMGs and mode of involvement. Other variables, namely first author, publication year, mean age, and condition of neck lymph nodes at level Ib, also were extracted. A random-effects model was used to analyze the rate of SMG involvement in OSCC.Twelve studies involving 2,126 patients with OSCC who underwent neck dissection were included in the study. Fifty-two SMGs were involved, and the pooled involvement rate was 2% (I2 = 73%; 95% confidence interval [CI], 1-3). Forty-eight SMGs were involved through direct spread from the primary site or extracapsular spread of positive lymph nodes, and the pooled involvement rate was 1.9% (I2 = 72%; 95% CI, 0.9-3.1). Except for direct spread, 4 SMGs were involved through the intraglandular lymph node or carcinoma growing along Wharton ducts, and the pooled involvement rate was only 0.1% (I2 = 0%; 95% CI, 0-0.2).The rate of SMG involvement in OSCC is very low, and the most common mode of involvement is by direct spread. The SMG might be preserved during neck dissection in OSCC when it is unlikely to be involved through direct spread.

Relevance of Intraparotid Metastases in Head and Neck Skin Squamous Cell Carcinoma.

Parotid lymph node metastases are common in head and neck cutaneous squamous cell carcinoma (cSCCHN). Here we evaluate the diagnostic, prognostic, and therapeutic implications of intraglandular lymph node (IGLN) metastases in cSCCHN. Retrospective study in a tertiary referral university cancer institute. We included patients with cSCCHN who underwent parotidectomy and neck dissection (ND), with or without synchronous resection of the skin primary, between January 1999 and January 2018. The characteristics of cSCCHN with or without IGLN involvement were compared. Altogether, 68 patients were included. Of the 29 (42.6%) patients classified as cN0, eight were upstaged pN+ and had concomitant IGLN involvement. Of 21 patients with pN0 disease, IGLN metastases were absent in only three cases, resulting in a specificity and sensitivity of parotid metastases to diagnose occult nodal neck metastases of 14.29% and 100%, respectively. The positive and negative predictive values were 14.29% and 100%, respectively. Univariate analyses only displayed a significantly higher rate of moderately and poorly differentiated primaries in patients with IGLN metastases (P = .015). Only advanced T-stages were significantly associated with neck recurrences. IGLN status in advanced cSCCHN is potentially predictive for occul nodal neck metastases. Our results suggest that ND in patients with histopathologically negative IGLNs and clinically negative neck lymph nodes may not be necessary given the high negative predictive value of IGLN status in this group of patients. Therefore, accurate diagnostic evaluation of IGLN involvement is mandatory. 4 Laryngoscope, 131:788-793, 2021.

Rate of Submandibular Gland Involvement in Oral Squamous Cell Carcinoma

Whether the submandibular gland (SMG) can be preserved during neck dissection in the surgical treatment of oral squamous cell carcinoma (OSCC) is controversial. This study investigated the SMG involvement rate and provides a basis for preserving the SMG during neck dissection in appropriate cases of OSCC. A comprehensive systematic review was conducted on the PubMed and MEDLINE, Embase, and Cochrane Library databases for studies on SMG involvement in OSCC published before December 2017 with a data analysis technique. Predictor variables were numbers of patients and resected SMGs, primary site, and tumor, node, and metastasis stage. Outcome variables were the number of involved SMGs and mode of involvement. Other variables, namely first author, publication year, mean age, and condition of neck lymph nodes at level Ib, also were extracted. A random-effects model was used to analyze the rate of SMG involvement in OSCC. Twelve studies involving 2,126 patients with OSCC who underwent neck dissection were included in the study. Fifty-two SMGs were involved, and the pooled involvement rate was 2% (I2=73%; 95% confidence interval [CI], 1-3). Forty-eight SMGs were involved through direct spread from the primary site or extracapsular spread of positive lymph nodes, and the pooled involvement rate was 1.9% (I2=72%; 95% CI, 0.9-3.1). Except for direct spread, 4 SMGs were involved through the intraglandular lymph node or carcinoma growing along Wharton ducts, and the pooled involvement rate was only 0.1% (I2=0%; 95% CI, 0-0.2). The rate of SMG involvement in OSCC is very low, and the most common mode of involvement is by direct spread. The SMG might be preserved during neck dissection in OSCC when it is unlikely to be involved through direct spread.

Implications of intraglandular lymph node metastases in primary carcinomas of the parotid gland.

Assess the diagnostic and prognostic relevance of intraglandular lymph node (IGLN) metastases in primary parotid gland carcinomas (PGCs). Retrospective study at a tertiary referral university hospital. We reviewed the records of 95 patients with primary PGCs, treated at least surgically, between 1997 and 2010. We assessed the clinicopathological associations of IGLN metastases, their prognostic significance, and predictive value in the diagnosis of occult neck lymph node metastases Twenty-four (25.26%) patients had IGLN metastases. This feature was significantly more prevalent in patients with advanced pT status (P = .01), pN status (P < .01), and overall stage (P < .001); high-risk carcinomas (P = .01); as well as in patients with treatment failures (P < .01). IGLN involvement was significantly associated with decreased univariate disease-free survival (P < .001). Positive and negative predictive values and accuracy for IGLN involvement in the detection of occult neck lymph node metastases were 63.64%, 90.48%, and 84.91%, respectively. The diagnostic values were generally higher in patients with low-risk subtype of PGCs. IGLN involvement provides prognostic information and is associated with advanced tumoral stage and higher risk of recurrence. This feature could be used as a potential readout to determine whether a neck dissection in clinically negative neck lymph nodes is needed or not. 4.

Peripheral T‐cell lymphoma arising from an intraglandular lymph node in the parotid gland: A case report and literature review

T/NK-cell lymphoma of the salivary gland is rare. A 58-year-old man complained of a tumor mass in the left parotid gland region and he was diagnosed to have a left parotid tumor. The tumor was subsequently resected, revealing a diffuse growth pattern of medium to large sized atypical cells. The tumor was surrounded by fibrous connective tissue in the form of a capsule, and those were positive for CD3, CD4, CD5 and CD30, but negative for Bcl2, CD8, CD10, CD15, CD20, CD25, CD56, CD79a, CD246, EMA, granzyme B, TdT and TIA-1. There was no molecular evidence of Epstein-Barr virus (EBV) infection. It was diagnosed as peripheral T-cell lymphoma (PTCL) arising from an intraglandular lymph node in the parotid gland. In conclusion, Only 17 cases of primary T/NK-cell lymphoma of the salivary glands have been recorded until now, and the characteristics of these are not clear yet. Additional study is needed.

Lymphoepithelial carcinoma of the parotid gland arising in an intraglandular lymph node: report of a rare case mimicking metastasis

We present a case (female patient aged 40 years) with a primary Epstein-Barr virus-associated lymphoepithelial carcinoma of the parotid gland that was confined to an intraparotid lymph node. This appearance of the tumor simulated a metastasis that was excluded by exhaustive radiologic and clinicopathologic investigations.

Evaluation of Metastases in the Submandibular Gland in Head and Neck Malignancy

: Either excision of the submandibular gland during neck dissection or having the submandibular gland in radiation field can result in xerostomia, leading to reduced quality of life. The purpose of this study was to evaluate the prevalence of metastasis to the submandibular gland and to identify potential risk factors leading to the presence of metastases into the gland. : Of 376 patients with head and neck malignancy who were treated between 1999 and 2008, 130 patients underwent a neck dissection, and in total, 171 submandibular glands were removed. The average age was 61.1 years. : Twenty-three patients (17.7%) revealed some type of pathology in the submandibular gland such as chronic sialadenitis (15), atrophy (5), tumor infiltration (5), and intraglandular lymph node (1). In the group with sialadenitis, the mean age was 57.7 years. Forty-four percent had a pretreatment (radiation, 9%; local resection, 13%; or combined therapy, 22%) before neck dissection. Of the sialadenitis group, 9 of 12 patients had the primary tumor in the lower jaw, floor of mouth, or tongue. : One needs to be aware of the possibility of occult metastases in level I in oral cavity carcinomas, whereas oropharynx carcinoma constitutes a lower risk for involvement of lymph node metastases at level I. The excision of the submandibular gland should be performed in cases with positive lymph nodes at level I and in tumor sites with a high risk of occult metastasis at level I.

Rare involvement of submandibular gland by oral squamous cell carcinoma

The true involvement of the submandibular gland in primary oral cancer seems quite uncommon. We retrospectively reviewed the pathologic records of 342 patients with oral squamous cell carcinoma who underwent wide excision of primary oral cancer and simultaneous neck dissection from January 2000 to December 2003. Of the 383 submandibular glands, only 7 (1.8%) exhibited tumor involvement. Of them, 5 glands were involved by direct extension from the primary tumor. One gland showed local invasion from an adjacent involved lymph node in level I and 1 was from intraglandular lymph node metastasis. All of these 6 tumors with submandibular gland involvement were T4 disease (p = .0003) and the neck nodal status on each was more than N2b (p < .0001). The patients with early-stage oral squamous cell carcinoma with preoperative N0 neck may be candidates for preservation of the submandibular gland.

Concurrent primary Hodgkin’s lymphoma and recurrent pleomorphic adenoma of the ipsilateral parotid gland

The synchronous occurrence of two histologically different and morphologically distinct tumours in a single parotid gland is an exceptionally rare and probably coincidental event. We have recently experienced such a case initially suspected of being a recurrent pleomorphic adenoma. Superficial parotidectomy, however, revealed two separate masses. Postoperative histopathological examination diagnosed the presence of a pleomorphic adenoma with a concurrent primary parotid gland Hodgkin's lymphoma arising from an intraglandular lymph node. The management of this case is presented along with a brief review of the literature concerning the evaluation and management of this rare entity.

Clinicopathologic study of parotid involvement in 21 cases of eosinophilic hyperplastic lymphogranuloma (Kimura’s disease)

To investigate the clinicopathologic features of eosinophilic hyperplastic lymphogranuloma (Kimura's disease) in the parotid gland. The hematoxylin and eosin sections and clinical data of 60 patients with eosinophilic hyperplastic lymphogranuloma (Kimura's disease), including with parotid involvement, were reviewed. Of 60 cases of eosinophilic hyperplastic lymphogranuloma (average age, 42 years; average disease duration, 5.8 years), 35 cases (58%) were clinically seen to involve swelling of the parotid region. Parotid specimens were available in 21 cases and showed different microscopic changes. In mildly affected parotid samples, the histological features included infiltration of lymphocytes and eosinophils around the ducts of the interlobular connective tissues. In the moderately involved glands, the infiltrated area was enlarged and contained lymphoid follicles, resulting in adjacent acinar atrophy that was particularly obvious around the salivary ducts. In severe lesions, most acini were lost and only a few ducts remained. All cases with parotid involvement showed more severe pathological changes in the subcutaneous connective tissues and/or local lymph nodes. The parotid lesions often surrounded a central intraglandular lymph node with characteristic features of the disease; however, the salivary parenchyma was left alone. Nerve fibers affected by inflammatory lymphocytes and eosinophils were seen in 38/60 (63%) cases of eosinophilic hyperplastic lymphogranuloma (Kimura's disease) examined in this study. Eosinophilic hyperplastic lymphogranuloma (Kimura's disease) does not show primary parotid involvement, but instead, pathological changes in the parotid gland are a result of disease spread from the intraparotid lymph nodes and adjacent soft tissues. In addition, our observations suggest that the pruritus often associated with the disease may be due to nerve infiltration by lymphocytes and eosinophils.

Acinic cell carcinoma with primary presentation in an intraparotid lymph node

A rare case of a poorly-differentiated acinic cell carcinoma with primary presentation in a hyperplastic intraparotid lymph node, is reported. As the tumour mainly consisted of ductular and undifferentiated cells growing in solid cords, diagnosis was rendered difficult. Typical acinic cells were only rarely observed. In the multiple sections reviewed a single tumour nodulus occurred in salivary gland tissue outside the lymph node capsule. The possibility of a microscopic clinically occult primary acinic cell carcinoma that metastasized and presented primarily in an intraparotid lymph node, is mentioned. A multifocal origin in salivary tissue within and outside the intraglandular lymph node is another assumption, which is discussed. Differential diagnoses are mentioned and results of immuno- and histochemical studies are reported.

A case of Hodgkin's disease arising from an intraglandular lymph node in the parotid gland

Malignant lymphoma of the parotid gland region, especially Hodgkin's disease of the gland, is an extremely rare disorder. We have recently experienced a case initially suspected of being pleomorphic adenoma and later, on postoperative histopathological examination, diagnosed as Hodgkin's disease. The present report describes this case of Hodgkin's disease arising from an intraglandular lymph node in the parotid gland.

Malignant Lymphoma of the Parotid Gland

A case of malignant lymphoma of the parotid gland was described. A 15-year-old male developed a mass which was a firm and non-tender. The patient underwent a superficial parotidectomy with preservation of the facial nerve. The tumor was a grey, soft mass, 3 X 4 X 4 cm in size. On microscopic examination, the tumor was intraglandular lymph node with invasion of salivary gland tissue. The tumor cells were seen between acini and ducts. A diagnosis of lymphosarcoma, prolymphocytic, nodular type was made according to the WHO's classification system and the patient was refered for radiation therapy. Further investigations, including radio-isotope scanning of liver, spleen and bone and a biopsy of bone marrow revealed no sign of the disease. The patient was treated with 5380R of cobalt irradiation and in follow-up of a one year's duration there was no recurrence. Our case fulfilled the criteria which was represented by Hyman and Wolff and we reviewed the literature of this condition.