Malignant Minor Salivary Gland Research Articles

Unique presentation of adenoid cystic carcinoma in postcricoid region: a case report and review of the literature

Malignant tumors of minor salivary glands are uncommon, representing only 2-4% of all head and neck malignancies. In the larynx, minor salivary gland tumors rarely occur and constitute less than 1% of laryngeal tumors. Most of the minor salivary gland tumors arise in the subglottis; however, they can also occur in the supraglottis in the false vocal cords, aryepiglottic folds, and caudal aspect of the epiglottis. The most common type of malignant minor salivary gland tumor is adenoid cystic carcinoma. In the last 20years, only 40 cases of adenoid cystic carcinoma arising in variable locations of the larynx have been reported in the English language literature. We present a case of adenoid cystic carcinoma of the larynx arising in the inter-arytenoid and postcricoid region in a 54-year-old woman. To our knowledge, this is the first case of adenoid cystic carcinoma arising in this particular region of the larynx.

A Retrospective Review of Malignant Minor Salivary Gland Tumors and a Proposed Protocol for Future Care

Malignant tumors affecting minor salivary glands present a wide range of histopathologic types. The present study sought to design a protocol for management of patients with malignancy of minor salivary glands. The data of 22 patients with malignant tumors of the minor salivary glands, surgically treated at our department in the past 10 years, were accumulated and studied. All patients underwent a diagnostic workup prior to surgery. The most useful examinations were magnetic resonance imaging of the head and neck and computerized tomography of the thorax. Wide local excision was sufficient for the majority of patients. Adjuvant treatment is indicated for high-grade, tumor-positive lymph nodes and residual disease. Malignant tumors of minor salivary glands are very rare. Therefore, design of management protocols is challenging. Management of the neck is necessary in evidence of metastasis and in high-grade and advanced-stage disease. Adjuvant treatment should be included in the treatment protocol in certain indications. Most importantly, long-term follow up is very important for all patients with malignant minor salivary tumors.

Factors Predicting Outcome in Malignant Minor Salivary Gland Tumors of the Oropharynx

to report our experience in the care of patients with minor salivary gland cancers occurring only in the oropharynx and to determine factors predictive of outcome. Retrospective analysis. memorial Sloan-Kettering Cancer Center. sixty-seven patients with malignant minor salivary gland tumors were identified from a preexisting database of patients with cancers of the oropharynx between January 1985 and December 2005. overall survival, disease-specific survival, and recurrence-free survival were calculated by the Kaplan-Meier method. Factors predictive of outcome were identified by univariate and multivariate analyses. the most common histologic types were mucoepidermoid carcinoma in 26 patients (39%), adenoid cystic carcinoma in 16 (24%), adenocarcinoma in 16 (24%), and malignant mixed tumor in 7 (10%). The tumors were located in the base of the tongue in 41 patients (61%), soft palate in 20 (30%), and tonsil in 6 (9%). With a median follow-up time of 86 months (range, 12-249 months), overall outcomes at 5 and 10 years were overall survival, 80% and 53%; disease-specific survival, 87% and 67%; and recurrence-free survival, 69% and 60%, respectively. Tumor recurred in 20 patients (34%); 12 of these patients had locoregional failure and 15 developed distant metastases. Multivariate analyses showed that clinical T stage, anatomic subsite, and margin status were independent predictors for overall survival; T stage and margin status were independent predictors for locoregional recurrence-free survival. clinical T stage, anatomic subsite, and margin status are independent predictors of outcome of patients with minor salivary gland cancers of the oropharynx.

A Palatal Mass

A 19 year old female patient presented to the ENT department with complaints of slow growing, painless palatal mass for three months duration. On examination, there was a smooth surface 3x3 cm mass arising from the left side of hard palate (Fig. 1) which was firm in consistency on palpation. The rest of ENT examinations were normal. Figure 1 Pre-operative clinical photograph showing the palatal mass The Computed tomography (CT) showed a well defined contrast enhancing mass with no obvious bony erosion, (Fig. 2). The fine needle aspiration cytology from the lesion showed the histological features of epithelial and myoepithelial elements arranged in a variety of patterns and embedded in a mucopolysaccharide stroma. Figure 2 Showing a soft tissue mass arising from the hard palate at the level of ethmoid sinus Questions What is the likely diagnosis in this patient? What is the role of Fine needle aspiration cytology (FNAC) in such lesion? How would you manage this case and what is the role of CT scan in such lesions? Answer Pleomorphic adenoma of minor salivary gland arising from hard palate. The other rare differential diagnosis includes malignant minor salivary gland tumor, neurogenic tumors. Preoperatively, the FNAC has a diagnostic role in such lesions. The mass lesion arising from the hard palate can be a malignant lesion requiring a radical approach. Complete surgical excision under general anesthesia is the treatment of choice for such a lesion (Fig. 3). The preoperative CT scan not only helps in delineating the extent of lesion but also is useful in assessing any bony erosion of hard palate. Figure 3 Post operative scan of the patient showing a clear hard palate at the level of ethmoid sinus Discussion The palate has the highest concentration of minor salivary glands in the upper aero-digestive tract.1 The pleomorphic adenoma is the most common benign minor salivary gland tumor arising from the palate.2 The clinical presentation of such a lesion is typically a firm or rubbery submucosal mass without ulceration or surrounding inflammation. The exact etiology of this tumor is unknown but it is hypothesized that it originates from the intercalated and myoepithelial cell.2 Preoperatively, the fine needle aspiration cytology has a definite diagnostic role and shows epithelial, myoepithelial, and stromal components. The CT scan and magnetic resonance imaging (MRI) showed, always performed to asses for the presence of any bony erosion, soft tissue or nerve involvement. Since the majority of minor salivary gland neoplasms arising from palate are malignant, a detailed history, examination and investigations are essential before the excision of such lesions.3 The complete surgical excision is the treatment of choice in cases such as pleomorphic adenoma. The lesion in the current case was excised completely under general anesthesia and patient was symptoms free in the six months follow up.

Estrogen receptor overexpression in malignant minor salivary gland tumors of the sinonasal tract

Objectives To identify the expression of estrogen receptors in malignant minor salivary gland tumors of the sinonasal tract. Study Design Case series with chart review. Subjects and Methods A retrospective review of a pathology database identified 17 patients with malignant salivary gland tumors between December 1987 and January 2006. Clinicopathologic data were collected, and immunohistochemical staining for estrogen receptor α and β was performed. Results Among these malignant tumors, adenoid cystic carcinoma was the predominant histologic type. In addition to epistaxis and nasal obstruction, the headache, facial, or ocular symptoms were also commonly noted in this cohort. Seventy-five percent of cases of adenoid cystic carcinoma were positive for estrogen receptor α. In contrast, only 17 percent of cases of adenoid cystic carcinoma were positive for estrogen receptor β. Conclusion Malignant minor salivary gland tumors of the sinonasal tract are rare disease entities. In the present series, adenoid cystic carcinoma was the most common form of tumor, but the prognosis was poor. Most of the cases were positive for expression of estrogen receptor α, which suggests that hormone therapy may have a role in the management of certain minor salivary gland tumors of the paranasal sinus and nasal cavity.

Carcinoma Ex‐Pleomorphic Adenoma of the Base of Tongue: A Case Report and Review of Malignant Minor Salivary Gland Tumors

Carcinoma Ex‐Pleomorphic Adenoma of the Base of Tongue: A Case Report and Review of Malignant Minor Salivary Gland Tumors

Malignant minor salivary gland tumors of the larynx

To study the clinical features, treatment and prognosis of malignant minor salivary gland tumors of the larynx. Treatment and outcome were retrospectively analyzed in a consecutive series of 15 patients with malignant minor salivary gland tumors of the larynx treated in this hospital from 1959 to 2005. Ten patients (66.7%) had adenoid cystic carcinoma and 2 (13.3%) had adenocarcinoma. The other three patients had mucoepidermoid carcinomas, polymorphic adenocarcinoma and base cell carcinoma respectively. Eleven (73.3%) were located in the supraglottis and 4 (26.7%) in the subglottis. Fourteen had surgery (7 with adjuvant radiotherapy) and one was treated with radiotherapy plus chemotherapy. Five patients were found to have recurrent disease, 4 of whom underwent salvage surgery, 1 of whom had palliation radiotherapy. With a median follow-up of 8 years (ranging from 2 to 16 years), 7 patients are alive. Five patients have no evidence of disease, 1 of whom had surgery alone, 4 of whom were treated with surgery plus radiotherapy. Four patients died of distant metastases in a range of 2 to 10 years. The other 4 patients were lost to follow-up after treatment (ranging from 2 years to 16 years). Seven patients developed recurrent disease, 1 of whom had local recurrence alone, 1 had regional recurrence alone, 2 had distant metastases alone, and 3 had local and distant metastases. Minor salivary gland carcinomas of the larynx are rare and they are prone to the local recurrence and the distant metastasis in advanced stage. Distant metastases remain the principal cause of treatment failure. Surgery is the primary treatment modality used in most cases and the radiotherapy combining surgery has better local and regional control rate.

Prognostic factors in malignancy of the minor salivary glands

The purpose of this study was to identify prognostic factors associated with minor salivary gland malignancies. This was a retrospective study of 171 patients. Statistical analysis of both clinical and pathological parameters with survival outcomes was performed. Adenoid cystic carcinoma (46.8%), mucoepidermoid carcinoma (22.8%), and adenocarcinoma (18.7%) were the most common pathologies. The most frequent sites of primary tumor were in the oral cavity (44.4%) and nasal cavity (40.4%). The 5-year and 10-year overall survivals were 73.8% and 58.1%. Disease-specific survivals (DSS) were 78.2% and 66.7% and disease-free survivals (DFS) were 64.8% and 47.5%, respectively. Local recurrence rate was 26.9%, regional recurrence 7%, and distant failure was 18.7%. The grade of tumor was the only factor associated with DSS on multivariate analysis. Overall and DSS of minor salivary gland malignancies were good. Surgery, either alone or in combination with radiation, was an efficacious treatment modality. High-grade tumors were associated with worse DSF.

Malignant tumors of the minor salivary glands in northern Pakistan: A clinicopathological study

Malignant tumors of the minor salivary glands comprise a small but significant proportion of oral cancers. We analyzed this group of tumors in our population. The records of all cases of malignant minor salivary gland tumors diagnosed at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan, during a period of 10 years (1994-2003) are described. The institute receives biopsy material from armed forces and public and private sector hospitals in northern Pakistan as well as referrals for second opinion. A total of 21168 tumors were recorded at the AFIP Tumor Registry during the study period. These included 70 malignant minor salivary gland tumors. Twenty-three of these (32.8%) arose in the palate while the remaining tumors originated at other sites in the oral cavity. The commonest histological type was adenoid cystic carcinoma, constituting 30 cases (42.8%). The next most common type was mucoepidermoid carcinoma comprising 26 (37.1%) cases. The mean age of cases was 43.4 years and the male-to-female ratio was 1:1.4. There were 2 cases each of polymorphous low-grade adenocarcinoma and clear cell adenocarcinoma. The remaining cases included undifferentiated carcinomas, adenocarcinomas (not otherwise specified) and a few other rare tumors. Adenoid cystic carcinoma was the commonest malignant neoplasm of the minor salivary glands followed by mucoepidermoid carcinoma. The palate was the commonest location of these tumors.

Polymorphous low-grade adenocarcinoma of the head and neck

Polymorphous low-grade adenocarcinoma is an entity described in 1984. An increasing number of reports in the pathology literature since then have identified this as the second or the third most common minor salivary gland malignancy. The natural history of polymorphous low-grade adenocarcinoma is distinct from other malignant salivary tumours. The present review will identify the diagnostic difficulties, the treatment options and the treatment outcome of this tumour. Polymorphous low-grade adenocarcinoma is a slow-growing tumour that is locally invasive. The most common presentation is that of a lump in the oral cavity, usually on the palate. Diagnosis is established after a biopsy because cytological studies are not helpful. The morphological features can resemble pleomorphic adenoma and adenoid cystic carcinoma. Therapy is primarily wide surgical resection. The role of radiation therapy is not clear in the management of polymorphous low-grade adenocarcinoma. Metastases are rare and recurrences tend to occur more than 5 years after treatment, underlining the need for long-term follow-up. Recurrences can be successfully salvaged in more than 50% of the cases. Polymorphous low-grade adenocarcinoma is primarily a pathologic diagnosis. Surgical resection is the mainstay of treatment. Long-term follow-up of 10 years or more is essential to ensure local control.

Poster 061: Recurrence of Minor Salivary Malignancies: An Analysis of the Mayo Clinic Experience

Minor salivary gland tumors account for approximately 15% of all salivary gland neoplasms. Approximately 50% of all minor salivary gland tumors are malignant. Treatment of these tumors has generally been associated with a favorable outcome. However, in many cases patients succumb to late regional and distant recurrence. Identification of patients at high risk for recurrence may help the surgeon appropriately tailor effective treatment. Using the Mayo Clinic Tumor Registry, patients who presented from 1993-2004 with minor salivary gland malignancies were identified. A retrospective chart review was performed to identify patient variables predictive of recurrence. Data was statistically analyzed using a univariate model to identify features predictive of tumor recurrence. One hundred and eleven patients with minor salivary gland malignancies were identified from the institution’s tumor registry. Of these, seventy-eight met inclusion criteria. Histologically, the population included mucoepidermoid carcinoma (41.5%), adenoid cystic carcinoma (34.5%), adenocarcinoma (17.5%), polymorphous low grade adenocarcinoma (3.5%), and acinic cell carcinoma (2.5%). Seventeen (21.8%) patients suffered a recurrence. The mean time to recurrence was 753 days and 87% of recurrence occurred within the first 3 years. Three tumors recurred locally, 8 regionally, and 6 distantly. Gender (p=0.1657), primary tumor location (p=0.3397) and grade (p=0.3958) were not associated with recurrence. Histologic subtype was suggestive of recurrence (p=0.0776). Advancing T stage (p=0.0003) and tumors requiring multimodality treatment (p<.0001) were statistically significant predictors of recurrence. The overall recurrence for this study population was 21.8%. While histologic subtype was suggestive of recurrence, extent of local disease and the need for postoperative adjuvant therapy were predictors of recurrence. Tumors amenable to surgical extirpation were the least recurrent. Therefore surgery is an essential component in the initial treatment of minor salivary gland malignancies and offers the most durable chance of cure in tumors amenable to resection.

Malignant Minor Salivary Gland Tumors of the Larynx

To report our experience in treating patients with malignant minor salivary gland tumors of the larynx. Thirty-three-year retrospective study. Tertiary referral center specializing in head and neck surgery. Twelve patients with malignant minor salivary gland tumors of the larynx were identified from a search of the institutional databases and pathology records at Memorial Sloan-Kettering Cancer Center, New York, NY, between the years 1970 and 2003. All slides were independently reviewed by 2 pathologists (R.G. and D.C.). Details on patient and tumor characteristics, as well as treatment and surgical outcome, were recorded. Ten patients (83%) had adenoid cystic carcinoma and 2 (17%) had myoepithelial carcinoma. Five (42%) were located in the supraglottis and 7 (58%) in the subglottis. Ten (83%) had surgery (6 with adjuvant radiotherapy) and 2 (17%) were treated with radiotherapy alone. Of the 10 patients who had surgery, total laryngectomy was required in 6 (60%), supraglottic horizontal laryngectomy in 2 (20%), and cricotracheal resection in 2 (20%). With a median follow-up of 55 months (range, 1-194 months), 10 patients are alive, 6 of whom have no evidence of disease. Seven patients (58%) developed recurrent disease, 2 of whom had local recurrence alone, 1 had regional recurrence alone, 3 had distant recurrence alone, and 1 had local and distant recurrence. Up to 60% of patients with malignant minor salivary gland tumors of the larynx will develop recurrent disease locally, regionally, or at distant sites. In adenoid cystic carcinoma, regional recurrence is rare, but distant recurrence is common and may occur up to 10 years after the index therapy. For both adenoid cystic and myoepithelial carcinoma, partial surgery is possible in selected cases, but because of the high propensity for submucosal spread and perineural and lymphovascular invasion, total laryngectomy is usually recommended.

Oral malignant neoplasia: A survey of 428 cases in two Zimbabwean hospitals

A review of oral malignant neoplasms biopsies accessioned in the pathology services of Harare Central Hospital and Parirenyatwa Hospital, Harare, Zimbabwe, during the 10year period January 1982 to December 1991 was carried out. Clinical records of 428 patients with histologically diagnosed oral malignant neoplasms by ICD-O type and site (COO.O-CO6.9) were retrieved and analyzed for gender, age, history of tobacco and alcohol usage, neoplastic type and histologic differentiation of squamous cell carcinoma (8000/3). Oral malignant neoplasms constituted 24.8% (n = 428) of the 1723 biopsies accessioned in the department during this period. There was a male to female ratio of 1.9:1, with lesions being most common in the 41-60 year age group. Squamous cell carcinoma, (8070/3) 73.1%, was the predominant oral malignancy most common in the 61-70 year age group with 21.1% on the mandibular gingivae (CO3.1), 20.5% on the tongue (CO1.9-CO2.9), 18.5% on the floor of the mouth (CO4.9) and 10.5% each on the maxillary gingivae (CO3.O) and buccal mucosa (CO6.O). The hard palate (CO5.9) had 9% of the lesions. Lip malignancy (COO-COO.9 and C44.0), inclusive of mucosa of lip, vermilion and skin, constituted 3.3% and minor salivary gland (CO6.9) malignancy (M-8940/3) 4.9%. The remaining oral malignancies, 11%, included Burkitt's lymphoma (M-9687/3) 4.7%; Kaposi's sarcoma (M-9140/3) 3.7%; osteosarcoma (M-9180/3) 2.6% and malignant melanoma (M-8720/3) 1.9%. Fourty five percent of the patients admitted tobacco and alcohol consumption, of whom 95% were males. Oral malignant neoplasms were more common in males than females and occurred in a relatively young age group. Well-differentiated squamous cell carcinoma (M-8070/31) was the most common oral malignant neoplasm and was most frequently found on the mandibular gingivae (CO3.1), tongue (CO1.9-CO2.9) and floor of the mouth (CO4.9). The lip (COO-COO.9) was least affected with a high palatal (CO5.9) involvement.

Malignant tumours of the minor salivary glands—a 20 year review

The UK incidence of malignant disease of the minor salivary glands is only 0.6 per million per year. The tumours have a varied histology, can present in any age group and are frequently advanced if located in the sinonasal cavities. In a 20-year review of 21 patients treated for minor salivary gland malignancy in a single institution, it was found that mucoepidermoid tumours were more common in the oral cavity and adenoid cystic carcinomas in the sinonasal tract ( p=0.002). Outcome was variable with sinonasal and adenoid cystic carcinoma having a poorer outcome. Kaplan–Meier curves showed that oral tumours had a higher probability of long term survival. Radical surgery with reconstruction and post-operative adjuvant radiotherapy was effective in achieving loco-regional control. There were no local recurrences within 5 years and three after 5 years. Five patients developed metastatic disease within 10 years and a further two after 10 years. Late recurrences occurred and survival was mainly determined by the presence of systemic disease.

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.

Malignant tumours of the minor salivary glands: a survival analysis of 17 years from a tertiary referral cancer centre.

Malignant tumours of the minor salivary glands are rare and constitute less than 0.5% of all malignant neoplasms. This study was carried out to evaluate the clinical presentation, site distribution, treatment, survival and predictors of survival in malignant minor salivary gland tumours. A tertiary care, superspeciality referral hospital. Retrospective analysis. Forty-two cases of minor salivary gland tumours treated over a period of 17 years were reviewed for clinical presentation, histopathology, stage distribution, treatment and treatment outcome. Survival by Kaplan Meier Method and the outcomes were compared using log-rank test. The mean age of the patients was 46.9 years with a male to female ratio of 1.4:1. Majority of the patients presented with a painless progressive swelling, with 13 (31%) of them in T2 stage. About one-third of the patients had palpable lymph nodes at presentation, while none had distant metastasis. Palate was the commonest site and mucoepidermoid carcinoma was the commonest hispathological type. About 1/3 of the patients were treated with primary surgery and were followed up by adjuvant radiotherapy. Seven patients underwent palliative treatment alone. Over a mean follow-up of 30 months, 5 patients failed. The disease free survival was 72% at 5-year, none of the factors studied were found to significantly influence survival. Results of the present study suggest that minor salivary gland tumours should be treated with primary surgery irrespective of site and histological type to achieve best loco-regional control and survival.

Management of nasopharyngeal salivary gland malignancy.

The objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy. Retrospective case review at tertiary care skull base center. Pertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan-Meier and Cox proportional hazards methods. Histological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High-grade tumors had a significantly poorer outcome (P =.035) with a relative risk of 4.6 compared with low-grade disease. Local control was seen to be 77% at 5 years. Planned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro-omental free flap.

MUC4 (sialomucin complex) expression in salivary gland tumors and squamous cell carcinoma of the upper aerodigestive tract

Objectives: This study investigates MUC4 expression in normal squamous epithelia and squamous cell carcinoma (SCC) of the upper aerodigestive tract (UADT), and in salivary gland neoplasms. Study design: MUC4 antigens in tumor and adjacent normal tissue are localized by immunocytochemical studies. Fresh frozen tissues from surgical resection specimens are further analyzed by Western blot. Results: MUC4 is identified by immunocytochemical staining throughout the normal UADT mucosa, in 34 of 40 primary UADT SCC, and in 11 of 12 metastatic cervical lymph nodes. A trend toward decreased MUC4 staining in moderately and poorly differentiated tumors is noted. Immunoblots show MUC4 in 4 of 5 SCC analyzed. Immunocytochemical staining of MUC4 in 13 major and minor salivary gland neoplasms reveal variable staining of normal and neoplastic tissue. MUC4 is demonstrated in immunoblots of normal parotid tissue and in the single parotid malignancy analyzed, but is not demonstrated in one minor salivary gland malignancy. These findings characterize normal UADT mucosal and salivary MUC4 expression, and MUC4 expression in SCC of the UADT and in salivary gland tumors. Significance: Correlation of MUC4 expression with clinical outcomes may establish MUC4 as a potential molecular prognostic marker for these tumors. (Otolaryngol Head Neck Surg 2001;124:127-41.)

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.

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.