Malignant Salivary Gland Tumors Research Articles

Histomorphological Spectrum of Juvenile Salivary Gland Swelling: A Retrospective Case Series Study

Abstract Background: Salivary gland neoplasms are a rare group of disorders with diverse morphologies and are even rarer in pediatric population. Aims and Objectives: This aimed to explore our experience with the histomorphological spectrum of salivary gland tumors in a tertiary care pediatric referral center so that it can add to the cumulative knowledge to these tumors. Materials and Methods: The histopathology records from the department of pathology from January 2012 to December 2020 were reviewed in retrospect. Perisalivary gland region lesions were excluded from the study. Results: A total of 50 cases were included in the study. The most common location for salivary gland masses was parotid region (70%). Nonneoplastic lesions were seen in 3 (6%) patients and neoplastic lesions were seen in 47 (94%) patients. The most found benign lesion of salivary gland tissue origin was pleomorphic adenoma and 10 out of 15 cases (66.7%) of malignant tumors were found to be mucoepidermoid carcinoma on histology. Conclusion: Salivary gland tumors, rare in childhood and adolescence, differ in their incidence and prognosis from those in adult patients. The percentage of malignant salivary gland tumors compared with benign is much more frequent than in adults. The parotid is the most common site, and mucoepidermoid carcinoma is the most common malignant tumor.

Malignant Minor Salivary gland neoplasms ofLarynx: Our Experience.

<br><b>Introduction:</b> Malignant minor salivary gland tumors are rare, accounting for fewer than 1% of all laryngeal cancers.</br> <br><b>Aim:</b> This study aims to share our experiences regarding clinical, radiological, pathological profiles and their management.</br> <br><b>Materials and methods:</b> The current study reviews 11 cases of malignant minor salivary gland tumors of the larynx treated surgically at our Institute between 2005 and 2019.</br> <br><b>Results:</b> The mean age of the patients was 54 years (range 38-75 years) with six females and five males in the series (1.2:1). Subglottis and trachea were the sites of origin in 54% of the cases, and hoarseness with dyspnea were the most common presenting symptoms. There were nine Adenoid cystic and two Mucoepidermoid carcinoma patients. Surgery was the primary mode of treatment.</br> <br><b>Conclusions:</b> Most of the larynx's malignant minor salivary gland tumors are submucosal in origin. The outcome and prognosis vary considerably based on the tumor's histology, grade, and stage.</br&gt.

Oncocytoma: A Mystifying Parotid Gland Tumour

Oncocytoma is a rare salivary gland tumor consisting of oncocytes with many hyperplastic mitochondria. It usually occurs in the parotid gland. Very few cases of parotid oncocytoma have been reported in literature. Because of its rarity (<1-2% of salivary gland tumors) and clinical presentation of the tumor. Clinical diagnosis is often challenging due to the likeness of oncocytoma to other benign and low-grade malignant salivary gland tumors there is a tendency among the clinicians to misdiagnose it as pleomorphic adenoma, hemangioma, or other forms of oncocytosis. Previously published articles had all agreed on the reality of this lesion occurring over the parotid gland. The paper aims to review previously published cases of oncoytoma to provide a better insight regarding demographic, clinicopathological, radiological and histological features of this rare tumor of parotid gland. A systemic review of English literature was performed after using a sensitive search strategy involving two different databases: google scholar and PubMed. A total number of 9 cases were included. The tumour is mostly presented in old age as a slowly growing tumour (mean duration 3.17 years) and showed a slightly higher female predominance (Female:Male=1.25:1). They were mostly located over superficial lobe,100%. Conventional histological variant has only been reported. Complete surgical excision was performed for all the cases without any reports of recurrence or malignant transformation. Imaging studies diagnosed the lesion as a benign tumor. Only histopathological examination can confirm it. Definitive histology examination concludes to oncocytoma. Furthermore, our aim is to bring to the forefront how these lesions require a comprehensive workup and how to choose the best treatment strategy. Mugda Med Coll J. 2023; 6(1): 30-36

Ultrasonography characteristics of cystic components in primary salivary gland tumors

ObjectivesThe present study aimed to characterize the ultrasonography (US) features of cystic components in salivary gland tumors (SGTs).Materials and methodsA total of 207 patients (218 lesions) with pathologically confirmed primary SGTs were analyzed. Preoperative US revealed the presence of cystic components in lesions. Lesion size, shape, margin, and US findings of the cystic components, including number, distribution, margin, occupying rate, and internal characteristics, were evaluated.ResultsSimilarities were observed between the US performance of benign SGTs (B-SGTs) and malignant SGTs (M-SGTs) with cystic components. Differences in sex and age of patients, number, distribution, and internal characteristics of cystic components were statistically significant. For SGTs with cystic components, the proportions of M-SGTs to ill-defined margins (P = 0.002), eccentric distribution (P = 0.019), and none of the internal characteristics (P = 0.019) were significantly higher than those of B-SGTs. Younger age (P = 0.001), eccentric distribution (P = 0.034) and ill-defined margin (P < 0.001) were risk factors for diagnosing M-SGTs. Cystic component features needed to be combined with lesion indicators (border and shape) to improve diagnostic sensitivity.ConclusionsUS features of the B-SGTs and M-SGTs were significantly different. Cystic component is of interest in the US-related differential diagnosis of B-SGT and M-SGT.Clinical relevanceCystic components are potentially valuable in the differential diagnosis of B-SGTs and M-SGTs on US.

Malignant and Benign Tracheobronchial Neoplasms: Comprehensive Review with Radiologic, Bronchoscopic, and Pathologic Correlation.

Tracheobronchial neoplasms are much less common than lung parenchymal neoplasms but can be associated with significant morbidity and mortality. They include a broad differential of both malignant and benign entities, extending far beyond more commonly known pathologic conditions such as squamous cell carcinoma and carcinoid tumor. Airway lesions may be incidental findings at imaging or manifest with symptoms related to airway narrowing or mucosal irritation, invasion of adjacent structures, or distant metastatic disease. While there is considerable overlap in clinical manifestation, imaging features, and bronchoscopic appearances, an awareness of potential distinguishing factors may help narrow the differential diagnosis. The authors review the epidemiology, imaging characteristics, typical anatomic distributions, bronchoscopic appearances, and histopathologic findings of a wide range of neoplastic entities involving the tracheobronchial tree. Malignant neoplasms discussed include squamous cell carcinoma, malignant salivary gland tumors (adenoid cystic carcinoma and mucoepidermoid carcinoma), carcinoid tumor, sarcomas, primary tracheobronchial lymphoma, and inflammatory myofibroblastic tumor. Benign neoplasms discussed include hamartoma, chondroma, lipoma, papilloma, amyloidoma, leiomyoma, neurogenic lesions, and benign salivary gland tumors (pleomorphic adenoma and mucous gland adenoma). Familiarity with the range of potential entities and any distinguishing features should prove valuable to thoracic radiologists, pulmonologists, and cardiothoracic surgeons when encountering the myriad of tracheobronchial neoplasms in clinical practice. Attention is paid to any features that may help render a more specific diagnosis before pathologic confirmation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Metastasis of maxillary sinus adenoid cystic carcinoma to the humerus bone—A rare case report

Adenoid cystic carcinoma accounts for 10 to 12% of all salivary gland malignant neoplasms with an estimated incidence of 3 to 4.5 cases per million per year. Perineural spread and multiple local recurrences are its defining features, although the liver and lung are the most frequent sites for distant metastases. It is extremely uncommon for adenoid cystic carcinoma of the maxillary sinus to spread to distant bones. Few cases of adenoid cystic carcinoma with distant bone metastasis have been reported. Here, we report a known case of the adenoid cystic carcinoma of the maxillary sinus in a 40-yearold male, with isolated metastasis to the left humerus bone presenting 4 years later to the excision of the primary lesion. The fine-needle aspiration cytology, trucut biopsy, and immunocytochemistry of the left humerus osteoexpansile lesion confirmed the diagnosis of metastatic adenoid cystic carcinoma. This rare case report re-emphasizes the distant metastatic potential of adenoid cystic carcinoma.

Molecular Factors in Carcinoma Ex Pleomorphic Adenoma: Systematic Review and Meta-Analysis.

Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant salivary gland tumor. Although multiple reviews have been published on salivary gland malignancies, it has been a decade since the last dedicated systematic review pertaining to CXPA alone was published. This study examines molecular factors in CXPA diagnosis. MEDLINE, CINAHL, Embase, Scopus, Web of Science (BIOSIS), Cochrane CENTRAL, Health Collection (Informit), OpenDOAR, and GreyNet International. Systematic review and meta-analysis from inception to October 31, 2022 for all English language studies pertaining to "carcinoma ex pleomorphic adenoma." Predicted incidence of each biomarker was calculated with meta-analysis. Comparison against pleomorphic adenoma (PA) and salivary duct carcinoma (SDC) when reported within the same study are performed. Risk of bias performed with JBI tool for prevalence studies. Of 19151 unique studies undergoing abstract screening, 55 studies (n = 1322 patients) underwent data analysis. Biomarkers with >3 studies were p53, HER2, AR, EGFR, PLAG1, ERBB, ER, PR, HMGA2, p16, p63, a-SMA, RAS, PTEN, PDL1, BRAF, PIK3CA, and c-kit. Highest incidence was seen in AR, EGFR, p16, and p53. Significant differences were demonstrated compared with PA and SDC. There was high heterogeneity and overall high risk of bias within studies. Molecular factors are an area of interest in the diagnosis of CXPA. Our study results support examining CXPA as a discrete cohort in future targeted therapy trials. Laryngoscope, 134:1042-1053, 2024.

Mammary analogue secretory carcinoma (MASC) of parotid gland- A case report

Mammary analogue secretory carcinoma is a rare salivary gland carcinoma which shares morphologic and immunohistochemical features with the secretory carcinoma of breast and was first proposed by Skalova in 2010 with translocation of (q13; q25), t (12; 15), subsequently giving ETV6-NTRK3 gene rearrangement. Usually, it is a benign tumor that affects the parotid gland, with slight predilection for males. The present article report a case of secretory carcinoma of right parotid gland with special emphasis on histological feature and immunohistochemistry for diagnostic purpose and its management. Differential diagnosis includes AciCC, ADC-NOS and MEC. In a review by Chiosa et al (2012) in 337 cases of salivary gland malignancy included AciCC, ADC-NOS, MEC, LGCC, non-ITAC, signet ring adenocarcinoma, PLGA and most common malignancy reclassified as MASC were AciCC (11/89), ADC-NOS (14/37), MEC (1/165). Management for MASC includes surgical excision of the lesion (either superficial or total parotidectomy) for local, less aggressive disease like for low-grade malignant salivary gland neoplasms. For more invasive, metastatic disease and positive margins- neck dissection, radiotherapy and chemotherapy are reserved. There is no standard multidisciplinary treatment protocol established due to scarcity of this disease.

TRPS1 immunohistochemical expression in salivary gland tumors: A pilot study.

TRPS1 is a new, sensitive marker for breast carcinoma (BC). Salivary glands and breasts are both exocrine glands; thus, their tumors may share similar morphology and immunophenotype. Among salivary gland-type BC, TRPS1 is reported to be positive in secretory carcinomas (SCs) but negative in acinic cell carcinomas (AciCCs) and most adenoid cystic carcinomas (AdCCs). A subset of salivary duct carcinomas (SDCs) is positive for TRPS1. Herein, we investigate TRPS1 immunohistochemical expression in salivary gland tumors (SGTs). A retrospective search yielded 110 SGTs (97 primary and 13 metastatic). TRPS1 immunohistochemistry was scored as negative, low positive, intermediate positive, or strongly positive. TRPS1 was expressed in 78% (14/18) of pleomorphic adenoma (PA) cases but negative/low positive in all Warthin tumors (6/6 [100%]). In basal cell adenoma (BCA), TRPS1 expression was intermediate to strong (13/14 [92%]) in the stromal cells, whereas ductal or basal cells showed low expression. TRPS1 expression varied in malignant SGTs, with intermediate to strong staining in 100% (15/15) of AdCCs, 100% (5/5) of basal cell adenocarcinoma, 100% (3/3) of intraductal carcinoma, 89% (8/9) of polymorphous adenocarcinoma, and 89% (7/8) of SDCs; negative/low positive expression was observed in 100% (3/3) of SCs, 89% (8/9) of AciCCs, and 50% (3/3) of mucoepidermoid carcinomas. In addition, strong and intermediate TRPS1 expression was observed in metastatic SGT to the lungs, lymph nodes, and soft tissue. Overall, TRPS1 is strongly expressed in PA as well as malignant and metastatic SGT. In addition, TRPS1 is positive in stromal cells of BCA but negative or low positive in ductal and basal cells.

Pattern of Salivary Gland Tumours among Patients Attending Otorhinolaryngology and Maxillofacial Services at Tertiary Hospital in Tanzania, A Cross-Sectional Study

The proportion of neoplasms of the salivary gland in the study population accounted for 10% of all head &amp; neck and 3% of all neoplasms in the body. There is a scarcity of information regarding salivary gland tumours in Tanzania; therefore, this study addresses important issues in prevalence, histological, demographic characteristics, co-morbidities and treatment of salivary gland tumours. This study aimed to determine the pattern of salivary gland tumours among patients attending Otorhinolaryngology and Maxillofacial services at a tertiary hospital. This was a cross-sectional study done on patients diagnosed with salivary gland tumours. A total of 276 patients were recruited. Pre-tested coded questionnaires were used to collect data which were later analysed using SPSS statistical computer software version 20.0. Of the studied 276 participants, 156 (56.5%) were males, and 120 (43.5%) were females. Their age group ranged between 0 to 90 years with a mean age of 49.47 years, SD ±15.7. Most of them, 69 (28.6 %) aged above 60 years, and 31 (26.1 %) were in the age group of 40-49 and 60+ years. Mostly affected were males, 64 (55.1%) and 52 (44.8%) were females, P=0.76. The most commonly affected site was the parotid gland (75%), and the least affected sites were submandibular and sublingual (7.5%). Among 116 patients, malignant and benign types accounted for 76 (66%) and 40 (34%), respectively. Both benign and malignant salivary gland tumours (SGT) had male preponderance. Pleomorphic adenoma was high in males (28.1%) compared to females (25.0%); mucoepidermoid carcinoma was commonly found, accounting for 23.4% in males and 28.9% in females. More males were commonly affected, particularly the 40-49 age group, although the differences were statistically insignificant (p-value= 0.07). In conclusion, the majority of salivary gland tumours were malignant type and mucoepidermoid carcinoma being the most common histological type, while pleomorphic adenoma was the most frequently encountered benign type, and both had male preponderance, mostly seen at the age of 40 years and above. The majority of patients with malignant tumours presented late to the hospital; therefore, there is a need for advocacy for early health-seeking behaviour to the community and early detection of the disease by health personnel in the primary health centres.

Prognostic factors in surgically treated malignant salivary gland tumors

ObjectivesTo identify prognostic factors for evidence-based risk stratification in malignant salivary gland tumors. MethodsThis retrospective study identified 162 patients who presented with malignant salivary gland tumors between 2010 and 2020. Final analysis included 91 patients who underwent surgical treatment at our institution and were followed-up for ≥ 1 year. Medical records were reviewed and patients were categorized according to their risk profile. ResultsThis study included 91 patients (51 males, 40 females, mean age 61 years). The most frequent entities were adenoid cystic carcinoma (n = 13, 14.3%) and mucoepidermoid carcinoma (n = 12, 13.2%). Kaplan-Meier analysis demonstrated a five-year overall survival (OS) of 66.2% and a recurrence-free survival (RFS) of 50.5%. Age > 60 years (p = 0.011), categorization into high-risk group (p = 0.011), UICC stage (p = 0.020), T stage (p = 0.032), grading (p = 0.045) and vascular invasion (p < 0.001) were significantly associated with OS; age > 60 years (p = 0.014), categorization into high-risk group (p < 0.001), UICC stage (p = 0.021), T stage (p = 0.017), grading (p = 0.011), vascular invasion (p = 0.012) and lymphovascular invasion (p < 0.001) were significantly associated with RFS. Multivariate Cox regression with backward elimination identified T stage (HR 1.835; 95% CI 1.187–2.836; p = 0.006) and grading (HR 2.233; 95% CI 1.113–4.480; p = 0.024) as significant factors for OS. Grading (HR 2.499; 95% CI 1.344–4.648; p = 0.004) was confirmed as a significant factor for RFS. ConclusionConsidering the risk of recurrence and distant metastasis in malignant salivary gland tumors, locoregional surgical control may not be sufficient and adjuvant therapies such as radiotherapy and/or systemic therapies should be considered.

Detection of salivary gland and sinonasal fusions by a next-generation sequencing based, ligation-dependent, multiplex RT-PCR assay.

The discovery of tumour type-specific gene fusion oncogenes in benign and malignant salivary gland and sinonasal (SGSN) tumours has significantly increased our knowledge about their molecular pathology and classification. We developed a new targeted multiplexed next-generation sequencing (NGS)-based method that utilizes ligation dependent reverse-transcriptase polymerase chain reaction (LD-RT-PCR) to detect oncogenic fusion transcripts involving 116 genes, leading to 96 gene fusions known to be recurrently rearranged in these tumours. In all, 180 SGSN tumours (formalin-fixed, paraffin-embedded samples, 141 specimens and 39 core needle biopsies) from the REFCORpath (French network for rare head and neck cancers) with previously identified fusion genes by fluorescent in situ hybridisation (FISH), RT-PCR, or molecular immunohistochemistry were selected to test its specificity and sensitivity and validate its diagnostic use. Tested tumours encompassed 14 major tumours types, including secretory carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary gland intraductal carcinoma, clear cell carcinoma, pleomorphic adenoma, adamantinoma-like Ewing Sarcoma, EWSR1::COLCA2 sinonasal sarcoma, DEK::AFF2 sinonasal carcinoma, and biphenotypic sinonasal sarcoma. In-frame fusion transcripts were detected in 97.8% of cases (176/180). Gene fusion assay results correlated with conventional techniques (immunohistochemistry [IHC], FISH, and RT-PCR) in 176/180 tumours (97.8%). This targeted multiplexed NGS-based LD-RT-PCR method is a robust, highly sensitive method for the detection of recurrent gene fusions from routine clinical SGSN tumours. It can be easily customized to cover new fusions. These results are promising for implementing an integrated NGS system to rapidlydetect genetic aberrations, facilitating accurate, genomics-based diagnoses, and accelerate time to precision therapies in SGSN tumours.

MAXILLARY METASTASIS OF BREAST CANCER

Metastatic tumor in the oral cavity represents approximately 1% of all oral tumors and usually affects soft tissues or jawbones. A 45-year-old female sought an oral medicine service due to a painful well-defined ulcerated lesion with oroantral communication in the hard palate. The lesion measured 1.5 × 1.0cm and had a 21-day history. The patient reported headache, dysphagia, and left breast sectorectomy three years earlier for treating triple-negative breast cancer positive for BRCA2 mutation. The diagnostic hypotheses included metastatic lesion of breast adenocarcinoma, necrotizing sialometaplasia, and malignant salivary gland tumor. A partial biopsy was performed and the histopathological and immunohistochemistry analyses confirmed the mammary origin of the tumor. The patient was referred to the medical team for managing the recurrence of the disease. Further evaluation showed metastatic lesions in the skin, lungs, bones, liver and brain. Considering the disease was disseminated and uncontrolled, the patient was referred to palliative care. Metastatic tumor in the oral cavity represents approximately 1% of all oral tumors and usually affects soft tissues or jawbones. A 45-year-old female sought an oral medicine service due to a painful well-defined ulcerated lesion with oroantral communication in the hard palate. The lesion measured 1.5 × 1.0cm and had a 21-day history. The patient reported headache, dysphagia, and left breast sectorectomy three years earlier for treating triple-negative breast cancer positive for BRCA2 mutation. The diagnostic hypotheses included metastatic lesion of breast adenocarcinoma, necrotizing sialometaplasia, and malignant salivary gland tumor. A partial biopsy was performed and the histopathological and immunohistochemistry analyses confirmed the mammary origin of the tumor. The patient was referred to the medical team for managing the recurrence of the disease. Further evaluation showed metastatic lesions in the skin, lungs, bones, liver and brain. Considering the disease was disseminated and uncontrolled, the patient was referred to palliative care.

Magnetic resonance imaging features of parotid mucoepidermoid carcinoma: a retrospective analysis

Background: Parotid mucoepidermoid carcinoma (P-MEC) is the most common of malignant salivary gland tumors and its accurate preoperative diagnosis is crucial for better management and prognostication. This becomes even more critical because in most cases P-MEC is difficult to distinguish from other common benign parotid lesions including abscess both clinically and radiologicall, but where management is entirely different. MRI could prove a vital cog in the wheel in this whole endeavor. This study aims to analyse the various MRI features in parotid mucoepidermoid carcinoma and the control group of non-MEC benign parotid masses which will aid in better distinguish between the two entities thereby coming to a confident diagnosis which will aid in management planning and better prognosis. Methods: This retrospective study was conducted at Sree Uthradom Thirunal Academy of Medical Science (SUTAMS), Thiruvananthapuram, India from July 2021 to July 2022 after obtaining Institutional Ethical committee approval. An informed consent was obtained from all patients before conduct of MRI imaging. The various MRI findings was applied in 60 patients in age bracket of 45-90 yrs with HPE proven parotid gland tumors. The cohort was divided into 2 groups: MEC (n=30) and non–MEC (n=30) as a control group. Results: Logistic regression analysis identified presence of cystic component (p&lt;0.001), T1 hypointense signal (p&lt;0.001), T2 hyperintense signal (p&lt;0.001), heterogeneous post contrast enhancement (p&lt;0.001) and perineural invasion (p=0.002) as characteristic MRI features of parotid MEC that aided in its accurate distinction from other non-MEC lesions of parotid. Conclusions: MRI can be a valuable tool for reliably distinguishing parotid mucoepidermoid from other parotid lesions.

Analysis of ultrasonography and cytology potential in differential diagnosis of major salivary gland neoplasms

Background: Salivary gland tumors account for up to 5% of all head and neck neoplasms. Ultrasonography is one of the main diagnostic modalities for the salivary gland pathology; however, its diagnostic potential is under scrutiny. Fine needle aspiration cytology is considered the main diagnostic method, although its role in the differential diagnosis is disputable.Objective: To identify, based on morphology results, the effectiveness of the main ultrasonographic signs indicating major salivary gland neoplasms in the differential diagnosis and study these signs, to evaluate the effectiveness of fine needle aspiration in the diagnosis of benign and malignant major salivary gland neoplasms.Materials and methods: This retrospective study evaluated a group of 220 patients. We calculated sensitivity, specificity, and accuracy of qualitative ultrasonographic signs of salivary gland neoplasms, analyzed the fine needle aspiration effectiveness, and compared results accuracy by calculating Pearson’s empirical χ-square.Results: Common ultrasonographic signs of benign salivary gland neoplasms included a clear contour (97.5%) and decreased echogenicity (72.7%). Malignant tumors frequently presented with a clear contour (76.7%), uneven contour (72.1%), and decreased echogenicity (69.8%). Fine needle aspiration sensitivity and specificity in the diagnosis of benign neoplasms were 75.5% and 53.6%, respectively. Fine needle aspiration sensitivity and specificity in respect of malignant tumors were 50% and 94%, respectively. Pearson’s χ-square value for the clear contour had significant differences in favor of benign neoplasms.Discussion: Benign and malignant salivary gland neoplasms often have a similar ultrasonographic pattern. A significant diagnostic sign of malignant tumors is the uneven contour. We compared the effectiveness of cytological differentiation between benign and malignant neoplasms and found high rates of specificity and accuracy for malignant tumor diagnosis.Conclusions: Clear contour and decreased echogenicity are significant ultrasonographic signs in the differentiation of benign neoplasms. Uneven contour is a significant differentiating factor for malignant neoplasms. Cytology can be used for initial morphology in diagnosing major salivary gland neoplasms, but in half of the cases it fails to identify the nature and type of the tumor.

Neural network combining with clinical ultrasonography: A new approach for classification of salivary gland tumors.

Little information is available about deep learning methods used in ultrasound images of salivary gland tumors. We aimed to compare the accuracy of the ultrasound-trained model to computed tomography or magnetic resonance imaging trained model. Six hundred and thirty-eight patients were included in this retrospective study. There were 558 benign and 80 malignant salivary gland tumors. A total of 500 images (250 benign and 250 malignant) were acquired in the training and validation set, then 62 images (31 benign and 31 malignant) in the test set. Both machine learning and deep learning were used in our model. The test accuracy, sensitivity, and specificity of our final model were 93.5%, 100%, and 87%, respectively. There were no over fitting in our model as the validation accuracy was similar with the test accuracy. The sensitivity and specificity were comparable with current MRI and CT images using artificial intelligence.

A deep learning model for the differential diagnosis of benign and malignant salivary gland tumors based on ultrasound imaging and clinical data.

The preoperative differentiation between benign parotid gland tumors (BPGTs) and malignant parotid gland tumors (MPGTs) is of great significance for therapeutic decision-making. Deep learning (DL), an artificial intelligence algorithm based on neural networks, can help overcome inconsistencies in conventional ultrasonic (CUS) examination outcomes. Therefore, as an auxiliary diagnostic tool, DL can support accurate diagnosis using massive ultrasonic (US) images. This current study developed and validated a DL-based US diagnosis for the preoperative differentiation of BPGT from MPGT. A total of 266 patients, including 178 patients with BPGT and 88 patients with MPGT, were consecutively identified from a pathology database and enrolled in this study. Ultimately, considering the limitations of the DL model, 173 patients were selected from the 266 patients and divided into 2 groups: a training set, and a testing set. US images of the 173 patients were used to construct the training set (including 66 benign and 66 malignant PGTs) and testing set (consisting of 21 benign and 20 malignant PGTs). These were then preprocessed by normalizing the grayscale of each image and reducing noise. Processed images were imported into the DL model, which was then trained to predict the images from the testing set and evaluated for performance. Based on the training and validation datasets, the diagnostic performance of the 3 models was assessed and verified using receiver operating characteristic (ROC) curves. Ultimately, before and after combining the clinical data, we compared the area under the curve (AUC) and diagnostic accuracy of the DL model with the opinions of trained radiologists to evaluate the application value of the DL model in US diagnosis. The DL model showed a significantly higher AUC value compared to doctor 1 + clinical data, doctor 2 + clinical data, and doctor 3 + clinical data (AUC =0.9583 vs. 0.6250, 0.7250, and 0.8025 respectively; all P<0.05). In addition, the sensitivity of the DL model was higher than the sensitivities of the doctors combined with clinical data (97.2% vs. 65%, 80%, and 90% for doctor 1 + clinical data, doctor 2 + clinical data, and doctor 3 + clinical data, respectively; all P<0.05). The DL-based US imaging diagnostic model has excellent performance in differentiating BPGT from MPGT, supporting its value as a diagnostic tool for the clinical decision-making process.

Head and Neck Tumor Histopathological Image Representation with Pr with Pre- Trained Conv ained Convolutional Neur olutional Neural Network and Vision al Network and Vision Transformer

Image representation via machine learning is an approach to quantitatively represent histopathological images of head and neck tumors for future applications of artificial intelligence-assisted pathological diagnosis systems. Objective: This study compares image representations produced by a pre-trained convolutional neural network (VGG16) to those produced by a vision transformer (ViT-L/14) in terms of the classification performance of head and neck tumors. Methods: Whole-slide images of five oral tumor categories (n = 319 cases) were analyzed. Image patches were created from manually annotated regions at 4096, 2048, and 1024 pixels and rescaled to 256 pixels. Image representations were classified by logistic regression or multiclass Support Vector Machines for binary or multiclass classifications, respectively. Results: VGG16 with 1024 pixels performed best for benign and malignant salivary gland tumors (BSGT and MSGT) (F1 = 0.703 and 0.803). VGG16 outperformed ViT for BSGT and MSGT with all magnification levels. However, ViT outperformed VGG16 for maxillofacial bone tumors (MBTs), odontogenic cysts (OCs), and odontogenic tumors (OTs) with all magnification levels (F1 = 0.780; 0.874; 0.751). Conclusion: Being more texture-biased, VGG16 performs better in representing BSGT and MSGT

Cribriform adenocarcinoma of the minor salivary glands: a case report

BackgroundPolymorphous adenocarcinoma is the third most common malignant salivary gland tumor. Within polymorphous adenocarcinoma, cribriform adenocarcinoma of salivary glands is a rare subtype and resembles papillary thyroid carcinoma histopathologically. Diagnostically, cribriform adenocarcinoma of salivary glands is challenging for pathologists and surgeons alike as initial presentation and cytologic nuclear features can be easily confused with papillary thyroid carcinoma arising from a thyroglossal duct remnant or lingual thyroid.Case presentationA healthy 64-year-old Caucasian woman presented to a community otolaryngologist with a 4-year history of progressive postnasal drip, globus sensation, and eventual dysphonia. Flexible fiberoptic laryngoscopy showed a large, smooth, vallecular lesion filling the oropharynx. Computed tomography imaging of the neck showed a rounded heterogeneous mass centered within the right aspect of the oropharynx measuring 4.2 × 4.4 × 4.5 cm. Fine needle aspiration biopsy was suspicious for papillary carcinoma due to microscopic findings of malignant cells, nuclear grooves, and a powdery chromatin pattern. In the operating room, the tumor was resected en bloc using a lateral pharyngotomy approach with partial resection of the right lateral hyoid. A limited cervical lymphadenectomy was performed to facilitate the lateral pharyngotomy approach and two out of three lymph nodes demonstrated regional metastatic disease. Nuclear grooves, nuclear membrane notching, and occasional intranuclear pseudoinclusions were identified, which are overlapping histopathological characteristics of papillary thyroid carcinoma and cribriform adenocarcinoma of salivary glands. It was negative for thyroglobulin and thyroid transcription factor-1, which was in keeping with cribriform adenocarcinoma of salivary glands rather than papillary thyroid carcinoma.ConclusionIt is difficult to distinguish cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma solely by cytology, and the distinct characteristics of regional lymph node metastasis coupled with nuanced histologic differences should be emphasized in the evaluation of patients presenting with neck lymphadenopathy and an unknown primary or tongue mass. If sufficient fine needle aspiration biopsy material is available, thyroid transcription factor-1, thyroglobulin, or molecular testing may prove useful in differentiating cribriform adenocarcinoma of salivary glands from papillary thyroid carcinoma. A misdiagnosis of papillary thyroid carcinoma may lead to inappropriate treatment including unnecessary thyroidectomy. Therefore, it is critical for both pathologists and surgeons to be aware of this uncommon entity to avoid misdiagnosis and subsequent mismanagement.

An Investigation of the Clinico-histopathologic Trend of Salivary Gland Tumors in Amir Alam Hospital During 2010- 2019: A Retrospective Study

Background: The incidence and mortality rates of salivary gland tumors have increased according to previous evidence. No study has so far focused on the trend of clinical and histopathologic patterns of salivary gland tumors in Iran. Therefore, the aim was to investigate the incidence and clinico-histopathologic trend of salivary gland tumors in a retrospective, cross-sectional, institutional study from 2010-2019 in Amir Alam hospital. Methods: The archived medical records were collected from patients with the histopathologic diagnosis of benign and malignant salivary gland tumors from Amir Alam hospital, Tehran during (April-April) 2010- 2019. Demographic data and histopathologic features, including tumor size, lymph node involvement, vascular invasion, perineural involvement, and histopathologic differentiation were retrieved, and the samples were categorized and reviewed based on the new classification of head and neck tumors. Finally, the frequencies of characteristics were determined and expressed as numbers (percentage values). Results: Of 1203 salivary gland tumors, 77.6% and 22.4% were benign and malignant, respectively. The incidence of benign tumors was increased from 37 (22.2%) in 2010 to 178 (364.9%) in 2019. In the collection of the total samples, the incidence of malignant tumors was relatively steady from 23 (13.8%) samples in 2010 to 27 (55.35%) in 2019. However, an increase in the incidence of tumors with low-grade differentiation was found from 12.5% in 2010 to 80% in 2019. Conclusions: The incidence of benign and malignant salivary tumors with a higher degree of malignancy had an increasing trend in Amir Alam hospital during 2010-2019.