Malignant Salivary Gland Tumors Research Articles

Morphologic and Ancillary Studies of Pediatric Acinic Cell Carcinoma: A Single Institute Experience.

Acinic cell carcinoma (AciCC) is the second most common pediatric malignant salivary gland tumor. However, there are limited pathology publications about this tumor in the pediatric population. We describe four pediatric AciCC cases diagnosed between 2000 and 2021 in our institute. Reticulin histochemistry plus immunohistochemistry for NR4A3 and DOG1 were performed on all cases. Histologically, all four cases featured a tumor-associated lymphoid proliferation and collagenous stroma, in which two formed central scars. The tumors were predominantly solid, with a lobular pattern and variably sized dilated spaces, including one case with focal microcysts. High-grade transformation was not observed in any of our cases. Reticulin stain and immunohistochemistry for NR4A3 showed distinct features between AciCC and non-neoplastic salivary gland parenchyma. DOG1 immunohistochemistry confirmed the acinar origin of AciCC. Our study reveals that pediatric AciCCs often present with tumor-associated lymphoid proliferation (TALP) and sclerosis. Special stains such as reticulin histochemistry and NR4A3 immunohistochemistry are helpful to separate tumor from adjacent benign parenchyma. The ancillary study is helpful for the diagnosis of small specimens. Our study is limited by its low case number, but we hope that our results will promote more studies on this rare salivary gland tumor in the pediatric population.

Discriminating between benign and malignant salivary gland tumors using diffusion-weighted imaging and intravoxel incoherent motion at 3 Tesla

PurposeThe purpose of this study was to retrospectively evaluate the diagnostic performances of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) for discriminating between benign and malignant salivary gland tumors (SGTs). Materials and methodsSixty-seven patients with 71 SGTs who underwent MRI examination at 3 Tesla were included. There were 34 men and 37 women with a mean age of 57 ± 17 (SD) years (age range: 20–90 years). SGTs included 21 malignant tumors (MTs) and 50 benign SGTs (33 pleomorphic adenomas [PAs] and 17 Warthin's tumors [WTs]). For each SGT, DWI and IVIM parameters, mean, skewness, and kurtosis of apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion volume fraction (f) were calculated and further compared between SGTs using univariable analysis. Areas under the curves (AUC) of receiver operating characteristic of significant parameters were compared using the Delong test. ResultsSignificant differences in ADCmean, Dmean and D*mean were found between SGTs (P < 0.001). The highest AUC values were obtained for ADCmean (0.949) for identifying PAs and D*mean (0.985) for identifying WTs and skewness and kurtosis did not outperform mean. To discriminate benign from malignant SGTs with thresholds set to maximize Youden index, IVIM and DWI produced accuracies of 85.9% (61/71; 95% CI: 75.6–93.0) and 77.5% (55/71; 95% CI: 66.0–86.5) but misdiagnosed MTs as benign in 28.6% (6/21) and 61.9% (13/21) of SGTs, respectively. After maximizing specificity to 100% for benign SGTs, the accuracies of IVIM and DWI decreased to 76.1% (54/71; 95% CI: 64.5–85.4) and 64.8% (46/71; 95% CI: 52.5–75.8) but no MTs were misdiagnosed as benign. IVIM and DWI correctly diagnosed 66.0% (33/50) and 50.0% (25/50) of benign SGTs and 46.5% (33/71) and 35.2% (25/71) of all SGTs, respectively. ConclusionIVIM is more accurate than DWI for discriminating between benign and malignant SGTs because of its advantage in detecting WTs. Thresholds set by maximizing specificity for benign SGTs may be advantageous in a clinical setting.

Profile of Serum Heat Shock Protein-27 Level in Patients with Salivary Gland Tumor.

Heat shock protein 27 (HSP27) plays important roles in many cellular processes and has been implicated in different types of diseases such as cancers. This study aimed to evaluate the serum level of HSP27 in patients with salivary gland tumors and to determine its possible correlation with the prognosis of the disease. This cross-sectional study was performed on 60 patients with sali-vary gland tumor including 16 pleomorphic adenoma, 33 adenoid cystic carcinoma, 6 mu-coepidermoid carcinoma, 5 acinic cell carcinoma, and 28 healthy control subjects. The con-trol cases were healthy blood donors who matched the study group in age and sex. Serum samples were obtained from the clotted blood and HSP27concentrations were measured with sandwich enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed by using one-way ANOVA, post Hoc test, independent sample t-test, and ROC analysis. A p value of less than 0.05 was considered as significant. The mean serum level of HSP27 was 3956.1±3830.1 (pg/ml) in patients with malig-nant salivary gland tumor, which was significantly higher than that in benign salivary gland tumor (752.2±485.6) and healthy controls (602.3±575.8) (p <0.001). However, there was no significant difference in the HSP27 serum levels between the patients with benign salivary gland tumors and healthy controls (p= 0.2). No association was detected between the mean serum levels of HSP27 and clinicopathologic factors such as age, sex, stage and nodal metas-tasis (p > 0.05), except for the tumor size (p= 0.04). The HSP27 concentration increased in patients with malignant salivary gland tumors. Moreover, the HSP27 level was correlated with tumor growth, invasiveness, and diagnosability. Yet, larger clinical studies are required to explore its prognostic value.

38: Malignant Salivary Gland Tumours and Long-Term Patient Outcomes Based on the American Joint Committee on Cancer 8th Edition Staging System

38: Malignant Salivary Gland Tumours and Long-Term Patient Outcomes Based on the American Joint Committee on Cancer 8th Edition Staging System

Clinical Prediction Nomograms to Assess Overall Survival and Disease-Specific Survival of Patients with Salivary Gland Adenoid Cystic Carcinoma.

Aim Salivary gland adenoid cystic carcinoma (SACC) is the second highest incidence of malignant salivary gland tumor. The purpose of this study was to establish nomograms combined with SACC patients based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with SACC were included in the SEER∗Stat Database from 2004 to 2016. The least absolute shrinkage and selection operator (LASSO) Cox regression analysis was applied to filter potential prognostic clinical variables. Multivariate analysis from the Cox proportional hazards model was performed to determine the independent prognostic factors on overall survival (OS) and disease-specific survival (DSS), applied to develop nomograms. The Schönfeld residual test verified the proportional hazard assumption. The discrimination and consistency of nomograms was assessed and validated according to concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration curves using an internal 1,000 times bootstrap resampling. The nomogram's net clinical benefit was assessed through decision curve analysis (DCA). Results A total of 658 patients with SACC were included. Age, T stage, N stage, M stage, histologic grade, and surgery were independent prognostic factors for OS and DSS. Based on these independent prognostic factors, nomograms were developed to predict 3-, 5-, and 10-year OS and DSS. In the validation of 1,000 times bootstrap resampling, the C-index and ROC curves had good discriminatory ability. The calibration curves indicated excellent consistency between the predicted and actual survival results in the nomograms. The DCA curves demonstrated that the nomograms had good clinical benefit and were superior to the TNM stage and other variables. Conclusions Two nomograms developed in this study precisely predicted the 3-, 5-, and 10-year OS and DSS rates of patients with SACC in accordance with independent prognostic factors, and their clinical value is better than TNM staging, providing a prognostic reference for other SACC patients.

Expression of mitochondrial dynamic markers in adenoid cystic carcinoma.

Mitochondrial fission and fusion processes are known as mitochondrial dynamics and the occurrence of imbalances in the mitochondrial activity is related to the pathogenesis of many human cancers. However, the importance of mitochondrial dynamics in malignant salivary gland tumours remains unknown. Therefore, we aimed to investigate its prognostic significance in adenoid cystic carcinoma. Fifty-seven formalin-fixed paraffin-embedded cases were retrieved and disposed in tissue microarray. Histological sections were submitted to immunohistochemical reactions against AMT, DRP1, FIS1, MFN1, MFN2 and OPA1 proteins. Clinical data were retrieved from the patients' medical files, including specific and disease-free survival data. It was observed that 50.9% of the cases were strongly positive for AMT and DRP1, and 49.1%, 21.1%, 22.8% and 24.6% strongly positive for FIS1, MFN1, MFN2 and OPA1, respectively. Reactions were observed in both epithelial and myoepithelial components of the tumour. The higher expression of MFN2 was associated with solid microscopic pattern (p=0.016). DRP1 overexpression showed a trend towards a shorter overall survival (p=0.054), while negative/weak OPA1 showed a trend towards a lower disease-free survival (p=0.051) in the univariate analysis, but no mitochondrial marker represented an independent prognostic determinant under multivariate analysis. In conclusion, mitochondrial dynamics markers do not seem to carry a prognostic significance for adenoid cystic carcinoma patients, but these proteins may play an important role in its pathogenesis.

METASTATIC PROSTATIC ADENOCARCINOMA IN THE ORAL CAVITY: CASE REPORT

Metastasis to the oral cavity represents a challenging diagnosis, because it often clinically mimics reactive hyperplastic lesions and even primary malignancies. About 90% of cancer-related deaths are direct outcomes of metastatic disease. This study reports a clinical case of a 72-year-old male with a 3.5-cm asymptomatic nodule on the hard palate with unknown duration. The patient's medical records included a prostatic adenocarcinoma diagnosed 4 years before, treated with radiotherapy. No radiographic alterations were detected. Differential diagnosis included malignant tumors of salivary glands or metastasis from prostate cancer. An incisional biopsy was performed and the specimen was sent to histopathologic analysis. The final diagnosis was metastatic prostatic adenocarcinoma. The patient did not return for his results and died 3 weeks later. Despite being considered a rare event, metastasis to the oral cavity must be included in the differential diagnosis, especially for patients with a history of cancer. Metastasis to the oral cavity represents a challenging diagnosis, because it often clinically mimics reactive hyperplastic lesions and even primary malignancies. About 90% of cancer-related deaths are direct outcomes of metastatic disease. This study reports a clinical case of a 72-year-old male with a 3.5-cm asymptomatic nodule on the hard palate with unknown duration. The patient's medical records included a prostatic adenocarcinoma diagnosed 4 years before, treated with radiotherapy. No radiographic alterations were detected. Differential diagnosis included malignant tumors of salivary glands or metastasis from prostate cancer. An incisional biopsy was performed and the specimen was sent to histopathologic analysis. The final diagnosis was metastatic prostatic adenocarcinoma. The patient did not return for his results and died 3 weeks later. Despite being considered a rare event, metastasis to the oral cavity must be included in the differential diagnosis, especially for patients with a history of cancer.

POLYMORPHOUS LOW-GRADE ADENOCARCINOMA OF THE UPPER LIP: A CASE REPORT

A 49-year-old female patient presented with a nodule in the upper lip lasting 1 year. The patient had diabetes and had a 37-year smoking history (had quit 14 months before). On clinical examination, a firm, well-circumscribed submucosal nodule measuring 0.8 cm in diameter was observed in the upper lip, left side. Because it had mobility, an excisional biopsy was performed, under the clinical hypothesis of a benign neoplasm of salivary gland. Hematoxylin and eosin staining of the specimen was compatible with a malignant neoplasm of salivary gland. Immunohistochemical analysis showed positive staining for p63, S-100, CEA, CK and Ki-67, and a diagnosis of polymorphous low-grade adenocarcinoma was established. An investigation of the anatomical region with magnetic resonance imaging did not evidence remaining lesion. The patient has been under clinical and imaging follow-up for 5 years without any sign of recurrence of the neoplasm. A 49-year-old female patient presented with a nodule in the upper lip lasting 1 year. The patient had diabetes and had a 37-year smoking history (had quit 14 months before). On clinical examination, a firm, well-circumscribed submucosal nodule measuring 0.8 cm in diameter was observed in the upper lip, left side. Because it had mobility, an excisional biopsy was performed, under the clinical hypothesis of a benign neoplasm of salivary gland. Hematoxylin and eosin staining of the specimen was compatible with a malignant neoplasm of salivary gland. Immunohistochemical analysis showed positive staining for p63, S-100, CEA, CK and Ki-67, and a diagnosis of polymorphous low-grade adenocarcinoma was established. An investigation of the anatomical region with magnetic resonance imaging did not evidence remaining lesion. The patient has been under clinical and imaging follow-up for 5 years without any sign of recurrence of the neoplasm.

PRIMARY MYOEPITHELIAL CARCINOMA OF THE PALATE: REPORT OF AN UNCOMMON SALIVARY GLAND TUMOR

Myoepithelial carcinoma is considered an extremely rare (0.45%-1%) malignant salivary gland neoplasm. A 45-year-old male patient presented with a slow-growing ulcerated mass on the palate, measuring approximately 5 cm in diameter. The patient reported a history of 3 years since first noticing the lesion. Medical history was noncontributory. An incisional biopsy was performed, and histological analysis revealed proliferation of cells with predominantly ovoid and sometimes fusiform or plasmacytoid morphology, with hyperchromatic basophilic nuclei and slightly eosinophilic cytoplasm. Neoplastic cells were organized mainly into cords, assuming a trabecular aspect, and islets. An increase in the number of mitoses and karyorrhexis figures was observed. The tumor showed a fibrous stroma exhibiting mononuclear inflammatory infiltrate and vascular invasion. Immunohistochemistry reactions were positive for CK14, p63, S-100, and vimentin and negative for CK7. A diagnosis of myoepithelial carcinoma was made and the patient was referred for cancer treatment. Myoepithelial carcinoma is considered an extremely rare (0.45%-1%) malignant salivary gland neoplasm. A 45-year-old male patient presented with a slow-growing ulcerated mass on the palate, measuring approximately 5 cm in diameter. The patient reported a history of 3 years since first noticing the lesion. Medical history was noncontributory. An incisional biopsy was performed, and histological analysis revealed proliferation of cells with predominantly ovoid and sometimes fusiform or plasmacytoid morphology, with hyperchromatic basophilic nuclei and slightly eosinophilic cytoplasm. Neoplastic cells were organized mainly into cords, assuming a trabecular aspect, and islets. An increase in the number of mitoses and karyorrhexis figures was observed. The tumor showed a fibrous stroma exhibiting mononuclear inflammatory infiltrate and vascular invasion. Immunohistochemistry reactions were positive for CK14, p63, S-100, and vimentin and negative for CK7. A diagnosis of myoepithelial carcinoma was made and the patient was referred for cancer treatment.

CLINICO-EPIDEMIOLOGICAL ASPECTS OF 562 SALIVARY GLAND TUMORS: A RETROSPECTIVE STUDY FROM A SINGLE BRAZILIAN INSTITUTION

<h3>Objectives</h3> The aim of this study was to review cases of benign and malignant salivary gland tumor (SGT) and correlate it with clinical and epidemiologic characteristics of affected patients. <h3>Study Design</h3> Clinical and epidemiologic data were obtained from medical records from 1993 to 2019 and tabled in a spreadsheet of the Microsoft Office Excel. <h3>Results</h3> Five hundred sixty-two SGTs were identified, among which most were classified as benign neoplasms. In general, tumors were more frequent in women than in men, with the parotid gland being the most affected site. The mean age of patients affected by malignant tumors was higher than that of patients with benign tumors. Pleomorphic adenoma (PA) and mucoepidermoid carcinoma were the most prevalent tumors in the benign and malignant groups, respectively. PA was the most common SGT. <h3>Conclusions</h3> Our results corroborate the literature and show that SGTs are rare, and benign tumors are more common than malignant tumors. The parotid gland remains the most affected gland and pleomorphic adenoma is the most prevalent neoplasm.

INTEGRATIVE REVIEW AND EPIDEMIOLOGICAL SURVEY OF SALIVARY GLAND LESIONS IN A UNIVERSITY HOSPITAL

<h3>Objectives</h3> Conduct an epidemiologic cases survey of salivary gland lesions seen in the pathology sector in a university hospital in the period from 2013 to 2019 and carry out an integrative review. <h3>Study Design</h3> This is a cross-sectional study, with a duration of 7 years. Through the analysis of clinical records of patients diagnosed with salivary gland lesions in the pathology sector, the following information was collected: sex, age, lesion site, and histopathologic diagnosis. <h3>Results</h3> One hundred forty-three salivary gland lesions were diagnosed; 60.1% were nonneoplastic salivary gland lesions (NNSGLs), and mucous extravasation phenomena represented 81.4% of NNSGLs. The neoplastic salivary gland lesions (NSGLs) represented 39.9% of all cases. Most of these injuries were benign neoplasms (88%), with an emphasis on pleomorphic adenoma (PA; 68%). Only 7 malignant salivary gland neoplasms were found. <h3>Conclusions</h3> NNSGL was more prevalent than NSGL, with an emphasis on the mucus leakage phenomenon, which most affected the lower lip salivary glands. Among NSGLs, benign neoplasms were the most common and PA was the most diagnosed, with the parotid gland being the most affected site.

ADENOID CYSTIC CARCINOMA IN THE VENTRAL SURFACE OF THE TONGUE: A CASE REPORT

Adenoid cystic carcinoma (ACC) is one of the most common malignant tumors of the minor salivary glands, which may uncommonly affect the ventral surface of the tongue. In this report, we describe the case of a 48-year-old female patient who was referred to us due to a swelling in the ventral of the tongue on the right side. The patient reported approximately 12 months growing history, and the intraoral exam revealed a normochromic painful tumor and submandibular lymphadenopathy. Her medical history was noncontributory, and no harmful habits were reported. The working diagnosis was salivary gland neoplasm, and an incisional biopsy, which revealed a gelatinous lesion yellowish in color, was performed. The histopathologic examination of the excised lesion revealed hyperchromatic cells surrounding cyst-like spaces in a cribriform pattern. Despite the unusual location, the final diagnosis was adenoid cystic carcinoma, and the patient was submitted to total excision of the lesion with surgical margins.

MUCOEPIDERMOID CARCINOMA: A CASE REPORT

Mucoepidermoid carcinoma is an important and heterogeneous malignant salivary gland tumor. A 30-year-old male patient presented to the oral and maxillofacial pathology service with a painless enlargement in the hard palate for 1 year. No systemic alteration was observed. Intraoral examination revealed a firm consistency and fixed swelling measuring about 40 mm with a bluish color and smooth surface. Incisional biopsy was performed. Microscopic examination showed mucous cells with empty cytoplasm, intermediate cells with basaloid nucleus, and epidermoid cells in a solid arrangement and formation of cystic spaces. Mucous cells and cystic contents stained positively with periodic acid-Schiff and neoplastic cells were also anti-P63 positive. Immunohistochemistry to smooth actin muscle antibody was negative. A final diagnosis was mucoepidermoid carcinoma and the patient was referred to medical oncological treatment. Mucoepidermoid carcinoma is an important and heterogeneous malignant salivary gland tumor. A 30-year-old male patient presented to the oral and maxillofacial pathology service with a painless enlargement in the hard palate for 1 year. No systemic alteration was observed. Intraoral examination revealed a firm consistency and fixed swelling measuring about 40 mm with a bluish color and smooth surface. Incisional biopsy was performed. Microscopic examination showed mucous cells with empty cytoplasm, intermediate cells with basaloid nucleus, and epidermoid cells in a solid arrangement and formation of cystic spaces. Mucous cells and cystic contents stained positively with periodic acid-Schiff and neoplastic cells were also anti-P63 positive. Immunohistochemistry to smooth actin muscle antibody was negative. A final diagnosis was mucoepidermoid carcinoma and the patient was referred to medical oncological treatment.

CLINICOPATHOLOGICAL ANALYSIS AND SURVIVAL OUTCOMES OF SALIVARY GLAND TUMORS IN PEDIATRIC PATIENTS: A SYSTEMATIC REVIEW

<h3>Objectives</h3> To evaluate the clinicopathologic profile and survival outcomes of pediatric patients affected by salivary gland tumors (SGTs). <h3>Study Design</h3> An electronic search was carried out using the MEDLINE/PubMed, EMBASE, Scopus databases, and grey literature. <h3>Results</h3> A total of 2,830 articles were initially retrieved with 54 remaining for data extraction, resulting in 2,937 cases. SGTs were slightly more prevalent in female patients (57.4%), with a mean age of 13.3 years (age range: 0.3-19). Parotid was the most affected site (81.9%), and 99.2% of cases clinically exhibited swelling. Presence of pain and/or tenderness was reported in 13.5% of the cases, with an average duration of 12.6 months for the appearance of symptoms. Most of the reported cases were malignant tumors (75.4%), with mucoepidermoid carcinoma being the most common tumor (44.8%), followed by pleomorphic adenoma (24.1%). Surgery alone was the leading treatment choice in 74.9% cases, and the 5-year overall survival rate of patients was 93.1%. Patients with symptoms (<i>P</i> = .001), local recurrence (<i>P</i> < .001), metastasis (<i>P</i> < .001), and those not undergoing surgery or surgery combined with radiotherapy (<i>P</i> < .001) showed lower survival rates. <h3>Conclusions</h3> The pediatric patients present a high frequency of malignant SGTs and a high overall survival rate.

IMMUNOEXPRESSION OF STEM CELL BIOMARKERS IN SALIVARY GLAND TUMORS

<h3>Objectives</h3> We investigated the expression profile of tumor stem cell (TSC) biomarkers (CD44, ALDH1, OCT4, and SOX2) in salivary gland tumors (SGTs). The expression of these biomarkers was compared between pleomorphic adenomas (PAs), adenoid cystic carcinomas (ACCs), and mucoepidermoid carcinomas (MECs). <h3>Study Design</h3> Twenty cases each of PA, ACC, and MEC were selected. Immunoexpression of biomarkers was analyzed in parenchyma and stroma, based on the percentage of positive cells and staining intensity. <h3>Results</h3> Epithelial immunoexpression of ALDH1 was low in ACCs and higher in PAs compared to malignant SGTs (<i>P</i> < .001). Immunoexpression of OCT4 was related to tumors in minor salivary glands (<i>P</i> = .011) and myoepithelial differentiation (<i>P</i> = .009). MECs, but not PAs or ACCs, showed high immunoexpression of SOX2. This biomarker was related to the absence of myoepithelial differentiation (<i>P</i> < .001) and malignant behavior (<i>P</i> = .002). In most PAs, ACCs, and MECs, stromal immunopositivity was evidenced for the studied biomarkers, except for SOX2. Stromal immunopositivity for CD44, ALDH1, and OCT4 was significantly related to malignant behavior. <h3>Conclusions</h3> We suggest the presence of distinct subpopulations of TSCs in parenchyma and stroma of SGTs, which might play important roles in the pathogenesis of these neoplasms.

Serum metabolomics reveals an innovative diagnostic model for salivary gland tumors

An early diagnosis of salivary gland tumors (SGTs) and determination of their malignancy are conducive to developing individualized therapeutic strategies and thus improving prognosis. The aim of this study was to investigate the difference of serum metabolic profiles in patients with SGTs to better understand the mechanism of this disease and disease risk stratification. We used ultrahigh-performance liquid chromatography Q Exactive mass spectrometry and multivariate statistical analyses to conduct a comprehensive analysis of serum metabolites in a population with normal control and SGTs. 32 differentially expressed metabolites were identified, while the level of serine and lactic acid were investigated to gradually upregulate in benign SGTs and malignant SGTs. Then, the expression of serine and lactic acid were assessed in validation cohort using multiple reaction monitoring (MRM) based targeted metabolite analysis. A risk score formula based on the amount of serine and lactic acid was developed and explored to be significantly related to benign SGTs and malignant SGTs in discovery and validation cohort. Our work highlights the possible use of the risk score assessment based on the serum metabolites not only reveal in the early diagnosis of SGTs but also assist in enhancing current therapeutic strategies in the clinic.

Ultrasonographic prediction model for benign and malignant salivary gland tumors: a preliminary study

To establish an ultrasonographic (US) prediction model for benign and malignant salivary gland tumors. We retrospectively analyzed the clinical data of 575 patients with salivary gland tumors. Patients were divided into benign (N=420) and malignant (N=155) tumor groups based on histopathologic results. The clinical and US features of the tumor groups were statistically compared. With histopathologic findings as the dependent variable and clinical and US features as independent variables, a multiple logistic regression model was established. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate its diagnostic efficacy. Statistically significant differences between tumor groups were discovered for patient age, tumor site, and the US features of tumor size, shape, and margins; posterior echo pattern; microcalcification, abnormal lymph nodes, and tumor vascularity. Individual US features had limited diagnostic value. The AUC, sensitivity, specificity, and accuracy values of the logistic regression equation were 0.893, 84.3%, 80.0%, and 83.1%, respectively. The diagnostic performance of the predictive model was significantly better than that of any single US factor. This suggests that establishment of multiple models based on US features can improve the accuracy of diagnosis of benign and malignant salivary gland tumors and can be applied clinically.

Case report on adenoid cystic carcinoma of palate with review of literature

Adenoid cystic carcinoma (ACC) is a malignant tumor of minor salivary glands of the oral cavity, particularly the palate which accounts for about 5–10%. These tumors are slow growing with a high incidence of local recurrence, perineural invasion, and distant metastasis. Here, we report the case of a 69-year-old female who presented with swelling over the hard palate. Computerized tomography shows enhancing lesion along the undersurface of the left side of the hard palate, abutting the maxillary alveolus in the region of the second premolar and first two molars. There was no erosion of the inner cortex of the maxillary alveolus and no extension into the nasal cavity. Following the biopsy, she underwent a left hard palatectomy with upper alveolar resection. The final histopathological report confirmed ACC with no perineural invasion. Following she received adjuvant radiotherapy using an intensity-modulated radiotherapy technique. Now at 6 months of follow-up, there was no evidence of recurrence. Thus, our patient requires long-term follow-up to assess the benefit and survival outcome.

Cystic Salivary Duct Carcinoma Penetrated by Facial Nerve.

Salivary duct carcinoma is a rare malignant salivary gland tumor that mainly has solid features. When it occurs in the parotid gland, it can invade the facial nerve and cause facial nerve paralysis. However, in our case, the salivary duct carcinoma exhibited cystic features on computed tomographic imaging, and the facial nerve passed through the cyst. Total parotidectomy with level-I to -III dissections was performed and nerve passing through the tumor was sacrificed. The patient received postoperative radiotherapy and was clinically and radiologically followed-up for every 3 months. Recurrence or distant metastasis was not reported. To the best of our knowledge, this is the first case involving a salivary duct carcinoma with cystic features and facial nerve invasion. Here, we report a first case of cystic salivary duct carcinoma of the parotid gland which uncommonly undergo cystic change and penetrated by facial nerve and successfully resected without causing facial nerve injury.

SOX10 EXPRESSION IN SELECTIVE MALIGNANT SALIVARY GLAND TUMORS OF INTERCALATED AND EXCRETORY DUCTAL ORIGIN

Objective: To determine the level of immunohistochemical expression of SOX10 in malignant tumors of salivary gland of intercalated ductal and excretory ductal origin. Material and Methods: An analytical cross-sectional study was designed. Sample size was 90 and categorised into two groups i.e., intercalated ductal (adenoid cystic carcinoma AdCC and polymorphous low-grade adenocarcinoma PLGA) and excretory ductal (mucoepidermoid carcinoma MEC). Blocks were retrieved from the histopathology lab of Pakistan Institute of Medical Sciences (PIMS), Peshawar Medical College (PMC) and Islamabad Diagnostic Center (IDC) from 2015 – 2020. Hematoxylin &amp; Eosin (H&amp;E) and Immunohistochemistry (IHC) slides were prepared and examined under microscope. Statistical analysis was done using SPSS version 25. Results: The intensity was found weak in 24 (85.7%) and moderate 4 (14.3%) in excretory ductal tumors. Similarly, the intensity was strong and intense in most of the intercalated ductal tumors compared to none in the excretory ductal tumors. The difference was statistically highly significant (p-value,&lt;0.001). Similarly, the proportion of SOX10 was found with no positive cells in 25 (89.3%) and &lt;10% cells in 3 (10.7%) cases of excretory ductal tumors whereas in the intercalated ductal tumor cases almost two third (62.8%) patients had cells between 51- 80% and above 80%. The difference in proportion of SOX10 was found statistically significant (p-value, &lt;0.001). Conclusion: The conclusion of this study is that immunohistochemical expression of SOX10 can help in differentiating the origin of tumors of intercalated ductal and excretory ductal origin. Key Words: Adenoid cystic carcinoma, Polymorphous low-grade adenocarcinoma, Mucoepidermoid carcinoma, SOX1O, Immunohistochemistry, Hematoxylin &amp; eosin.