Minor Glands Research Articles

Questionnaire survey of the application of four objective indicators necessary for standardized diagnosis of Sjögren's syndrome

Objective: To investigate the current status and challenges of carrying out the four objective indicators which are necessary for the Sjögren's syndrome (SS) diagnosis in hospitals all over China. Methods: A questionnaire survey was conducted online by Questionstar from May to July 2023 among rheumatologists nationwide, to investigate whether unstimulated salivary flow (UWSF), Van Bijsterveld score (VBS), Schirmer test and labial gland focus score (FS) are carried out in their hospitals and the challenges that hinder their development. A cohort of patients with established SS was enrolled to verify the importance of the four objective indicators in diagnosing SS. Statistical analyses were performed using the chi-square test. Results: The questionnaire was completed by rheumatologists from 660 hospitals in 225 cities of 32 provinces, autonomous regions and municipalities all over China (one doctor from each hospital completed the questionnaire), of which 548 (83.0%) were tertiary care hospitals. The rate of carrying out the objective indicators in 660 hospitals was low: UWSF (290/660, 43.9%), FS (497/660, 75.3%) and VBS (393/660, 59.5%). The percentage of hospitals who consider it difficult to carry out UWSF, VBS, minor labial gland biopsy and Schirmer test was 92.6%(611/660), 69.4%(458/660), 59.8%(395/660) and 58.6%(387/660), respectively. All four objective indicators mentioned above could be carried out in only 139 (21.1%) hospitals. In 521 hospitals in which less than four objective indicators could be carried out, 23.2% (121/521) of rheumatologists selected clinical experience to diagnose SS. A total of 180 patients with SS diagnosed by perfecting all objective indices and meeting the 2016 the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria were included, 173 females (96%), aged (46.6±13.6) years, with the missed diagnosis rate was 17.8% (32/180) assuming their labial FS was unavailable. In 166 patients with established SS who met the classic 2002 AECG criteria, 160 females (96%), aged (47.0±13.6) years, the missed diagnosis rate was 52.4% (87/166) assuming their labial FS was unavailable; or 10.8% (18/166) assuming their UWSF was unavailable. SS diagnosis couldn't be estimated according to 2002 AECG criteria, assuming both labial FS and UWSF were unavailable in 156 (94.0%) patients with positive anti-SSA/Ro; or assuming either labial FS or UWSF was unavailable in 10 (6.0%) patients with negative anti-SSA/Ro. Conclusion: The application rates of four objective indicators necessary for SS diagnosis are low, the rate of carrying out labial gland biopsy should be increased, and the labial FS reports and UWSF test should be standardized.

Molecular characterization of the salivary adenoid cystic carcinoma immune landscape by anatomic subsites

Adenoid cystic carcinoma (AdCC) is a slow-growing salivary gland malignancy that relapses frequently. AdCCs of the submandibular gland exhibit unique differences in prognosis and treatment response to adjuvant radiotherapy compared to other sites, yet the role of tumor anatomic subsite on gene expression and tumor immune microenvironment (TIME) composition remains unclear. We used 87 samples, including 48 samples (27 AdCC and 21 normal salivary gland tissue samples) from 4 publicly available AdCC RNA sequencing datasets, a validation set of 33 minor gland AdCCs, and 39 samples from an in-house cohort (30 AdCC and 9 normal salivary gland samples). RNA sequencing data were used for single sample gene set enrichment analysis and TIME deconvolution. Quantitative PCR and multiplex immunofluorescence were performed on the in-house cohort. Wilcoxon rank-sum, nonparametric equality-of-medians tests and linear regression models were used to evaluate tumor subsite differences. AdCCs of different anatomic subsites including parotid, submandibular, sublingual, and minor salivary glands differed with respect to expression of several key tumorigenic pathways. Among the three major salivary glands, the reactive oxygen species (ROS)/nuclear factor erythroid 2-related factor 2 (NRF2) pathway signature was significantly underexpressed in AdCC of submandibular compared to parotid and sublingual glands while this association was not observed among normal glands. Additionally, the NRF2 pathway, whose expression was associated with favorable overall survival, was overexpressed in AdCCs of parotid gland compared to minor and submandibular glands. The TIME deconvolution identified differences in CD4+ T cell populations between AdCC of major and minor glands and natural killer (NK) cells among AdCC of minor, submandibular, and parotid glands while plasma cells were enriched in normal submandibular glands compared to other normal gland controls. Our data reveal key molecular differences in AdCC of different anatomic subsites. The ROS and NRF2 pathways are underexpressed in submandibular and minor AdCCs compared to parotid gland AdCCs, and NRF2 pathway expression is associated with favorable overall survival. The CD4+ T, NK, and plasma cell populations also vary by tumor subsites, suggesting that the observed submandibular AdCC tumor-intrinsic pathway differences may be responsible for influencing the TIME composition and survival differences.

Differential Expression of Mucin in Salivary Gland Tumours.

Background and Objectives: Mucin has been implicated via various mechanisms in the development and growth of tumour cells. However, mucin expression studies in salivary gland tumours are limited, especially with samples from minor salivary glands. This study aims to investigate and compare mucin expression in benign and malignant salivary gland tumours of minor and major salivary gland origins. Materials and Methods: Special stains were used to stain neutral mucin (Periodic acid Schiff), sialomucin (Alcian Blue) and sulfomucin (Aldehyde Fuschin) within tissues from six normal salivary glands and 73 salivary gland tumours including 31 pleomorphic adenomas, 27 mucoepidermoid carcinomas, and 15 adenoid cystic carcinomas. A semi-quantitative approach was used to evaluate mucin expression within ductal lumens. Sialomucin was the most expressed mucin in all salivary gland tumours, regardless of origin. Results: A significant difference was observed in the mucin expression between benign and malignant salivary gland tumours, as pleomorphic adenoma showed three times significantly higher expression of sialomucin compared to mucoepidermoid carcinoma and adenoid cystic carcinoma (p = 0.028). Pleomorphic adenomas of major glands showed 42 times significantly higher expression of sialomucin compared to those of minor glands (p = 0.000). Conclusions: Sialomucin content in pleomorphic adenomas of major glands was vastly increased compared to that in minor glands. Differential sialomucin expression in benign and malignant salivary gland tumours suggests a role in diagnosing of borderline salivary gland tumours.

Secretory carcinoma of minor salivary glands.

Secretory carcinoma is a malignant salivary gland tumor, which typically presents as an indolent painless mass within the parotid gland. Involvement of the minor gland is reported but less common. Secretory carcinoma was often misclassified as other salivary gland mimics, particularly acinic cell carcinoma, prior to 2010. It was first recognized as a molecularly distinct salivary gland tumor harboring the same fusion gene as well as histologic and cytogenetic features seen in juvenile breast cancer. Secretory carcinoma is generally managed in the same way as other low-grade salivary gland neoplasms and has a favorable prognosis; however, high-grade transformation requiring aggressive therapeutic interventions have been documented. Recent studies of biologic agents targeting products of this fusion gene offer the promise of a novel therapeutic option for treatment of this malignancy. Due to the limited number of reported cases, the spectrum of clinical behavior, best practices for management, and long-term treatment outcomes for secretory carcinoma remain unclear. A long-standing secretory carcinoma involving minor salivary glands of the mucobuccal fold, which was detected years after it was first noted by the patient, is reported. This case brings to light the importance of a thorough clinical exam during dental visits and reviews diagnostic differentiation of this malignancy from other mimics and discusses decision making for its management.

Mucoepidermoid Carcinoma of Minor Salivary gland Mimicking as Traumatic Fibroma: A Rare Case Report

This comprehensive case report details a rare presentation of Mucoepidermoid Carcinoma (MEC) in the minor salivary gland, manifesting with clinical characteristics remarkably similar to those of a benign fibroma. MEC, a predominant malignancy within the salivary gland neoplasms, primarily affects the major salivary glands, with occurrences in the minor glands being particularly rare and challenging to diagnose due to their indolent progression and atypical presentations. This report highlights the case of a 69-year-old female who presented with a painless, gradually enlarging mass in the floor of the mouth, initially presumed to be a traumatic fibroma based on its clinical appearance and location. Histopathological examination following an excisional biopsy revealed it to be intermediate-grade MEC, characterized by a mix of intermediate, epidermoid, and mucus-producing cells, along with notable mitotic activity and perineural invasion. Treatment includes surgical excision with clear margins and consideration of adjuvant radiotherapy, according to current guidelines for MEC management. This case underscores the critical importance of histopathological analysis in the differential diagnosis of oral lesions and the necessity for a high degree of clinical suspicion for malignancies in cases of atypical presentations. This case adds valuable insight into the diverse presentations of MEC and reinforces the importance of considering this diagnosis in the evaluation of persistent oral lesions, particularly when they mimic benign conditions.

Analysis of pattern of salivary gland cancers: Descriptive analysis from a single center

Salivary gland carcinomas are the malignant tumours arising from major or minor salivary glands, accounting for 5% of all head and neck cancers. There is scarce data available regarding pattern of presentation and clinical outcome of salivary glands in Pakistan. Thus this retrospective analysis of the patients presenting with salivary gland tumours was designed. A total of 305 patients were diagnosed with salivary gland cancers from 2008 till 2023, including 127 (41.6%) of females and 178 (58.4%) of male patients. There were 191 (62.6%) patients with parotid gland cancer and 114(37.4%) with submandibular and other minor glands. Mucoepidermoid carcinoma was the most prominent histological type followed by Adenoid Cystic carcinoma. Grade 2 (44.1%) was most frequently reported followed by Grade 1 (33.9%) and 3 (22.0%). These cancers did not show any significant association with age or gender. Salivary gland cancers are relatively rare cancer. Further studies to explore biological characteristics and long term clinical outcome are recommended.

Cystadenoma of the Tongue: A Case Report

Cystadenoma is a rare benign salivary gland neoplasm characterized by a predominantly multicystic growth pattern. The parotid gland is involved in about 45–50% of cystadenoma cases, with the minor glands of the lip and buccal mucosa being the next most common sites. The tongue is rarely involved. We report the case of a 56 year-old patient who presented a cystadenoma of the base of the tongue.

Early Evaluation of Minor Serous Gland Injuries Following Fractionated Radiotherapy for Head and Neck Cancer (Immunohistochemical Study)

Early Evaluation of Minor Serous Gland Injuries Following Fractionated Radiotherapy for Head and Neck Cancer (Immunohistochemical Study)

Malignant salivary gland tumors: agreement between fine needle aspiration biopsy, incisional biopsy and final histopathological diagnostic.

Incisional biopsy is indicated for intraoral tumors, but it is a contraindicated surgical procedure for major salivary glands. To avoid complications and facilitate diagnosis, fine needle aspiration biopsy (FNAB) is a type of biopsy widely used for preoperative diagnosis in these glands. The aim of this study was to analyze the agreement between the diagnosis by FNAB (major glands), incisional biopsy (minor glands) and histopathological analysis of the surgical specimen in salivary gland tumors from a database (medical records) of patients treated in a cancer treatment reference center in the Northeast region of Brazil. The sample consisted of 110 cases, being 86 of them malignant tumors in major salivary glands (parotid gland=73; submandibular gland=13) and 24 cases in minor salivary glands (palate). The female gender was the most affected (57.3%), especially in patients over 60 years (42.7%). In the TNM classification, 41.8% of the cases were in T2 at the time of diagnosis, with most of the regional lymph nodes in N0 (85.5%) and 87.3% of the cases in M0. FNAB was able to identify malignant neoplasms in 68.6% of the cases (n=59), while incisional biopsy in palatal tumors obtained agreement of 75% of the cases (n=18). The analysis revealed that tumors classified as T3-T4 (p=0.012) showed greater agreement between pre- and post-surgical diagnosis. The results obtained in this study indicate that FNAB has similar accuracy to incisional biopsy in providing satisfactory preoperative diagnoses of malignant tumors in salivary glands.

Human Minor Salivary Glands: A Readily Available Source of Salivary Stem/Progenitor Cells for Regenerative Applications.

Resident stem/progenitor cells within the secretory salivary glands offer a potential therapeutic resource for use in the regeneration of salivary glands needed to restore saliva production in patients with chronic xerostomia, or dry mouth. Methods were developed previously to isolate human stem/progenitor cells (hS/PCs) from major salivary glands (parotid/submandibular). Abundant minor salivary glands located in readily accessible locations in the oral cavity and lip could provide an additional valuable therapeutic resource. An advantage of this cell resource is that these minor glands about the size of grape seeds can be harvested from healthy donors using minimally invasive surgical procedures. The disadvantage of using minor glands is that they contain many fewer cells than do major glands, and thus harvested cells need to be expanded in the lab to create a therapeutic resource. While earlier work has described isolation of proliferative cell populations from minor salivary glands that could be used in regenerative medicine, most of these expanded cells possess properties of mesenchymal cells rather than the epithelial population that secretes salivary products.Here, we describe in detail our recently established methods to isolate and expand hS/PCs isolated from human labial minor salivary glands. Expanded hS/PC populations are epithelial assessed by their expression of epithelial progenitor markers K5 and K14. Like expandable cell populations previously isolated from the major salivary glands, these cells also express nuclear p63, consistent with their ability to be expanded after explant culture. When hS/PCs with these properties are encapsulated into a customized 3D biomimetic hyaluronic acid-based hydrogel, they will assemble into microstructures that retain some progenitor markers while also beginning to differentiate. The increased expression of secreted mucin MUC-7 was used to demonstrate differentiation and secretory potential in assembled hS/PC microstructures. Compared to hS/PCs from major glands, those from minor salivary glands tend to be more heterogeneous in early passage; thus, use of K5/K14/p63 as an early quality assessment tool is highly recommended. Additionally, hS/PCs from minor glands are sensitive to stress and if mishandled will demonstrate a stress response that leads to their transitioning to a flat, squamous cell-like appearance that is of limited utility in regenerative medicine applications. We conclude that properly handled hS/PCs from minor salivary glands represent a powerful new source of therapeutic cells for applications including treating patients with chronic xerostomia.

Minor Salivary Gland Tumors a Clinicopathological Study and Management

Salivary gland tumors are uncommon and most reported series include tumors affecting both major and minor glands. Very few series have focused solely on intra-oral minor salivary gland tumors. Is to report the clinicopathological d ata of intra-oral minor salivary gland tumors in sample of patients in Baghdad, Most important characteristic features of benign and malignant tumors, different pathological behavior and the importance of pathological classification in changing the management plans. Thirty five patients with tumors of minor salivary gland were analyzed clinlcopathologically and the management of these tumors is discussed. 19 female and 16 male patients, age range from9-79years. The range of duration of tu mors was about 3 years and the size range from 1-7cm. The most commo n site was the palate followed by floor of mouth, lips, cheek, and the maxillary alveolar ridge respectively. Different methods of surgical management of minor salivary gland tumors from simple excision of tumors mass to total maxillectomy were also described.

Salivary gland carcinomas in children and adolescents: A retrospective analysis of the European Cooperative Study Group for Pediatric Rare Tumours (EXPeRT)

BackgroundSalivary gland carcinomas (SGCs) are exceedingly rare in children, with a reported annual incidence of 0.8–1.4/1000,000 under 20 years of age. Evidence regarding optimal treatment of pediatric SGCs is limited, and for a long time, no guidelines have been available. Here, we report on an international retrospective series of SGCs in children and adolescents collected by several national rare tumor study groups cooperating in the European Cooperative Study Group of Pediatric Rare Tumors (EXPeRT) Patients and methodsPatients diagnosed between 2000 and 2014 were included. Data were reviewed by the respective national rare tumor working groups and reported on a harmonized data sheet to EXPeRT for central analysis. ResultsOverall, 121 patients were identified, including 103 patients with parotid tumors, 12 with submandibular tumors and six tumors in minor glands. In 11 patients, SGCs were secondary cancers. Mucoepidermoid carcinoma was the most frequent diagnosis (n = 65), followed by acinic cell carcinoma (n = 39), adenocystic carcinoma (n = 7), sialoblastoma (n = 3) and other carcinomas (n = 7). All patients underwent tumor resection (R0: 66%, R1: 34%). Neck dissection was performed in 47 patients, revealing nodal metastases in 13. Twenty-four patients underwent irradiation, and 11 patients received adjuvant chemotherapy. During a median follow-up of 25 (6–140 months), 14 relapses were observed (7 local, 5 with nodal and 2 with distant metastases). Five patients died of disease. Higher histological tumor grade was associated with advanced local tumor stage and risk of recurrence. ConclusionsSGCs in children and adolescents mostly present as localized tumors with low malignant potential. In approximately 10% of patients, regional lymph node metastases present at diagnosis. After complete resection, prognosis is favorable. Surgery is the mainstay of treatment; adjuvant local or cervical irradiation should be reserved to those rare patients with nodal metastases or less favorable biology such as adenocystic carcinoma.

Architectural and cytological features of epithelial dysplasia associated with transformation risk.

This study explored associations between histological features of dysplasia and malignant transformation, as well as genomic copy number alterations. Overall, 201 samples were collected from patients of oral leukoplakia. The associations of dysplastic features with malignant transformation and copy number alterations were investigated by Cox proportional hazards regression analysis and the Mann-Whitney U-test. Eight individual histological features, such as irregular epithelial stratification (p = 0.001), mitoses high in epithelium (p = 0.033), extension of changes along minor gland ducts (p < 0.001), etc., were associated with greater risk of malignant transformation. A model including histological features and age showed good performance for predicting malignant transformation (area under receiver operating characteristic curve: 0.806). Irregular epithelial stratification (p = 0.007), abnormal nuclear shape (p = 0.005), abnormal cell size (p = 0.004), etc. were associated with greater genomic instability. A Cox proportional hazards model using eight histological features and patient age reliably predicted the malignant potential of oral epithelial dysplasia. Identification of these histological features closely related to malignant transformation may aid the management of oral potentially malignant disorders and early detection of oral squamous cell carcinoma.

Domain swap facilitates structural transitions of spider silk protein C-terminal domains.

Domain swap is a mechanism of protein dimerization where the two interacting domains exchange parts of their structure. Web spiders make use of the process in the connection of C-terminal domains (CTDs) of spidroins, the soluble protein building blocks that form tough silk fibers. Besides providing connectivity and solubility, spidroin CTDs are responsible for inducing structural transitions during passage through an acidified assembly zone within spinning ducts. The underlying molecular mechanisms are elusive. Here, we studied the folding of five homologous spidroin CTDs from different spider species or glands. Four of these are domain-swapped dimers formed by five-helix bundles from spidroins of major and minor ampullate glands. The fifth is a dimer that lacks domain swap, formed by four-helix bundles from a spidroin of a flagelliform gland. Spidroins from this gland do not undergo structural transitions whereas the others do. We found a three-state mechanism of folding and dimerization that was conserved across homologues. In chemical denaturation experiments the native CTD dimer unfolded to a dimeric, partially structured intermediate, followed by full unfolding to denatured monomers. The energetics of the individual folding steps varied between homologues. Contrary to the common belief that domain swap stabilizes protein assemblies, the non-swapped homologue was most stable and folded four orders of magnitude faster than a swapped variant. Domain swap of spidroin CTDs induces an entropic penalty to the folding of peripheral helices, thus unfastening them for acid-induced unfolding within a spinning duct, which primes them for refolding into alternative structures during silk formation.

Anticholinergic burden of medications is associated with dry mouth and reflected in minor labial gland secretion

ObjectiveMedications with anticholinergic potential inhibit saliva secretion. Polypharmacy potentiates anticholinergic burden, causing dry mouth symptoms and chronic deterioration of oral health. Patients of any age can be affected by anticholinergic medication-triggered hyposalivation (the objective measure of dry mouth); therefore, seeking predictions of hyposalivation to screen dry mouth is needed. DesignIn our prospective, cross-sectional clinical study, 55 middle-aged adult patients participated. We examined whether the anticholinergic burden calculated from anticholinergic medications (anticholinergic drug score; ADS) and blood serum anticholinergic activity (SAA; the gold standard measure of anticholinergic burden) is associated with hyposalivation. As no prior studies measured minor salivary glands regarding the quantifiable anticholinergic burden, we assessed hyposalivation by the minor saliva flow (MSF) and unstimulated whole saliva (UWS) secretion. ResultsOur data showed a negative linear relationship between SAA and UWS (p < 0.05); when SAA increases by one pmol/ml unit, the saliva flow decreases by 0.058 ml/min. MSF showed a linear correlation (p < 0.005) with UWS. In a multivariate logistic regression model (including age, gender, race, smoking status, xerostomia severity, ADS, and BMI), we identified SAA and age as predictors of hyposalivation (p < 0.05). ConclusionsWe provide evidence for the significant relationship between measurable anticholinergic burden and saliva flow. The correlation between UWS and MSF suggests that both saliva flow rate measurement methods could reflect anticholinergics-induced changes in salivary health.

Identification of key genes in salivary gland in Sjögren's syndrome complicated with Hashimoto thyroiditis: Common pathogenesis and potential diagnostic markers.

The coexistence of Sjögren's syndrome (SS) and Hashimoto thyroiditis (HT) has been confirmed, but the common mechanism of its co-occurrence remains unknown. This study aims to further explore the underlying mechanism and biomarkers for the co-occurrence of SS and HT. The Gene Expression Omnibus databases were used to obtain gene expression profiles for SS (GSE127952 and GSE23117) and HT (GSE29315 and GSE138198). Following identifying SS and HT's shared differentially expressed genes, functional annotation, protein-protein interaction network creation, and module assembly were performed to discover hub genes. H&E staining and immunohistochemistry were performed to validate the expression of the hub genes in salivary glands. Finally, the receiver operating characteristic (ROC) curve was utilized to assess the discrimination of the hub genes as biomarkers in predicting SS, this study applied CIBERSORTx to analyze the immune infiltration in SS and HT in addition. A total of 48 common differentially expressed genes (48 upregulated genes and 0 downregulated genes) were chosen for further investigation. We analyzed the expression and function of PTPRC, CD69, IKZF1, and lymphocyte cytosolic protein 2 via H&E, immunohistochemistry, and ROC analysis. The 4 hub genes were mainly enriched in the T-cell receptor signaling pathway. We then evaluated and verified the diagnosis value of 4 hub genes in clinical minor labial gland biopsy of SS with HT, SS without HT, and non-SS. ROC analysis revealed that the 4 hub genes had a strong diagnostic value. Our study showed the common pathogenesis of SS and HT. These hub genes and diagnostic models may put forward some new insights for diagnosing and treating SS complicated with HT.

Advances in clinical examination of lacrimal gland.

In humans, the lacrimal gland is located in the socket of the frontal bone above the outer orbital area. As an essential part of the eye surface, the gland is fixed to the orbital periosteum by connective tissue. The lacrimal gland passes through the outer tendon membrane, which divides the gland into larger orbital and minor eyelid glands. The lacrimal glands are the main contributors to tear film. They secrete electrolytes, proteins, and water to help nourish and protect the eye's surface. Furthermore, clinically, lacrimal glands are associated with a variety of inflammatory reactions and immune factors and are also vulnerable sites for tumors. Changes in tear gland morphology or secretory function affect tear film stability and tear secretion quality. Various technological devices have been developed and applied to lacrimal glands. This article systematically reviewed the clinical examination of the lacrimal gland to help inform personalized strategies for the diagnosis of lacrimal gland-related diseases.

(005) The Forgotten Region of the Vestibule: The 12:00 Location

Abstract Introduction The vestibule, consisting of the urethral meatus and minor and major vestibular glands, is a unique surface of endodermal tissue between Hart’s line, at the inner aspect of the labia minora, and the hymen, just at the vaginal opening. The vestibule releases mucinous lubrication during sexual arousal, achieved, in part, by robust vestibular innervation. Although not well studied, this likely consists of both somatic (perineal nerve), and autonomic (pelvic and hypogastric) nerves. The vestibule is commonly involved in entrance dyspareunia pathology related to infectious, dermatologic, hormonal, neurologic, pelvic floor, neuro-proliferative and other factors. Examination of the vestibule in symptomatic patients is best performed by vulvoscopy, and usually involves cotton swab testing of the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00, and 11:00 locations, assessing for intensity of pain and degree of erythema. However, this examination does not assess the entire vestibule. The vestibule actually extends superiorly from just above the urethral meatus to just below the clitoris/right and left frenulum and laterally to Hart’s line. This may be considered as the “12:00” region of the vestibule; few providers examine there, and few surgeons excise the 12:00 region during vestibulectomy. Objectives The primary goal was to assess the relationship of the pathology of the 12:00 region to pathology in the usual vestibular locations. A secondary goal was to assess for presence of ostia of minor vestibular glands in the 12:00 region of the vestibule. Methods Women presenting to our clinic for sexual dysfunction were consented and underwent vulvoscopy with photography and cotton swab testing using a vulvoscope (Wallach Zoomscope) with attached camera (Cannon). Figure 1 shows cotton swab testing for pain and erythema at 12:00. Pain intensity was rated 0 – 10, with pain &amp;gt;3/10 considered clinically significant. Erythema was rated absent, mild, moderate or severe with any erythema considered clinically significant. Results Of 88 patients (mean age 42 +/− 19, range 13-83 years) with various sexual dysfunctions who underwent vulvoscopy with photography and cotton swab testing, 19 (22%) had absent pain and absent erythema throughout the usual vestibular locations as well as at the 12:00 location. Of 54 (61%) patients with positive findings of significant pain and erythema in at least 4 of the usual locations, 38 (70%) also had significant pain and erythema at 12:00. 26% of photographs examined revealed obvious single or multiple ostia of minor vestibular glands in the 12:00 region of the vestibule. Figure 2 shows 2 minor vestibular glands at 12:00. Conclusions While the vestibule extends from Hart’s line to the hymen including the usual 1:00, 3:00, 5:00, 6:00, 7:00, 9:00, and 11:00 locations, it also includes the region superiorly from just above the urethral meatus to just below the clitoris/right and left frenulum and laterally to Hart’s line. There are minor vestibular glands in this 12:00 region of the vestibule that can contain significant pathology. Providers are encouraged to consider the entire vestibule during diagnosis and treatment of women with sexual dysfunction. Disclosure No.

Why is the histomorphological diagnosis of small salivary gland tumours so much more difficult?

There is awidespread impression among clinicians and pathologists that the histomorphological diagnosis of minor salivary gland tumours is more difficult and more frequently misdiagnosed than that of major glands. This is based on subjective clinical impression; scientific proof of and potential reasons for this difference are lacking. We identified 14putative clinical, histopathological and combined clinical-histological reasons and fourconsequences, which together could explain the perceived greater difficulty of diagnosing minor gland tumours. We performed athorough literature search and astatistical comparison of data from apersonal large consultation series (biased for "difficult" cases) with cumulated data from a routine, unselected (non-consultation) series from the literature. Through this comparison, we could prove with statistical significance aseries of reasons and consequences for this greater diagnostic difficulty in minor glands. Frequent incisional biopsies, almost obligatory low-grade bland cytology in malignant tumours and insufficient clinical-pathological communication emerged as the most important reasons. The special anatomic location of the hard palate contributes to further diagnostic difficulties, such as tumour necrosis, mucosal ulceration, pseudoinvasion and the "tumoural-mucosal fusion" phenomenon. Knowledge of these pitfalls in clinic and pathology can help overcome these difficulties and reduce the misdiagnosis rate in minor gland tumours. Our findings result in aseries of recommendations both for the clinic and pathology.

Tubarial Salivary Gland – The New Member of Nasopharynx

Tubarial Salivary Gland – The New Member of Nasopharynx