Minor Glands Research Articles

146 Standardization of Vulvoscopy: A Step-Wise Approach

In the medical evaluation of a woman with sexual dysfunction, there is no standard methodology for physical examination. The purpose of this was to develop a standardized technique of magnified examination of the vulvar, vestibular and vaginal region by vulvoscopy. The technique of medical healthcare providers in our facility who perform vulvoscopy using regularly, was reviewed. Options for examination are a standard colposcope with an attached camera to project the image onto a flat screen for viewing, or a tripod mounted smart phone with blue tooth remote, connected to the flat screen wirelessly. Photographs are taken at each step of the examination. Maximal diagnostic information was gained using a step-wise approach to vulvoscopy, beginning from lateral to medial, external to internal, conducted in a standardized manner. The vulvoscopy protocol begins with examination of right and left labia majora, followed by sulci, and then labia minora, assessing for pathology, and followed by cotton swab (Q-tip) palpation used to assess for pain. Labia minora width (cm) is then measured and degree of resorption from posterior fourchette assessed. The glans clitoris is examined via cephalad retraction of the prepucial hood so the corona can be visualized to assess for presence of clitoral adhesions. Glans size is compared to size of the cotton swab. Lateral retraction of labia minora enables visualization of Hart's line and close inspection of the vestibule and urethral meatus. The ostia of minor vestibular glands are observed for erythema and Q-tip testing performed at 1:00, 3:00, 5:00, 6:00, 7:00, 9:00, 11:00 to evaluate for pain on a scale of 0-10. Speculum exam is then performed by rotating the speculum 90 degrees to evaluate presence of vaginal rugae, vaginal pathology, as well as quality of the anterior vaginal wall periurethral tissue.

English

Pleomorphic adenoma of the salivary gland is described as a slow growing painless benign tumor characterized histologically by its mixed appearance with epithelial and myoepithelial components. It occurs in both the major and minor salivary glands with the parotid gland as the commonest site for the major gland while the palate is the commonest site for the minor glands. This study was conducted to evaluate the clinical presentation of pleomorphic adenoma seen in the University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria. Records of all the patients with pleomorphic adenoma seen in the clinics within a six year period (January 2009 to December 2014) were retrospectively reviewed. Relevant information retrieved from the patients’ file. Data was analyzed using SPSS version 23; qualitative variables were compared using chi-square test. A total of 37 cases (prevalence = 41.1%) of pleomorphic adenoma of the major and minor salivary gland met the required criteria for inclusion in the study. Majority of the cases occurred in females. The mean age of the patients was 38.2 and standard deviation was 16.4. The mean duration of the tumor at presentation was 39.4 months. Parotid gland was the commonest site. Postoperative complication seen was facial nerve palsy. Most of the tumors occurred on the left side. Pleomorphic adenoma present as a painless swelling is seen more in our environment among women. The peak age of occurrence is in the 4th decade of life. Surgical excision is the mainstay of treatment. Many of the patients presented years after the onset of tumor growth. Key words: Pleomorphic adenoma, salivary gland, benign tumors.

Physiologic distribution of PSMA-ligand in salivary glands and seromucous glands of the head and neck on PET/CT

Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is used for detection and (re)staging of prostate cancer. However, healthy salivary, seromucous, and lacrimal glands also have high PSMA-ligand uptake. This study aimed to describe physiologic PSMA-ligand uptake distribution characteristics in the head and neck to aid in PSMA PET/CT interpretation and to identify possible new clinical applications for PSMA-ligand imaging. Thirty consecutive patients who underwent PSMA PET/CT for prostate cancer were evaluated. Tracer maximum standardized uptake values (SUVmax) in the salivary, seromucous, and lacrimal glands were determined visually and quantitatively. Overall and intraindividual variations were reported. All gland locations had increased tracer uptake. The mean SUVmax ± standard deviation varied: parotid 12.3 ± 3.9; submandibular 11.7 ± 3.5; sublingual 4.5 ± 1.9; soft palate 2.4 ± 0.5; pharyngeal wall 4.3 ± 1.3; nasal mucosa 3.4 ± 0.9; supraglottic larynx 2.7 ± 0.7; and lacrimal 6.2 ± 2.2. The parotid had the largest overall variation in SUVmax (5.2-22.9), and the sublingual glands had the largest mean intraindividual difference (18.1%). Major and minor salivary and seromucous glands consistently have high PSMA-ligand uptake. Minor gland locations can be selectively visualized by this technique for the first time. This provides potential new applications such as quantification of present salivary gland tissues and individualization of radiotherapy for head and neck cancer or lutetium-177-PSMA radionuclide treatment.

Pleomorphic adenoma of submandibular gland: not so common occurrence

Background: The salivary glands tumour are relatively rare, yet they represent a wide variety of both benign and malignant histologic subtypes. Several studies have been conducted on the tumors of the parotid and minor salivary glands, but very few reports in the literature have focused on submandibular gland tumors as they are rare and are usually grouped with other salivary glands. Approximately 70% of the salivary gland tumors affect parotid gland with the submandibular gland being affected in 5-10% of the cases, sublingual gland in 1% and minor glands in 5-15% of the cases. So, we describe a series of 50 patients of pleomorphic adenoma affecting submandibular gland.Methods: The prospective study was conducted at Department of General Surgery, Indira Gandhi Government Medical College, Nagpur between January 2008 to December 2017.Results: Out of the 50 patients, 10 were male and 40 were female. Thus, male to female ratio is 1:4. Most of the 42 (84%) patients presented with painless swelling in submandibular region. Clinically the tumour has the texture of cartilage and has an irregular and bosselated surface observed in all the patients. The size of tumour was 3 to 6 cm in 32 (64%) patients observed in the present study. Fine needle aspiration cytology was performed in all the patients. All patients were managed by surgical excision. Recurrence occurred in a single patient who was managed with radical excision including a neck dissection with postoperative radiotherapy.Conclusions: Submandibular gland pleomorphic adenoma being common benign tumor, occurring commonly between the 3rd and 5th decade of life and presenting as slow growing asymptomatic swelling with female preponderance. The precise surgical excision along with whole submandibular salivary gland and postoperative radical radiotherapy required for recurrence as the accepted mode of management. However, further long-term studies involving submandibular gland have to be carried out to know the pattern of tumor recurrence.

Radiation Doses to All Salivary Glands Affect Patient-Reported Xerostomia and Quality of Life: A Longitudinal Study

Randomized studies comparing 2-dimensional (2D) radiotherapy (RT) and parotid-sparing intensity-modulated RT (IMRT) in patients with head and neck cancer (HNC) have demonstrated improvements in saliva output and observer-rated xerostomia with IMRT. However, patient-reported xerostomia (PRX) has either not differed (Kam MK et al., JCO, 2007) or been only marginally better with IMRT in the first year post-therapy (Nutting CM et al., Lancet Oncology, 2011). We hypothesized that doses to all salivary glands, including the mucin-producing submandibular and minor glands within the oral cavity, are important determinants of PRX. We sought to assess the effect of doses to these structures in patients with HNC receiving IMRT aiming to spare all glands. Patients with HNC receiving IMRT to the bilateral neck answered a validated xerostomia questionnaire (XQsum) consisting of 4 questions inquiring about oral dryness during eating and speaking (XQeat), and 4 about dryness at rest (XQrest), as well as a validated, multi-domain HN quality of life questionnaire (HNQOL). The scale for XQ ranges from 0-100, with higher scores denoting worse xerostomia. PRX and HNQOL data were obtained at each follow-up visit through 48 months. Univariate and multivariate Cox-regression were used to correlate PRX and HNQOL scores with clinical factors, time since therapy, and mean RT doses to the parotid glands (PG), contralateral submandibular gland (SMG), and oral cavity (OC). These factors were combined into random effect models to account for within-person correlations arising from repeated measures. Two-hundred and fifty-two HNC patients treated with IMRT completed a total of approximately 600 PRX and HNQOL questionnaires through 48 months post-RT. Median mean doses to both parotids, contralateral SMG, and OC, were 36 (range 3-64), 31 (6-57), and 37 (8-70) Gy, respectively. Mean OC doses correlated moderately with both mean PG (r=0.42, p<0.001) and SMG (r=0.34, p<0.001) doses, as did mean PG and SMG doses with each other (r=0.33, p<0.001). Mean XQsum scores were 39 (standard deviation 21), 31 (22), 29 (22), and 27 (21) at 1, 12, 24, and 48 months post-RT, respectively. On univariate analysis, N stage, and mean PG, SMG, and OC doses statistically significantly correlated with XQsum, XQeat, XQrest, HNQOL Summary, and HNQOL Eating domain scores (all p<0.01). In all instances, higher mean doses were associated with higher (worse) scores. Scores improved significantly over time, with steeper improvement of XQsum at lower SMG dose. On multivariate analysis, mean PG and OC doses significantly correlated with XQtotal, XQeat, and HNQOL Eating scores, and mean SMG dose with HNQOL summary. These results suggest that reducing doses to all salivary glands, including PG, SMG, and minor glands within the OC, is likely to improve PRX and HNQOL compared with PG-sparing alone.

Role of Salivary Biomarkers in Detection of Cardiovascular Diseases (CVD).

Human whole mouth saliva (WMS) is secreted by salivary glands, namely parotid, submandibular/sublingual and other minor glands of the oral cavity. It is secreted in a systematic way, and contain informative proteins and peptides for the early detection of contagious diseases and organ-related diseases. The role of WMS as a liquid biopsy for the detection of cardiovascular diseases (CVD) through Myoglobin (MYO), Cardiac troponin I (cTnI), Creatine phosphokinase MB (CK-MB), Myeloperoxidase (MPO), brain natriuretic peptide (NT-proBNP), Exosomal miRNA, C-Reactive Protein (CRP), Matrix metalloproteinase-8 (MMP-8), MMP-9 and tissue inhibitor of MMP-8 (TIMP-1), leukotriene B4 has been well reported in last decade, that have been reviewed in the literature comprehensively below.

Morphological and functional diversity of minor ampullate glands in spiders from the superfamily Amaurobioidea (Entelegynae: RTA clade)

Minor ampullate glands produce fibers that are involved in construction of the complex adhesive band for capturing prey, which is produced by particular cribellate spiders. Despite such a specific role, however, the glands persist even in species where production of cribellate capturing bands no longer occurs. In these species, minor ampullate fibers are instead used to reinforce major ampullate fibers in draglines and capturing webs. The fibers are also used in combination with the aciniform fibrils to make silk for bridging lines – airborne lines used by spiders to allow them to move to points on the substrate where these threads adhere. In this study, we compare the morphology of minor and major ampullate glands in related cribellate and ecribellate groups within spider families of the group traditionally termed the Amaurobioidea, which lies at the base of the RTA clade. We found that the minor ampullate glands are bifurcated in the cribellate members of this group, in particular in the representatives of the families Amaurobiidae, Titanoecidae, Desidae, Amphinectidae and Phyxelididae. In ecribellate representatives, the major ampullate glands are never bifurcated. We found irregularly branched minor ampullate glands in some representatives of the family Agelenidae. In other ecribellates, the glands are either unbranched or they are absent. Thus, bifurcation of the minor ampullate gland seems to be important in determining some aspect of cribellate capturing band formation that is as yet undetermined.

Systematic screening for skin, hair, and nail abnormalities in a large-scale knockout mouse program.

The International Knockout Mouse Consortium was formed in 2007 to inactivate (“knockout”) all protein-coding genes in the mouse genome in embryonic stem cells. Production and characterization of these mice, now underway, has generated and phenotyped 3,100 strains with knockout alleles. Skin and adnexa diseases are best defined at the gross clinical level and by histopathology. Representative retired breeders had skin collected from the back, abdomen, eyelids, muzzle, ears, tail, and lower limbs including the nails. To date, 169 novel mutant lines were reviewed and of these, only one was found to have a relatively minor sebaceous gland abnormality associated with follicular dystrophy. The B6N(Cg)-Far2tm2b(KOMP)Wtsi/2J strain, had lesions affecting sebaceous glands with what appeared to be a secondary follicular dystrophy. A second line, B6N(Cg)-Ppp1r9btm1.1(KOMP)Vlcg/J, had follicular dystrophy limited to many but not all mystacial vibrissae in heterozygous but not homozygous mutant mice, suggesting that this was a nonspecific background lesion. We discuss potential reasons for the low frequency of skin and adnexal phenotypes in mice from this project in comparison to those seen in human Mendelian diseases, and suggest alternative approaches to identification of human disease-relevant models.

Margin Analysis: Malignant Salivary Gland Neoplasms of the Head and Neck.

There are no established protocols for the optimum surgical margin required for salivary gland malignancies. Factors including histologic diagnosis and TNM stage have been shown to be important in prognosis and survival outcome and mandate special consideration of margin size. Salivary cancers are treated differently at different anatomic sites, and different histologic types show a propensity for major or minor glands. Low-grade malignancies are treated with soft tissue margins of 1cm or less. The facial nerve is preserved unless infiltrated and encased. Adenoid cystic carcinoma and carcinoma ex pleomorphic adenoma require more complex planning to obtain negative margins.

Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

SUMMARYSaliva testing is a non-invasive and inexpensive test that can serve as a source of information useful for diagnosis of disease. As we enter the era of genomic technologies and –omic research, collection of saliva has increased. Recent proteomic platforms have analysed the human salivary proteome and characterised about 3000 differentially expressed proteins and peptides: in saliva, more than 90% of proteins in weight are derived from the secretion of three couples of "major" glands; all the other components are derived from minor glands, gingival crevicular fluid, mucosal exudates and oral microflora. The most common aim of proteomic analysis is to discriminate between physiological and pathological conditions. A proteomic protocol to analyze the whole saliva proteome is not currently available. It is possible distinguish two type of proteomic platforms: top-down proteomics investigates intact naturally-occurring structure of a protein under examination; bottom-up proteomics analyses peptide fragments after pre-digestion (typically with trypsin). Because of this heterogeneity, many different biomarkers may be proposed for the same pathology. The salivary proteome has been characterised in several diseases: oral squamous cell carcinoma and oral leukoplakia, chronic graft-versus-host disease Sjögren's syndrome and other autoimmune disorders such as SAPHO, schizophrenia and bipolar disorder, and genetic diseases like Down's Syndrome and Wilson disease. The results of research reported herein suggest that in the near future human saliva will be a relevant diagnostic fluid for clinical diagnosis and prognosis.

Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity

ABSTRACT Pleomorphic adenomas occurring in the nasal cavity are rarely encountered; nevertheless, the abundance of minor seromucinous glands in that region is seen. Most cases present with a painless, slowly progressing unilateral nasal obstruction, a nasal mass, and epistaxis. Herewith, we present an unusual case of pleomorphic adenoma arising from the lateral wall of right nasal cavity in a 41-year-old male, who complained of right nasal obstruction with no history of epistaxis. Rigid nasal endoscopy revealed a swelling continuous with right inferior concha. Computed tomography showed a well-defined, soft tissue mass in the right nasal cavity. The lesion was completely excised endoscopically. Histopathology confirmed a pleomorphic adenoma consisting of epithelial and mesenchymal elements. Wide exposure is crucial for complete excision with negative margins to achieve positive outcome and to prevent recurrence. How to cite this article Pandey AK, Bhardwaj A, Maithani T, Rathi S. Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity. Clin Rhinol An Int J 2017;10(1):11-13.

Reproductive Tract Histology in South American Fur Seal Pups (Arctophoca australis).

In the present study, a detailed histological description of the female reproductive tract of South American fur seal (Arctophoca australis) pups has been conducted. The uterine tube was covered by cuboidal to columnar epithelium; nerve fibers were present in the mesosalpinx and beneath the muscular layer. The uterus was bipartitus; the endometrial surface of the horns was lined by a simple cuboidal or columnar epithelium with deep tubular glands; caudally ("the transition area"), the epithelium changed to pseudostratified columnar, few tubular glands were present and the myometrium increased in width. A bistratified epithelium internally coated the uterine body, whereas it changed to cylindrical stratified epithelium with a highly vascularized lamina propria and a strong muscular layer in the cervix; no endometrial glands were observed in this region. From the transition area of the uterus to the vagina there were several nerve fibers and ganglia belonging to the uterovaginalis plexus. In the vestibule, hymenal folds were poorly developed; adnexa structures included the major vestibular glands and a neurovascular structure similar to the vestibular bulb. Minor vestibular glands were associated with the clitoris. The skin of the perineum was lined by a keratinized stratified epithelium, pigmented, with sebaceous glands, sweat glands and hair follicles. This is the first detailed histological description of the reproductive tract of South American fur seal pups, including the glandular adnexa and nerve structures. These results contribute to the reproductive biology in Pinniped species, and give a better understanding of the utero-placental perfusion mechanism during diving. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:600-613, 2017. © 2016 Wiley Periodicals, Inc.

Spinnerets and silk-producing system of Segestria senoculata (Araneae, Araneomorphae, Segestriidae)

The spinning apparatus and silk of &lt;em&gt;Segestria senoculata&lt;/em&gt; were studied with the use of scanning electron microscopy and light microscopy, which confirmed the presence of four categories of spigots connected with four types of spinning glands (&lt;em&gt;i.e&lt;/em&gt;., &lt;em&gt;Glandulae ampullaceae major, Glandulae ampullaceae minor, Glandulae piriformes and Glandulae pseudaciniformes&lt;/em&gt;). New data about the morphology of spinnerets and spigots were obtained for both the adults and nymphal stages of both sexes. For the first time the silken threads of retreats, signal threads and attachment discs of the members of &lt;em&gt;Segestria&lt;/em&gt; were subjected to a detailed SEM study. The data resulting from studying the spinning apparatus of &lt;em&gt;S. senoculata&lt;/em&gt; was compared to current knowledge of the silk producing systems of families belonging to the Dysderoidea superfamily. Silks that are emitted from spigots in the course of retreat construction are not (similarly to the other dysderoids) processed by the spider’s legs during the subsequent process of hardening. Apart from the major ampullate glands/spigots, segestriids also possess developed minor ampullate glands. Minor ampullate threads are used by &lt;em&gt;S. senoculata&lt;/em&gt; spiders when making their signal threads.

Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity

ABSTRACT Pleomorphic adenomas occurring in the nasal cavity are rarely encountered; nevertheless, there is abundance of minor seromucinous glands in that region. Most cases present with a painless, slowly progressing unilateral nasal obstruction, a nasal mass, and epistaxis. Herewith, we present an unusual case of pleomorphic adenoma arising from the lateral wall of the right nasal cavity in a 41-year-old male who complained of right nasal obstruction with no history of epistaxis. Rigid nasal endoscopy revealed a swelling continuous with right inferior concha. Computed tomography showed a well-defined, soft tissue mass in the right nasal cavity. The lesion was completely excised endoscopically. Histopathology confirmed a pleomorphic adenoma consisting of epithelial and mesenchymal elements. Wide exposure is crucial for complete excision with negative margins to achieve positive outcome and to prevent recurrence. How to cite this article Pandey AK, Bhardwaj A, Maithani T, Rathi S. Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity. Clin Rhinol An Int J 2016;9(3):146-148.

Feeding Tube Utilization in Patients with Salivary Gland Malignancies.

Objectives To evaluate feeding tube utilization in patients with salivary gland malignancies (SGMs). Study Design Case series with planned data collection. Setting The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Subjects and Methods Patients (N = 287) were sampled from an epidemiologic SGM registry during a 12-year period. Feeding tube history was retrospectively reviewed. Patients with outside locoregional therapy or palliative treatment were excluded. Enteral feeding and length of dependence were analyzed as a function treatment modality and site of SGM. Results Of 287 patients, 79 (28%) required temporary nasogastric tube feeding (median duration: 13 days, interquartile range: 6-21). Among those 79, 30 (10% of total cohort) required conversion to percutaneous gastrostomy tube (G-tube). Median G-tube duration was 4.8 months (interquartile range: 3.7-13.1). G-tube placement was necessary only in patients receiving multimodality therapy ( P < .001), and among those, 50% with SGMs arising from pharyngeal/laryngeal sites required G-tube, as compared with 8% to 19% of SGMs arising from all other sites ( P < .01). At a median follow-up of 2.4 years, 9 (3%) of all SGM patients were G-tube dependent, but 14% (3 of 22) with laryngeal/pharyngeal sites treated with multimodality therapy remained chronically G-tube dependent. Conclusion While almost 30% of SGM survivors require a temporary nasogastric tube, G-tube utilization is uncommon, in roughly 10% of SGM overall. G-tube utilization appears exclusive to patients treated with multimodality therapy, and chronic gastrostomy remains high (14%) in patients with minor gland cancers arising in the pharynx/larynx, suggesting impetus for dysphagia prophylaxis in these higher-risk subsets, similar to patients treated for squamous cancers.

Immune activation enhances epithelial nerve growth in provoked vestibulodynia

Provoked vestibulodynia manifests as allodynia of the vulvar vestibular mucosa. The exact mechanisms that result in altered pain sensation are unknown. Recently, we demonstrated the presence of secondary lymphoid tissue, which is the vestibule-associated lymphoid tissue in the vestibular mucosa, and showed that this tissue becomes activated in provoked vestibulodynia. The purpose of this study was to examine whether expression of intraepithelial nerve fibers and nerve growth factor are related to immune activation in provoked vestibulodynia. Vestibular mucosal specimens were obtained from 27 patients with severe provoked vestibulodynia that was treated by vestibulectomy and from 15 control subjects. We used antibodies against the protein gene product 9.5, the neuron specific neurofilament, and nerve growth factor for immunohistochemistry to detect intraepithelial nerve fibers and nerve growth factor expressing immune cells in the vestibular mucosa. For intraepithelial nerve fibers, we determined their linear density (fiber counts per millimeter of the outer epithelial surface, protein gene product 9.5) or presence (neuron specific neurofilament). Nerve growth factor was analyzed by counting the staining-positive immune cells. Antibodies against CD20 (B lymphocytes) and CD3 (T lymphocytes) were used to identify and locate mucosal areas with increased density of lymphocytes and the presence of germinal centers (ie, signs of immune activation). B-cell activation index was used to describe the overall intensity of B-cell infiltration. We found more protein gene product 9.5-positive intraepithelial fibers in vestibulodynia than in the control samples (6.3/mm [range, 0.0-15.8] vs 2.0/mm [range, 0.0-12.0]; P=.006). Neuron specific neurofilament -positive intraepithelial fibers were found in 17 of 27 vestibulodynia cases (63.0%) and in none of the control cases. Protein gene product 9.5-positive intraepithelial fibers were more common in samples with more pronounced immune activation. The density of these fibers was higher in samples with than without germinal centers (6.1/mm [range, 4.3-15.8] vs 3.0/mm [range, 0.0-13.4]; P=.020). A positive correlation between the fiber density and B-cell activation index score of the sample was found (Spearman's Rho, 0.400; P=.004; R2=0.128). No significant difference, however, was found in the density or presence of nerve fibers between samples with high and low T-cell densities. We identified areas of minor and major vestibular glands in 16 of the patient samples and in 1 control sample. Protein gene product 9.5-positive nerve fibers were found more often in glandular epithelium surrounded by B-cell infiltration than in glands without B cells (P=.013). Also, the presence of neuron specific neurofilament-positive fibers in glandular epithelium was associated with B-cell infiltrates (P=.053). Nerve growth factor-positive immune cells were more common in mucosal areas with than without B-cell infiltration and intraepithelial nerve fibers. Excessive epithelial nerve growth in provoked vestibulodynia is associated with increased B-cell infiltration and the presence of germinal centers. This supports the fundamental role of immune activation in provoked vestibulodynia.

Pediatric malignant salivary gland tumors: 60 year follow up

ObjectiveTo evaluate the presentation, treatments and outcomes in pediatric patients with salivary gland malignancies. Study designRetrospective chart review (1950–2012), Prospective phone interview. MethodsPatients ≤18 years old with a salivary gland malignancy treated at our institution were identified. Patients were also contacted by phone for a follow up survey. ResultsFifty-six patients were identified. Tumor origin was 88% parotid (n = 49), 5% (n = 3) submandibular and 7% (n = 4) minor salivary glands. Time from onset of symptoms to diagnosis was over one year (mean = 14.4 years). Fifteen out of 52 patients with major gland malignancy had a locoregional recurrence and local recurrences were almost all after initial enucleation. Two of these patients died of disease (overall disease specific survival = 96%). Three out of 4 patients with minor gland malignancy had a local recurrence and two patients with high grade pathology developed metastases and died of their disease (overall survival = 50%). On long term follow up survey in 13 patients (25%), 100% reported normal facial movement and 54% described symptoms of Frey's syndrome, which is higher than other reported series in children. Recurrence was noted up to 45 years after initial treatment. ConclusionsThe majority of malignant pediatric salivary gland tumors are low grade and have excellent survival, especially if found at an early stage. Minor salivary gland malignancies, particularly high grade, have a worse prognosis. Long term mild Frey's syndrome can be expected in approximately half of patients. We advocate a need for long term follow up and increased awareness among providers to diagnose these patients earlier.

052 Development of a Harmonized Multi-Site, Prospective Research Registry to Accelerate Evidence-Based Treatment of Sexual Disorders in Women and Girls with Cancer

to any known direct injuries to her genital area. She began having “feelings” around age 6 and by age 9 she needed to cross her legs to help relieve symptoms. Results: MRI of the sacral spine S2-4 ruled out Tarlov cyst. No evidence of genital arousal: lubrication, swelling of clitoris or labia, was noted. She had a significant pain/grimacing response to umbilical hypersensitivity testing. Vulvoscopy revealed pubic hair consistent with Tanner Stage 3. Clitoris and hood were normal, both labia minora met at the posterior fourchette. Minor vulvar vestibular glands at 1, 3, 5, 6, 7, 9 and 11:00 oclock revealed moderate erythema with 8-9, 10, 10, 10, 10, 10 and 10/10 discomfort to cotton swab testing consistent with provoked vestibulodynia. Testosterone was low (9 ng/dl), SHBG 48 nmol/ L, calcu-lated free testosterone was low (0.126 ng/dl), dihydrotestosterone was <5 ng/dl, LH was 2.1, FSH was 4.9, estradiol was 37 pg/ml and progesterone was absent. A vestibular anesthesia test (VAT) was performed with topical bupivicaine, lidocaine, tetracaine between Hart’s line and intact hymen. She experienced loss of her “feeling” for the first time and there was a dramatic shift in mood and affect, going from tearful to giddy, happy, joking, and ambulating in the office halls. Local vestibular testosterone 0.1% and estradiol 0.02% cream x 6 months was not successful. Her current diagnosis is congenital neuro-proliferative vestibulodynia. Current management includes tramadol 2.5 mg TID and zolpidem 0.5 mg prn. She is considering complete vestibulectomy in 5 years when she is 18 years. Conclusion: PGAD in adolescents is a significant clinical challenge. Disclosure: Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Testosterone modulation of the male marsupial Metachirus nudicaudatus paracloacal (scent) glands

We investigated the possible influence of androgens on the odoriferous (scent) glands of the neotropical male marsupial Metachirus nudicaudatus. Glands of control animals from wild populations in the breeding and non-breeding seasons were compared with the ones of castrated animals. Radioimmunoassay was used to detect testosterone levels in all studied groups. When compared with the major (yellow) and the minor (brown) glands in the breeding season, the yellow gland was larger in two of three animals. In the non-breeding season, they were closely the same size, whereas in castrated animals, the major glands were smaller than the minor ones. The number of layers of the holocrine secretory epithelium and the mean cell area of the major (yellow) gland were also well developed in the breeding season (8–12 layers) in contrast to non-breeding (1–9 layers) and castrated animals (1–5 layers). There was no significant difference in the minor (brown) gland concerning the gland volume and the number of layers of the holocrine secretory epithelium in all surveyed groups. The mean cellular areas of tubular glands inserted in yellow glands of the breeding season were larger than those in the non-breeding season and castrated subjects. On the other hand, some variations observed in the average cell areas of the brown glands did not obey the standard of testosterone activity. In conclusion, the major (yellow) paracloacal gland of Metachirus nudicaudatus males is under the influence of testosterone, while the minor (brown) gland is not.

083 Partner Prosthesis Panic

Introduction: Approximately 300,000 penile implants are placed annually in the US. Female partners in relationships with men with ED considering implant surgery have expressed concern over re-introduction of an erect penis into their sexual lives. We define “Partner Prosthesis Panic” as the concerns of the female sexual partner who during pre- or post-operative interview openly described issues such as: her low sexual desire, reduced arousal, muted orgasm, and bothersome pain during penetration. These conditions may negatively influence the post-operative outcome and frequency of implant use. We examined prevalence of “Partner Prosthesis Panic” and management strategies of the distressed female partners of men undergoing IPP insertion. In the last fifty consecutive penile implant surgeries in men in monogamous heterosexual relationships, 11 (22%) female sexual partners were identified (mean age 57±11 years) who expressed “Partner Prosthesis Panic” and underwent management in our facility. Contemporary management of women with sexual dysfunction is biopsychosocial including judicious use of FDA-approved and non-approved treatments. 82% were menopausal and 18% were peri-menopausal. All had FSD >5 years prior to implant procedure. FSFI (mean 18±4) and SDS (21±6) scores were abnormal in all. Psychologic interviews revealed findings consistent with a history of sexual trauma/abuse (27%) and mood issues: anxiety, depression, panic, use of mood-related medications (45%). Pelvic floor physical exams were abnormal in 73%. Vulvoscopic assessments revealed abnormalities such as clitoral atrophy, resorption of labia minora, erythema and tenderness of minor vestibular glands, limited robust peri-urethral tissue, urethral prolapse, limited gavial rugae, abnormal vaginal pH in all patients. Hormonal assessments of sex steroids were abnormal in all patients. Following sex therapy, physical therapy and biologic management, 8 of 11 experienced markedly improved sexual function that significantly facilitated couple satisfaction post-penile implantation.