Malignant Minor Salivary Gland Research Articles

Occult Nodal Metastases in Individuals with Clinically Node-Negative Salivary Gland Malignancies.

Salivary gland malignancies comprise a heterogeneous group of pathologies, for which treatment of the clinically negative neck may vary depending on numerous factors. Herein we present data on occult nodal metastases (ONM) as well as survival and recurrence from a large series of cN0 salivary gland malignancies. Retrospective chart review was conducted on 532 patients, with 389 patients with major salivary gland cancers and 143 patients with minor salivary gland cancers. Demographic and treatment data were included and rates of ONM, overall survival, local recurrence, regional recurrence, and distant recurrence were analyzed. We found that the overall rate of ONM for parotid was 27% (63/235), for submandibular/sublingual was 35% (18/52), and for minor was 15% (4/26). Analysis of ONM rate at each nodal level was also performed, finding higher rates of level IV and V ONM than prior studies. Submandibular/sublingual and minor salivary gland malignancies showed a predominance of ONMs at levels I-III. Our survival and recurrence rates were similar to those found in previous studies. Our data also demonstrate a predominance of ONM in levels I-III for submandibular/sublingual and minor salivary gland cancers, suggesting elective dissection in these levels. 4 Laryngoscope, 134:1705-1715, 2024.

Malignant Minor Salivary gland neoplasms ofLarynx: Our Experience.

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

Predictive factors for survival and treatment outcomes of patients with minor salivary gland malignancies: a retrospective study.

Aim of this study was to explore the incidence, pathology, clinical behaviour and evaluate factors predictive on survival and treatment outcomes in a cohort of patients with minor salivary gland (MiSG) malignancies treated at a single center over a period of 25years. Patients who had received primary treatment for MiSG malignancy during 25years observation period were identified. Outcomes that were evaluated were overall survival (OS), disease specific survival (DSS), recurrence free survival (RFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DFS). A total of 88 patients with MSG malignancies were included in the study. The most common location for MiSG malignancies was the oral cavity (65 tumors; 77%). Cumulative OS for 5 and 10year follow up period was 82% and 62% respectively. Cumulative DSS for 5 and 10year follow up period was 85% and 73% respectively. Twenty one (23%) patients developed distant metastases during follow-up. High-grade pathology and tumor stage were significant variables on multivariate analysis for all survival and treatment outcomes. Minor salivary gland malignancies are minor only by name. Tumor histological grade, AJCC tumor stage and pT stage were the strongest predictive factors for survival and treatment outcomes. The elective neck dissection could be considered therapeutic approach for selected cases of high grade MiSG malignancies. Distant metastases were the main cause of death and treatment failure.

Adenoid cystic carcinoma of trachea presenting as a medical emergency- A case report

Adenoid cystic carcinoma is a chief histologic type of malignancy of minor salivary glands. Primary malignant Tracheal neoplasms are rare <0.1%, with Adenoid Cystic Carcinoma being very rare. It arises from mucous secreting cells of salivary glands and upper respiratory tract. After Squamous Cell Carcinoma it is second most common Primary tracheal malignancy. Diagnosis can be done by Computed Tomography or Magnetic Resonance Imaging. But histopathology remains gold standard of diagnosis.

Polymorphous adenocarcinoma of the palate

Introduction: Polymorphous adenocarcinoma (PAC) is a malignant tumour which arises mainly from the minor salivary glands. According to the literature review PAC is the second most common intra oral malignant minor salivary gland tumour.

UNUSUAL LIP TUMORS: A CASE SERIES

<h3>Background</h3> The majority of isolated persistent lip swellings are attributed to mucoceles. However, minor salivary gland neoplasm must be included in the differential diagnosis, particularly with upper lip swellings. Benign pleomorphic adenomas are the most frequent labial mucosa neoplasm; however, other benign and malignant tumors may also develop in the lips. <h3>Objective</h3> To demonstrate the rare and unusual neoplasms that may present in this area. <h3>Methods</h3> Our 5-year retrospective review of oral pathology reports identified 8 unusual neoplasms within the labial mucosa. Clinical case note review was conducted to identify patient demographics, presenting complaints, medical and social histories, diagnoses, and treatment. <h3>Results</h3> The patients were aged from 8 to 73 years old. Clinically, all lesions were described as well-defined submucosal swellings; however, their sizes ranged from 2 mm to 15 mm. Common clinical differential diagnoses included mucocele and lipoma. The histopathologic diagnoses included 2 cases of schwannoma and 1 case each of basal cell adenoma, papillary cystadenoma, canalicular adenoma, granular cell tumor, and myxoid neurothekeoma. One malignant secretory carcinoma was also identified in a child. All lesions were excised and monitored postoperatively, with the malignant neoplasm requiring a second surgery to gain complete excision. <h3>Conclusions</h3> This review demonstrates the interesting and unusual pathologies that may arise within the labial mucosa. It highlights the importance of performing biopsy of persistent swellings in both adult and pediatric patients to confirm the diagnosis. Although rare, malignant minor salivary gland tumors can occur within labial mucosa, and early histopathological diagnosis and surgical removal can significantly improve prognosis.

Imaging of Malignant Minor Salivary Gland Tumors of the Head and Neck.

Minor salivary gland carcinomas (MSGCs) are nonminor tumors in the head and neck region and account for about half of all salivary gland carcinomas. Imaging evaluation based on the anatomy of minor salivary and mucous glands in the head and neck region as well as invasion patterns in each site helps in identifying optimal treatment modalities and planning suitable treatment strategies. MSGCs can be divided radiologically into localized and invasive subtypes on the basis of the clinical utility of such categorization. Characteristic invasion patterns of the invasive type include deep submucosal extension, bone marrow infiltration, and perineural spread, which are difficult to assess clinically. MSGCs easily invade adjacent structures because of their submucosal location and may spread along the muscles, nerves, periosteum, and dura mater. Moreover, the tumor may spread into the bone marrow without obvious bone destruction. In addition to imaging classification, examining the anatomy and distribution of the minor salivary glands, including the palatal, lingual, buccal, labial, and retromolar glands, as well as other mucous glands, including the glands of the sinonasal cavity and nasopharynx, lacrimal glands, ceruminous glands, laryngeal glands, and tracheal glands, facilitates MSGC diagnosis and tumor extension assessment. The authors review the precise anatomy of the minor salivary and mucous glands in the head and neck region, discuss the MSGC imaging classifications, and describe how to evaluate the extent of MSGCs in each site on the basis of the imaging classification and invasion patterns. ©RSNA, 2020.

Primary Epithelial Minor Salivary Gland Tumors in South Africa: A 20-Year Review.

Minor salivary gland tumours represent 9-25% of all salivary gland tumours. South African epidemiological reports on minor salivary gland tumours are lacking. This study aims to evaluate the frequency, epidemiology and histology of minor salivary gland tumours in a defined South African population from 1997 to 2016. This cross sectional retrospective review of epithelial minor salivary gland neoplasms recorded patient demographic data: prevalence, age, gender, site, histology. There were 553 benign (57%) and malignant (43%) minor salivary gland tumours, in patients between the ages of 9 and 93years. There was no significant age (p = 0.64) or gender (p = 0.18) difference between males and females. Common histologic types of salivary gland tumours in the continually evolving spectrum were pleomorphic adenoma (52%), adenoid cystic carcinoma (12%) and mucoepidermoid carcinoma (10%). Common sites were the palate (56%), cheek (11%), lip (9%) and paranasal sinuses (7%). Minor salivary gland tumours represent 2.3% of head and neck pathology. Although this prevalence is higher than reported, there is no overall increase in number diagnosed per year. Minor salivary gland tumours were more prevalent in females. Benign tumours occurred at a younger age than malignant tumours. This study serves as a baseline for future studies, especially in South Africa.

Salivary gland neoplasms – At unusual sites: A study of seven cases

Introduction: Salivary gland neoplasms represent neoplasms. Outcome is variable and is influenced by tumor type and anatomical location of the tumour. Minor salivary gland tumors (MSGTs) have a high recurrence rate (5-30%) when surgical removal is incomplete, and the possibility of malignant transformation must be taken into consideration. Aim: Scrutiny over the clinical behaviors, anatomical location, histological findings of the tumor and correlation with immunohistochemistry (IHC). Materials and Methods: Prospective evaluation of the minor salivary gland tumors (MSGTs) in a tertiary care center from January 2018 to June 2019. We studied the cases of minor salivary gland tumors. This comprised patient age and sex, the clinical characteristics and location of the tumor, the duration of the lesion, its size, the treatment provided, and the histopathological findings along with IHC. Results: Of the seven cases of MSGTs, there were pleomorphic adenomas, one in nasal cavity and two in parapharyngeal space and adenoid cystic carcinomas, three in nasal cavity and one in bronchus. Among those, four corresponded to females and three to males. Patients belonged mostly from fourth to sixth decade of life. We also have a younger age group of 10 years. The patients have undergone treatment and are still under follow up. Discussion and Conclusions: Minor salivary gland malignancies are rare tumors with varied histology and can occur in any age group including younger patients. Preoperative radiological assessment is very essential for the head and neck surgeon to know the pattern of spread and to remove the tumour completely so that there is least chance of recurrence. Keywords: Pleomorphic adenoma, Adenoid cystic carcinoma, Nasal cavity, Parapharyngeal space, Bronchus.

Sex disparities in salivary malignancies: Does female sex impact oncological outcome?

ObjectivePrevious population-based studies in salivary gland carcinomas have described a relationship between female sex and superior oncological outcome. Patients and methodsOur institutional database of 884 surgically treated patients with salivary gland malignancies from 1985 to 2015 was analyzed for the impact of sex on oncological outcomes. Histologies were classified in three risk groups, low, intermediate and high. Survival outcomes were determined using the Kaplan-Meier method. Hazard ratios for male sex were determined using the Cox proportional hazards model. ResultsEight hundred sixty-seven patients were identified; median age was 59 years, and 51% had a minor salivary gland malignancy. Female patients were younger (58 versus 60 years; p = 0.040) and had a lower incidence of high-risk histologies (25% versus 40%, p < 0.001) and T3-T4 tumors compared to men (23% versus 31%, p < 0.001). With a median follow-up of 57 months, female patients had a superior 5-year disease-specific survival (DSS) (90% versus 79%; p < 0.001). The unadjusted hazard ratio showed male patients had a 2.15-fold increased risk of death (HR 2.15; 95% CI, 1.50–3.06, p < 0.001). After adjusting for Charlson comorbidity index, tobacco use, histological risk group, and overall pathological stage, males still had a statistically significant increased risk of death (HR 1.48; 95% CI 1.05–2.17; p = 0.047). Subgroup analysis showed DSS for females was significantly better in the high-risk histological group (5-year 68% versus 49%, p = 0.007). ConclusionOur study shows that sex has an impact on cancer-specific survival and that female sex favors improved survival.

Buccal Myomucosal Flap Reconstruction After Resection of Palatal Mucoepidermoid Carcinoma

Salivary gland tumors are rare, constituting approximately 0.5% of pediatric malignancies, yet account for over 50% of malignant salivary gland neoplasms, of which a majority are mucoepidermoid carcinomas (MECs). We present a case of MEC involving the palatal minor salivary gland of an adolescent patient successfully reconstructed using buccal myomucosal flap. The subject presented as a 17-year-old male with a painless left hard palatal mass found to have imaging suspicious for minor salivary gland tumor and punch biopsy consistent with a low-grade MEC. The subject underwent wide local excision of a 1.0 × 1.2 cm mass with 1.0 cm margins down to hard palate nasal mucosa excluding the abutting first and second molars of the ipsilateral maxilla. Pathology confirmed low-grade MEC confined to hard palate. Two weeks, thereafter, the subject underwent buccal myomucosal flap reconstruction inset into the palatal defect and divided 2 weeks thereafter. Postoperative course was complicated by a pinpoint oronasal fistula at the posterior aspect of the flap-palate junction requiring reelevation and advancement. The subject subsequently recovered without complication. Mucoepidermoid carcinomas represent rare, malignant minor salivary gland tumors with nonspecific presentations that require multidisciplinary workup and management. The authors recommend reconstruction of resultant palatal defects to prevent progression to oronasal fistulae or speech and swallow impairment.

Developmental localization of syntaxin 1 and synaptosomal‐associated protein 25 in rat palate

IntroductionThe palate, which plays an important role in oral cavity function, including the mastication and swallowing of food, obviously differs structurally with feeding habits. Nevertheless, the palate is considered the most common location of both benign and malignant minor salivary gland tumors. Soluble N‐ethylmaleimide‐sensitive fusion protein attachment protein receptor (SNARE) proteins are important in the control of tumorigenesis through the regulation of multiple signaling and transportation pathways. However, the developmental distribution of SNARE proteins on the palatal structures has been scarcely reported. Therefore, this study aimed to investigate SNARE proteins, syntaxin‐1, synaptosomal‐associated protein of 25 kDa (SNAP‐25) during the development of rat palates.Materials and MethodsImmunohistochemistry for protein gene product 9.5 (PGP 9.5), a pan‐neuronal marker, syntaxin‐1 and SNAP‐25 was performed on frozen sections of rat palatal tissues at different stages.ResultsPGP 9.5 immunoreactive fibers (IRF) were present in developing palate. They were observed along the palatal sub‐epithelial layer and the underlying connective tissues in association with developing acini, ducts, blood vessels. Nerve fibers containing syntaxin‐1 and SNAP‐25 showed similar distribution to PGP 9.5 and thick bundles of nerve fibers were observed with smooth muscles and varicoses. With maturation after postnatal day 7 (PN7), thin nerve fibers containing PGP 9.5 and SNAP‐25, but less syntaxin‐1, were detected penetrating into the epithelium, reaching beneath the cornified layer. They ramified out from subepithelial thick bundles into connective tissues until encircling the secretory units observed (PN21). In adults, the number of syntaxin‐1‐IRF was low in comparison with SNAP‐25 and PGP 5 fibers.ConclusionThe findings indicated the importance of SNARE proteins during the maturation of the palatal tissues.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Review of Salivary Gland Malignancies: Common Histologic Types, Anatomic Considerations, and Imaging Strategies.

Major and minor salivary gland malignancies come in various shapes and sizes. They can present as palpable masses or can be detected incidentally when imaging patients for other indications. A complete evaluation of salivary gland malignancies requires knowledge of the anatomy and various routes of spread of neoplasias. Computed tomography (CT) and MR imaging are complementary tools in this respect and offer useful information to the proceduralist. Advanced imaging (diffusion-weighted imaging and PET-CT) and other modalities (eg, ultrasound) help with characterization, although biopsy or excision is often needed for definitive tissue diagnosis.

Cellular Subtype May Predict Survival Outcomes in Salivary Adenoid Cystic Carcinoma Patients: A Single-Institution Experience

Background Adenoid cystic carcinoma (ACC) is a biphasic salivary gland malignancy that is characterized by cellular, morphologic, and clinical heterogeneity. ACCs are the second most common salivary gland malignancy, are the most common malignancy of minor salivary glands, and comprise 15 to 25% of all salivary carcinomas. ACC arises from the intercalated ducts, which are composed of inner ductal epithelial and outer myoepithelial cell. The histogenesis of these tumors is uncertain. However, an origin from stem cells with multidirectional differentiation is likely possible. Histologic architecture alone determines the grade of ACC: tubular and cribriform growth patterns are associated with a longer survival time than solid forms are. We are currently starting to understand and get insights into intrinsic subtypes of this cancer directly linked to the dominant myoepithelial (M-ACC) or epithelial (E-ACC) cell type.

Jaw pain secondary to atypical maxillary torus near the incisive canal: A cone beam computed tomography study

Pain in the anterior maxilla can be odontogenic or nonodontogenic. If it is not related to the teeth, then the differential diagnosis is based on a clinical exam, radiographic exam, and often, on advanced imaging. This case report is based on a 58-year-old male with a chief complaint of chronic pain with acute exacerbations in the region of the rugae of the maxillary central incisors. Clinical examination and planar radiography led to the suspicion of a cyst in the region of the incisive foramen. The patient was referred for advanced imaging. Cone beam computed tomography imaging confirmed the presence of an unusual tori in the region of the incisive foramen that led to periodic inflammation in the region. A differential diagnosis of the pain included pain secondary to a localized inflammation of the incisive canal and nasopalatine duct, and an inflammation of the soft tissue interdental col in the region of the central incisors as well as the benign and malignant minor salivary gland tumors. Because the rugae is attached to the palate, any expansion of the soft tissues in this region causes pain that must be diagnosed accurately to treat the cause.

Posttreatment Response Assessment Using 18 F-FDG PET in Salivary Gland Carcinoma Patients Treated With Definitive Radiation Therapy—A Multicentric Retrospective Study

Presence of residual soft tissue lesions in the post-treatment anatomical imaging studies is frequently observed in salivary gland carcinoma (SGC) patients treated with definitive radiotherapy. This report aims to investigate the clinical utility of 18F-FDG PET in the post-radiotherapy response evaluation in SGC patients. We retrospectively reviewed the medical records of 35 SGC patients who were treated with definitive radiotherapy and received post-treatment 18F-FDG PET scan between 2004 and 2014. Adenoid cystic (N = 13) and mucoepidermoid (N = 9) carcinomas were the most common histology subtypes. Most patients (N = 24, 68%) had minor salivary gland malignancies, and parotid, submandibular, and sublingual gland tumors were documented in 8 (23%), 2 (6%), and 1 (3%) patients, respectively. Thirty-four (97%) patients also received pretreatment 18F-FDG PET. Pre- and post-treatment maximum standardized uptake values (SUVmax) were measured. The median radiation dose was 72 Gy (range, 66-80). Concurrent chemotherapy was performed in 33 (94%) patients. The median follow-up time for the survivors was 46 (range, 26-148) months. In the post-radiotherapy anatomical images (CT or MRI), 22 (63%) patient presented residual soft tissue [partial response (PR), N = 16; stable disease (SD), N = 3; progressive disease (PD), N = 3], and complete response (CR) was recorded in 13 (37%) patients. The post-radiotherapy 18F-FDG PET images documented metabolic CR, PR, SD, and PD in 20 (60%), 8 (22%), 3 (9%), and 3 (9%) patients, respectively. In addition, the metabolic CR was more likely to be observed in patients with a pretreatment low-SUVmax (≤7.4) tumor than in those with a high-SUVmax tumor (>7.4) (78% vs 50%, P = 0.091). The metabolic complete responders had significantly higher 5 year locoregional control (86% vs 42%, P = 0.007), distant metastasis-free survival (87% vs 46%, P = 0.003), disease-free survival (83% vs 27%, P = 0.002), and overall survival rates (96% vs 40%, P = 0.003) rates, compared with the metabolic non-complete responders (PR+SD+PD). Nearly two third of SGC patients presented residual soft tissue lesions in the anatomical images after definitive radiotherapy, and post-treatment 18F-FDG PET is effective to differentiate responders from patients resistant to the radiation treatment.

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

BackgroundTransoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy.MethodsA retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included.ResultsThe base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.ConclusionIn this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies.Trial registration numberNone/not applicable

Prognostic factors of palatal mucoepidermoid carcinoma: a retrospective analysis based on a double-center study

Mucoepidermoid carcinoma (MEC) of the palate is a common malignancy of minor salivary glands. This study was designed to identify the prognostic factors for MEC of the palate. The medical records of patients diagnosed with MEC of the palate who visited the Department of Oral and Maxillofacial Surgery at Nanjing Stomatological Hospital and the Department of Stomatology at Central Hospital of Xuzhou were retrospectively studied. The prognostic factors were determined using a Cox proportional hazards model. Furthermore, the expression of cancer stem cell (CSC) markers CD44, CD133, Nanog and Sox2 were detected in neoplastic samples of these patients by immunohistochemistry. As a result, both univariate analysis and multivariate analysis proved a high histological grade and an advanced tumor stage as negative prognostic factors for overall survival. By immunohistochemistry staining and survival analysis, a combination of CD44/CD133/SOX2 was found to have the strongest prognostic value for palatal MEC patients. In conclusion, the proposed nomogram which include histological grade and tumor stage along with cancer stem cell markers provides a more accurate long-term prediction for palatal MEC patients.

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.

Current management of the neck in salivary gland carcinomas.

Salivary gland cancers include a diverse group of tumours with many histological subtypes which occur in both major and minor salivary glands. As a result of this heterogeneity and different sites of presentation, there have been no randomised controlled trials to evaluate the indications and efficacy of neck treatments by either surgery or radiotherapy for occult or apparent neck node metastases. Neck dissection is an important treatment strategy for neck metastases arising from major and minor salivary gland malignancy as well as being useful for disease staging. However, there is considerable controversy in how to manage the neck in these patients. In this review, we discuss the management of neck metastases relating to malignant salivary gland tumours.