Minor Salivary Gland Tumors Research Articles

Pitfalls in the biopsy diagnosis of intraoral minor salivary gland neoplasms: diagnostic considerations and recommended approach.

Department of Diagnostic Pathology and Laboratory Medicine Beth Israel Medical Center St Luke’s and Roosevelt Hospitals New York, NY The author has no funding or conflicts of interest to disclose.

Ongoing challenges in the treatment of adenoid cystic carcinoma of the head and neck.

Adenoid cystic carcinoma is a malignant tumour of major and minor salivary glands. Distant metastasis and poor survival are persistent in the literature, with recent publications aimed at understanding molecular pathogenesis and development of pharmaceutical therapeutic options. Provide an update of recent studies in the management of adenoid cystic carcinoma of the head and neck. Literature search using Medline, Scopus, Google Scholar, the Cochrane Database of Systematic Reviews and the Cochrane central register of controlled trials for articles on adenoid cystic carcinoma from January 2005 to January 2015. Adenoid cystic carcinoma is characterized by a slow growing mass, with distant metastasis independent of local or regional control. Primary tumour resection remains the preferred option with radiotherapy having an adjuvant role. Recent advances have been made with novel targeted therapies however, limited to clinical trials and advanced disease.

Survival benefit for adjuvant radiation therapy in minor salivary gland cancers

The goal of the current study is to investigate the role of adjuvant radiation therapy (adjuvant RT) in minor salivary gland tumors (mSGT) using an established national database. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients treated with or without adjuvant RT for mSGT from 1988 to 2008. Regression analyses were performed to identify factors associated with improved overall survival (OS). Most tumors were located within the oral cavity (75%) followed by nasal cavity/paranasal sinuses (15%). Multivariate Cox analysis showed that adjuvant RT was associated with better OS compared to surgery alone. Using logistic regression analysis, we provide a novel web based tool for predicting survival impact of adjuvant RT in patients with mSGT. Adjuvant RT is associated with improved survival in patients with mSGT and adverse clinicopathologic factors such as advanced T/N category, adenoid cystic histology, high grade, and nasopharynx location.

Sarcomatoid Lung Carcinoma Case and Clinicopathologic Review

Lung cancer remains the leading cause of cancer deaths in both men and women in the United States. Lung cancers are broadly divided into non–small cell lung carcinomas and small cell carcinomas for treatment purposes; non–small cell carcinoma is by far the most common type of bronchogenic malignancy. Rare primary pulmonary malignancies include adenosquamous carcinoma, carcinoid tumors, minor salivary gland tumors, and poorly differentiated lung malignancies with sarcomatoid differentiation; the latter are referred to under the umbrella term “sarcomatoid carcinomas.” Sarcomatoid lung carcinomas account for 0.1% to 0.3% of all lung cancer diagnoses. These malignancies often present at imaging as nonspecific peripherally located masses that may be associated with chest wall invasion. Sarcomatoid carcinomas are aggressive cancers associated with a poor prognosis. Although they may present with clinical features resembling other non–small cell lung malignancies, the pathologic features, response to treatment, and prognosis of sarcomatoid carcinomas often differ from other non–small cell lung malignancies.

Minor Salivary Gland Neoplasms of the Oral Cavity: Our Hospital Experience of 17 Cases

Minor Salivary Gland Neoplasms of the Oral Cavity: Our Hospital Experience of 17 Cases

Transoral Robotic Surgery for Parapharyngeal Space Tumors Reduces Risk of Postoperative First Bite Syndrome

Background: Transoral robotic surgery (TORS) has extended the applications of transoral surgery for a variety of conditions. Tumors of the parapharyngeal space (PPS) may be excised with a minimally invasive approach transorally and TORS provides many technical advantages. Our early experience with TORS parapharyngeal space resection suggests that one major advantage of TORS over open surgery for prestyloid tumors is the relatively infrequent occurrence of first bite syndrome (FBS). Objective: This study aims (1) to evaluate the prevalence of FBS in TORS PPS resection and (2) to compare the prevalence of FBS in our largest subset of patients (prestyloid parapharyngeal space pleomorphic adenoma) to a control group of patients who had open surgery with parapharyngeal pleomorphic adenoma (PA) resection. Methods: An IRB-approved retrospective review of parapharyngeal space resection was conducted. Patients who underwent TORS and those who underwent parapharyngeal space resection for PA were included. Results: A total of 43 patients underwent TORS resection. Only one patient experienced signs or symptoms of first bite syndrome. This patient had a schwannoma of the sympathetic chain. Overall, 26 patients had TORS resection of PPS minor salivary gland tumors, and 21 of these patients were for pleomorphic adenoma. None of these patients experienced FBS. Among a similar cohort who underwent open resection, 7 of 21 did experience symptoms of FBS. This difference is highly significant (p < 0.05). Conclusion: Although the study is not randomized, our series of prestyloid parapharyngeal space pleomorphic adenoma cases has accumulated to a significant cohort. The complete absence of FBS in our TORS group and the high prevalence of FBS for open resection of PPS pleomorphic adenoma in both the literature (range, 22–60%) and our control group (33%) strongly suggest that the transoral approach reduces the risk of FBS in this group. It also supports the theory of sympathetic denervation of the parotid gland, which appears less likely to occur from the transoral approach. Transoral robotic surgery for removal of parapharyngeal space tumors has numerous advantages and is considerably less invasive than open surgery. Our most frequent indication for TORS PPS resection is minor salivary gland pleomorphic adenoma. Absence of FBS appears to be one of the major benefits of TORS parapharyngeal space resection for this group or patients.

Malignant minor salivary gland tumors: A retrospective study of 28 cases: Clinical experience of a single institution

Purpose: This retrospective study was done to report our experience with the management of patients with primary malignant tumors of minor salivary glands that were treated with various combinations of surgery, radiation, and chemotherapy and to review treatment outcome. Methods: The records of all patients with malignant minor salivary gland tumors presenting for treatment at our department between 2000 and 2010 were retrospectively reviewed. Variables were collected and outcome measures were defined in terms of overall survival, disease-free survival. Descriptive statistics were compiled and statistically evaluated. Survival was described using the Kaplan-Meier method. Results: Twenty eight patients (10 males and 18 females) ranging in age from 18 to 80 years (median, 64 years) met the criteria for inclusion in the study. The majority of tumors were located in the oral cavity (n = 20), followed by nasal cavity and paranasal sinuses (n = 8). Adenoid cystic carcinoma was the most common neoplasm (n = 18). All patients were treated with surgery as the primary modality. Neck dissection was performed in 18% of patients, and all patients (n = 28) were treated with adjuvant external beam radiation therapy to a dose of 50 to 60 Gy. The disease-free survival rate and overall survival at 5 years were 80% and 85%, respectively. Conclusion: Postoperative radiation therapy is effective in preventing local recurrence in most patients with minor salivary gland tumors after gross total excision.

Polymorphous Low-Grade Adenocarcinoma

Polymorphous low-grade adenocarcinoma (PLGA) is a low-grade malignant epithelial tumor that is the second most common malignant neoplasm of minor salivary glands. Diagnosis on biopsy remains challenging owing to histological similarities with other salivary glands, including benign and malignant neoplasms. The most important differential diagnoses to consider include pleomorphic adenoma, adenoid cystic carcinoma, low-grade papillary adenocarcinoma, cribriform adenocarcinoma of minor salivary glands, and mucoepidermoid carcinoma. Recently, a PRKD2 rearrangement was described in PLGA. The definitive treatment is complete surgical excision with negative clear margins. These tumors typically follow an indolent course and rarely metastasize but have a propensity to recur. The focus of this review is on the histopathologic features of PLGA and findings that might allow differentiation from histologically similar–appearing salivary gland neoplasms.

Rare occurrence of lip spindle cell lipoma.

Spindle cell lipoma (SCL) is a rare distinct variant of lipoma, which presents as a painless, circumscribed, slow-growing, superficial lesion on the lip and can mimic a minor salivary gland tumour. We present a slow growing lower lip lesion and its management. Case Report. A 38-year-old female gave an eight-year history of a slow-growing mass on her lower lip with intermittent change in size. She presented with a submucosal nodule and thin overlying mucosa adjacent to the vermilion border. Surgical excision was carried as the diagnostic and therapeutic approach. Conclusion. Lip SCL is rare, and surgical excision is advocated in order to exclude underlying pathology and minor salivary gland tumours.

Mammary Analog Secretory Carcinoma of Salivary Glands

Mammary analog secretory carcinoma (MASC) is a newly described neoplasm of the major minor salivary glands that is characterized by considerable morphologic, immunophenotypic, and genetic similarities to secretory carcinoma of the breast. Since its initial description in 2010, the number of reported MASCs has grown considerably; it is probably not as rare as was initially believed. As experience with MASC has grown, its clinical histological spectra have come increasingly into focus. This article presents an illustrative case of MASC, followed by a review of its defining features. Finally, the differential diagnosis will be discussed along with strategies to resolve diagnostic dilemmas.

Salivary gland cancer in Benin City, Nigeria: A pathologic study

Introduction: This is a 20-year retrospective audit of salivary gland cancers (SGC) in University of Benin Teaching Hospital (UBTH) Benin City, Nigeria, and is aimed at determining the epidemiological profile of these tumors. Materials: The materials for this study consisted of available slides and paraffin-embedded tissue blocks of all SGC received during the study period. Results and Conclusion: SGC are rare, accounting for 0.5% of all tumors seen in the study centre. The mean age of patients with SGC was 49.1± 17.1 years, and the peak age was in the 6th decade. A male to female ratio of 0.77 was observed in the study. A changing frequency from mucoepidemoid to adenoid cystic carcinoma as the most common SGC was also demonstrated in this study. The commonest site for SGC in this study was parotid gland, while the palate was the commonest site for minor malignant salivary gland tumors.

Recurrent pleomorphic adenoma of the upper lip: Case report and review of the literature

Pleomorphic adenoma or mixed tumour is a benign salivary gland tumour, presenting usually in the parotid or submandibular glands. This tumour contains elements of both epithelial and mesenchymal origin. They are the most common tumours (50%), (60-65%) of the major and minor salivary glands. The palate is considered as the most common intraoral site (42.8-68.8%), followed by the upper lip (10.1%) and cheek (5.5%). A 37 year old female Nigerian house wife was seen with a four year history of painless slowly progressive upper lip swelling. Prior to her presentation, she had surgery for same swelling in a peripheral hospital. All other histories were not significant. PA remains the commonest benign minor salivary gland neoplasm and excision with safe margins the treatment of choice.

Pleomorphic adenoma of the palate

Pleomorphic adenoma is a benign salivary gland tumor commonly affecting in the major salivary glands. Incidence of pleomorphic adenoma affecting minor salivary gland tumors has also been reported. Presenting a case report of a 48-year-old male diagnosed with pleomorphic adenoma arising from minor salivary gland.

口腔小唾液腺腫瘍73症例の臨床統計学的検討

口腔小唾液腺腫瘍73症例の臨床統計学的検討

Pleomorphic adenoma of minor salivary gland in the cheek

The pleomorphic adenoma comprises the majority of both major and minor salivary gland tumors accounting for 3–10% of neoplasms of head and neck region. The palate is the predominant intraoral site, and the mucosa of the cheek is an uncommon site for these tumors. These minor salivary gland pleomorphic adenomas require diagnosis based on clinical features and incisional biopsy should be avoided. These are managed by wide surgical excision. The recurrence of this tumor is a well-known factor, and inadequate initial surgical procedure is the most common cause of recurrence. Carcinoma arising from pleomorphic adenoma accounts for about 3% of salivary tumors. Recurrence rates and malignant transformation of this tumor cells for long-term follow-up of these cases. We are reporting a case of pleomorphic adenoma in the left buccal mucosa in a 48-year-old female patient.

Radiation Therapy in the Treatment of Minor Salivary Gland Tumors

Minor salivary gland cancers are rare and account for roughly 2% to 3% of all head and neck tumors. This is a retrospective review in a modern cohort of patients treated for this rare cancer with surgery and adjuvant radiation therapy. Between February 1990 and December 2010, 98 patients with cancer of the minor salivary glands were identified and treated at a single institution. The median radiation dose was 63 Gy. Outcomes assessed included local control (LC), locoregional control (LRC), and overall survival (OS). Toxicity was graded using the Common Terminology Criteria for Adverse Events, version 3.0. Competing-risk analysis using the Gray test was performed, with death as the competing risk. OS was calculated by the Kaplan-Meier method. With a median follow-up of 7.3 years, the 5- and 10-year LC and LRC rates were 87.9% and 83%, and 80.5% and 73.7%, respectively. Higher T stage and adenocarcinoma histology were the significant negative prognostic factors for both LC and LRC. Freedom from distant metastasis at 5 and 10 years were 83% and 63%, respectively. The median OS was 19.6 years. Overall, no grade 4 or 5 toxicities occurred, and 20% of the cohort experienced an acute grade 3 toxicity, and 6% with a grade 3 late toxicity. In a modern cohort treated with surgery and radiotherapy, excellent outcomes can be achieved with lower toxicity rates compared with older published series.

Mammary analogue secretory carcinoma (MASC) of salivary gland in four Mexican patients.

The Clinco-pathological, immunohistochemical and molecular findings of four cases of Mammary Analogue Secretory Carcinoma (MASC) of salivary glands found in Mexico are described. The cases were extracted from 253 salivary gland tumors from a single institution in Mexico City. The 85 candidates for initial selection were: low grade mucoepidermoid carcinoma (MEC) (N=70 ), acinic cell cancinoma (AciCC) (N=14), papillary cystadenocarcinoma (N=1), and adenocarcinoma NOS (N=0). Tumors with some histological features consistent with MASC (N= 17, 6.7%) were studied by immunohistochemistry for mammaglobin, STAT5, and S-100 protein and four cases were positive (1.5%), thus the diagnosis of MASC was established, and these were submitted for molecular studies for ETV6-NTRK3. Fusion gene was demonstrated in three cases, two had been erroneously diagnosed as poorly granulated AciCC, and one as low grade MEC with microcystic pattern. Female gender predominated (3:1); one occurred in the parotid, two in minor salivary glands and one in the submaxillary gland; infiltrating borders, atypical mitosis and lymph node metastases were seen in the parotideal tumor. Two patients with major salivary gland tumors are alive and well at 10 and 20 months respectively, the two patients with minor salivary gland tumors are lost. It can be concluded that is important to think in MASC in poorly granulated AciCC and low grade MEC with microcystic pattern. Immunohistochemisty studies confirm the diagnosis, preferentially supported by molecular studies. MASC may follow aggressive behavior or transform into a high grade neoplasm. Key words:Acinic cell carcinoma, ETV6-NTRK3, Mammary Analogue Secretory Carcinoma, secretory breast carcinoma.

Minor salivary gland tumors in the Indian population: A series of cases over a ten year period

Problem consideredMinor salivary glands are found in the sino-nasal cavities, oropharynx, larynx and trachea with the majority being found in the oral cavity. 80% or more of minor salivary gland tumors are malignant and they tend to have a great variation in presentation and histology. We sought out to compare the presentation of various minor salivary gland tumors (MSGT's) in the Indian population as compared to that reported in different races and regions. MethodsWe report a clinical case series in which 17 patients with biopsy proven minor salivary gland tumors both benign and malignant at various intraoral sites viz the palate, cheek, retromolar trigone and floor of the mouth were operated upon and followed up over a span of 10 years from 2001 to 2011. Results15 patients were treated timely with complete removal of the lesions by wide local excision and as confirmed by histopathology; one patient with adenoid cystic carcinoma delayed in seeking treatment and expired within a month and another with salivary duct carcinoma presented with advanced disease and regional metastases in the form of multiple ipsilateral enlarged lymph nodes and distant metastases in the liver. He was given palliative radiotherapy but he died after six weeks of receiving treatment. Conclusionthe results that we obtained for Indians were comparable to the various population studies done around the world.

Frequency and Distribution Pattern of Minor Salivary Gland Tumors in a Northeastern Chinese Population: A Retrospective Study of 485 Patients

The relative frequency of individual minor salivary gland tumors (MSGTs) is not well documented in the literature. The aim of this study was to determine the range and demographics of all histologically diagnosed MSGTs in a northeastern Chinese population. A total of 485 cases of MSGT were retrospectively studied. The files of the Department of Oral and Maxillofacial Pathology, School of Stomatology, China Medical University served as a source of material for this study. All epithelial tumors from minor salivary glands accessioned from August 2004 to April 2014 were analyzed for demographic features, anatomic location of tumors, and pathologic classification. Tumors were classified according to the 2005 World Health Organization classification of salivary gland tumors. Statistical analysis was performed using analysis of variance. MSGTs were identified in 485 (2.60%) of 18,670 accessed cases. There were 268 (55.26%) benign and 217 (44.74%) malignant tumors. Female outnumbered male patients (male-to-female ratio, 1:1.43). The mean ages of patients with benign and malignant MSGTs were 47.58 and 51.51 years, respectively. Pleomorphic adenoma and adenoid cystic carcinoma were the most frequent types of benign and malignant tumors, respectively. The palate was the most commonly affected site (64.74%), followed by the buccal mucosa (7.63%) and the tongue (5.98%). From the results of this study and a review of the literature, it is suggested that MSGTs in the northeastern Chinese population may be characterized by a higher incidence of MSGTs than in the populations of other reviewed regions, a higher incidence of myoepithelioma, a rarer occurrence of polymorphous low-grade adenocarcinoma, and an absence of canalicular adenoma occurrence.

Canalicular Adenoma: A Clinicopathologic and Immunohistochemical Analysis of 67 Cases with a Review of the Literature

There is a lack of a comprehensive immunohistochemical (IHC) analysis of canalicular adenoma (CanAd), especially when combined with a description of the unique histologic features. Given the usual small biopsies, IHC may be useful in distinguishing CanAd from other tumors in the differential diagnosis. Retrospective. The patients included 54 females and 13 males (4.2:1), aged 43-90years, with a mean age at presentation of 69.9years. Clinical presentation was generally a mass (n=61) slowly increasing in size (mean 38.5months), affecting the upper lip (n=46), buccal mucosa (n=17) or palate (n=4), involving the right (n=29), left (n=24) or midline (n=9), without any major salivary gland tumors. The tumors ranged in size from 0.2 to 3cm (mean 1.2cm). Most tumors were multilobular or bosselated (76%), often surrounded by a capsule. Histologically, the tumors were characterized by cystic spaces, tumor cords with beading, tubule formation, and by the presence of luminal squamous balls (n=41). The cells were cuboidal to columnar with stippled chromatin. Mitoses were inconspicuous. A myxoid stroma (n=64), sclerosis (n=42), luminal hemorrhage (n=51), and luminal microliths (calcifications) (n=33) were characteristic. Nine (13.4%) were multifocal. CanAd showed the following characteristic immunohistochemistry findings: CK-pan and S100 protein (strong, diffuse reaction); peripheral or luminal GFAP reaction; CK5/6 and p16 luminal squamous ball reaction; SOX10 nuclear reaction; cytoplasmic p63 reaction. CanAd are unique minor salivary gland tumors showing a distinct architecture and phenotype. They predilect to older women, with the majority multilobulated and affecting the upper lip, multifocal in 13%; no major salivary gland tumors were identified. S100 protein, CK-pan, GFAP and SOX10 are positive, with luminal squamous balls highlighted by CK5/6 or p16.