Major Salivary Gland Tumors Research Articles

Clinical and own experience in the treatment of major salivary gland tumors

The paper aims to demonstrate the Clinic's and own research in the treatment of major salivary gland tumors. In the years 2013-2019, there were 95 salivary gland surgeries, including 45 performed in women (47.36%) aged between 24 and 82 and in 50 men (52.64%) aged 29 to 86. Diagnostics of major salivary glands included: patient history, otolaryngological examination, ultrasound and fine needle aspiration (BACC) (of tumor), laboratory tests (morphology, CRP) and computed tomography (CT) or magnetic resonance imaging (MRI) to accurately assess salivary glands, location of lesion and lymph nodes prior to elective surgery. Research results: In the analyzed material patients with major salivary gland tumors were most frequently operated on at the age of 61-70 (34.7%) and 51-60 years (23.2%). Most patients with tumors were hospitalized in the last 4 years between 2016-2019, which accounted for 77.8% of all operated cases. Among the operated lesions, benign neoplasms and tumors occurred in 93.7%, of which the most frequent findings in histopathological examination were Warthin tumor in 50.5%, and multiform adenoma in 26.3%. The remaining tumors and benign neoplasms constituted only 16.9% and were observed in isolated cases, including eosinophilic adenoma, lymphoepithelial cyst, myoepithelial adenoma, lipofibrosarcoma, congestive cyst, air cyst, tubular adenoma, basal cell carcinoma, cyst with squamous metaplasia features, vascular malformation. Malignant salivary gland tumors were found in 6.3%, including the following malignant tumors were revealed histopathologically: adenocarcinoma, mucoepidermal carcinoma, acinocellular carcinoma, epithelialmyoepithelial carcinoma, ductal carcinoma. The majority of operated salivary gland tumors were benign (93.7%), of which the most common histopathologically were: Warthin tumor (50.5%) and multiform adenoma (26.3%), while malignant tumors occurred in 6.3%. Tumors were localized mainly in the parotid gland in as many as 93.7% cases, of which the most common localization concerned the superficial lobe in 56.8%. The most frequent surgical technique used in the Clinic was extracapsular dissection of the tumor in 88.4%, and other methods were used rarely.

Treatment approaches for benign tumors of major salivary glands

Introduction: Salivary gland tumours (SGT) are heterogenous group of neoplasms in the maxillofacial area with complex morphologic appearances and different clinical behaviour. They often present as painless enlarging masses, mostly located in parotid glands and mostly benign. Epidemiology: SGT’s are more common in women than in men which represents 2%-3% of head and neck neoplasms. Pleomorphic adenomas are most common benign SGT’s followed by Warthin tumours. Treatment: Difficulty with salivary gland tumour is they are rare and have long clinical course that requires follow up data for a decade or more. Prospective randomised trails have therefore not been undertaken and hence progress happens slowly. Improved methods of assessment (MRI, CT, Ultrasound, fine needle aspiration biopsy) have had major impact on salivary gland surgery. Most benign tumours are either pleomorphic adenomas (71%) or Warthin’s tumours (22%). Conclusion: Treatment for this include both medical and surgical therapy. Medical therapy is indicated for inflammatory infectious masses (eg: reactive or fungal) and lymphoma. When symptomatic, recurrent chronic gland infection (eg: parotitis) proves refractory to conservative medical or endoscopic (i.e. sialoendoscopy) treatments, salivary gland excision is sometimes indicated. Surgical therapy includes parotidectomy and submandibular gland surgery.

Minimal acute toxicity from proton beam therapy for major salivary gland cancer

Introduction: Proton beam therapy (PBT) reduces normal organ dose compared to intensity-modulated radiation therapy (IMRT) for patients with major salivary gland tumors. It is not known whether this dosimetric advantage is clinically meaningful for reducing acute toxicity.Methods: We evaluated treatment parameters and acute toxicity outcomes of patients with major salivary gland cancers enrolled on the Proton Collaborative Group REG001-09 trial (NCT01255748).Results: One-hundred and five patients with a median age of 61 years were included. The majority had parotid (N = 90) versus submandibular gland (N = 15) tumors. The patients were treated across seven institutions in the United States between 2010 and 2017, most commonly in the postoperative setting (70.5%) although a minority were treated definitively (29.5%). Median PBT dose was 66.5 GyE in 33 fractions; only one patient was prescribed less than 50 GyE. Chemotherapy was given concurrently to 20%. Median follow-up was 14.3 months. Acute grade 2 or higher toxicity included nausea (1.5%), dysgeusia (4.8%), xerostomia (7.6%), mucositis (10.5%) and dysphagia (10.5%).Conclusions: PBT should be strongly considered when ipsilateral radiation therapy is indicated for major salivary gland cancer based on a considerably lower incidence of acute grade 2 or higher toxicity in this analysis compared to historical IMRT outcomes.

Pattern of Major Salivary Gland Malignancy in B.P. Koirala Memorial Cancer Hospital

Background: Salivary gland tumors represent a different variety of histological types. The definite diagnosis of type of salivary gland tumor is required for proper treatment planning. The aim of this study was to evaluate the pattern of salivary gland malignancy in B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan.
 Methods: This cross-sectional study was carried out in patients of malignant salivary gland tumor registered in B.P. Koirala Memorial Cancer hospital retrospectively from September 2009 to August 2012.
 Results: Parotid gland was the most common sites for malignant salivary gland tumor (80%) followed by submandibular gland (20%). Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of parotid gland and Adenoid cystic carcinoma was the most common malignant tumor of submandibu-lar gland. Male: Female ratio was 1.5:1 with age range from 12 years to 71 years. Common age group for malignant salivary gland tumor was from 50 to 60 years.
 Conclusions: Parotid was the most common site whereas Mucoepidermoid carcinoma was the most common malignant tumor of major salivary gland.

Surgical Treatment Outcome of Salivary Gland Tumors

Background: Salivary gland neoplasms constitute a group of heterogeneous lesions with complex clinicopathologic characteristics and distinct biological behavior. Numerous studies have suggested geographical variation, therefore the aims of this study were to analyze the characteristics of salivary gland neoplasms in two Iraqi centers and to analyze the postoperative complications that are encountered after surgical treatment of these tumors. Materials and Methods: A retrospective study of the patients who were treated for major and minor epithelial salivary gland tumors was conducted. The analyzed data included; demographic information (age and gender), the site of the tumor, the clinical manifestations, the histological type of the tumor, the type of the treatment and the postoperative complications. Results: Fifty seven patients were included in this study. The parotid gland was involved in most patients (n=37, 64.9%). Thirty five patients (61.4%) had benign tumors while 22 patients (38.6%) had malignant tumors. The mean age of patients with malignant tumors was 52.05 (±17.3) while of patients diagnosed with benign tumors was 41.6 (±11.4) years, the difference was statistically significant (p= 0.008). Surgical treatment consisted of superficial parotidectomy, total parotidectomy, surgical excision of the submandibular gland, surgical excision of minor salivary glands and maxillectomy. The most common complication was weakness of one or multiple branches of the facial nerve, complications were significantly associated with patients’ age, whereas gender and type of tumor whether benign or malignant did not affect the complication rate Conclusions: benign salivary gland tumors are more common than malignant tumors with no gender predilection and that patients who are diagnosed with malignant tumors are significantly older that patients with benign tumors, parotid gland is the most commonly affected gland with pleomorphic adenoma as the most frequent diagnosis. Facial nerve dysfunction was the most common complication and the complication rate was significantly associated with the age of patients.

SALIVARY GLAND SONOELASTOGRAPHY: TO DO OR NOT TO DO?

Background Sonoelastography (SEG) is a non-invasive, relatively new imaging modality that maps the elastic properties through stiffness of soft tissue. Pathological conditions such as inflammation and neoplasia can change tissue elasticity; as a result, when used in the major salivary glands, this non-invasive modality may provide information that could be useful for diagnosis. Objective Two preliminary studies are presented; both assess the diagnostic utility of SEG: the first in primary Sjogren's syndrome (pSS) and the second concerns major salivary gland tumors. Methods and materials The first study included fifteen patients with pSS that underwent SEG of the major salivary glands before starting pilocarpine treatment versus diffused sialadenitis and normal glands. The second study included nineteen benign and malignant tumors, just before ultrasound-guided needle aspiration for cytology and excisional biopsy. Quantitative indices of the shear elastic modulus were compared with cytological and histopathological results. Elastography was scored on color-scaled elastograms. Results Mean elasticity/stiffness values for pSS were not significantly different from those of diffused sialadenitis and normal salivary gland tissue. As for salivary gland tumors, scores showed clustering according to pathological condition. For example, pleomorphic adenomas were firmer than Warthin's and adenoid cystic carcinoma was firmer than polymorphus adenocarcinoma. Conclusions SEG did not show a diagnostic advantage in regard to the assessment of pSS. Nevertheless, it might serve as a tool in the evaluation of benign and malignant major salivary glands tumors. Our studies should be continued to confirm these preliminary observations.

Amide Proton Transfer-weighted MRI in the Diagnosis of Major Salivary Gland Tumors

Amide proton transfer-weighted magnetic resonance imaging (APTw-MRI), which is effective in tumor characterization, has expanded its role in the head and neck. We aimed to evaluate the diagnostic ability of APTw-MRI in differentiating malignant from benign major salivary gland tumors compared with diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE)-MRI. Between December 2017 and November 2018, 38 subjects, who were diagnosed with major salivary gland tumors and who underwent preoperative 3 T MRI, including APTw-MRI, DWI, and DCE-MRI, were included in this retrospective study. Twenty-three subjects had benign tumors, and fifteen had malignancies. APTw-signals of the tumors were measured and compared according to the histopathological diagnosis. Using receiver operating characteristic curve analysis, diagnostic performance of APTw-MRI was evaluated and compared with DWI and DCE-MRI using DeLong test. The maximum, mean, and median APTw-signals were significantly higher in malignant than in benign tumors (P < 0.001). The mean and maximum APTw-signals showed excellent area under the curve for predicting malignant tumors (0.948 and 0.939), which were significantly higher than the combining use of DWI and DCE-MRI (0.780) (P = 0.021 and 0.028). Therefore, APTw-MRI could be a useful tool for differentiating malignant from benign major salivary gland tumors, and can be applicable in the clinical setting.

A clinical study of the incidence of salivary gland tumors in a tertiary care teaching hospital

Background: The salivary gland system of the upper aero digestive tract plays a critical role in the functions of digestion, respiration, communication, and overall homeostasis. The Salivary gland swellings can be broadly classified into inflammatory, non-inflammatory and neoplastic swellings like calculi, benign tumours such has pleomorphic adenoma, oncocytoma, Warthin's tumour, malignant tumors which include-adenocarcinoma, adenoid cystic carcinoma, undifferentiated carcinoma.Methods: The present cross-sectional study was conducted at the Department of general surgery, Sri Siddhartha Medical College over a period of 2 years from August 2016 to July 2018. All major salivary gland neoplastic swellings confirmed by FNAC were included in this study.Results: In our study 23 patients had major salivary gland tumours out of that 19 patients had parotid and 4 had submandibular major salivary gland tumour. In our study out 23 cases of salivary tumours 19 cases were benign and 4 cases were malignant, out of 19 cases of parotid tumours, 15 (78.94%) cases were seen in superficial lobe and 4 (21.06%) were in deep lobe, out of 23 salivary gland tumours, 19 (82.6%) cases were pleomorphic adenoma 3(13.05%) cases were mucoepidermoid carcinoma and one case (4.35%) was acinic cell carcinoma.Conclusions: Parotid gland was the most common site of origin of both benign and malignant tumours, Pleomorphic adenoma was the most common benign salivary gland tumour and mucoepidermoid carcinoma was the most frequent malignant neoplasm.

Proteomic Investigation of Malignant Major Salivary Gland Tumors.

The purpose of this study was to define the proteome profile of fine needle aspiration (FNA) samples of malignant major salivary gland tumors (MSGT) compared to benign counterparts, and to evaluate potential clinical correlations and future applications. Patients affected by MSGT (n = 20), pleomorphic adenoma (PA) (n = 37) and Warthin's tumor (WT) (n = 14) were enrolled. Demographic, clinical and histopathological data were registered for all patients. FNA samples were processed to obtain the protein extracts. Protein separation was obtained by two-dimensional electrophoresis (2-DE) and proteins were identified by mass spectrometry. Western blot analysis was performed to validate the 2-DE results. Statistical differences between groups were calculated by the Mann-Whitney U test for non-normal data. Spearman's rank correlation coefficient was calculated to evaluate correlations among suggested protein biomarkers and clinical parameters. Twelve and 27 differentially expressed spots were found for MSGT versus PA and MSGT versus WT, respectively. Among these, annexin-5, cofilin-1, peptidyl-prolyl-cis-trans-isomerase-A and F-actin-capping-alpha-1 were able to differentiate MSGT from PA, WT, and healthy samples. Moreover, STRING analysis suggested cofilin-1 as a key node of protein interactions. Some of the overexpressed proteins are related to some clinical factors of our cohort, such as survival and outcome. Our results suggest potential protein biomarkers of MSGT, which could allow for more appropriate treatment plans, as well as shedding light on the molecular pathways involved.

Comparative immunohistochemical characteristics of benign and malignant major salivary gland tumors: A retrospective study

Comparative immunohistochemical characteristics of benign and malignant major salivary gland tumors: A retrospective study

MUCOEPIDERMOID CARCINOMA: A RARE CASE REPORT

Minor salivary gland carcinomas are rarely reported. Mucoepidermoid carcinoma (MEC) is one of the most common salivary glandmalignancies. MEC accounts for 1% to 2% of major salivary gland neoplasms and 9% of minor gland tumors. It is most commonly seenin the parotid gland and usually appears as asymptomatic swelling. However, the palate is a frequent site when it occurs in the minorsalivary glands. Follow-up of the patient is very important as local recurrence rate with conservative treatment is high. Here we arereporting a low-grade mucoepidermoid carcinoma involving palatal region in a 25-years-old female patient. The patient presented witha fast-growing swelling, invading the underlying anatomical structures and was treated successfully through the antrostomy procedure.

Necrotizing sialometaplasia can hide the presence of salivary gland tumors: A case series.

Necrotizing sialometaplasia (NS) is an uncommon benign process which affects minor and, more rarely, major salivary glands. While self-limiting, the condition might be clinically and histologically mistaken for malignancy. Furthermore, NS may accompany neoplasms. The aim of this paper was to report a series of Italian patients affected by NS associated with an unusual high presence of neoplasms of minor and major salivary glands. Clinical and histological features of twelve patients with NS were retrospectively evaluated. Eight patients presented NS of the minor salivary glands of the palate, and two of them had associated neoplasms (pleomorphic adenoma and adenoid cystic carcinoma) at the same site. Four patients had NS of the parotid gland associated with a history of fine-needle aspiration biopsy performed to diagnose parotid neoplasms. These were epithelial-myoepithelial carcinoma, adenoid cystic carcinoma, Warthin's tumor, and oncocytoma, respectively. Tumors of minor and major salivary glands might be associated with NS more frequently than previously reported. While NS of the parotid is generally the result of invasive diagnostic procedure and is detected after the excision of the tumor, NS of the minor salivary glands may obscure an underlying neoplasm, resulting in delays in referral or treatment.

Histomorphological comparison of pleomorphic adenoma in major and minor salivary glands of oral cavity: A comparative study.

Background and Objectives:Pleomorphic adenoma, being the most common benign tumors of salivary gland, is morphologically characterized by a biphasic pattern containing the epithelial and mesenchymal components. The modified myoepithelial cells present are thought to play an important role in its histologic diversity by the formation of extracellular matrix. The aim of the present study was to observe, compare and correlate the histomorphological diversity of epithelial and stromal components along with different morphological cell types of modified myoepithelial cells.Materials and Method:Histomorphological features were compared in twenty cases of pleomorphic adenoma of major salivary glands and twenty cases of minor salivary glands using hematoxylin and eosin stains. The features were analyzed by observing under the light microscope.Results:Statistical analysis showed significance of plasmacytoid cells, and squamous metaplasia was extensive with formation of keratin cyst-like structure resembling cystic pleomorphic adenoma, in minor salivary gland tumors.Conclusion:Plasmacytoid cells, squamous cells and areas of hyalinization were observed predominantly in major salivary gland tumors compared to minor salivary glands. Keratin pearls were predominant in minor salivary gland tumors.

Histopathological spectrum of salivary gland neoplasms in a tertiary care center

Introduction: Salivary gland tumors are common neoplasms encountered in the head and neck region. Salivary gland neoplasms have varied histopathological findings with some of the tumors showing morphologic overlap. Majority of these neoplasms are benign in nature. They occur in both major and minor salivary glands. Benign tumors are more common in major salivary glands and malignant tumors generally occur in minor salivary glands. 80% of major salivary gland tumors occur in the parotid gland. Most of the minor salivary gland tumors are located in the palate. Proper diagnosis of malignant tumors with accurate staging is very important in the treatment and management of the patient. Aims and Objectives: This study was carried out to study the histopathological spectrum of salivary gland neoplasms in a tertiary care center.Materials and methods: The present study was conducted in the Pathology department of M.S Ramaiah Hospital on the surgically resected salivary gland tumor specimens received for routine histopathological evaluation, from January 2010 to December 2014. A total of 66 cases of salivary gland neoplasms were included in the study.Results: Out of total 66 cases studied, 38 cases (57%) were benign and 28 cases (43%) were malignant. Most common age group for salivary gland tumor was between 40- 60 years. Among the tumors, female preponderance was seen in all except Warthin tumor. Pleomorphic adenoma was the most common benign tumor and mucoepidermoid carcinoma was the common malignant tumor. Parotid gland was the commonest site for various tumors, notable exception being adenoid cystic carcinoma, which showed predilection for the minor salivary glands. Pleomorphic adenoma was the most common salivary gland tumor representing 76.3% of benign and 43.9% of total salivary gland neoplasmsConclusion: Due to the varied histopathological findings with some morphologic overlap in salivary gland neoplasms histopathological examination is the mainstay for diagnosis and clinical management. Pleomorphic adenoma is the most common neoplasm of salivary glands.Benign tumors are more common in major salivary glands and malignant tumors are more common in minor salivary glands.

Abstract 4036: Differential expression of claudins between benign and malignant salivary gland tumors

Abstract Salivary gland tumors comprise a heterogeneous group of lesions presenting different histological features and diverse clinical behavior. Pleomorphic adenoma is the most common benign tumor of major salivary glands. It shows a marked histological diversity with epithelial, myoepithelial, and mesenchymal components in a variety of patterns. Although it presents a slow progression, without treatment can cause significant morbidity and even death. Mucoepidermoid carcinoma is the most common malignant tumor of the salivary glands. Local recurrence rates range from 7% to 26% and distant metastasis rates range from 6% to 15%. Tight junctions (TJ) are considered one of the major structures in the establishment and maintenance of cell polarity having important physiological function in the formation of tubular organs, including the salivary glands. Some studies have demonstrated an association between tumor behavior and protein expression of tight junctions, particularly claudins. Claudins are transmembrane proteins important for the maintenance of cell adhesion and polarity and act as selective barriers. Changes in claudin expression have been detected in several tumors and appear to be related to progression and invasion. However, few studies have evaluated the role of claudins in the development of salivary gland tumors. In this study, using Real Time RT-PCR we have analyzed the expression of claudins-1, -3, -4, -5, -7, -11 in a series of 40 salivary gland tumor samples (20 cases of pleomorphic adenoma and 20 cases of mucoepidermoid carcinoma) and 10 samples of normal salivary glands tissue samples. Increased expression of claudin-1 and claudin-7 was observed in mucoepidermoid carcinoma when compared to pleomorphic adenoma (p=0.010 and p=0.001, respectively). Decreased expression of claudin-3 and claudin-11 was observed in mucoepidermoid carcinoma when compared to pleomorphic adenoma (p=0.005 and p=0.030, respectively). Regarding mucoepidermoid carcinoma tissue samples, we have evaluated the presence/absence of CRTC1/MAML2 fusion and demonstrated that 57.9% of the cases were positive for the presence of the fusion. Claudin-7 expression was associated with the presence of the fusion (p=0.048) and the absence of the fusion was associated with high histological grade tumors (p=0.023). Our study provides evidence of alterations in the expression of claudins in salivary gland tumors demonstrating that regulation of tight junction components is an important feature in salivary gland tumors behavior. CNPq Research Grant 443243/2014-0 Citation Format: Maria L. Arrojo, Claudia Arruda, Luiz P. Kowalski, Fernando A. Soares, Silvia V. Lourenço, Cláudia M. Coutinho-Camillo. Differential expression of claudins between benign and malignant salivary gland tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4036.

Incompletely treated malignancies of the major salivary gland: Toward evidence-based care.

Unexpected malignancy is common in major salivary gland tumors due to variability of workup, creating challenging treatment decisions. The purpose of this study was to define treatment-related outcomes for patients with incompletely treated major salivary gland tumors. A retrospective cohort study was completed of patients with incompletely treated major salivary gland tumors. Tumor burden at presentation was established and treatment categorized. The Cox Proportional Hazards model was used to determine predictors of survival and failure. Of the 440 included patients, patients with gross residual or metastatic disease had a worse overall survival (OS; P < .001). Presentation status was an independent predictor of OS on multivariate analysis (gross residual disease adjusted hazard ratio [HRadjusted ] 2.55; 95% confidence interval [CI] 1.20-5.30; metastatic disease HRadjusted 9.53; 95% CI 3.04-27.06). Failure to achieve gross total resection during initial surgery resulted in worse OS. Adequate preoperative planning is required for initial surgical management to optimize tumor control and survival.

Cripto-1 is overexpressed in carcinoma ex pleomorphic adenoma of salivary gland.

Cripto-1 is a member of the epidermal growth factor-Cripto-1/FRL-1/Cryptic family. Besides being critical for early embryonic development, Cripto-1 is also associated with the development and behavior of several cancers. We analyzed the immunoexpression of Cripto-1 in normal salivary glands (NSGs), pleomorphic adenomas (PAs), and carcinoma ex pleomorphic adenomas (CaExPAs) of salivary glands. A total of 12 NSGs, 16 PAs and 12 CaExPAs underwent immunohistochemical study by the polymeric biotin-free technique. Immunopositive cells were evaluated semiquantitatively (scores 0-3). For statistical analysis, Mann-Whitney and Kruskal-Wallis tests were performed and a significance level of p ≤ 0.05 was established. Most CaExPAs (n = 10) were strong positive (score 3) for Cripto-1, and only three cases of PAs and two specimens of NSGs exhibited some expression (score 1), being statistically significant these findings (p < 0.001). No difference between the expression of this protein in tumors of major and minor salivary glands was observed. Overexpression was found mainly in cases of CaExPAs with invasive growth (n = 8) when compared to those without capsular invasion (intracapsular pattern) (p = 0.036). Patients with or without lymph node metastasis showed no difference (p = 0.294). The results revealed a significantly higher expression of Cripto-1 in CaExPA compared to PA and NSG, suggesting this protein is possibly deregulated in PA malignant transformation. Furthermore, the increased expression of this protein is associated with a more aggressive behavior (invasive growth) in salivary gland tumors.

Proceedings of the NASHNP Companion Meeting, March 18th, 2018, Vancouver, BC, Canada: Salivary Neuroendocrine Carcinoma-An Overview of a Rare Disease with an Emphasis on Determining Tumor Origin.

Salivary neuroendocrine carcinomas are rare and the overwhelming majority is high-grade. The parotid gland is the most commonly involved site followed by the submandibular gland. Most arise de novo but rare examples occurring as a high-grade transformation of another type of salivary gland neoplasm exist. There is significant morphologic and immunophenotypic overlap with neuroendocrine carcinomas of other sites, especially the skin. Like cutaneous neuroendocrine (or Merkel cell) carcinomas, approximately three-fourths are cytokeratin 20 positive. Cytokeratin 20 positive salivary neuroendocrine carcinomas are often referred to as being of the 'Merkel cell type' since most other non-cutaneous neuroendocrine carcinomas are cytokeratin 20 negative. Salivary neuroendocrine carcinomas may be challenging to separate from Merkel cell carcinomas of the head and neck on pathologic grounds because the latter often metastasize to the parotid gland. Clinical history is often relied upon to separate primary salivary tumors from cutaneous metastases but may not be helpful in all cases. Here we review the clinical, pathologic and molecular features of salivary neuroendocrine carcinomas focusing on high-grade major salivary gland tumors. The difficulty in separating salivary tumors from metastatic Merkel cell carcinoma will be highlighted.

Surgical morbidities and outcomes of major salivary gland neoplasms treated at a tertiary cancer center.

Salivary gland neoplasms are relatively uncommon. They have a wide variety of histopathological types with diverse biological behavior. It involves all the major and minor salivary glands in the head and neck. This article focuses on the various types of major salivary gland tumors treated at a tertiary cancer center along with their surgical morbidities and outcomes. Data of all the salivary gland neoplasms operated in the head and neck services between January 2012 and December 2013 were retrieved from a prospectively collected database. The clinical, demographic data and types of surgeries along with the morbidities were collated from the database and the details regarding the follow-up were collected from the electronic medical record. Out of 235. cases registered, 107. patients were treated at our institute. The parotid gland was most commonly involved; majority were malignant lesions. Sixty-two patients were treatment naive at presentation. Majority presented with advanced disease. Superficial parotidectomy was the most common surgery performed and neck dissection was done in 27. patients. Facial nerve palsy was the most common complication following surgery. (16%). Sixty patients received adjuvant treatment. All patients on follow-up were alive at their last visit, with 10. patients having recurrence. Factors influencing the disease-free survival were extracapsular spread, tumor grade, and perineural invasion. The postoperative morbidities and outcomes for major salivary gland neoplasms in our series were acceptable and comparable to the results available in the literature. Appropriate treatment of the salivary gland neoplasm will yield good outcomes with acceptable morbidity.

Sonoelastographic Features of Major Salivary Gland Tumors and Pathology Correlation

Objectives: To investigate the diagnostic efficiency of elastography in differentiation of malignant and benign tumors by evaluating salivary gland masses in means of their elastography scores and strain ratios. Patients and Methods: Twenty five patients with salivary gland mass lesions were detected through B- mode ultrasonography, Doppler ultrasonography, strain elastography and their strain ratios were calculated. The results were compared with histopathologic results. Results: Twenty five patients had 27 lesions consisting of seven malignant and 20 benign lesions. Mann Whitney U test, ROC analysis, Fisher test and Chi square tests were used statistically. Mean strain rates were calculated as 2.26 ± 0.29 in the benign group and 2.02 ± 0.59 in the malignant group. There was no statistically significant difference between the two groups (P = 0.698). Elastography score was calculated as mean 2.4 ± 0.94 in the benign group and mean 2.28 ± 0.38 in the malignant group. There was no statistically significant difference between the two groups (P = 0.708). Accepting the strain rate as 0.89; sensitivity of elastography in differentiating malignant from benign lesions is 71%, and the specificity is 50%. However, the area under the ROC curve is 0.55, which is not statistically significant (P = 0.699). Conclusion: In conclusion, elastography is a supporting method for B-mode ultrasonography in the differentiation of benign and malignant salivary gland masses. However, the overlap of elastographic findings is evident in benign and malignant masses. Care should be taken to have tissues with similar stiffness under the reference tissue and the lesions in elastographic evaluation of the superficial mass. We have not met a study that has pointed out the importance of stiffness of the tissue located beneath the lesion that may affect the elastography results in the literature. In this respect our study is unique.