Non-neoplastic Salivary Gland Diseases Research Articles

Non-neoplastic salivary gland diseases in children: a 10-year review at a tertiary center.

Non-neoplastic salivary gland diseases are rare in children. This paper aims to present the spectrum of encountered non-neoplastic salivary gland diseases at a tertiary center by describing the demographics, clinical characteristics, and outcomes in this patient population. A review of electronic medical records was performed from 2010 until 2020. Relevant data were retrieved and charted according to the type of salivary gland disease. A comparison between diseases was made for demographics, presenting symptoms, treatment, and outcomes. Fifty patients with 11 different non-neoplastic salivary gland diseases were identified. Sialolithiasis was the most prevalent condition (12/50), with 83% localized in the submandibular gland. In contrast to gender, age, and symptoms, the location of pathology was significantly associated with the diagnosis (p < 0.001). In patients with sialolithiasis, a hybrid procedure (combined endoscopy and lithotomy) resulted in 100% resolution of symptoms. For (plunging) ranula, marsupialisation had a relative risk of recurrence of 9.6 compared to (partial) extirpation of the sublingual gland. Children with salivary gland diseases present with overlapping symptoms, making clinical diagnosis challenging. The present study may aid physicians and specialists in diagnosing the most prevalent conditions in children. Although no gold standards exist for their treatment, hybrid procedures (sialolithiasis) and subglingual gland extirpation (ranula) showed superior results over alternatives.

An overview of the diagnosis and management of non-neoplastic salivary gland pathologies

Salivary gland pathologies can be caused by obstruction, inflammation, bacterial or viral infections and neoplasia. Patients can present with acute or chronic presentations of salivary gland disease. Salivary gland disorders can have a significant impact on a patient's systemic health, oral health and quality of life. This article aims to increase awareness of salivary gland pathologies and how they may present in practice. It aims to offer general dental practitioners an understanding of how salivary gland disease can be managed in primary care and which conditions may warrant referral to secondary care, including suspected malignancy. The dental profession has a duty of care to recognize pathologies and treat or refer patients. This article provides an overview of non-neoplastic salivary gland disease, including diagnoses, management and when to refer to secondary care. CPD/Clinical Relevance: It is important to understand the signs, symptoms and management of non-neoplastic salivary gland diseases, and when to refer patients to secondary care.

Human prominin-1 (CD133) is detected in both neoplastic and non-neoplastic salivary gland diseases and released into saliva in a ubiquitinated form.

Prominin-1 (CD133) is physiologically expressed at the apical membranes of secretory (serous and mucous) and duct cells of major salivary glands. We investigated its expression in various human salivary gland lesions using two distinct anti-prominin-1 monoclonal antibodies (80B258 and AC133) applied on paraffin-embedded sections and characterized its occurrence in saliva. The 80B258 epitope was extensively expressed in adenoid cystic carcinoma, in lesser extent in acinic cell carcinoma and pleomorphic adenoma, and rarely in mucoepidermoid carcinoma. The 80B258 immunoreactivity was predominately detected at the apical membrane of tumor cells showing acinar or intercalated duct cell differentiation, which lined duct- or cyst-like structures, and in luminal secretions. It was observed on the whole cell membrane in non-luminal structures present in the vicinity of thin-walled blood vessels and hemorrhagic areas in adenoid cystic carcinoma. Of note, AC133 labeled only a subset of 80B258–positive structures. In peritumoral salivary gland tissues as well as in obstructive sialadenitis, an up-regulation of prominin-1 (both 80B258 and AC133 immunoreactivities) was observed in intercalated duct cells. In most tissues, prominin-1 was partially co-expressed with two cancer markers: carcinoembryonic antigen (CEA) and mucin-1 (MUC1). Differential centrifugation of saliva followed by immunoblotting indicated that all three markers were released in association with small membrane vesicles. Immuno-isolated prominin-1–positive vesicles contained CEA and MUC1, but also exosome-related proteins CD63, flotillin-1, flotillin-2 and the adaptor protein syntenin-1. The latter protein was shown to interact with prominin-1 as demonstrated by its co-immunoisolation. A fraction of saliva-associated prominin-1 appeared to be ubiquitinated. Collectively, our findings bring new insights into the biochemistry and trafficking of prominin-1 as well as its immunohistochemical profile in certain types of salivary gland tumors and inflammatory diseases.

Submandibular gland sialolithiasis with chronic sialadenitis: A case report

The most common non-neoplastic salivary gland disease is obstructive sialadenitis. Sialoliths are the main cause of obstructive submandibular sialadenitis. Sialolithiasis leads to recurrent painful swelling of the involved gland, which increases in size during meals. Sialoliths occurs commonly in the submandibular gland in 80% of the cases. Pathogenesis of sialolithiasis seems to be based on anatomical position of the salivary duct and gland. This article reports a case of submandibular gland sialolithiasis with chronic sialadenitis of the right side in 55-year-old male patient with recurrent symptoms of pain and swelling during mealtime. Clinical and radiographic fi ndings are important in determining the precise location and size of the sialolith. It helps in establishing the right treatment for the individual patient. Diagnosis of sialolithiasis is based on careful consideration of patient history and thorough clinical examination which demonstrates its typical symptoms.

Non-neoplastic Salivary Gland Diseases

Non-neoplastic Salivary Gland Diseases

Non-neoplastic salivary gland lesions: a 15-year study

The spectrum of salivary gland lesions is wide and the relative incidence of neoplastic versus non-neoplastic lesions is variable in different studies. A series of non-neoplastic salivary gland lesions is reviewed to analyze their spectrum and their relative frequency. This is a retrospective study of salivary gland excisions and biopsies received in our department from January 1994 to December 2008. Routine hematoxylin and eosin-stained sections of all the salivary gland excisions and biopsies received were analyzed. Of the 393 salivary gland excisions and biopsies received, 216 cases were reported as non-neoplastic (55%) and formed our study group; 177 (45%) were neoplastic. Non-neoplastic lesions were more frequent in major salivary glands (65.7%) and submandibular gland was the most commonly involved (66.2%). Lip was the most frequent site (81.7%) for minor salivary gland lesions. Inflammation was the predominant pathological finding (49.5%), of which non-specific chronic sialadenitis constituted the majority (86.9%). Sialolithiasis was present in 22 cases (20.6%); all of these cases were of non-specific chronic sialadenitis. Cysts were second in frequency (36.6%), of which mucocele was the most common (54.5%). There were 5.6% cases of benign lympho-epithelial lesions, while normal salivary gland tissue was seen in 6.5% cases. Non-neoplastic salivary gland diseases are more common than neoplastic diseases and have a wide disease spectrum.

Exérèse des lithiases postérieures de la glande submandibulaire par abord endobuccal

Sialolithiasis is the most common non-neoplastic salivary gland disease, accounting for 1.2% of the autoptic population. More than 80% of salivary calculi are located in the submandibular ductal system. Hilar calculi are usually removed by transcervical submandibular sialadenectomy. However, intra-oral removal of hilum submandibular calculi is an interesting alternative.The main criterion for intra-oral removal is the calculi palpability, knowing that calculi under 8mm of diameter are often treated by other techniques (sialendoscopy and lithotripsy).We describe a conservative and gland-preserving transoral surgical technique for hilar submandibular calculi with postoperative sialendoscopic control. The different surgical steps are illustrated.Preservation of the submandibular gland has been attempted in the treatment of sialotithiasis by transoral resection of calculi from the hilum of the gland. This technique features a low morbidity and leads to a complete recovery of glandular function.

Detection of C-KIT (CD117) molecule in benign and malignant salivary gland tumours

C-KIT (CD117), a tyrosine kinase receptor, is involved in the growth and development of normal tissues and some types of neoplasms. In the present study we analysed the expression of this molecule in salivary gland tumours. Archival formalin-fixed, paraffin-embedded sections of 40 benign and 57 malignant salivary gland tumours were retrieved and retrospectively studied immunohistochemically using a polyclonal C-KIT antibody in an Envision/HRP technique. In addition five samples of chronic submandibular sialadenitis, five normal minor salivary glands and parotid or submandibular gland tissue adjacent to benign tumour were also studied. C-KIT expression was observed in cases of adenoid cystic, acinic cell polymorphous low grade, epithelial-myoepithelial, carcinosarcoma and basal cell adenocarcinomas, as in luminal cells of pleomorphic adenomas, in serous acinar and only in intercalated and a small number of striated ductal cells of inflammatory salivary gland tissue, whereas normal salivary lobules were generally negative except a weak positivity of intercalated cells. Contrary to other reports, this study suggests that, C-KIT protein does not appear to be an exclusively specific marker for benign or malignant salivary gland neoplasms, but may be useful in differential diagnosis of adenoid cystic carcinoma from polymorphous low grade adenocarcinoma. Furthermore its expression in serous acinar cells in sialadenitis and intercalated ductal cells in normal and inflammatory lesions may indicate a possible participation in pathogenesis of both neoplastic and non-neoplastic salivary gland diseases.

Nontyrosine crystalloids in salivary gland lesions: Report of seven cases with fine-needle aspiration cytology and follow-up surgical pathology

We report a series of seven patients who underwent fine-needle aspiration (FNA) for clinically apparent parotid gland lesions. In all seven cases, numerous to abundant polyhedral, multifaceted (nontyrosine) crystalloids were noted in the background of scanty cellular specimens composed predominantly of oncocytic cells. Subsequent surgical excision showed that three of the seven glands revealed sialolithiasis and sialadenitis without evidence of neoplasia. The histology of the remaining four cases consisted of two Warthin's tumor, one oncocytic papillary cystadenoma, and one cellular benign mixed tumor. In all seven cases the nontyrosine crystalloids were found in highest concentrations in cystic spaces lined with oncocytic metaplastic cells. We conclude that nontyrosine cystalloids can be associated with both neoplastic and nonneoplastic salivary gland disease, and they may be a product of oncocytic cell secretion. Diagn. Cytopathol. 2000;22:167–171. © 2000 Wiley-Liss, Inc.

Nontyrosine crystalloids in salivary gland lesions: report of seven cases with fine-needle aspiration cytology and follow-up surgical pathology.

We report a series of seven patients who underwent fine-needle aspiration (FNA) for clinically apparent parotid gland lesions. In all seven cases, numerous to abundant polyhedral, multifaceted (nontyrosine) crystalloids were noted in the background of scanty cellular specimens composed predominantly of oncocytic cells. Subsequent surgical excision showed that three of the seven glands revealed sialolithiasis and sialadenitis without evidence of neoplasia. The histology of the remaining four cases consisted of two Warthin's tumor, one oncocytic papillary cystadenoma, and one cellular benign mixed tumor. In all seven cases the nontyrosine crystalloids were found in highest concentrations in cystic spaces lined with oncocytic metaplastic cells. We conclude that nontyrosine cystalloids can be associated with both neoplastic and nonneoplastic salivary gland disease, and they may be a product of oncocytic cell secretion. Diagn. Cytopathol. 2000;22:167-171.

Submandibular gland excision: a five-year review.

Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes. This retrospective study of 93 consecutive patients who underwent excision of the submandibular gland in the Department of Otolaryngology, Singapore General Hospital over a five-year period was undertaken to study the indications of surgery, the pathology of the excised submandibular gland and the demographic profile of patients. Fifty-six (60.2 per cent) patients underwent submandibular gland excision for non-neoplastic salivary gland disease while 37 (39.8 per cent) had neoplastic submandibular gland disorders. The commonest pathology encountered was sialadenitis/sialolithiasis (53.76 per cent) followed by pleomorphic adenoma (33.33 per cent). Fine needle aspiration cytology (FNAC) was a valuable pre-operative investigation with a sensitivity and specificity of 94.7 per cent and 100 per cent respectively for neoplastic disease. The morbidity rate for this surgery was 4.3 per cent.

Pathology of the salivary glands: The contribution of electron microscopy

Electron microscopy has a limited role in the diagnosis of primary salivary gland tumors, although it can be helpful in metastatic lesions of possible salivary gland origin. The diversity of subtypes in salivary gland tumors, as well as the range of histomorphology within any one subtype, is unparalleled in any other human tumor. This and their relative infrequency causes diagnostic problems for pathologists. Ultrastructural techniques have been of major importance in determining the inter-relationship of these tumors for classification purposes, revealing the subtle variations in common cellular differentiation pathways, determining the organization of tumor cells, and displaying the importance of extracellular matrix materials in establishing diagnostic criteria for each of the many subtypes. Electron microscopy has also been valuable in non-neoplastic salivary gland disease and has an increasing role in experimental studies involving tissue from human and animal salivary parenchyma.

Medical Management of Non-Neoplastic Salivary Gland Disease

Non-neoplastic salivary gland disorders are increasing as a result of many factors. The role of salivary secretion in providing protection to the oral and pharyngeal tissues is discussed along with the diagnosis and treatment of some of the more common non-neoplastic salivary gland diseases.

The incidence of neoplastic versus inflammatory disease in major salivary gland masses diagnosed by surgery

What is the incidence of non-neoplastic diseases when dealing with masses of the major salivary glands? A knowledge of this information would aid the physician in making decisions relative to the management of the masses. Furthermore, the expected malignancy rate may need to be adjusted according to the findings of this study. Many reported series of salivary gland neoplasms show the relative incidence of benign vs. malignant neoplasms; however, not every patient with a mass of the salivary gland who comes to surgery is finally diagnosed as having had a neoplasm. Knowing the relative incidence of neoplastic vs. non-neoplastic salivary gland diseases has important diagnostic, therapeutic, and prognostic implications. Records of all patients who underwent either a parotidectomy or submandibular gland excision from 1975 to the present at the Eye and Ear Hospital of Pittsburgh were reviewed; 73% of the parotidectomies performed were done for neoplastic disease. A patient with a parotid mass has a likelihood of 1:10 of having a malignancy. Similarly, on a population basis, 1 submandibular mass in 12 will be malignant.

Non-neoplastic Salivary Gland Diseases in Children

Parotid enlargement in childhood is a diagnostic challenge to all physicians. A frame of reference has been established wherein the disease spectrum involving the child's parotid glands can be outlined in a stepwise manner. In some instances after sialography, specific hematologic tests, and cultures the diagnosis will remain obscure until a biopsy is performed. Protracted conservative management should be instituted prior to the consideration of ablative surgical procedures.