Malignant Salivary Gland Tumors Research Articles

Abstract CT165: Phase II study of nivolumab and ipilimumab for treatment of metastatic/recurrent adenoid cystic carcinoma (ACC) of all anatomic sites of origin and other malignant salivary gland tumors

Abstract Introduction: Dual checkpoint inhibitor therapy with nivolumab and ipilimumab has been FDA-approved for a number of different cancers including melanoma, recurrent NSCLC, and hepatocellular carcinoma. However, their role in the treatment of ACC and other salivary gland carcinomas is not well established. Methods: We performed a Simon’s two-stage prospective single-institution phase II clinical trial of nivolumab (240 mg intravenously every 2 weeks for 16 weeks, then 480 mg every 4 weeks) with ipilimumab (1 mg/kg intravenously every 6 weeks), both of which were provided until intolerable toxicity or disease progression. Two cohorts were analyzed: patients with metastatic/recurrent ACC and patients with other salivary gland cancers. The primary endpoint was median progression-free survival (PFS) based on RECIST and immune-related RECIST (irRECIST) criteria; secondary endpoints were overall response rate (ORR), overall survival (OS), and toxicity. Results: Patients with ACC (n=19) and other salivary gland carcinomas (total n=5; parotid gland adenocarcinoma (n=3), salivary duct carcinoma (n=1), and myoepithelial carcinoma (n=1)) were enrolled between May 2017 and July 2019. Among the patients with ACC, the median OS was 30.0 months (95% confidence interval (CI) 15.3 months to not reached), the median PFS was 8.3 months (95% CI 5.5 - 30.0 months), and the disease control rate (DCR) was 53% (10/19). The ORR in the ACC group was 5% (CR 0%, n=0; confirmed PR 5%, n=1) using both RECIST and irRECIST criteria, with one patient having continued stable disease at the time of trial conclusion. In the salivary gland tumor cohort, the median OS was 10.4 months (95% CI 6.21 months to not reached), the median PFS time was 6.21 months (95% CI 2.83 months to not reached), and the DCR was 40% (2/5). The ORR in this cohort was 0% using both RECIST and irRECIST criteria. Across both cohorts, platelet counts above the joint cohort’s median were significantly associated with better OS (p=0.032) and PFS (p=0.046). Additionally, although not significant, there was a trend for improved OS and PFS among patients with neutrophil-to-lymphocyte ratios >5 (OS p=0.42, PFS p=0.25) and above median neutrophil counts (OS p=0.24, PFS p=0.18). Four patients with ACC underwent circulating tumor DNA sequencing, resulting in the identification of two MYB-NFIB translocations, one NOTCH1 Cys1383 frameshift mutation, one MTOR N1760K mutation, and one PDGFRA copy number gain. Common immune-related toxicities include fatigue (54%), lymphocytopenia (46%), and anemia (42%) with lymphocytopenia being the most common grade III/IV adverse event. Conclusion: In patients with recurrent or metastatic ACC and other salivary gland neoplasms, combination nivolumab with ipilimumab resulted in moderate disease control. Further studies are warranted to validate our findings. Citation Format: Young Kwang Chae, Richard Duan, Liam Il-Young Chung, Youjin Oh, Maria Matsangou, Mark Agulnik, Victoria Villaflor, Devalingam Mahalingam. Phase II study of nivolumab and ipilimumab for treatment of metastatic/recurrent adenoid cystic carcinoma (ACC) of all anatomic sites of origin and other malignant salivary gland tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT165.

A CASE REPORT OF MUCOEPIDERMOID CARCINOMA: A RARE PRESENTATION AT SUBMANDIBULAR SALIVARY GLAND

Introduction: Mucoepidermoid Carcinoma (MEC) is the most common malignant salivary gland neoplasm, representing 10 to 15% of all salivary neoplasms. Case Report: Ÿ A rare case of mucoepidermoid carcinoma of the left submandibular gland in a 36-year-old female patient who presented to ENT OPD with a painless mass in the left submandibular region. Ÿ histopathological examination conrmed the diagnosis of low-grade mucoepidermoid carcinoma of the submandibular gland. Ÿ Not all diagnostic features are found on ne needle aspiration, especially in low-grade lesions. Ÿ The diagnosis may be missed or confused with other benign and malignant lesions. Ÿ Treated by total excision of the left submandibular gland and no recurrence seen within 3 months of follow-up.

Support Tools in the Differential Diagnosis of Salivary Gland Tumors through Inflammatory Biomarkers and Radiomics Metrics: A Preliminary Study

The purpose of this study was to investigate how the systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), and radiomic metrics (quantitative descriptors of image content) extracted from MRI sequences by machine learning increase the efficacy of proper presurgical differentiation between benign and malignant salivary gland tumors. A retrospective study of 117 patients with salivary gland tumors was conducted between January 2015 and November 2022. Univariate analyses with nonparametric tests and multivariate analyses with machine learning approaches were used. Inflammatory biomarkers showed statistically significant differences (p < 0.05) in the Kruskal-Wallis test based on median values in discriminating Warthin tumors from pleomorphic adenoma and malignancies. The accuracy of NLR, PLR, SII, and SIRI was 0.88, 0.74, 0.76, and 0.83, respectively. Analysis of radiomic metrics to discriminate Warthin tumors from pleomorphic adenoma and malignancies showed statistically significant differences (p < 0.05) in nine radiomic features. The best multivariate analysis result was obtained from an SVM model with 86% accuracy, 68% sensitivity, and 91% specificity for six features. Inflammatory biomarkers and radiomic features can comparably support a pre-surgical differential diagnosis.

Malignant salivary gland tumours: treatment outcomes from a tertiary referral centre in the UK

Salivary gland malignant tumours are a complex and highly variable pathological group. Their diagnosis can be challenging, and management is guided by multidisciplinary teams. This project aimed to establish clinicopathological and sociodemographic features that significantly impacted overall disease-free or progression-free survival in patients diagnosed with malignant salivary gland disease between 2010 and 2019 in a tertiary referral centre. In total, 86 patients were included for analysis, with a female:male gender ratio of 1.3:1. Mean age at diagnosis was 57.7 years. Mucoepidermoid carcinomas constituted almost 25% (n = 20) of all cases, with adenoid cystic carcinomas (20%, n = 17) and acinic cell carcinomas (17.5%, n = 15) being the next most frequently diagnosed. The parotid gland was the most frequently affected site (80.2%, n = 69). Perineural and lymphovascular invasion, and a maximum tumour dimension of ≥4 cm were highly associated with the decision to provide a neck dissection as part of treatment. Involved margins, extracapsular spread, and lymphovascular and perineural invasion were associated with the need for adjuvant treatment. However, no factors remained statistically significant on multivariate analysis. This retrospective service evaluation demonstrates the difficulty of predicting treatment outcomes for patients diagnosed with malignant salivary gland disease.

Usefulness of apparent diffusion coefficient values for distinguishing between squamous cell carcinoma and malignant salivary gland tumor of the head and neck.

The aim of the study was to assess the usefulness of apparent diffusion coefficient (ADC) values for differentiating between SCC and malignant salivary gland tumors of the head and neck. This retrospective cross-sectional study was conducted on 29 patients with SCCs and 10 patients with malignant salivary gland tumors who underwent pretreatment MRI of the head and neck. The minimum and average ADC values of the tumors were measured, with normalized tumor to spinal cord ADC ratios generated. Comparisons of ADC values and normalized ADC ratios between the two tumor types were performed using the unpaired t-test. The minimum and average ADC values and normalized average ADC ratios of SCCs (753.17 ± 214.47 × 10-6mm2/s, 848.79 ± 250.13 × 10-6mm2/s, and 0.92 ± 0.25, respectively) were significantly lower than those of malignant salivary gland tumors (1084.90 ± 242.60 × 10-6mm2/s, 1305.90 ± 270.99 × 10-6mm2/s, and 1.58 ± 0.31, respectively; all p < 0.001). A cutoff value of 1.31 for the normalized average ADC ratio was used to distinguish between SCCs and malignant salivary gland tumors and achieved an area under the curve of 0.93, sensitivity of 96.6%, specificity of 90%, and accuracy of 94.6%. ADC value measurement could help differentiate between SCCs and malignant salivary gland tumors.

Efficacy of Ultrasound Shear Wave Elastography in the Diagnosis of Salivary Gland Tumors

Diagnostic accuracy of fine-needle aspiration cytology (FNAC) as the ability to discriminate between the target condition and health in the evaluation of salivary gland tumors is not perfected yet and false-negative results are possible. The purpose of the present study was to measure and compare the diagnostic accuracy of FNAC performed with conventional B-mode ultrasound and ultrasound with shear wave elastography (SWE) FNAC navigation. The investigators implemented a single-blind randomized study (sealed envelope method). The study population was composed of all patients presenting for evaluation and management of suspected benign or malignant tumors of the major salivary glands between July 2013 and December 2020. The involvement of SWE navigation was the primary predictor variable affecting FNA targeting. The method involved analysis of redistribution of SWE values within the affected gland expressed in kilopascals (kPa) and the four-point ES1 (soft tissue) to ES4 (stiff) scoring. The primary outcome variable was the success in obtaining diagnostic tissue resulting in a histologically confirmed FNAC diagnosis and coded as yes/no. Age and sex of the patients and topographical locations of lesions were covariates. Descriptive and bivariate statistics were computed and the P value was set at .05. The sample included 132 subjects (male/female 59/73; mean age 54±11years; 144 tumors). SWE+Group (n=66) consisted of patients presurgically diagnosed with salivary tumors SWE-guided FNAC and SWE- Group (n=66) was diagnosed with tumors by conventional ultrasound-(B-mode)-guided FNAC. The SWE-guided FNAC statistically significantly reduced the incidence of false-negative results (n=0; P=.001) and nondiagnostic cases (n=3 SWE FNAC vs n=7 B-mode US FNAC; P=.04). For SWE+Group, the FNAC diagnosis was confirmed by postsurgical histology in 95.5% with 91.0% sensitivity (confidence interval [CI] 0.62 to 0.97) and 84.4% specificity (CI 0.58 to 0.96). For SWE- Group, 81.8% confirmation was obtained (P=.05) with 82.3% sensitivity (CI 0.54 to 0.90) and 74.0% specificity. SWE can increase success in obtaining diagnostic tissue when used for FNAC navigation purposes. We suggest combining both SWE and standard B-mode US methods when the FNAC procedure is performed.

Central mucoepidermoid carcinoma of the maxilla, a challenging diagnosis

Objective: To present a pictorial review on central mucoepidermoid carcinoma.&#x0D; Case report: Central mucoepidermoid carcinoma (CMEC), also known as intraosseous mucoepidermoid carcinoma (IMEC), is an extremely rare disease (less than 2-4% of all MEC). However, CMEC is the most frequent malignant salivary gland tumour found in intraosseous locations. Due to this unusual location, diagnosis of CMEC can be challenging. Therefore, CMEC is often mistaken for other intraosseous or odontogenic pathologies. Radiological assessment shouldinclude panoramic X-Ray, CBCT and thoracic CT, which should be performed after diagnosis. The recommended treatment includes radical resection surgery, followed by radiotherapy if indicated. A long-term follow-up is recommended for up to 10 years.&#x0D; Conclusion: The authors experienced the challenging diagnosis of CMEC through the case of a patient who presented with a slowly growing palatal mass.&#x0D;

Insulin Like Growth Factor II mRNA-Binding Protein 3 (IMP3) Immunohistochemical Expression in Salivary Glands Tumors- Local Study

Objective: To identify the relationship between the expression of IMP3 in benign and malignant tumors of salivary glands and other clinic-pathological variables. Materials and Methods: Twenty-six cases of salivary gland tumors were collected from the histopathology department, Gazi-Hariri hospital/ Baghdad Medical City from January 2021 to June 2021. Patients’ reports were included for diagnosis and clinicopathological data. Three histological sections were taken from the paraffin blocks for each case. The first section was stained with H&amp;E stain, and the other two sections were stained with IMP3 (Dako-code M3626) monoclonal antibody by the immunohistochemical method. Results: Twenty-six cases of salivary gland tumor, with equal male/female distribution; the mean age for the patients was 45 years (19-60 years). There was no significant relationship between gender (P=.0.115), tumor size (P=0.359), tumor location (P=0.335), and tumor type (P=0.673) with positive expression of IMP3. Regarding malignant cases, no significant relation between IMP3 expression and tumor stage (P=1.000), and lymphovascular invasion (P=1.000). On the other hand, there was a highly significant relationship (P=0.000) between IMP3 expression and cell type (epithelial/mesenchymal). Conclusion: Imp3 might not be conclusive in differentiation between benign and malignant salivary gland tumors. Further studies with follow-up are needed to assess the prognostic value of this marker in salivary gland pathologies.

Malignancy rates of salivary gland tumors in Greenlandic Inuit comparable to non-endemic populations; epidemiological mapping of salivary gland tumors 1990–2019

BackgroundSalivary gland tumors are assumed to be predominantly malignant in the Greenlandic Inuit population, but there is limited literature on the subject. We conducted a retrospective cohort study using national registers to describe the histological tumor types, location, incidence, and survival of benign and malignant salivary gland tumors.MethodsWe analyzed data on all Greenlandic Inuit with an epithelial-derived salivary gland tumor from 1990 to 2019. We extracted data from the Central Personal Registry and crossmatched it with the Danish Pathology Data Bank. All specimens were reviewed by a specialized pathologist. We noted patient and histological characteristics, calculated crude and age-adjusted incidence rates, overall survival, and excess mortality.ResultsOur study found that 76% of salivary gland tumors in the Greenlandic Inuit population were benign, with pleomorphic adenoma being the most common. Malignant tumors accounted for 24% of cases, with lymphoepithelial carcinoma being the most common type. The most common place of origin for malignant tumors was the parotid gland (71%) and the submandibular gland (15%). The median age of onset for malignant tumors was 47 years. Age-adjusted incidence rates of malignant tumors for men and women were 3.00 and 4.12 per 100,000 person-years, respectively.ConclusionOur findings suggest that the proportion of malignant salivary gland tumors in the Greenlandic Inuit population is similar to other nonendemic populations. Our incidence rates are higher than previously reported, likely due to differences in methodology and definitions of the Inuit population. This study provides valuable insights into the epidemiology of salivary gland tumors in the Greenlandic Inuit population and may have implications for other Inuit populations as well.

A Rare Case of Muco-epidermoid Carcinoma Parotid in a 6-Year-Old Girl and Review of Literature.

Mucoepidermoid carcinoma (MEC) is the commonest malignant salivary gland tumor affecting the parotid gland in adults and children. In children and adolescents, there is a peak incidence in the second decade. We came across a 6-year-old girl with intermediate-grade MEC parotid gland, which is very unusual below 10 years of age. A global literature search revealed only 3 other similar cases in children below 10 years of age. She presented with a 2-year history of left parotid gradually increasing hard swelling involving the overlying skin and underlying sternocleidomastoid muscle which was confirmed on a contrast-enhanced computed tomography (CECT) scan of the face and neck as well as a core biopsy to be a MEC left parotid. The patient underwent a left radical parotidectomy sacrificing the main trunk of the facial nerve while carefully preserving its distal branches along with a left selective neck dissection (SND) followed by facial reanimation using primary neurorrhaphy. Histopathology confirmed an intermediate-grade MEC pT4aN2bMx with close deep lobe margin warranting adjuvant radiotherapy. Albeit very rare, salivary gland neoplasms may occur in children in the first decade of life. Appropriate planning regarding oncological resection with/without facial reanimation, appropriate rehabilitation followed by adjuvant treatment based on histopathology ensures a good prognosis.

Predictors of recurrence and disease-free survival for salivary gland tumors among children and young adults in Kampala, Uganda: a retrospective follow-up study

BackgroundSalivary gland tumors are a group of tumors which are highly heterogeneous, and they are uncommon among children and young adults. We aimed to investigate the predictors of recurrence and disease-free survival for salivary gland tumors among children and young adults.MethodsWe retrospectively extracted clinical, pathologic, and follow-up data of patients who were diagnosed histologically with salivary gland tumors from January 2013 to December 2018 at the department of pathology, Makerere University in Kampala, Uganda. Then, we applied Cox regression analysis to determine the predictors of disease-free survival using hazard ratio as the measure of probability of the survival with 95% confidence interval. We also used Kaplan–Meier curves to analyze the disease-free survival. P ˂ 0.05 was considered significant.ResultsA total of 144 patients with salivary gland tumors were included in the present study who were aged not more than 20 years with mean age of 13.9 ± 4.5 years. Over one quarter (26.4%, n = 38) of the salivary gland tumors that were analyzed in the present study were malignant. The prevalence of recurrence was (27.1%, n = 39), and the mean disease-free survival was 58.7 ± 1.9 months. Category of the salivary gland (AHR = 1.36, 95% CI = 0.137–0.942, p = 0.037) and behavior of the tumors (AHR = 1.82, 95% CI = 0.729–0.990, p = 0.023) were the potential predictors of disease-free survival.ConclusionOver one quarter of the patients had malignant salivary tumors, and also, one-third of the patients developed recurrence at the end of the follow-up period of 6 years. Involvement of minor salivary glands and having a malignant salivary gland tumor both have shown increased risk of recurrence as well as short disease-free survival. Therefore, patients with minor salivary gland involvement and those with malignant variants require optimal surgical resection of the tumors for possible prevention of early recurrence and increasing the survival of the patients without relapse of such tumors after initial resection of the primary lesions.

Huge Recurrent Mucoepidermoid Carcinoma of Parotid - a Rare Presentation.

Mucoepidermoid carcinoma is the commonest primary malignant salivary gland tumor in both children and adults and constitutes around 2.8-16% of all salivary gland tumors. There is a wide age range of 3 to 95 years with a mean age of 47 years. We reported a case of 85 years old female patient, who presented to the department of Surgical Oncology, Srinivasan Medical College and Hospital, Trichy, with history of right parotid swelling for past 25 years, who had undergone Superficial parotidectomy 10 years back, followed by recurrence of tumor with huge increase in size, around 20cm in greatest dimension. Right Completion Radical Parotidectomy with Modified Radical neck dissection type 1 with Cervical Rotation Flap cover was done and histopathological examination of the surgical specimen confirmed as high grade Mucoepidermoid carcinoma. Following surgery, the patient's outcome is better, uneventful with periodic regular follow-up.

Comparison of four convolutional neural networks for histopathological diagnosis of salivary gland carcinomas

Malignant salivary gland tumors represent aparticular diagnostic challenge due to the large number of histopathological entities, their rare occurrence, and the diverse clinical and histological presentations. The aim of this work is to investigate and compare convolutional neural networks (CNNs) as adiagnostic tool for histological diagnosis of salivary gland cancer. From salivary gland cancer preparations of 68patients, 118histological slides were digitized at high resolution. These virtual sections were then divided into small image sections, and the resultant 83,819images were sorted into four categories: background, connective tissue, non-neoplastic salivary gland tissue, and salivary gland cancer tissue. The latter category grouped the entities adenoid cystic carcinoma, adenocarcinoma (not otherwise specified), acinar cell carcinoma, basal cell carcinoma, mucoepidermoid carcinoma, and myoepithelial carcinoma. The categorized images were then processed in atraining, validation, and test run by the ImageNet pretrained CNN frameworks (Inception ResNetv2, Inceptionv3, ResNet152, Xception) in different pixel sizes. Accuracy values ranged from 18.8% to 84.7% across all network architectures and pixel sizes, with the Inceptionv3 network achieving the highest value at 500 × 500pixels. The recall values/sensitivity reached up to 85% for different pixel sizes (Inceptionv3 network at 1000 × 1000pixels). The minimum F1 score achieved was 0.07 for the InceptionResNetv2 and the Inceptionv3 at 100 × 100 pixels each, the maximum F1 score achieved was 0.72 for the Xception at 1000 × 1000pixels. Inceptionv3 was the network with the shortest training times, and was superior to all other networks at any pixel size. The current work was able to demonstrate the applicability of CNNs for histopathological analysis of salivary gland tumors for the first time and provide acomparison of the performance of different network architectures. The results indicate aclear potential benefit for future applications.

Association of Vascular Endothelial Growth Factor (VEGF) in Salivary Gland Tumors

Aim: To identify the association of vascular endothelial growth factor (VEGF) immunoexpression in the progression of salivary gland tumor. Study design: Comparative cross-sectional study Place and duration of study: Department of Pathology, Peshawar Medical College. Duration of study was six months from date of approval. Methodology: Forty five specimen of salivary gland tumor were studied in which 30 were benign and 15 were malignant. The endpoint assessment included Hematoxylin &amp; Eosin (H&amp;E) and VEGF immunoexpression. Results: The association of VEGF expression with salivary gland tumor was statistical significant (P&lt;0.05). Maximum 18 samples (benign: 13, malignant: 5) were shown to have strong expression, 24 (benign: 16, malignant: 8) were shown moderate expression. Whereas, small and no expression was found in 2 (benign: 0, malignant: 2) and 1 (benign: 1, malignant: 0) sample, respectively. Conclusion: Overexpression of VEGF in both malignant and benign salivary gland tumors might be associated to progress salivary gland tumors. Keywords Benign tumor, Warthin tumor, Adenoma, Salivary gland carcinoma, Vascular endothelial growth factor

Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors.

Increased use of functional magnetic resonance imaging (MRI) methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI consisting of sequential contrast series, allows us to obtain more information on the microstructure, cellularity, interstitial distance, and vascularity of tumors, which has increased the discrimination power for benign and malignant salivary gland tumors (SGTs). In the last few years, quantitative DCE MRI data containing T1 perfusion parameters (Ktrans, Kep and Ve), were reported to contribute to the differentiation of benign or malignant subtypes in SGTs. To evaluate the diagnostic efficacy of DWI and semiquantitative and quantitative perfusion MRI parameters in SGTs. Diffusion MRI [apparent diffusion coefficient (ADC) value] with a 1.5 T MR machine, semiquantitative perfusion MRI [time intensity curve (TIC) pattern], and quantitative perfusion MRI examinations (Ktrans, Kep and Ve) of 73 tumors in 67 patients with histopathological diagnosis performed from 2017 to 2021 were retrospectively evaluated. In the ADC value and semiquantitative perfusion MRI measurements, cystic components of the tumors were not considered, and the region of interest (ROI) was manually placed through the widest axial section of the tumor. TIC patterns were divided into four groups: Type A = Tpeak > 120 s; type B = Tpeak ≤ 120 s, washout ratio (WR) ≥ 30%; type C = Tpeak ≤ 120 s, WR < 30%; and type D = flat TIC. For the quantitative perfusion MRI analysis, a 3D ROI was placed in the largest solid component of the tumor, and the Ktrans, Kep and Ve values were automatically generated. The majority of SGTs were located in the parotid glands (86.3%). Of all the SGTs, 68.5% were benign and 31.5% were malignant. Significant differences were found for ADC values among pleomorphic adenomas (PMAs), Warthin's tumors (WTs), and malignant tumors (MTs) (P < 0.001). PMAs had type A and WTs had type B TIC pattern while the vast majority of MTs and other benign tumors (OBTs) (54.5% and 45.5%, respectively) displayed type C TIC pattern. PMAs showed no washout, while the highest mean WR was observed in WTs (59% ± 11%). Ktrans values of PMAs, WTs, OBTs, and MTs were not significantly different. Kep values of PMAs and WTs were significantly different from those of OBTs and MTs. Mean Ve value of WTs was significantly different from those of PMAs, OBTs, and MTs (P < 0.001). The use of quantitative DCE parameters along with diffusion MRI and semiquantitative contrast-enhanced MRI in SGTs could improve the diagnostic accuracy.

The Impact of Tissue Preparation on Salivary Gland Tumors Investigated by Fourier-Transform Infrared Microspectroscopy.

Due to the wide variety of benign and malignant salivary gland tumors, classification and malignant behavior determination based on histomorphological criteria can be difficult and sometimes impossible. Spectroscopical procedures can acquire molecular biological information without destroying the tissue within the measurement processes. Since several tissue preparation procedures exist, our study investigated the impact of these preparations on the chemical composition of healthy and tumorous salivary gland tissue by Fourier-transform infrared (FTIR) microspectroscopy. Sequential tissue cross-sections were prepared from native, formalin-fixed and formalin-fixed paraffin-embedded (FFPE) tissue and analyzed. The FFPE cross-sections were dewaxed and remeasured. By using principal component analysis (PCA) combined with a discriminant analysis (DA), robust models for the distinction of sample preparations were built individually for each parotid tissue type. As a result, the PCA-DA model evaluation showed a high similarity between native and formalin-fixed tissues based on their chemical composition. Thus, formalin-fixed tissues are highly representative of the native samples and facilitate a transfer from scientific laboratory analysis into the clinical routine due to their robust nature. Furthermore, the dewaxing of the cross-sections entails the loss of molecular information. Our study successfully demonstrated how FTIR microspectroscopy can be used as a powerful tool within existing clinical workflows.

TERT Promoter Mutation in Benign and Malignant Salivary Gland Tumors; A Cross-Sectional Study.

Telomere-related tumorigenesis mechanisms in the salivary gland, including mutation in the promoter region of TERT, have been rarely investigated. Therefore, the present study aimed to investigate the mutation in the promoter region of TERT in benign and malignant salivary gland tumors. This was a descriptive-analytical cross-sectional study. Tissue samples of 54 patients with primary salivary gland tumors sent to the pathology department of Rasool-e-Akram Hospital from September 2017 to September 2021 were examined. Fifteen samples including two groups of the most common benign tumors (n=5; 3 pleomorphic adenomas and 2 Warthin tumors) and four groups of the most common malignant tumors (n=10; 3 mucoepidermoid carcinomas, 3 adenoid cystic carcinomas, 2 acinic cell carcinoma, and 2 salivary duct carcinoma) were selected. The promoter region of TERT, including well-known hot spot regions, is sequenced using the Sanger sequencing method. Data were analyzed using statistical software R version 4.1.2. Of 15 salivary gland tumor specimens, consisting of 5 benign tumors and 10 malignant tumors after DNA sequencing, TERT promoter region mutation was only seen in one of the adenoid cystic carcinoma samples, located at -146 bp upstream from ATG (chr5: 1,295,250 C>T). TERT promoter mutation was not different in malignant and benign salivary tumors. Nonetheless, there are a few studies that report TERT promoter mutation in adenoid cystic carcinoma of the salivary gland, necessitating the need for further investigations.

Burnished and Luminous-Hyalinising Clear Cell Carcinoma

Hyalinising clear cell carcinoma is a unique, exceptionally encountered, malignant neoplasm of salivary glands commonly incriminating minor salivary glands, especially intraoral glands. Typically, tumefaction exhibits genomic fusion EWSR1: ATF1. Besides, various fusion oncogenes or concurrent, variant genetic fusions are encountered.

Significance of Nuclear Morphometry in Salivary Gland Neoplasms: A Cross-sectional Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is one of the commonest and most efficient investigation done for salivary gland swellings, which is of much help in diagnosing inflammatory, benign and malignant lesions. The morphology of nucleus determines the behaviour of the cell/tissue as benign or malignant. Nuclear morphometry analysis is done by using various software. Aim: To determine the nuclear morphometry parameters in salivary gland neoplasm of FNAC smears by Image J software and to determine its association with the cytological diagnosis. Materials and Methods: This was a retrospective laboratory observational cross-sectional study done for four years (2018- 2021) at a tertiary healthcare centre, attached to Sri DevarajUrs Medical College, Kolar, Karnataka, India. All the FNAC smears of salivary gland neoplasms were considered and classified by cytomorphology as benign and malignant tumours. All smears were analysed using Image J software for nuclear morphometric parameters such as area of the nucleus, perimeter of the nucleus, feret diameter, minimum ferret and skewness. The nuclear morphometric findings of benign and malignant tumours were compared and statistical analysis was doneby using Student’s t-test, p-value of &lt;0.05 was considered statistically significant. Results: A total of 52 cases were studied. The average age of presentation of benign and malignant salivary gland neoplasm was 38.7 and 49.4 years, respectively. Among, 30 (57.6%) benign neoplasms there were 23 (76.7%), pleomorphic adenoma was the commonest and among 22 (42.4%) malignant squamous cell carcinoma 16 (72.7%) deposits was the commonest. The nuclear morphometry analysis showed that the mean values of area (p-value ≤0.001), perimeter (p-value≤0.001), ferret diameter (p-value≤0.001) and minimum ferret (p-value=0.001) of malignant lesions were comparatively higher than benign and was statistically significant. Conclusion: Nuclear morphometry along with routine cytopathological evaluation will improve the accuracy of diagnosis of neoplastic lesions of salivary gland. This information can be used to plan better treatment and predict prognosis of the disease. Digital morphological analysis helps in obtaining quantitative values from qualitative data which can be utilised further for automation.

A Novel Prediction Model Based on Quantitative Texture Analysis of Sonographic Images for Malignant Major Salivary Glandular Tumors.

The aim of this study was to compare multiple objective ultrasound (US) texture features and develop an objective predictive model for predicting malignant major salivary glandular tumors. From August 2007 to May 2018, 144 adult patients who had major salivary gland tumors and subsequently underwent surgery were recruited for this study. Representative brightness mode US pictures were selected for texture analysis and used to develop a prediction model. We found that the grayscale intensity and standard deviation of the intensity were significantly different between malignant and pleomorphic adenomas. The contrast, inverse difference (INV) movement, entropy, dissimilarity, and INV also differed significantly between benign and malignant tumors. We used stepwise selection of predictors to develop an objective predictive model, as follows: Score = 1.138 × Age - 1.814 × Intensity + 1.416 × Entropy + 1.714 × Contrast. With an optimal cutoff of 0.58, the diagnostic performance of this model had a sensitivity, specificity, overall accuracy, and area under the curve of 83% (95% confidence interval [CI]: 74%-92%), 74% (65%-84%), 78% (72%-85%), and 0.86 (0.80-0.92), respectively. We have developed a novel computerized diagnostic model based on objective US features to predict malignant major salivary gland tumor. Further improving the computer-aided diagnosis model might change the US examination for major salivary gland tumors in the future.