Salivary Gland Tumors Research Articles

903P Patterns and predictors of recurrence-free survival (RFS) in salivary gland cancers (SGCs): A Spanish multicenter study

903P Patterns and predictors of recurrence-free survival (RFS) in salivary gland cancers (SGCs): A Spanish multicenter study

LBA36 A randomised phase II study to evaluate the efficacy and safety of androgen deprivation therapy (ADT) vs chemotherapy (CT) in patients with recurrent and/or metastatic, androgen receptor (AR) expressing, salivary gland cancers

LBA36 A randomised phase II study to evaluate the efficacy and safety of androgen deprivation therapy (ADT) vs chemotherapy (CT) in patients with recurrent and/or metastatic, androgen receptor (AR) expressing, salivary gland cancers

849O Phase II study of trastuzumab deruxtecan in patients with HER2-positive recurrent/metastatic salivary gland cancer: Results from the MYTHOS trial

849O Phase II study of trastuzumab deruxtecan in patients with HER2-positive recurrent/metastatic salivary gland cancer: Results from the MYTHOS trial

Milan System Salivary Gland Neoplasm of Uncertain Malignant Potential: Males and 30–69-year-olds have the Highest Risk of Malignancy

Milan System Salivary Gland Neoplasm of Uncertain Malignant Potential: Males and 30–69-year-olds have the Highest Risk of Malignancy

Oncocytic Lipoadenoma of the Parotid Gland against a Background of Multifocal Oncocytic Hyperplasia: Report of a Rare Case

ABSTRACT Oncocytic lipoadenoma is an extremely rare benign salivary gland tumor with only few cases reported in the literature. We herein report a case of oncocytic lipoadenoma originating in the parotid gland of a 65-year-old man. The tumor presented as a slowly growing asymptomatic right-sided parotid gland mass. On MRI, right parotid showed a 40 × 32 × 20 mm well-encapsulated, neoplastic mass in the superficial lobe. On core biopsy, differentials considered were nodular oncocytosis and oncocytoma. Subsequently, superficial parotidectomy was performed. The resected tumor was encapsulated, yellowish brown, and homogenous. Microscopically, it was composed of oncocytoma-like epithelial component admixed with mature adipocytes, each contributing to 50% of the mass. Adjacent salivary gland showed multiple foci of oncocytosis. Differential diagnosis includes lipomatous tumors as well as neoplastic and non-neoplastic oncocytic lesions of the salivary gland. The present case of oncocytic lipoadenoma against a background of multifocal oncocytic hyperplasia has been reported for its rarity.

Pseudonormal Morphology of Salivary Gland Adenoid Cystic Carcinoma Cells Subverts the Antitumor Reactivity of Immune Cells: A Tumour-Cell-Based Initiation of Immune Evasion.

Salivary gland adenoid cystic carcinoma (ACC), mucoepidermoid carcinoma (MEC) and oral squamous cell carcinoma (OSCC) occurs within the head and neck region. So far immune check point inhibitors failed in ACC. Gipie (CCDC88B) is a microtubule linker protein that activates immune cells. Gipie expressions found in head and neck cancer cells. We hypothesised that the presence of Gipie diminishes anti-tumour reactivity of immune cells towards head and neck cancer. To determine the effect of Gipie in oral and salivary gland cancer cells, Gipie was silenced in cancer cells in cancer-immune cells co-culture models and we performed 3D Z series confocal imaging, annexin V and immune activation flow cytometry, proteome profiler and discovery phase proteomics. ACC cells morphed into pseudonormal morphology in immune co-culture models. Silencing Gipie in ACC cells showed significant increase of apoptotic cells and activated natural killer cells, and lowering of regulatory T cells. Other salivary and oral cancer cells showed negligible effect of Gipie. Proteome profiler and proteomics assay confirmed Gipie affecting proliferation mechanism and immune activated proteins in ACC immune co-culture models. Overall, we conclude that the presence of Gipie has a confounding role during the ACC-immune cell interaction.

Warthin tumor concomitant with mantle cell lymphoma: a case report and review of literature

RationaleWarthin tumor (WT) is the second most common benign tumor in salivary gland. It has a slow growth rate and most frequently occurs in the parotid gland. Most patients present with an incidental finding of a painless mass inferior/anterior to the ear. Besides the epithelial component of the tumor, WT is characteristically associated with lymphoid stroma that is considered benign. While there have been a few reports of malignant transformation of the lymphoid components in WT, cases of WT concomitant with mantle cell lymphoma (MCL) are extremely rare. To the best of our knowledge, two cases have been described in the English literature. Herein, we report a case of WT concomitant with MCL in a 70-year-old female patient, and emphasize the importance of careful examination of lymphoid stroma in WT so that concurrent lymphoma is not missed.Patient concernsA 70-year-old Chinese woman with a 40-year history of cigarette smoking presented with a one year history of a right submaxillary mass with recent enlargement.DiagnosisCervical ultrasound (US) and computed tomography (CT) scans of the neck revealed a well-circumscribed mass in the right parotid with a maximum diameter of 3.1 cm. Surgical resection of the mass was performed. Histopathological examination revealed a characteristic double-layer of neoplastic epithelium with prominent lymphoid stroma, suggesting WT. In addition, morphology and immunohistochemistry studies confirmed the coexistence of MCL. Thereafter, the final diagnosis of this case was WT concomitant with MCL.InterventionsThe patient was staged as stage I after clinical assessment. Due to the slow growth of parotid lesions, close observation was decided with periodic clinical and radiological monitoring.OutcomesCurrently, the patient demonstrates a stable disease by clinical evaluation.LessonsTo the best of our knowledge, reported cases of WT concomitant with MCL are very rare. This case highlights the importance of a comprehensive assessment of the lymphoid stroma of WT to avoid missed diagnosis of a lymphoma component in a collision tumor.

“The correlation between histopathological pattern and surgical treatment for palatal pleomorphic adenoma. Can we choose a more conservative approach?”

Pleomorphic adenoma (PA) is the most prevalent benign salivary gland tumor. Although rare, among the minor salivary glands, palatal PA exhibits the highest incidence. Unlike other benign tumors, PA infiltrates the surrounding tissues, posing challenges for complete removal through conservative measures. Surgeons often resort to aggressive surgical procedures involving resection of adjacent tissue to ensure clear margins and prevent recurrence.This study aims to analyze diverse histological characteristics of palatal PA, seeking statistical correlations for early prediction of tumor aggressiveness. The goal is to facilitate the preservation of the periosteum during surgical resection and attain conservative surgical margins. A retrospective histopathological investigation encompassed 18 patients diagnosed with palatal PA who underwent surgical treatment at Hadassah Medical Centre, Jerusalem, Israel. Evaluated parameters included tumor size, pseudocapsule thickness, tumor-periosteum distance, and the presence of pseudopodia and satellite nodules indicating tumor penetration. Statistical significance was set at P < 0.05.Tumors of varying sizes, whether large or small, lack consistent features. Neither tumor size, pseudocapsule thickness, nor tumor-periosteum distance displayed correlations with tumor penetration features. Palatal PA exhibits varied histological attributes impacting surgical technique. The absence of correlations among these attributes impedes early prediction of tumor aggressiveness, casting doubt on periosteum preservation. The periosteum is sufficiently robust to contain the tumor and should be excised. There is no data to support either ostectomy or a through-and-through surgical resection as part of the treatment.

Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) (Milan IVB) and Its Subgroups: A Multi-Institutional Analysis of Risk of Neoplasm and Malignancy.

Fine needle aspiration (FNA) plays a crucial role in their initial assessment of salivary gland neoplasms. In the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), the category of Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP) categorizes lesions with ambiguous features. This study aims to investigate the risk of neoplasm (RON) and risk of malignancy (ROM) within different subgroups of SUMP lesions using data from three large academic institutions. We analyzed salivary gland (FNA) cases from three academic institutions post-MSRSGC implementation. Salivary gland FNA cases categorized as Milan IVB (SUMP) with subsequent surgical pathology follow-up were analyzed. Cases were divided into basaloid, oncocytic, and clear cell SUMP subtypes, with RON and ROM assessed and compared. Out of 1377 MSRSGC cases, 231 were SUMP (16.8%), with 101 subjected to surgical pathology follow-up. The overall ROM for SUMP was 20.8%, with variations of 10% to 29.5% observed amongst institutions, but no significant difference was observed among three institutions (p = 0.15). Basaloid and oncocytic SUMP displayed 17.1% and 20.5% ROM, respectively, without significant disparity. However, all clear cell SUMP cases were malignant on surgical resection. This study highlights the variability in ROM for SUMP lesions and the significantly higher ROM in SUMP cases with clear cell features. These findings emphasize the importance of accurately subcategorizing SUMP lesions, particularly those with clear cell features, for appropriate clinical management.

Disparities in pediatric parotid cancer treatment and presentation: A National study

ObjectivesAlthough parotid gland malignancies are uncommon, they nevertheless represent a cause of morbidity and mortality in the pediatric population. Few studies have sought to identify disparities related to their presentation, treatment, and survival. There is a need to understand these variations to improve care for historically underrepresented groups. Study designRetrospective Cohort Study. SettingSurveillance, Epidemiology, and End Results (SEER) Program Database. MethodsAnalysis of pediatric patients with parotid gland malignancies between 2000 and 2019. Race and ethnicity were classified as Non-Hispanic White, Non-Hispanic Black, Asian, and Hispanic for multivariable analysis. Outcomes included tumor size and stage at diagnosis, survival, and need for facial nerve sacrifice. Kaplan-Meier analysis was used to analyze survival. Multivariable logistic regression was conducted to identify predictors of outcomes. Results149 patients met the criteria for inclusion. Stratified by race/ethnicity, Non-Hispanic Black (Median 23 mm, IQR 15–33), Asian (30 mm, 14–32), and Hispanic (23 mm, 20–28) patients had larger tumors at presentation than Non-Hispanic White patients (18 mm, 12–25, p = 0.017). Disease-specific survival differed by time-to-treatment (log-rank, p = 0.01) and overall survival differed by income (p < 0.001). On multivariable analysis, Hispanic patients were more likely to experience facial nerve sacrifice (OR 3.71, 95%CI 1.25–11.6, p = 0.020), and Non-Hispanic Black (OR 3.37, 0.95–11.6, = 0.053) and Asian (OR 5.67, 1.46–22.2, p = 0.011) patients presented with larger tumors compared to Non-Hispanic White patients. ConclusionsVariations in presentation and treatment exist across race and ethnicity in pediatric parotid cancer. Identifying these disparities may help improve access and outcomes for underserved patient populations. Level of evidenceIII.

A Retrospective Cytomorphologic Analysis of Salivary Gland Fine Needle Aspirates Classified as Salivary Gland Neoplasm of Uncertain Malignant Potential: A 6-year Institutional Experience.

The Milan System for Reporting Salivary Gland Cytopathology is an effective reporting system for salivary gland fine needle aspirations with well-established risks of malignancy. Salivary gland neoplasm of uncertain malignant potential (SUMP) comprises a heterogenous group of lesions which have features that can be recognized as at least neoplastic but preclude further classification into benign or malignant. In this study, we reviewed the cytomorphologic features of salivary gland fine needle aspirations diagnosed as SUMP at our institution (over the past 6 years) and correlated those with the final diagnosis on surgical follow up. A retrospective search was performed to identify cases classified as SUMP at our institution from January 2018 to February 2024. Cytology slides were reviewed, and cases were subclassified based on key cytomorphologic features into the following categories: (1) basaloid, (2) oncocytic, (3) with clear cell features and (4) mixed features (myoepithelial/oncocytoid/squamoid features). Histologic diagnosis was recorded if available. A total of 36 cases of SUMP were identified; 31/36 had surgical follow up; final diagnosis included 22 benign lesions (2 non-neoplastic and 20 benign neoplasms), and nine malignant lesions. The overall risk of neoplasm and risk of malignancy were 93.5% and 29% respectively, with the oncocytic sub-category recording the highest ROM (42.8%). Mucoepidermoid carcinoma was the most common malignant diagnosis and pleomorphic adenoma the most common benign diagnoses. Our study supports the subclassification of SUMP lesions based on key cytomorphologic features, thereby aiding in refining this ambiguous entity and providing a precise risk assessment.

Comparison of Peptidomes Extracted from Healthy Tissue and Tumor Tissue of the Parotid Glands and Saliva Samples.

Salivary gland tumors are highly variable in clinical presentation and histology. The World Health Organization (WHO) classifies 22 types of malignant and 11 types of benign tumors of the salivary glands. Diagnosis of salivary gland tumors is based on imaging (ultrasound, magnetic resonance imaging) and fine-needle aspiration biopsy, but the final diagnosis is based on histopathological examination of the removed tumor tissue. In this pilot study, we are testing a new approach to identifying peptide biomarkers in saliva that can be used to diagnose salivary gland tumors. The research material for the peptidomic studies was extracts from washings of neoplastic tissues and healthy tissues (control samples). At the same time, saliva samples from patients and healthy individuals were analyzed. The comparison of the peptidome composition of tissue extracts and saliva samples may allow the identification of potential peptide markers of salivary gland tumors in patients' saliva. The peptidome compositions extracted from 18 tumor and 18 healthy tissue samples, patients' saliva samples (11 samples), and healthy saliva samples (8 samples) were analyzed by LC-MS tandem mass spectrometry. A group of 109 peptides was identified that were present only in the tumor tissue extracts and in the patients' saliva samples. Some of the identified peptides were derived from proteins previously suggested as potential biomarkers of salivary gland tumors (ANXA1, BPIFA2, FGB, GAPDH, HSPB1, IGHG1, VIM) or tumors of other tissues or organs (SERPINA1, APOA2, CSTB, GSTP1, S100A8, S100A9, TPI1). Unfortunately, none of the identified peptides were present in all samples analyzed. This may be due to the high heterogeneity of this type of cancer. The surprising result was that extracts from tumor tissue did not contain peptides derived from salivary gland-specific proteins (STATH, SMR3B, HTN1, HTN3). These results could suggest that the developing tumor suppresses the production of proteins that are essential components of saliva.

Pleomorphic adenoma in an adolescent, about a clinical case

Introduction: salivary gland tumors in children represent a low percentage of pediatric head and neck tumors; most of them are diagnosed in association with the Parotid salivary gland and present a higher proportion of malignancy than in adults. Objective: to present a case with a diagnosis of Pleomorphic Adenoma: clinical symptoms, complementary examinations, treatment and evolution. Case presentation: female patient, 13 years old, from a rural background and white race, attended the Maxillofacial Surgery consultation, in good general condition, accompanied by her parents, due to an increase in volume of a hard consistency, not fixed to deep planes ( mobile), asymptomatic, of 7 months of evolution and 3 cm in length located in the left parotid region. Ultrasound of soft tissues and neck was indicated, as well as contrast-enhanced facial mass tomography, which showed a mass in relation to the left parotid gland that captured contrast. In addition, complementary examinations and a fine needle aspiration biopsy (FNAB) were performed, resulting in a benign parotid gland tumor (Pleomorphic Adenoma). Superficial parotidectomy was performed with preservation of the facial nerve. The patient progressed satisfactorily and continues to be followed up by consultation. Conclusions: pleomorphic adenomas are discovered in practice as slowly growing asymptomatic masses; the size is variable and will always depend on the stage at which it is detected.

Machine Learning on Ultrasound Texture Analysis Data for Characterizing of Salivary Glandular Tumors: A Feasibility Study.

Objective quantitative texture characteristics may be helpful in salivary glandular tumor differential diagnosis. This study uses machine learning (ML) to explore and validate the performance of ultrasound (US) texture features in diagnosing salivary glandular tumors. 122 patients with salivary glandular tumors, including 71 benign and 51 malignant tumors, are enrolled. Representative brightness mode US pictures are selected for further Gray Level Co-occurrence Matrix (GLCM) texture analysis. We use a t-test to test the significance and use the receiver operating characteristic curve method to find the optimal cut-point for these significant features. After splitting 80% of the data into a training set and 20% data into a testing set, we use five machine learning models, k-nearest Neighbors (kNN), Naïve Bayes, Logistic regression, Artificial Neural Networks (ANNs) and supportive vector machine (SVM), to explore and validate the performance of US GLCM texture features in diagnosing salivary glandular tumors. This study includes 49 female and 73 male patients, with a mean age of 53 years old, ranging from 21 to 93. We find that six GLCM texture features (contrast, inverse difference movement, entropy, dissimilarity, inverse difference and difference entropy) are significantly different between benign and malignant tumors (p < 0.05). In ML, the overall accuracy rates are 74.3% (95%CI: 59.8-88.8%), 94.3% (86.6-100%), 72% (54-89%), 84% (69.5-97.3%) and 73.5% (58.7-88.4%) for kNN, Naïve Bayes, Logistic regression, a one-node ANN and SVM, respectively. US texture analysis with ML has potential as an objective and valuable tool to make a differential diagnosis between benign and malignant salivary gland tumors.

Outcome-oriented clinicopathological reappraisal of sinonasal adenoid cystic carcinoma with broad morphological spectrum and high MYB::NFIB prevalence

Adenoid cystic carcinoma (AdCC) is a salivary gland neoplasm that infrequently appears in the sinonasal region. The aim of this study was to evaluate the outcome and clinicopathological parameters of sinonasal AdCC. A retrospective analysis was conducted on all cases of AdCC affecting the nasal cavity or paranasal sinuses between 2000 and 2018 at the University Hospital Zurich. Tumor material was examined for morphological features and analyzed for molecular alterations. A total of 14 patients were included. Mean age at presentation was 57.7 years. Sequencing revealed MYB::NFIB gene fusion in 11/12 analyzable cases. Poor prognostic factors were solid variant (p < 0.001), histopathological high-grade transformation (p < 0.001), and tumor involvement of the sphenoid sinus (p = 0.02). The median recurrence-free survival (RFS) and OS were 5.2 years and 11.3 years. The RFS rates at 1-, 5-, and 10-year were 100%, 53.8%, and 23.1%. The OS rates at 1-, 5-, and 10- years were 100%, 91.7%, and 62.9%, respectively. In Conclusion, the solid variant (solid portion > 30%), high-grade transformation, and sphenoid sinus involvement are negative prognostic factors for sinonasal AdCC. A high prevalence of MYB::NFIB gene fusion may help to correctly classify diagnostically challenging (e.g. metatypical) cases.

Update of newly-recognized salivary gland neoplasms: molecular and immunohistochemical findings and clinical importance.

With the advancement of molecular testing and the routine use of immunohistochemical stains, salivary gland tumours previously categorized as adenoma or adenocarcinoma, not otherwise specified, are being reclassified with distinct diagnoses. Newly recognized benign entities include: sclerosing polycystic adenoma, keratocystoma, intercalated duct hyperplasia and adenoma, and striated duct adenoma. Newly recognized malignant salivary gland tumours include: microsecretory adenocarcinoma, sclerosing microcytic adenocarcinoma, and mucinous adenocarcinoma. Additionally, rare subtypes of mucoepidermoid carcinoma have been described, including Warthin-like and oncocytic. Understanding of intraductal carcinoma continues to evolve. Correctly distinguishing these lesions from mimickers can be crucial for appropriate patient care and prognostication, as well as future conceptualization of salivary disease.

Anlotinib reversed resistance to PD-1 inhibitors in recurrent and metastatic head and neck cancers: a real-world retrospective study

Patients with recurrent or metastatic head and neck cancers (R/M HNCs) are prone to developing resistance after immunotherapy. This retrospective real-world study aims to investigate whether the addition of anlotinib can reverse resistance to PD-1 inhibitors (PD-1i) and evaluate the efficacy and safety of this combination in R/M HNCs. Main outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), duration of response (DOR), and safety. Potential biomarkers included PD-L1 expression, lipid index, and genomic profiling. Twenty-one patients with R/M HNCs were included, including 11 nasopharyngeal carcinoma (NPC), five head and neck squamous cell carcinoma (HNSCC), three salivary gland cancers (SGC), and two nasal cavity or paranasal sinus cancers (NC/PNC). Among all patients, ORR was 47.6% (95% CI: 28.6–66.7), with 2 (9.5%) complete response; DCR was 100%. At the median follow-up of 17.1 months, the median PFS and OS were 14.3 months (95% CI: 5.9-NR) and 16.7 months (95% CI:8.4-NR), respectively. The median DOR was 11.2 months (95% CI: 10.1-NR). As per different diseases, the ORR was 45.5% for NPC, 60.0% for HNSCC, 66.7% for SGC, and 50.0% for NC/PNC. Most treatment-related adverse events (TRAEs) were grade 1 or 2 (88.9%). The most common grades 3–4 TRAE was hypertension (28.6%), and two treatment-related deaths occurred due to bleeding. Therefore, adding anlotinib to the original PD-1i could reverse PD-1 blockade resistance, with a favorable response rate, prolonged survival, and acceptable toxicity, indicating the potential as a second-line and subsequent therapy choice in R/M HNCs.

Assessment of hepatitis c core antigen in epithelial salivary gland neoplasms (ex-vivo study)

BackgroundSalivary gland neoplasms (SGNs) pose a challenge to both pathologists and clinicians. Despite research, the etiology of these neoplasms remains unclear. This study aimed to identify any potential association between the presence of hepatitis C virus (HCV) at the protein or gene level and epithelial salivary gland neoplasms.MethodsFormalin-fixed paraffin-embedded (FFPE) blocks of epithelial salivary gland neoplasms were retrieved from the archives of the Oral and Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University within the 5-year period from 2016 to 2020. Immunohistochemistry was used to assess HCV core antigen, while reverse transcription polymerase chain reaction was employed for the evaluation of HCV RNA.ResultsA total of 44 specimens were collected, 28 of which were benign neoplasms and 16 were malignant neoplasms. There was a statistically significant difference in HCV positivity between the two groups (P-value = 0.036). Benign tumors showed a statistically significant lower percentage of positive cases than malignant tumors. The localization of staining was also evaluated, revealing various patterns of HCV core antigen expression, including diffuse cytoplasmic, patchy cytoplasmic, nuclear, and a combination of nuclear and cytoplasmic expression. There was no statistically significant difference between the expression patterns in benign and malignant tumors (P-value = 0.616). Given that Pleomorphic Adenoma and Mucoepidermoid Carcinoma were the predominant tumor types in this study, four cases were selected for RNA detection. HCV RNA was detected in all cases using RT-PCR.ConclusionsHCV core antigen is frequently detected in SGNs and is suggested to be a potential risk factor for the development of these neoplasms. Further studies are required to discover other biomarkers, their roles, and the pathways associated with HCV in SGNs.

Application of the Milan System for Reporting Salivary Gland Cytopathology with Histopathological Correlation

Background: Fine-needle aspiration (FNA) is widely accepted as an efficient first line diagnostic of salivary gland lesions.Intratumoral heterogeneity and morphological overlap existing between salivary gland tumors makes it rigorous andchallenging in the diagnosis by FNA. The Milan System for Reporting Salivary Gland Cytopathology (TMSRSGC) is a tieredrisk-stratification scheme designed to standardize reporting and facilitate decision making. The objective of this study is toevaluate the efficacy of The Milan system for reporting salivary gland cytopathology with histopathological correlation.Method: A prospective study of salivary gland cytology was performed over a 1-year period at Department of PathologyBPKIHS. Cases were categorized as per the MSRSGC and histopathological correlation was obtained. The risk ofmalignancy were calculated for all diagnostic categories.Result: A total of 30 salivary gland cytology with histopathological follow up were evaluated. FNA had a sensitivity,specificity, diagnostic accuracy, PPV and NPV of 72.7%, 100%, 88.88%, 100% and 84.2% respectively. Good agreementwas seen between cytological and histopathological diagnosis.Conclusion: The Milan System for Reporting Salivary Gland Cytopathology provides an effective standardizeddiagnostic framework which aids in better clinicopathological communication and improves the quality, clarity as well asreproducibility of cytological diagnosis of salivary gland lesions.

Overview of Salivary Gland Tumors of General Hospitals in Iraq Over 8-Years

Overview of Salivary Gland Tumors of General Hospitals in Iraq Over 8-Years