Salivary Gland-type Tumors Research Articles

Basal cell adenoma of the salivary glands.

AbstractBasal cell adenoma is an unusual type of salivary gland tumor which has only recently been classified as a separate entity. Four cases are presented. Three were discovered by reviewing a series of adenoid cystic carcinomas and mixed tumors, and one was diagnosed originally. Three cases involved the parotid; one, the submaxillary gland. There was no facial nerve involvement in any case. Treatment was local excision. Follow‐up from two to nine years revealed no recurrence. The lesions typically are slow growing, firm, non‐tender, asymptomatic masses present for several years before treatment. The average age of the patients is generally older than those with mixed tumors. They are most often found in the parotid gland, but have been reported from the submaxillary and minor salivary glands of the upper lip, cheek, and palate. Microscopically the tumor consists of monomorphic basaloid cells with an absence of myoepithelial cells. Myoepithelial cells play an important role in salivary gland tumors. Their range of activity and products determine to a certain degree the morphology of adenoid‐cystic and mixed tumors. They resemble muscle cells as demonstrated by electron microscopy studies and also by functioning as contractile elements. The cell of origin is unknown. The tumors may closely resemble adenoid cystic carcinoma and mixed tumors; therefore, diagnostic and therapeutic questions may arise. The tumors are benign. No malignancy has been reported. The lesions can be unencapsulated; therefore, the best treatment is adequate local excision rather than enucleation, tumor may contribute more knowledge concerning the histogenesis of certain salivary gland tumors.With increased awareness and acceptance of this lesion as a separate entity by pathologists, we perhaps can expect an increase in its diagnosis.As otolaryngologists we should have a thorough knowledge of its clinicopathology in terms of clinical presentation, pathology, treatment, and prognosis.

Salivary gland tumors in the parotid gland, submandibular gland and the palate region

The relative incidence of the different types of salivary gland tumors and their prognoses has been shown to vary with the location in a study of 2,867 patients with tumors in the parotid gland, submandibular gland, and the palate region. After histologic reexamination and reclassification, 2,513 of the 2,867 tumors were classified as salivary gland tumors. The incidence of salivary gland tumors was strikingly high in the parotid gland, i.e., about twelve times more common in the parotid gland than in the submandibular gland. In all sites there was a striking predominance of pleomorphic adenoma, which altogether comprised 74% of the salivary gland tumors in the present series; the second largest group, mucoepidermoid carcinoma, only comprised 5%. The incidence of malignant salivary gland tumors was twice as high in the submandibular gland than in the parotid gland, but it was highest in the palate region. The prognosis for a given type of malignant tumor was most favorable when the primary tumor was located in the palate region, less favorable when it was in the parotid gland, and least favorable in the submandibular gland.

Salivary gland tumors in the parotid gland, submandibular gland, and the palate region.

The relative incidence of the different types of salivary gland tumors and their prognoses has been shown to vary with the location in a study of 2,867 patients with tumors in the parotid gland, submandibular gland, and the palate region. After histologic reexamination and reclassification, 2,513 of the 2,867 tumors were classified as salivary gland tumors. The incidence of salivary gland tumors was strikingly high in the parotid gland, i.e., about twelve times more common in the parotid gland than in the submandibular gland. In all sites there was a striking predominance of pleomorphic adenoma, which altogether comprised 74% of the salivary gland tumors in the present series; the second largest group, mucoepidermoid carcinoma, only comprised 5%. The incidence of malignant salivary gland tumors was twice as high in the submandibular gland than in the parotid gland, but it was highest in the palate region. The prognosis for a given type of malignant tumor was most favorable when the primary tumor was located in the palate region, less favorable when it was in the parotid gland, and least favorable in the submandibular gland.

ADENOCARCINOMA OF THE NASOPHARYNX.

In most series of malignant tumors of the nasopharynx that have been reported (1, 3–8, 11–14, 16, 17), adenocarcinomas represent less than 5 per cent of the total number of cases. Despite the recognized high incidence of neoplasms of the nasopharynx among the Chinese and Indonesians (2, 8, 18) adenocarcinoma is almost unknown in these groups. The biologic behavior of adenocarcinoma in its response to irradiation varies from the more common histologic types of nasopharyngeal cancer. The disease frequently persists at the primary site, and the patients die of extension into the skull and brain. Radiation therapists must be aware of these differences and, hence, of the radiotherapeutic approach to the disease. From the evidence in the literature, adenocarcinoma of the nasopharynx is seldom cured (1, 3–8, 11–14, 16, 17). Cures have nevertheless been reported when the radiation dose is carried to a high level within the nasopharynx (10, 14, 15). A twelve-year survival after surgical removal has also been recorded (9). Between 1932 and 1960, 124 patients with malignant tumors of the nasopharynx were treated at the University of California Medical Center (San Francisco) in the Section of Therapeutic Radiology. Of these, 35 survived five years (28.2 per cent). Tumors treated between 1932 and 1954 were the subject of an earlier report (16). Three of the malignant lesions in the 124 patients were adenocarcinomas, representing 2.4 per cent of the group (Table I). This percentage is in agreement with other published series (1, 3–8, 11–14, 16, 17). Of interest was the absence of adenocarcinoma of the nasopharynx in the 26 Chinese patients in this series. The glandular tissue of the nasopharynx may give rise to adenocarcinoma or to tumors of salivary gland type. Of the 3 adenocarcinomas, 1 was of a salivary pattern. The indolent behavior of salivary gland tumors is well known. Many of the nasopharyngeal adenocarcinomas of nonsalivary type also display a slowly progressing course. In 2 of the 3 patients, the presenting sign of bloody postnasal discharge preceded the appearance of lymphadenopathy. In the other patient, numbness of the palate was the presenting symptom. In all 3, the disease was histologically identified from a biopsy of the primary site rather than from lymph nodes. In 1 patient, nodes were not present on admission nor did they appear before death, approximately two years after completion of radiation therapy. In this patient, the roentgenogram gave evidence of erosion of the base of the skull, which was not noted in the other 2 cases. None of the 3 patients survived five years. The disease was far advanced in 2, with erosion of the base of the skull in 1 and bilateral lymphadenopathy in the other. In both of these advanced cases, the primary tumor healed after radiation therapy.

Epithelial tumors of the lacrimal gland A comparison of the pathologic and clinical behavior with those of the salivary glands

Abstract Considering the present state of knowledge of the histologic variations of epithelial tumors of the salivary glands in relation to their clinical course, the present concepts of the nature and behavior of similar tumors in the lacrimal gland, as gathered from the literature, are most inadequate. A series of 116 cases of epithelial tumors of the lacrimal gland was studied histologically. The histopathologic features as found in this series were considered to be identical to those found by Foote and Frazell [6] in the salivary glands. Benign mixed tumors were the most frequent (58.6 per cent), as compared to 80 per cent in the parotid gland. Thirty-three per cent of the lacrimal lesions were carcinomas as compared with 10 per cent in the parotid gland. Adenoid cystic carcinoma was the most frequent (25 per cent), whereas, the remainder were about equally divided between malignant mixed tumors (8.6 per cent) and other carcinomas (7.8 per cent). Other types of salivary gland tumors were not found in the lacrimal gland. The adenoid cystic variety of carcinoma is much more common in the lacrimal gland than in the parotid gland (ratio of 1:2.7 in the lacrimal gland and 1:31 in the parotid gland). However, in the tumors of the other salivary glands, as well as those in the mouth and pharynx, this ratio was found to be similar. The differences in the clinical characteristics in the two areas are chiefly because of the anatomic location. The lacrimal gland tumors tend to give more obvious clinical findings and tend to be attacked surgically earlier. In both areas the malignant tumors have significantly more rapid and often fatal clinical courses. In both areas the benign mixed tumors are truly benign, no deaths were reported in the Foote and Frazell series and only one from locally infiltrative growth in the present series of lacrimal gland lesions. These tumors do tend to recur with invasive growth in both sites if not completely removed. Characteristically, these tumors often recur years after the initial removal. The recurrence rate is higher in the present series than in the Foote and Frazell series (23 per cent versus 4.2 per cent) probably because of the more difficult surgical approach and a resultant higher percentage of incomplete removal. In both areas the carcinomas have a poor prognosis with high mortality. The prognosis of carcinoma of the lacrimal gland seems to be poorer than that in the parotid glands, not only because of the more difficult surgical approach, but also because of the higher frequency of adenoid cystic carcinoma. Another factor in the poorer prognosis is the great tendency of lacrimal gland tumors, both benign and malignant, to invade the bone of the lacrimal fossa. The management of these lesions in both sites is surgical excision. Simple excision is usually adequate for the benign mixed tumor, if care is taken to resect all of the capsule. In patients with diffuse invasive benign tumors, wider excision must be done. In all carcinomas of the lacrimal gland and in repeated infiltrative recurrences, exenteration of the orbit is indicated. If bony infiltration is present, resection of the frontal bone must be done.

Epithelial tumors of the lacrimal gland: A comparison of the pathologic and clinical behavior with those of the salivary glands

Considering the present state of knowledge of the histologic variations of epithelial tumors of the salivary glands in relation to their clinical course, the present concepts of the nature and behavior of similar tumors in the lacrimal gland, as gathered from the literature, are most inadequate. A series of 116 cases of epithelial tumors of the lacrimal gland was studied histologically. The histopathologic features as found in this series were considered to be identical to those found by Foote and Frazell [6] in the salivary glands. Benign mixed tumors were the most frequent (58.6 per cent), as compared to 80 per cent in the parotid gland. Thirty-three per cent of the lacrimal lesions were carcinomas as compared with 10 per cent in the parotid gland. Adenoid cystic carcinoma was the most frequent (25 per cent), whereas, the remainder were about equally divided between malignant mixed tumors (8.6 per cent) and other carcinomas (7.8 per cent). Other types of salivary gland tumors were not found in the lacrimal gland. The adenoid cystic variety of carcinoma is much more common in the lacrimal gland than in the parotid gland (ratio of 1:2.7 in the lacrimal gland and 1:31 in the parotid gland). However, in the tumors of the other salivary glands, as well as those in the mouth and pharynx, this ratio was found to be similar. The differences in the clinical characteristics in the two areas are chiefly because of the anatomic location. The lacrimal gland tumors tend to give more obvious clinical findings and tend to be attacked surgically earlier. In both areas the malignant tumors have significantly more rapid and often fatal clinical courses. In both areas the benign mixed tumors are truly benign, no deaths were reported in the Foote and Frazell series and only one from locally infiltrative growth in the present series of lacrimal gland lesions. These tumors do tend to recur with invasive growth in both sites if not completely removed. Characteristically, these tumors often recur years after the initial removal. The recurrence rate is higher in the present series than in the Foote and Frazell series (23 per cent versus 4.2 per cent) probably because of the more difficult surgical approach and a resultant higher percentage of incomplete removal. In both areas the carcinomas have a poor prognosis with high mortality. The prognosis of carcinoma of the lacrimal gland seems to be poorer than that in the parotid glands, not only because of the more difficult surgical approach, but also because of the higher frequency of adenoid cystic carcinoma. Another factor in the poorer prognosis is the great tendency of lacrimal gland tumors, both benign and malignant, to invade the bone of the lacrimal fossa. The management of these lesions in both sites is surgical excision. Simple excision is usually adequate for the benign mixed tumor, if care is taken to resect all of the capsule. In patients with diffuse invasive benign tumors, wider excision must be done. In all carcinomas of the lacrimal gland and in repeated infiltrative recurrences, exenteration of the orbit is indicated. If bony infiltration is present, resection of the frontal bone must be done.

Mixed tumors of the palate.

James Paget was first to draw attention to mixed tumors outside of major salivary glands, in 1851. Since this time, mixed tumors have been reported to arise from numerous areas: eyebrow, cheek, pharyngeal wall, tongue, and even in distant areas such as leg and hand, but these are most exceptional sites of origin. Outside major salivary glands, they are, by far, commoner in upper respiratory tree; Hayes Martin has stated that the palate is site of origin of a greater percentage of benign mixed tumors of salivary gland type, than any other structure of head and neck, except parotid salivary gland. Cordray reported that in 61 cases of mixed tumors seen during a period of 10 years, at tumor clinic of Massachusetts Eye and Ear Infirmary, 7 were in palate. Owens, reviewing literature over a period

Tumors of salivary gland origin presenting as primary jaw tumors

Two cases of malignant mixed tumors of salivary gland type presenting as primary jaw tumors are discussed.

Salivary gland type tumors of the head and neck.

Salivary gland type tumors of the head and neck.

Mixed tumor of the palate

A case of an unusual type of mixed tumor of salivary gland type of the palate has been presented, with the surgical technique and a discussion of the histopathology.

Papillary cystadenoma lymphomatosum.

PAPILLARY cystadenoma lymphomatosum is a relatively rare type of salivary gland tumor. It may be grouped roughly among the benign mixed tumors of the salivary glands but is so distinctive in its microscopic appearance that a special niche has been made for it. Because of the rarity of these tumors, one is inclined to dismiss them as pathological curiosities. However, when the surgeon is confronted with a patient with such a diagnosis, knowledge of the pathology, treatment, and prognosis are of paramount importance. We have had the opportunity to see two of these tumors within a period of four months, and these serve as the basis for this report. REPORT OF CASES Case 1 .—A 56 year old white man entered the hospital for evaluation of low back pain. An incidental finding was a firm, nontender tumor below the posterior part of the right mandible. The mass had been present

Adenoma of the Parotid Salivary Gland: Onkocyte Tumor

Among the neoplastic diseases of the parotid gland, tumors of the so-called mixed salivary gland type predominate. The histogenesis of these peculiar new growths has been a topic of unremitting discussion, the derivation of the various cell and tissue complexes which compose their histologic pattern still being explained by a number of divergent theories. Some authors believe these growths to be true mixed tumors originating from pluripotent embryonic cells of branchial rests (Cohnheim); others sponsor a theory of mesenchymal-endothelial origin, while still others explain them as epiblastic tumors, i.e. as adenomas of the glandular epithelium. In this latter case the so-called stroma is regarded as the product of an inverted secretory activity of the tumor cells (Masson), or as due to metaplasia of the neoplastic epithelium (Ehrich), or, in accordance with the suggestion of Stein and Geschickter (1), as the result of the inclusion of primitive connective tissue within the neoplasm at an early stage of its development. Benign tumors of the parotid gland without a stroma, so characteristic of these mixed tumors, are apparently uncommon. McFarland (2) found in his series of 151 benign parotid tumors only one in which the stroma was entirely lacking. In view of the great variability of the histologic pattern of these neoplasms, however, he hesitated to classify this single, apparently purely epithelial tumor, as a true adenoma, and suggested that most, if not all, so-called adenomas of the parotid gland are mixed tumors in which all other tissue elements have been supplanted by cells of the epithelial type.