Salivary Tumors Research Articles

Role of Chlorhexidine and Herbal Oral Rinses in Managing Periodontitis

The aim of this research was to assess the effect of 0.12% chlorhexidine (CHX) and a Salvadora persica-based mouthwash on whole salivary tumour necrosis factor-alpha (TNF-α) levels and periodontal inflammation in patients with type 2 diabetes mellitus (T2DM). Patients with and without medically diagnosed T2DM were included. Patients' medical records were evaluated to confirm the diagnosis of T2DM. All patients underwent nonsurgical periodontal therapy (NSPT). Patients were divided into 2 subgroups. In the test and control group, patients were advised to rinse with an S persica-based mouthwash and a non-alcoholic 0.12% CHX after NSPT twice daily for 2 weeks, respectively. Demographic data were collected. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were measured, and whole salivary TNF-α levels were gauged at baseline and at 3-month follow-up. Haemoglobin A1c (HbA1c) levels were measured in all patients at baseline and at 3-month follow-up. Sample size estimation was done, and group comparison was performed. Level of significance was set at P < .01. Twenty-one nondiabetic individuals and 21 patients with T2DM were included. At baseline, there was no significant difference in clinical and radiographic periodontal parameters amongst in patients with and without T2DM. At 3-month follow-up, HbA1c, TNF-α, PI, PD, and clinical AL were comparable with their respective baseline values in the test and control groups amongst patients with T2DM. In nondiabetic individuals, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01), and TNF-α (P < .01) at 3-month follow-up in the test and control groups compared with their respective baseline scores. In the short term, NSPT with 0.12% CHX or S persica-based mouthwashes is more effective in reducing periodontal inflammation and whole salivary TNF-α levels in nondiabetic individuals than in patients with T2DM with periodontal inflammation.

Polymorphous adenocarcinoma of the breast: A case report

We report a patient with polymorphous adenocarcinoma of the breast. Polymorphous adenocarcinoma of the breast is a rare tumour that corresponds to polymorphous adenocarcinoma in the salivary gland. The tumour consisted of a unimorphous population of one type of neoplastic cells with hyperchromatic, pleomorphic nuclei. Neoplastic cells were arranged in various architectural patterns including solid pattern, trabecular pattern and single “Indian-file“ arrangement with myxoid stroma in between. Tumour cells were negative for Estrogen, Progesterone, Her-2/neu, Smooth Muscle Actin, Cytokeratin 5/6, Cytokeratin 7, Synaptophysin and Chromogranin, while Cytokeratin AE1/AE3 (Pankeratin), BCL2 and E-cadherin were positive and p63 partially positive. Polymorphous adenocarcinoma is a rare and salivary gland-type tumour with only three cases reported up to date. To the best of our knowledge this is the fourth case of a polymorphous adenocarcinoma of the breast reported in the english literature.

The Milan System for Reporting Salivary Gland Cytopathology.

Our study assesses whether the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) offers any benefit over the original cytology classification, and measures interobserver agreement. Four cytopathologists retrospectively blindly classified preoperative cytology by MSRSGC from 101 resected salivary tumors. Consensus MSRSGC diagnoses were correlated with surgical pathology diagnoses and compared with the original cytology classification. Diagnostic parameters were calculated for both systems. Interobserver variability was assessed. The original cytology classification vs MSRSGC had sensitivity, specificity, positive predictive value, and negative predictive value of 75.0% vs 78.3%, 97.1% vs 98.0%, 91.2% vs 94.7%, and 90.1% vs 90.0%, respectively. The original cytology classification risk of neoplasm (RON) was 91.7% for "negative for malignancy" and 100.0% for other categories. The MSRSGC RON was 71.4% in category II (nonneoplastic) and 100.0% in all other categories. The original cytology classification risk of malignancy (ROM) ranged from 0.0% for "atypical" to 100.0% for "positive for malignancy." The MSRSGC ROM ranged from 0.0% in categories I (nondiagnostic) and III (nonneoplastic) to 100.0% in category VI (malignant). Weighted agreement using the MSRSGC was 92% (Gwet AC1, 0.84); unweighted agreement was 69% (Gwet AC1, 0.64). MSRSGC category IVA (benign neoplasm) was most likely to show interobserver agreement, with complete agreement in 67% of cases. The MSRSGC performs similarly to the original cytology classification and shows relatively high interobserver agreement.

NKX3.1 Expression in Salivary Gland "Intraductal" Papillary Mucinous Neoplasm: A Low-Grade Subtype of Salivary Gland Mucinous Adenocarcinoma.

Salivary gland intraductal papillary mucinous neoplasm (SG IPMN) is a recently proposed entity characterized by a papillary-cystic proliferation of mucin-producing cells. Because of overlapping histologic features and a clonal AKT1 p.E17K variant, SG IPMN has been presumed to be a precursor or a low-grade subtype of mucinous adenocarcinoma. NKX3.1 is a tumor suppressor gene located on chromosome 8p and is a known immunohistochemical marker of prostate epithelium and mucinous acinar cells of the intraoral salivary glands. We retrieved 12 SG IPMN cases, and performed histologic and genetic analysis. Given the association of SG IPMN with mucinous acinar cells, we also investigated the performance of NKX3.1 as a marker of this tumor entity. Diffuse and strong NKX3.1 expression was observed in all SG IPMN cases (12/12, 100%) as well as in normal mucinous acinar cells. In contrast, mucoepidermoid carcinoma and pancreatic IPMN cases as well as normal serous acinar cells were negative for NKX3.1. Genetically, 11 of 12 cases (92%) harbored an AKT1 p.E17K variant. A novel PTEN frameshift deletion (p.G36Dfs*18) was detected in the other single case. At least one of the histologic features implying malignant tumors, such as severe cellular atypia, brisk mitotic activity, high Ki-67 proliferating index, lymphovascular invasion, and lymph node metastasis, was detected in 6 SG IPMN cases (50%). The findings suggest that SG IPMN is a low-grade subtype of mucinous adenocarcinoma which may be derived from mucinous acinar cells of the minor salivary gland.

Targeted molecular profiling of salivary duct carcinoma with rhabdoid features highlights parallels to other apocrine and discohesive neoplasms: which phenotype should drive classification?

Salivary duct carcinoma with rhabdoid features (SDC-RF) is a recently-described salivary gland tumor that bears striking histologic similarity to lobular carcinoma of the breast. While this tumor has an apocrine phenotype that supports classification as a variant of SDC, it infrequently arises in association with conventional SDC. Furthermore, discohesive architecture can be seen in non-apocrine salivary carcinomas, raising the possibility that discohesive growth should define a separate entity. In this study, we aimed to perform comprehensive molecular profiling of SDC-RF to better understand its pathogenesis and classification. We documented the clinicopathologic features of 9 cases of SDC-RF and performed immunostains including AR, GCDFP, and e-cadherin on all cases. We also performed targeted next generation sequencing (NGS) panels on 7 cases that had sufficient tissue available. The SDC-RF represented 8 men and 1 woman with a median age of 67 years (range 63-83 years) and included 6 parotid, 2 buccal, and 1 submandibular primary. All tumors were uniformly composed of discohesive cells with abundant eosinophilic cytoplasm; signet-ring cell features were seen in 2 cases. All tumors were also positive for AR (100%) and GCDFP (100%), and 7 tumors (78%) displayed lost or abnormal e-cadherin. NGS highlighted concomitant PIK3CA and HRAS mutations in 4 tumors, with additional cases harboring TP53, PTEN, and AKT1 mutations. Furthermore, CDH1 alterations were seen in 6 cases, including a novel CDH1::CORO7 fusion. Among 5 patients with follow-up available, 3 (60%) developed local recurrence and widespread distant metastasis and died of disease at a median 20 months (range 10-48 months). Overall, our findings confirm frequent CDH1 mutations and e-cadherin inactivation in SDC-RF, similar to discohesive tumors from other sites. We also highlight an apocrine molecular profile similar to conventional SDC. However, occasional AKT1 mutation and signet-ring features suggest SDC-RF may also be related to mucinous adenocarcinoma. As more salivary tumors with discohesive growth are identified, it may become clearer whether SDC-RF should remain in the SDC family or be recognized as a separate entity.

Salivary gland-like breast tumors: A review of diagnostic features and prognosis

Salivary gland-like breast tumors are rare and diagnostic challenging tumors. The tumors show similar histological features and molecular diagnostic alterations to their counterpart in the salivary glands, except for acinic cell carcinomas. Some tumors show a complex epithelial and myoepithelial composition (pleomorphic adenoma, basal cell adenoma, adenomyoepithelioma, and adenoid cystic carcinoma). In contrast, others are predominantly epithelial (polymorphous adenocarcinoma, mucoepidermoid carcinoma, secretory carcinoma, and acinic cell carcinoma). Some tumors are benign, while others are carcinomas of low malignant potential. Occasional cases show high-grade transformation and aggressive behavior, with distant metastases.Despite being triple-negative tumors, they do not require conventional chemotherapy in most instances, except for cases with high-grade histology and metastases. Limited experience exists in metastatic secretory carcinomas with pan-NTRK inhibitor therapy, which is promising.

Distinct clinicopathological and genomic features in solid and basaloid adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (AdCC) of the breast is a rare indolent carcinoma of salivary gland-type tumors, frequently associated with MYB genetic alteration. Solid and basaloid adenoid cystic carcinoma (SB-AdCC) is considered a sparse variant of AdCC. This study sought to search for clinicopathological and genomic features in SB-AdCC. Registered clinicopathological data on a cohort of 13 AdCC of the breast cases, including six conventional adenoid cystic carcinoma (C-AdCC) cases and seven SB-AdCC cases, were collected. MYB gene rearrangement via fluorescent in situ hybridization was investigated and MYB protein expression was evaluated by immunohistochemistry. Compared with C-AdCC, we found that the distribution of SB-AdCC cases were shifted to older age and were more frequently distant metastasis. Moreover, metastasis cases also showed a high (exceed 30%) Ki-67 index. Both groups showed MYB rearrangements and MYB protein expression, but they were less frequent in SB-AdCC than C-AdCC. To conclude, our results suggest that SB-AdCC is an aggressive variant of mammary AdCC with a higher incidence of distant metastases compared with C-AdCC, though they share common molecular features. A high Ki-67 index may be an adverse prognostic factor for metastasis.

29P The molecular landscape of breast mucoepidermoid carcinoma

Mucoepidermoid carcinoma (MEC) of the breast is an extremely rare form of salivary gland-type tumor morphologically characterized by four types of cells (basaloid, intermediate, epidermoid, and mucinous) arranged in solid and cystic patterns. Despite its triple-negative phenotype, breast MECs are reported to have a relatively good clinical behavior. However, no data on their biology and therefore no guidelines for their clinical management are currently available. Here, we sought to characterize the molecular landscape of breast MECs.

Tumor blood flow and apparent diffusion coefficient histogram analysis for differentiating malignant salivary tumors from pleomorphic adenomas and Warthin’s tumors

We aimed to assess the combined diagnostic value of apparent diffusion coefficient (ADC) and tumor blood flow (TBF) obtained by pseudocontinuous arterial spin labeling (pCASL) for differentiating malignant tumors (MTs) in salivary glands from pleomorphic adenomas (PAs) and Warthin’s tumors (WTs). We used pCASL imaging and ADC map to evaluate 65 patients, including 16 with MT, 30 with PA, and 19 with WT. We evaluated all tumors by histogram analyses and compared various characteristics by one-way analysis of variance followed by Tukey post-hoc tests. Diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis. There were significant differences in the mean, 50th, 75th, and 90th percentiles of TBF among the tumor types, in the mean TBFs (mL/100 g/min) between MTs (57.47 ± 35.14) and PAs (29.88 ± 22.53, p = 0.039) and between MTs and WTs (119.31 ± 50.11, p < 0.001), as well as in the mean ADCs (× 10−3 mm2/s) between MTs (1.08 ± 0.28) and PAs (1.60 ± 0.34, p < 0.001), but not in the mean ADCs between MTs and WTs (0.87 ± 0.23, p = 0.117). In the ROC curve analysis, the highest areas under the curves (AUCs) were achieved by the 10th and 25th percentiles of ADC (AUC = 0.885) for differentiating MTs from PAs and the 50th percentile of TBF (AUC = 0.855) for differentiating MTs from WTs. The AUCs of TBF, ADC, and combination of TBF and ADC were 0.850, 0.885, and 0.950 for MTs and PAs differentiation and 0.855, 0.814, and 0.905 for MTs and WTs differentiation, respectively. The combination of TBF and ADC evaluated by histogram analysis may help differentiate salivary gland MTs from PAs and WTs.

Clear Cell Neoplasms of Salivary Glands: A Diagnostic Challenge.

This review focuses on the heterogenous group of clear cell neoplasms of salivary glands and attempts to identify major differential diagnostic features. Within the head and neck region, clear cells are found most commonly in salivary gland tumors, but may also be seen in tumors of squamous or odontogenic epithelial origin, primary or metastatic carcinomas, benign or malignant melanocytic lesions, or benign or malignant mesenchymal tumors. Clear cells occur fairly commonly among a wide variety of salivary gland neoplasms, but mostly they constitute only a minor component of the tumor cell population. Clear cells represent a major diagnostic feature in two salivary gland neoplasms, epithelial-myoepithelial carcinoma and hyalinizing clear cell carcinoma. In addition, salivary gland neoplasms composed predominantly of clear cells could also include clear cell variants of other salivary neoplasms, such as mucoepidermoid carcinoma and myoepithelial carcinoma, but their tumor type-specific histologic features may only be available in limited nonclear cell areas of the tumor. Diagnosing predominantly clear cell salivary gland tumors is difficult because the immunoprofiles and morphologic features may overlap and the same tumor entity may also have a wide range of other histologic presentations. Many salivary gland tumors are characterized by tumor type-specific genomic alterations, particularly gene fusions of the ETV6 gene in secretory carcinoma, the MYB and MYBL1 genes in adenoid cystic carcinoma, the MAML2 gene in mucoepidermoid carcinoma, the EWSR1 gene in hyalinizing clear cell carcinoma, and others. Thus, along with conventional histopathologic examination and immunoprofiling, molecular and genetic tests may be important in the diagnosis of salivary gland clear cell tumors by demonstrating genetic alterations specific to them.

Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Salivary Glands.

The salivary gland section in the 5th edition of the World Health Organization Classification of Head and Neck Tumours features a description and inclusion of several new entities, including sclerosing polycystic adenoma, keratocystoma, intercalated duct adenoma, and striated duct adenoma among the benign neoplasms; and microsecretory adenocarcinoma and sclerosing microcystic adenocarcinoma as the new malignant entities. The new entry also includes mucinous adenocarcinoma subdivided into papillary, colloid, signet ring, and mixed subtypes with recurrent AKT1 E17K mutations across patterns suggesting that mucin-producing salivary adenocarcinomas represent a histologically diverse single entity that may be related to salivary intraductal papillary mucinous neoplasm (IPMN). Importantly, the number of entities in the salivary chapter has been reduced by omitting tumors or lesions if they do not occur exclusively or predominantly in salivary glands, including hemangioma, lipoma, nodular fasciitis and hematolymphoid tumors. They are now discussed in detail elsewhere in the book. Cribriform adenocarcinoma of salivary gland origin (CASG) now represents a distinctive subtype of polymorphous adenocarcinoma (PAC). PAC is defined as a clinically, histologically and molecularly heterogeneous disease group. Whether CASG is a different diagnostic category or a variant of PAC is still controversial. Poorly differentiated carcinomas and oncocytic carcinomas are discussed in the category "Salivary carcinoma not otherwise specified (NOS) and emerging entities". New defining genomic alterations have been characterized in many salivary gland tumors. In particular, they include gene fusions, which have shown to be tightly tumor-type specific, and thus valuable for use in diagnostically challenging cases. The recurrent molecular alterations were included in the definition of mucoepidermoid carcinoma, adenoid cystic carcinoma, secretory carcinoma, polymorphous adenocarcinoma, hyalinizing clear cell carcinoma, mucinous adenocarcinoma, and microsecretory adenocarcinoma.

Severe symptoms predict salivary interleukin-6, interleukin-1β, and tumor necrosis factor-α levels in children and youth with obsessive-compulsive disorder

ObjectiveChildhood-onset obsessive-compulsive disorder (OCD) has been associated with immune dysregulation, including aberrant plasma inflammatory markers and increased rates of infectious and immune-mediated disorders. Saliva may provide a minimally-invasive tool for assessing oral mucosal immunity and inflammatory biomarkers in this population. The primary aim of this study was to compare salivary defense proteins and inflammatory mediators in saliva from children and youth with OCD and healthy controls, and evaluate their associations with measures of oral health and OCD phenotype. MethodsIn this cross-sectional observational study, saliva was collected from 41 children and youth with childhood-onset OCD and 46 healthy controls. Levels of lysozyme, α-amylase, secretory immunoglobulin A (sIgA), C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were quantified by enzyme-linked immunosorbent assays or electrochemiluminescent-based immunoassays. ResultsAll analytes were detectable in saliva. When adjusting for salivary flow rate and total protein, multiple linear regression models including demographic variables, oral health measures, and OCD status explained a significant proportion of the variance in IL-6, IL-1β, and sIgA but not TNF-α, CRP, α-amylase, or lysozyme levels. Diagnosis of OCD was associated with significantly higher IL-6 (β = 0.403, p = 0.026), while severity of OCD was a significant predictor of increased cytokines (IL-6, β = 0.325, p = 0.009; IL-1β, β = 0.284, p = 0.020; TNF-α, β = 0.269, p = 0.036), but not other analytes. ConclusionThese data point to the feasibility of analyzing soluble immune mediators in the saliva in childhood-onset OCD, suggesting that pro-inflammatory cytokines are associated with OCD diagnosis and symptom severity. Further work is required to elucidate the factors contributing to this association and implications for clinical practice.

Trans-Oral Robotic Surgery: 14 Cases of Pleomorphic Adenoma of the Parapharyngeal Space.

The aim of this study has been to describe our experience with pleomorphic adenomas of the parapharyngeal space (PPS) treated with trans-oral robotic surgery (TORS). Tumors arising from the PPS comprise less than 0.5% of all head and neck tumors. Salivary gland tumors account for 40% to 50% of PPS lesions with pleomorphic adenomas representing the most common salivary tumors (80%-90%). Parapharyngeal space tumors cause nonspecific symptoms and may be difficult to diagnose. In our study a preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging and the results were used to plan the correct surgical approach. In all cases we were able to employ TORS, a minimally invasive procedure that allows us to operate in narrow and anatomically complex spaces that we can only reach thanks to the use of well-articulated hand pieces. This report indicates that TORS is a safe surgical procedure for the excision of benign tumors of the PPS in selected cases.

Glial Fibrillary Acidic Protein Expression Helps Distinguish Pleomorphic Adenoma from Histologic Mimics.

Pleomorphic adenoma (PA) is the most common biphasic type of salivary gland tumour to arise in adults. It is a biphasic tumour composed of both luminal (ductal) cells and abluminal (basal and myoepithelial) cells. Other biphasic salivary gland type tumours, both benign and malignant, can mimic PA, especially on small biopsies. Previous studies have shown that glial fibrillary acidic protein (GFAP) is preferentially expressed in PA and can be useful in the distinction from other salivary gland tumours. However, most of these studies were performed on a small subset of tumour types at a time when the classification of salivary gland type tumours was less refined. The purpose of this study was to assess the expression of glial fibrillary acidic protein (GFAP) in a broad group of both benign and malignant salivary gland tumours. The expression of GFAP was assessed in 99 tumours including 54 PAs, 5 basal cell adenomas, 1 myoepitheliomas, 5 adenoid cystic carcinomas, 6 epithelial-myoepithelial carcinomas (EMCA), 6 mucoepidermoid carcinomas, 7 salivary duct carcinomas, 1 adenocarcinomas NOS, 2 myoepithelial carcinomas, 4 basal cell adenocarcinomas, 5 acinic cell carcinomas and 3 polymorphous adenocarcinomas. Of the malignant cases, 8 were classified as carcinomas ex PA. GFAP was also assessed in 19 concurrent biopsy specimens. GFAP was expressed in the resections of 51 PAs examined (94%). Expression was predominantly strong and diffusely seen in myoepithelial cells. Strong and diffuse GFAP expression was also seen in two EMCAs (33%) and one myoepithelial carcinoma (50%). On biopsy specimens, 100% of PAs and basal cell adenomas expressed GFAP. GFAP was also seen in 1 out of 3 carcinomas ex PAs on biopsies. Almost all PAs show strong and diffuse expression of GFAP. In contrast, most malignant neoplasms that can mimic PA on biopsies show only rare, focal expression. Other benign tumours composed of abluminal/myoepithelial cells also show focal expression of GFAP, highlighting the spectrum these tumours share with PA. Overall, the presence of strong and diffuse GFAP expression can favour a benign neoplasm, specifically a PA, on limited biopsy specimens.

Polymorphous adenocarcinoma of the parotid – An uncommon site of occurrence

Polymorphous low-grade adenocarcinoma is a neoplasm of the minor salivary glands and is malignant in origin but is indolent in nature. Currently, this neoplasm is documented and known as polymorphous adenocarcinoma (PAC) by WHO Classification of Salivary Gland Tumors (2017). Of all the salivary neoplasms, minor salivary gland neoplasm accounts for 9%–23%. Very rarely, it involves major salivary glands such as parotid, submandibular, and sublingual in <5% cases. It may develop either de novo or from pleomorphic adenoma. PAC mimics some benign as well as malignant neoplasms. Histopathological features alone cannot diagnose PAC due to the overlapping features with other neoplasms, and so immunohistochemistry is essential to confirm the diagnosis and hence aids in the proper management of PAC. We report a case of PAC arising from parotid gland in a 52-year-old male treated with facial nerve preservation.

Estrogen receptor α expression in different stages of salivary gland mucoepidermoid carcinoma.

Background:Since salivary and breast glands are both considered as a tubulo-acinar, exocrine glands, and they have a common neoplastic morphology, it is not surprising if they share a similar molecular mechanism responsible for their neoplastic transformation. From the first description of estrogen receptor-α (ER-α) in salivary tumors, tremendous attentions have been attracted to this receptor for evaluating its impact in mucoepidermoid carcinoma (MEC).Materials and Methods:In this descriptive analytics, 28 samples of MEC (14 high grade and 14 low grade) were collected from the Oral and Maxillofacial Pathology Department of Isfahan Dental School and Isfahan Alzahra Hospital. All of these samples were stained with immunohistochemical technique with ER-α marker. The expression of the receptor was evaluated by two oral and maxillofacial pathologists. Statistical data were saved at SPSS and had been analyzed by Mann–Whitney U- and independent t-tests (significance level: P ≤ 0.05).Results:The high-grade MEC was more common in patients with a higher average age (55.9); on the other hand, low-grade MEC was mostly observed in those with a mean age of 39.2 years. Moreover, high-grade MEC was more prevalent in men rather than in women. The staining intensity distribution average in high-grade MEC and low-grade MEC was 2.4 and 0.8, respectively (P = 0.48).Conclusion:The expression of ER-α in high-grade MEC was significantly more than low-grade MEC, indicating that targeting this receptor alongside surgery could bring more advantages for patients.

Coffee Ground Vomiting as the First Presentation of Salivary Gland Anlage Tumor: A Case Report and Review of the Literature

Coffee Ground Vomiting as the First Presentation of Salivary Gland Anlage Tumor: A Case Report and Review of the Literature

Ultrasonography of Lacrimal Gland involvement in systemic Sarcoidosis

Lacrimal gland lesions generally present as palpable masses in the superolateral aspects of the orbits. Approximately 50% of lacrimal gland masses are inflammatory lesions, 25% are lymphoid lesions or lymphoma, and the other 25% are salivary gland type tumors. Although there are overlaps and exceptions, features such as laterality, portion of gland involvement, presence or absence of bony findings, enhancement pattern, and clinical presentation are valuable in differentiating among lacrimal gland lesions. The 3D ultrasound has been used to define lacrimal gland shape, size, density, structural features the pattern of blood supply, as well as the anatomic and topographic position in the orbit. The study was conducted in the B- and 3D-modes of ultrasonography with color and energy Doppler mapping on both sides.

Relevance of Inflammatory Biomarkers in Salivary Gland Cancers Management

Objective: Preoperative diagnostic investigation of salivary neoplasms leaves a fair share of doubtful cases that complicate the therapeutic choices. The aim of our study was to look for new means to support the decision-making process for their management. Inflammatory biomarkers could play an important role in this process. Methods: A retrospective chart review of salivary glands tumors was performed between January 2016 and September 2020 in our Department. The samples were divided in 2 groups basing on the histological result after surgery: 191 patients with benign salivary glands tumors (SGbt), and 47 with salivary glands cancer (SGc). 90 patients were randomly selected to form the control group (C group). Results: Statistically significant increase of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocite ratio (NLR) and systemic immune-inflammation index (SII) was reported in SGc group compared to SGbt group and control group (p<0.001). Statistical evaluation estabilished optimal threshold for PLR (164,2), NLR (3,11) and SII (517.5) that can discriminate the doubtful cases with specificity of 85-86% and 62% respectively, and sensitivity of 40-45% and 64% respectively. Conclusions: Inflammatory biomarkers can have a relevant role as diagnostic tools in doubtful cases. They could be performed in the clinical setting for guiding the treatment of these neoplasms. Keywords: Salivary glands tumors; Blood inflammatory biomarkers; NLR; SII; PLR

Salivary tumor necrosis factor-Alpha and malondialdehyde levels in children with class II malocclusion and sleep disorders: An evaluative study.

Recently biomarkers for sleep disorders have provided an alternative and convenient means of diagnosis for children at risk. To evaluate salivary TNF-α and Malondialdehyde (MDA) levels in children with skeletal class II malocclusion and with a positive history of sleep disorders. This prospective evaluative study was carried out from October 2020 to March 2021, in the Department of Pediatric and Preventive Dentistry. 21 children aged 8-12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study (Group 1). 21 age and gender matched children with no skeletal malocclusion and no reported history of sleep disorders served as a comparison group (Group 2). All children were evaluated regarding their sleep history and clinically examined to determine craniofacial morphology. Unstimulated saliva was collected from all children. Salivary TNF-α was measured with a solid-phase sandwich ELISA. Salivary MDA was measured by using TBA reagent. Intergroup comparison for age and normally distributed data was done using t-test. Comparison of frequencies of categories of variables was done using Chi-square test. Inter group comparison for TNF-α was done using Mann-Whitney U test. There were significantly higher levels of salivary TNF-α and MDA, in children of Group 1 when compared to that of Group 2 children (p < 0.01). Salivary TNF-α and MDA may be a simple and non-invasive tool in the identification and screening of children at high risk for sleep disorders.