Salivary Pleomorphic Adenoma Research Articles

Retrospective Clinicopathological Study of 33 Cases of Pleomorphic Salivary Adenoma Diagnosed in Benghazi

Background: Pleomorphic salivary adenoma (PSA) is the most frequently found neoplastic tumor in major and minor salivary glands. It has a high recurrence rate and there is a possibility for benign PSA to transform into malignant form. No study on clinical and histopathological features of pleomorphic adenoma in Libya was found. occurrence of benign PSA is more common than PSA with malignant foci. Aim: The present study aimed to retrospectively analyze the clinical and histopathological features of cases diagnosed as pleomorphic adenoma and compare our findings to those of other studies. Materials and Methods: In this retrospective study, the pleomorphic salivary adenoma cases diagnosed between 1994-2019 in the Department of Oral Pathology, Dental School, University of Benghazi, Libya were retrieved. The diagnosis was confirmed by reevaluation of hematoxylin and eosin-stained slides. Descriptive statistics were used to describe the clinical data of the patient’s demographics and clinical features of the tumor. Results: It was found that among 33 diagnosed cases of PSA, 11 cases were males and 22 cases were females. The most common age range was 10-29 years (21 cases). The most common intra-oral site was the palate (15 cases) followed by buccal mucosa (6 cases) and submandibular glands and parotid glands were most commonly affected among major salivary glands. Benign pleomorphic adenoma (24 cases) was most common, myoepithelium was reported in 2 cases and malignant foci were reported in 7 cases. Conclusion: This study revealed that Females were more affected than males. The most common location of pleomorphic adenoma was the palate. The myoepithelioma is a rare.

Correlation of Clinical and Histopathological Features of Salivary Pleomorphic Adenoma.

Salivary gland tumors represent about 3% of the head and neck tumors. Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. This study was conducted to investigate and describe some clinical and histopathological aspects of salivary pleomorphic adenomas with special reference to the epithelial and mesenchymal components. In this retrospective study, one hundred tissue samples diagnosed as PA were sourced from archival tissue blocks between 2009 and 2019 in this retrospective study. Some clinical and demographic features, including age, sex, tumor size, and tumor location were recorded. This study included only samples taken by excisional biopsy. Then, the samples were histologically classified into three subtypes according to the proportion of epithelial and stromal components. The demographic and clinicopathological variables were statistically analyzed using Chi-square test or Fisher's exact test, considering a significance level of 5% (p< .05). In the present study, most cases (61%) were found in females, representing a female-male ratio of 1.6:1. The peak incidence was seen in the 4th and 5th decades of life. In 87% of cases, PA occurred in major salivary glands. There was a significant difference between the age of the patient and squamous metaplasia (p= 0.036). There was also a significant difference between the size of tumor and the amount of myxoid stroma (p= 0.021). Extensive myxoid stromawas mostly seen in tumors larger than 3.37cm (p= 0.001). In addition, there was a statistically significant difference between capsular invasion and the development of squamous metaplasia (p= 0.001). In this study, there was a significant correlation between the gland type and capsular features and between the size of tumor and rate of squamous metaplasia. A detailed clinical and histopathological analysis of PAs may provide a better insight to the pathophysiology of the lesion, tumor cell differentiation, and prognostic factors.

Hypoxia-Induced Biosynthesis of the Extracellular Matrix Molecules, Perlecan and Fibronectin, Promotes the Growth of Pleomorphic Adenoma Cells In Vitro Models.

Salivary pleomorphic adenoma is histopathologically characterized by its colorful stroma with myxoid, chondroid, and hyaline appearances, due to enhanced biosynthesis of extracellular matrix (ECM) molecules and poor vascularity. Thus, pleomorphic adenoma cells embedded in the stroma typically survive under hypoxic conditions. We determined the expression kinetics of ECM molecules, such as perlecan and fibronectin (FN), under hypoxia in SM-AP1 cells which are duct epithelial differentiated cells, and in SM-AP4 cells, which are myoepithelial differentiated cells, cloned from pleomorphic adenoma of the parotid gland. We investigated hypoxia-inducible factor-1α (HIF-1α)-inducing pathways through a variety of ECM molecules in association with their cellular proliferation and migration. We observed that hypoxic conditions with elevated HIF-1α protein levels induced increased expression of perlecan and FN in SM-AP cells than in controls. Moreover, perlecan and FN knockdown reduced the proliferation of SM-AP1 and SM-AP4 cells under hypoxia. Further, SM-AP1 cell migration was enhanced by both perlecan and FN knockdown, whereas SM-AP4 cell migration was increased by perlecan knockdown and inhibited by fibronectin knockdown. The results indicated that pleomorphic adenoma cells can survive under hypoxic conditions by promoting cell proliferation via enhanced synthesis of ECM molecules. Overall, ECM molecules may be a new anti-tumor target under hypoxic conditions.

Estrogen, Progesterone and Androgen Receptor in Primary and Recurrent Pleomorphic Salivary Adenomas.

Our study aimed to characterize alteration in the immunohistochemical expression of estrogen, progesterone and androgen receptor in the tumour cells of primary pleomorphic adenomas and recurrent pleomorphic adenomas. A retrospective study of data including 30 cases of primary pleomorphic adenomas (PA) without recurrences and 15 cases of recurrent pleomorphic adenomas were examined (RPA). RPA included 8 males and 7 females. Immunohistochemical expression of estrogen, progesterone and androgen receptor was examined in the selected cases. The percentage of slides was semi-quantitatively assessed by two independent observers and scores were given. The statistical analysis included the use of descriptive statistics and proportional frequencies. AR expression was identified in 12 (40. %) out of 30 cases of (PA) pleomorphic adenomas and 7 of 15 cases recurrent pleomorphic adenomas (RPA) (46 %). The results showed that ER and PR expression were negative in PA and RPA. Androgen receptors might have role in pathogenesis of PA and RPA. Estrogen and progesterone receptors have no role in development of recurrent pleomorphic salivary adenoma.

A Clinicopathological Analysis of 75 Salivary Gland Tumors at Mayo Hospital, Lahore

Aim: To describe the clinic-o-pathological pattern of patients presented with salivary gland tumors at Department of Maxillofacial surgery Mayo hospital Lahore during time period of one year from 1st January 2019 to 31st December 2019. Methods: This was a retrospective cross-sectional study conducted at Department of Oral and Maxillofacial Surgery, Mayo Hospital Lahore. 75 cases of Salivary gland tumors in the head and neck region were identified. Patient’s medical record and pathology reports were retrieved and carefully reviewed by a senior doctor to collect basic demographic data as well as tumor related information. Data entry and analysis was done with the help of SPSS version-26. Chi Square Test/Fisher exact test was applied to see the association between qualitative variables. Results: In this study Mean age of patients in this study was 40.45±13.18. Male patients were predominant as compared to female patients; Male 53.3% &amp; Female 46.7%.The most frequent tumor among patients was Pleomorphic Adenoma (61.3%) followed by Adenoid Cystic Carcinoma (17.3%), Mucoepidermoid Carcinoma (13.3%), Warthin’s Tumor (4%), Squamous cell Carcinoma of Parotid (2.7%) and adenocarcinoma (1.3%) respectively. However no significant association was seen between salivary gland tumors with age and gender of patients (p-value=0.521). Conclusion: Among the benign salivary gland tumors pleomorphic adenoma is the most common tumor whereas among malignant salivary gland tumors adenoid cystic carcinoma is the most frequent occurring tumor. Keywords: Salivary gland Tumors, Maxillofacial Surgery, Pathological Pattern,

Discovery proteomics reveals potential protein signature associated with malignant phenotype acquisition in pleomorphic adenoma.

To analyze the proteomic profile of salivary pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma (CXPA) samples and correlate them with the malignant transformation of the PA. Thirty samples (10 PA, 16 CXPA, and 4 residual PA) were microdissected and submitted to liquid chromatography-tandem mass spectrometry (LC-MS/MS). The proteomic data and protein identification were analyzed through LC-MS/MS spectra using the MaxQuant software. The proteomic analysis identified and quantified a total of 240 proteins in which 135 were found in PA, residual PA, and CXPA. The shared proteins were divided into six subgroups, and the proteins that showed statistically significant differences (p>0.05) and fold-change > or <2.5 in one subgroup to another subgroup were included. Seven proteins (Apolipoprotein A-I-APOA1, haptoglobin-HP, protein of the synaptonemal complex 1-SYCP1, anion transport protein of band 3-SLC4A1, subunit μ1 of AP-1 complex-AP1M1, beta subunit of hemoglobin-HBB, and dermcidin-DCD) were classified as potential protein signatures, being HP, AP1M1, and HBB with higher abundance for PA to residual PA, APOA1 with higher abundance for PA to CXPA, SLC4A1 with lower abundance in the PA to CXPA, SYCP1with lower abundance for residual PA to CXPA, and DCD with higher abundance in the CXPA with epithelial differentiation to myoepithelial differentiation. In this work, we demonstrated the comparative proteomic profiling of PA, residual PA, and CXPA, and seven were proposed as protein signatures, some of which may be associated with the malignant phenotype acquisition.

Parotid incidentalomas: a systematic review.

Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management. A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion. Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy. If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.

Degenerative nuclear atypia in pleomorphic adenoma of salivary glands: Histological and immunohistochemical observations

The occurrence and topographical distribution of nuclear changes regarded as degenerative were examined in 84 salivary pleomorphic adenomas (PAs). Haematoxylin and eosin-stained sections from them were light-microscopically studied for unusual variations in size, shape and chromatin pattern of tumour-cell nuclei. Selected cases were further examined by immunohistochemical techniques valuable in characterising cell phenotypes in PA, and cell cycle antigens. A single case (female, 26 years, palate; 1.2 %) showed prominent cells with eosinophilic cytoplasm and variably enlarged or giant, irregularly shaped and occasionally multi-vacuolated nuclei with condensed or stippled chromatin and no mitoses. These cells were variably dyscohesive and did not line lumina; were cytokeratins 5/6, 7 and 14 (+, cytoplasmic), smooth muscle actin (+, cytoplasmic), p63 (+, nuclear), S-100 protein (+, nuclear and cytoplasmic), and WT1 and podoplanin (+/−, cytoplasmic); and did not stain for DOG1, CD63, p16 or Ki67. The nuclear vacuoles were cytokeratin and WT1 (+) - hence, interpreted as cytoplasmic inclusions. Degenerative nuclear atypia in PA seems rare, associated with non-cycling, non-luminal cells of myomatous (‘myoepithelial’) or schwannomatous phenotype and not related to malignant transformation. The particular phenotype of the affected cells suggests similarities to the degenerative nuclear atypia in pleomorphic leiomyoma and ancient schwannoma.

Soft Palatal Pleomorphic Adenoma with Dystrophic Calcifications and Upper Airway Obstruction

Pleomorphic salivary adenoma (PSA) is a benign tumor composed of epithelial and mesenchymal elements. Approximately 10% of pleomorphic adenomas occur in the minor salivary glands, with the palate being the most common site. Mesenchymal elements in PSA are capable of giving rise to various components that are usually seen in the tumor. Still, the presence of calcifications either from degenerations or the mesenchymal elements is rare. We are reporting a case of giant pleomorphic adenoma of the soft palate with dystrophic calcification and significant upper aerodigestive obstruction in a 49-year-old Nigerian. Surgical excision was done under general anesthesia via oral route.

Spectrum of primary salivary gland tumors with special emphasis on their management and outcome at a rural tertiary care centre

Background: Salivary gland tumors (SGT) are uncommon tumors of diverse histopathology accounting for &lt;2% of all neoplasms. Early diagnosis differentiates between benign and malignant SGT and less extensive surgical procedure can be performed. The objective is to study the spectrum of primary SGT with special emphasis on their distribution, treatment and outcome at a rural tertiary care centre.Methods: A prospective observational study was conducted on 30 consecutive primary SGT patients attending the Departments of Surgery and Otorhinolaryngology of North Bengal Medical College and Hospital over a period of one and half years. All patients were clinically evaluated, investigated, treated accordingly and followed up during the period of study. Data was collected and compiled in Excel sheet and analysed using GraphPad Software and GraphPad QuickCalcs 2018 (San Diego, CA). A p value &lt;0.05 was considered statistically significant.Results: Maximum patients (83.3%) were in the age range of 31-60 years. The male to female ratio was 1:4 for benign tumours and 1:1 for malignant tumours. Malignant cases were 66.67%. Involvement of parotid gland was the commonest (43.3%) and mostly presented with swelling (73.3%). Pleomorphic salivary adenoma was the commonest benign tumor (33.3%) and mucoepidermoid carcinoma was the commonest malignant tumor (16.7%). Permanent facial palsy was observed in 2 (9.5%) and recurrence in 4 patients (19%).Conclusions: SGT are rare and present in various modes. Malignant cases were singularly more in this study.

Soft Tissue Special Issue: Myoepithelial Neoplasms of Soft Tissue: An Updated Review with Emphasis on Diagnostic Considerations in the Head and Neck.

Primary myoepithelial neoplasms of soft tissue have been shown to be related to their salivary gland counterparts, with which they often share morphologic, immunophenotypic, and molecular genetic features, such as the presence of PLAG1 rearrangement in both soft tissue mixed tumor and salivary pleomorphic adenoma. However, important distinctions remain between soft tissue and salivary myoepithelial neoplasms, namely differing criteria for malignancy. This review provides an overview of the current understanding of the clinicopathologic and molecular features of soft tissue myoepithelial neoplasms, including discussion of the similarities and differences between soft tissue and salivary counterparts and relevant diagnostic issues specific to head and neck pathology practice.

Roles of Proteoglycans in the Tumourigenesis and Development of Adenoid Cystic Carcinoma and Pleomorphic Adenoma of the Salivary Gland: A Systematic Review.

Salivary adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA) are the most common types of salivary gland tumours; the former is malignant and the latter is benign but with features of a border tumour. Proteoglycans (PGs) produced by neoplastic myoepithelial cells are ubiquitous in both types of tumours. However, normal myoepithelial cells of salivary glands do not have the ability to secrete PGs. When the synthesis of PGs is blocked, the pulmonary metastasis and perineural growth of salivary ACC as well as the implanting growth of salivary PA are inhibited, highlighting the important functions of PGs in the tumourigenesis and development of these two tumours. In this review, we summarise literature from the past 40 years, including more recent findings from our laboratory, to clarify the pivotal roles of PGs produced by neoplastic myoepithelial cells in both the histogenesis and biological behaviours of ACC and PA.

Estudio de la fluorescencia selectiva del estroma del adenoma pleomórfico salival con microscopio laser confocal en preparaciones coloreadas con Hematoxilina/ Eosina Y

Estudio de la fluorescencia selectiva del estroma del adenoma pleomórfico salival con microscopio laser confocal en preparaciones coloreadas con Hematoxilina/ Eosina Y

MASPIN EXPRESSION IN PLEOMOPHIC ADENOMA, POLYMORPHOUS LOW GRADE ADENOCARCINOMA AND ADENOCYSTIC ADENOCARCINOMA OF SALIVARY GLANDS SEEN AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS, NIGERIA

Objectives To immunostain with Maspin antibody, formalin fixed, paraffin embedded tissues of 41 samples of Pleomorphic Salivary Adenoma [PSA], 10 samples of Polymorphous Low-Grade Adenocarcinoma [PLGA] and 34 samples of Adenoid Cystic Carcinoma [AdCC]. To quantitatively assess Maspin expression in each of the three (3) Salivary Gland Tumours (SGTs) by combining immunostaining intensity scores with scores of proportion of positively stained cells (Total mean scores) in each, using the method described by Reiner et al 1990. To analyze data using Chi square, Fisher's Exact tests and analysis of variance to compare total mean scores of maspin expression among the three (3) SGTs, the statistical significance level being set at p Findings PSA had the greatest proportion of Maspin immunopositivity (73.2%), followed by PLGA (40.0%) and AdCC (35.2%). Mean total Maspin score of PSA (3.5±2.4) was statistically significantly higher than that of PLGA (1.2±1.8) [p=0.005]. and that of AdCC (1.0±1.5) [p Conclusion In this study, there was decreasing expression of Maspin from PSA to PLGA to AdCC, which is consistent with established increased order of clinical aggression of these tumors. It is suggested that Maspin expression could be a useful adjunct diagnostic tool to discriminate between PSA, PLGA and AdCC.

Plasmacytoid cells in salivary pleomorphic adenoma: an alternative interpretation of their immunohistochemical characteristics highlights function and capability for epithelial–mesenchymal transition

Plasmacytoid cells (PLCs) in salivary pleomorphic adenoma (SPA) are regarded as modified neoplastic myoepithelia and define plasmacytoid myoepithelioma (pMYO). However, histochemically, immunohistochemically and ultrastructurally, PLCs fail to demonstrate frank myogenous properties. Epithelial-mesenchymal transition (EMT) may explain the phenotypes in SPA. Our aim was to evaluate (1) PLCs with accepted or purported myoepithelial and EMT-related markers; and (2) pMYOs for PLAG1 aberrations by using fluorescence in situ hybridization. Eight SPAs with or without PLC-predominance and 3 pMYOs were immunohistochemically studied. PLCs in SPA and pMYO exhibited strong, scattered to diffuse positivity for K7, rare K14 positivity and were mostly negative for α-smooth muscle actin, h-caldesmon, and p63/p40. S100 staining was strong and diffuse, whereas calponin was variable. DOG1 was negative. PLCs in pMYO and PLC-rich SPA exhibited selective or diffuse WT1 and D2-40 immunoreactivity. EMT markers SNAIL/SLUG exhibited strong and variable immunoreactivity in PLCs in contrast to weak or absent E-cadherin expression. SOX10 was diffusely and strongly positive. PLAG1 rearrangement was present in 1 pMYO. PLCs mostly fail to express myoepithelial markers; PLCs are neoplastic cells adapting to microenvironmental changes and capable of EMT; and tumors composed solely of PLCs are apparently SPAs depleted of a ductal component.

Descriptive epidemiology of salivary gland neoplasms in Nigeria: An AOPRC multicenter tertiary hospital study.

Accurate diagnosis of salivary gland neoplasms (SGN) in many centers in Africa is limited by poor diagnostic resources and ancillary services. Hence, we have carried out a multicenter epidemiological study to understand the true burden of SGN in Nigeria. In this descriptive cross-sectional study, we have deployed resources available to members of the African Oral Pathology Consortium (AOPRC) to examine the burden of salivary gland lesions in Nigeria, using a multicenter approach. Data from seven major tertiary health institutions in northern, western, and southern Nigeria were generated using a standardized data extraction format and analyzed using the Epi-info software (Version 7.0, Atlanta, USA). Of the 497 cases examined across the seven centers, we observed that SGN occurred more in females than males. Overall, pleomorphic salivary adenoma (PA) was found to be the most common. PA was found to be the commonest benign SGN while adenocystic carcinoma (ADCC) was the commonest malignant SGN. Regional variations were observed for age group, diagnosis, and gender distribution. Significant statistical differences were found between males and females for malignant SGNs (p-value=0.037). We found regional variation in the pattern of distribution of SGN in Nigeria. This is the largest multicenter study of SGN in Nigeria, and our findings are robust and representative of the epidemiology of this neoplasm in Nigeria.

Effect of Xylosyltransferase-I Silencing on Implanting Growth of Salivary Pleomorphic Adenoma.

BackgroundSalivary pleomorphic adenoma is one of the most common salivary gland tumors. It has a relatively high tendency to recur and a high risk of malignant transformation. The present study aimed to study the effect of XT-I gene silencing on the implanting growth of salivary pleomorphic adenoma.Material/MethodsPrimary cultures of SPA cells and fibroblasts from the same patient were assessed. The adenovirus vector Ad-shRNA-XT-I was constructed and transfected into SPA cells. The expression of XT-I gene and XT-I protein was detected by real-time PCR and Western blot. The contents of proteoglycans were detected. The SPA cells transfected with Ad-shRNA-XT-I (group SPA-XT-I) and Ad-shRNA-HK (group SPA-HK), as well as without transfection (group SPA), were implanted into ADM scaffold with fibroblasts and then transferred into 18 BALB/C-nu nude mice for 3 months.ResultsPrimary cultures showed SPA cells were positive for human CK and S-100 protein and the fibroblasts were positive for human vimentin. The expressions of XT-I gene and protein were decreased by 51% and 51.31%, respectively. The content of proteoglycans was reduced by 48.45%. The results of the implanting growth in vitro and in vivo of nude mice indicated that no tumors grew in the SPA-XT-I group, whereas SPA grew in groups SPA-HK and SPA positive for human α-SMA, S-100 protein, and calponin.ConclusionsXT-I gene silencing effectively inhibited the implanting growth of SPA.

Recurrent pleomorphic salivary adenoma in submandibular gland

Case presentation: A 26-year-old woman presented to our department via her GP with two distinct lumps in her right anterior neck. Clinical history revealed she had surgery in the right submandibular gland in Pakistan several years previously. Ultrasound and fine needle aspiration cytology confirmed a recurrent pleomorphic salivary adenoma in the right submandibular gland. An MRI scan was carried out to aid surgical planning and visualised two separate areas of recurrence. The largest was at the anterior inferior aspect of the submandibular gland, and a smaller focus was as the posterolateral aspect, still within submandibular triangle, but separate from gland. Furthermore there was a noticeable asymmetric level 1B submandibular lymph node.

Metastasising Pleomorphic Adenoma: A rare case report of a pleomorphic salivary adenoma with synchronous cervical lymph node metastases

Introduction: Metastatic Pleomorphic Adenoma (MPA) is a rare and controversial salivary gland neoplasm. Classified as a low-grade malignancy, benign histological features exist discordantly alongside their biological behaviour. An enigma; a benign tumour capable of distant metastases. Since 1942, there have been approximately 62 reported cases, though diagnosis is controversial considering their rarity and confounding histological interpretation. Pathogenesis is hypothesised to occur haematogenously through incomplete resection of primary PSAs or surgical disruption, aspiration of seeded tumour cells, or a lymphatic metastatic route. This is the first known case in the English-literature of an untreated minor salivary gland pleomorphic adenoma metastasising to a cervical node, demonstrating support for lymphatic dissemination.

Immunohistochemical Evaluation of WT1 protein in Salivary Pleomorphic Adenoma and Carcinoma ex pleomorphic adenoma

Immunohistochemical Evaluation of WT1 protein in Salivary Pleomorphic Adenoma and Carcinoma ex pleomorphic adenoma