Warthin's Tumor Research Articles

Earring Lesion Of The Parotid Tail

Masses in the Parotid tail can be source of consternation to radiologist and clinicians and therefore need attention. Inaccurate localization may lead to significant iatrogenic complications. Anatomically localization lesions of Parotid tails is of relevance as it often creates radiological confusion, as was in this case also. Imaging features of Parotid tail involvement need to be reviewed for, proper understanding and discussed with radiologist for complication free management. A Clinico-radiological correlation reviewing 111 such cases was found which described pleomorphic adenoma(15) , Warthins tumor (14) , infective pathologies, Sjogren disease and also malignant lesions in 27 cases. The notable radiological findings in the cases where enhancement, multiplicity of lesions, on CT and diffusion weighted (varied) signal intensity of MR changes. Relationship of parotid tail/ lesions with surrounding structures like facial nerve or its branches , sternocleidomastoid muscle and posterior belly of digastric muscle, proximity close to the level II LN and posterior part of submandibular salivary gland all need to clearly examined and analyzed. Such a lesion has been referred to as Earring lesions in literature. Earring lesion is best appreciated and less confusing in coronal images and equally challenging in palpation. Though rare, localizing anatomical features of parotid tail lesions are reviewed in this paper along with a case report of parotid tail tumor.

Assessment of Parotid Gland Tumors by Means of Quantitative Multiparametric Ultrasound (mpUS)

The preoperative diagnostical differentiation of parotid gland tumor (PGT) is not always simple due to several different entities. B-mode-ultrasound (US) remains the imaging modality of choice, while histopathology serves as the gold standard for finalizing the diagnosis. We aimed to evaluate the use of multiparametric US (mpUS) in the assessment of PGT. We included 97 PGTs from 96 patients. A standardized mpUS protocol using B-mode-US, shear-wave elastography (SWE), and standardized contrast-enhanced ultrasound (CEUS) was performed prior to surgical intervention. SWE was assessed by real-time measurement conducting a minimum of five measurements, while quantitative CEUS parameters were assessed with a post-processing perfusion software. SWE allowed differentiation between benign PGT (Warthin's Tumor (WT) paired with lymph nodes (LN) and pleomorphic adenoma (PA)), and WT and LN were softer compared to PA. WT showed lower velocities than squamous cell carcinoma (SCC): the most common malignant PGT. CEUS parameters showed significant group differences between WT and PA, WT and malignant lesions, WT and SCC, WT paired with LN versus PA, and WT paired with LN versus SCC. MpUS seems to be beneficial in the assessment of PGT characterization, with benign PGT appearing to be softer in SWE than tumors with malignant tendencies. The quantitative CEUS parameter shows higher perfusion in WT than in PA, and malignant PGTs are less vascularized than WTs.

Low intensity whole-body oxidative stress in patients with parotid gland tumors.

Recently, there has been a significant increase in the number of patients hospitalized and undergoing surgery due to parotid gland tumors. We have observed an increase in the total number of salivary gland tumors, and hence an increased number of malignant tumors. Etiological factors of salivary gland tumors are still unknown. Oxidative stress (OS) has been suggested to be an important indicator of carcinogenesis in some tumors. Therefore, the aim of our study was to assess the state of OS in patients with selected benign and malignant parotid gland tumors. After final postoperative histological diagnosis of the tumor, patients were divided into the following groups i.e. pleomorphic adenoma 35 patients, Warthins tumor (WT) - 17 patients, mucoepidermoid carcinoma - 9 patients and 45 controls. The final study group included 106 patients. We found an increase in plasma lipofuscin levels in patients with all investigated parotid gland tumors. Furthermore, the activity of Cu/Zn-SOD in Warthins tumor patients was statistically lower compared to the controls, pleomorphic adenoma or mucoepidermoid carcinoma.In conclusion, we sustain the hypothesis on the presence of a low intensity whole-body OS in patients with parotid gland tumors. Furthermore, LPS may be a useful marker of OS in patients with benign and malignant tumors. Moreover, pathological mechanisms connected with WT seem to be different compared to malignant neoplasms and other benign tumors. It seems that Cu/Zn-SOD, as an antioxidative enzyme, may play an important role in those mechanisms taking part in WT.

Value of T2-weighted-based radiomics model in distinguishing Warthin tumor from pleomorphic adenoma of the parotid.

The differentiation of Warthin tumor and pleomorphic adenoma before treatment is crucial for clinical strategies. The aim of this study was to develop and test a T2-weighted-based radiomics model for differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. A total of 117 patients, including 61 cases of Warthin tumor and 56 cases of pleomorphic adenoma, were retrospectively enrolled from two centers between January 2010 and June 2022. The training set included 82 cases, and the validation set included 35 cases. From T2-weighted images, 971 radiomics features were extracted. Seven radiomics features remained after a two-step selection process. We used the seven radiomics features and clinical factors through multivariable logistic regression to build radiomics and clinical models, respectively. A radiomics-clinical model was also built that combined the independent clinical predictors with the radiomics features. Through ROC curves, the three models were evaluated and compared. In the radiomics model, AUCs were 0.826 and 0.796 in training and validation sets, respectively. In the clinical model, the AUCs were 0.923 and 0.926 in the training and validation sets, respectively. Decision curve analysis revealed that the radiomics-clinical model had the best diagnostic performance for distinguishing Warthin tumor from pleomorphic adenoma of the parotid gland (AUC = 0.962 and 0.934 for the training and validation sets, respectively). The radiomics-clinical model performed well in differentiating pleomorphic adenoma from Warthin tumor of the parotid gland. • The clinical model outperformed the radiomics model in distinguishing pleomorphic adenoma from Warthin tumor of the parotid gland. • The radiomics features extracted from T2-weighted images could help differentiate pleomorphic adenoma from Warthin tumor of the parotid gland. • The radiomics-clinical model was superior to the radiomics and the clinical models for differentiating pleomorphic adenoma from Warthin tumor of the parotid gland.

The Importance of Prostate-Specific Membrane Antigen Expression in Salivary Gland Tumors.

Prostate-specific membrane antigen (PSMA) is a cell membrane protein expressed by prostate tissues. It is not prostate specific and is also expressed by some non-prostatic solid neoplasms. Our study aimed to investigate the potential role of PSMA in salivary gland tumors. The present study was designed to retrospectively analyze our cases that presented with salivary gland tumors. The files of 105 patients were reviewed and their paraffin embedded blocks were retrieved from the pathology department. Immunohistochemical examination and staining were done using PSMA antibody. Tumor tissue PSMA immunohistochemical staining was scored semi-quantitatively with the modified quartile approach. Negative staining was scored 0, >0% and ≤25% tissue expression was considered weak (score 1), >25% and ≤50% tissue expression was considered mild (score 2), >50% and ≤75% tissue expression was considered moderate (score 3), and >75% tissue expression was considered strong (score 4). Eighty-eight patients (55 males, 33 females) were included in the study. Forty-eight patients had pleomorphic adenoma (PA), 35 had Warthin's tumor (WT), two had mucoepidermoid carcinoma, two had adenoid cystic carcinoma, and one had squamous cell carcinoma. There was statistically significant difference in terms of PSMA expression between PA and WT (p=0.003). PSMA expression was high in PA and absent in WT. PSMA is a potential source of inspiration for future studies on the development of novel diagnostic and theranostic investigations of salivary gland tumors. Prospective studies targeting intratumoral PSMA in salivary gland tumors should be planned.

Cytokeratin 13 (CK13) expression in cancer: a tissue microarray study on 10,439 tumors.

Cytokeratin 13 (CK13) is a type I acidic low molecular weight cytokeratin, which is mainly expressed in urothelium and in the squamous epithelium of various sites of origin. Loss of CK13 has been implicated in the development and progression of squamous epithelial neoplasms. To comprehensively determine CK13 expression in normal and neoplastic tissues, a tissue microarray containing 10,439 samples from 131 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. CK13 immunostaining was detectable in 42 (32.1%) of the 131 tumor categories including 24 (18.3%) tumor types with at least one strongly positive case. The highest rate of positive staining was found in various urothelial neoplasms (52.1-92.3%) including Brenner tumor of the ovary (86.8%) and in squamous cell carcinomas from various sites of origin (39.1-77.6%), Warthin tumors of parotid glands (66.7%), adenosquamous carcinomas of the cervix (33.3%), thymomas (16.0%), and endometroid carcinomas of the ovary (15.3%). Twenty other epithelial or germ cell neoplasms showed - a usually weak - CK13 positivity in less than 15% of the cases. In bladder cancer, reduced CK13 expression was linked to high grade and advanced stage (p < 0.0001 each). In squamous cell carcinoma of the cervix, reduced CK13 immunostaining was related to high grade (p=0.0295) and shortened recurrence-free (p=0.0094) and overall survival (p=0.0274). In a combined analysis of 1,151 squamous cell carcinomas from 11 different sites of origin, reduced CK13 staining was linked to high grade (p=0.0050). Our data provide a comprehensive overview on CK13 expression in normal and neoplastic human tissues. CK13 expression predominates in urothelial neoplasms and in squamous cell carcinomas of different organs, and a loss of CK13 expression is associated with aggressive disease in these tumors.

Facial nerve dysfunction following parotidectomy: role of intraoperative facial nerve monitoring.

Facial nerve dysfunction (FND) is a frequent and serious parotidectomy outcome. Intraoperative facial nerve monitoring (IFNM) is an increasingly used technique to identify the facial nerve (FN) and minimize its injury. This study aimed to evaluate the determinant factors in the presence and severity of FND after parotidectomy, including IFNM. A total of 48 patients consecutively submitted to parotidectomy between 2005 and 2020 in a tertiary hospital were retrospectively analyzed. The House-Brackmann Scale (HBS) was used to assess the severity of FND. There was a mean age of 54.2 ± 17.8years, 50% were male. Pleomorphic adenoma (41.7%) and Warthin's tumor (25.0%) were most common. From the 23 patients (47.9%) who developed some degree of FND (HBS score of 3.41 ± 1.53), 19 (82.6%) showed facial movement recovery, with a mean recovery time of 4.78 ± 2.53months. IFNM was performed in 39.6% of the surgeries. The use of IFNM (p = 0.514), the type of surgery-partial or total parotidectomy-(p = 0.853) and the type of histology-benign or malignant lesion-(p = 0.852) did not significantly influence the presence of FND in the postoperative period. However, in the subgroup of patients who developed FND, the HBS value was significantly lower in cases of benign pathology (p = 0.002) and in patients who underwent IFNM (p = 0.017), denoting a significantly lower severity. In the present study, IFNM and the existence of a benign lesion have been shown to be associated with lower severity of FND.

NOR-1 (NR4A3) immunostaining on cytologic preparations for the preoperative diagnosis of acinic cell carcinoma of the salivary gland.

Acinic cell carcinoma of the salivary gland (ACC-SG) is characterized by recurrent rearrangements in the nuclear receptor subfamily 4 group A member 3 (NR4A3). Immunostaining using an antibody targeting this rearrangement, neuron-derived orphan receptor 1 (NOR-1), has been recently studied on surgical specimens and cell block material of fine-needle aspirates for the diagnosis of ACC-SG. Our goal was to evaluate whether NOR-1 immunostaining could reliably be performed on destained cytologic preparations. This was a retrospective multi-institutional study. Immunostaining with the NOR-1 antibody (sc-393902 [H-7], Santa Cruz Biotechnology Inc.) was performed at a titer of 1:30 on destained cytologic preparations. ACC-SG cases (n = 17) were represented by twelve cases with alcohol-fixed preparations (n = 12), including direct smears and SurePath preparations, as well as 5 cases with air-dried preparations (n = 5). These were compared to 27 mimicker lesions (n = 27): normal acini (4), chronic sialadenitis (3), oncocytoma (2), pleomorphic adenoma (6), Warthin tumor (8), mucoepidermoid carcinoma (1), secretory carcinoma (2), and salivary duct carcinoma (1). The positivity of NOR-1 in ACC-SG cases was 100% on destained alcohol-fixed preparations (12/12) and 60% on air-dried preparations (3/5). All 27 mimicker lesions were negative for NOR-1 (0/27). Evaluation of 2 ACC-SG cases with both types of cytologic preparations showed that NOR-1 was positive on the alcohol-fixed slides but negative on the air-dried slides. NOR-1 immunostaining can reliably be performed on alcohol-fixed direct smears and liquid-based preparations for the diagnosis of ACC-SG. Air-dried preparations show a lower positivity rate and may be less suitable for diagnostic immunostaining.

CLINICOPATHOLOGICAL STUDY OF SALIVARY GLAND TUMOURS IN A TERTIARY CARE HOSPITAL IN CENTRAL INDIA

Salivary gland tumours are a relatively rare and morphologically diverse group of lesions, thus are highly prone to diagnostic confusion. Worldwide reports show difference in incidence, prevalence and histological type of this tumours. Location, age and gender distribution of salivary gland tumours vary depending on race and geographical conditions. OBJECTIVE 1) To study the clinicopathological ndings in Salivary Gland Tumours 2) To study various surgical modalities of treatment undertaken for salivary gland tumours RESULTS: Pleomorphic Adenoma (77.27%) was the most common benign tumour followed by warthins tumour (9.09%). Mucoepidermoid carcinoma was the most common malignant tumour in parotid gland. In our study Ultrasonography was found to had Sensitivity of 52.63% and Specicity of 95.45% And Fine needle aspiration cytology had sensitivity of 78.95% and specicity of 90.90% CONCLUSION: FNAC continues to be a reliable diagnostic technique in hands of an experienced cytopathologist. Ultrasonography is a reliable radiological rst line investigations for salivary gland tumours.

Warthin Tumor - Diagnostic Dilemma- Case Report

Warthin Tumor is also known as Papillary Cystadenoma lymphomatosum, is a fairly common tumor. Cytologically, it simulates many other lesions of salivary glands like chronic sialadenitis, low grade mucoepidermoid carcinoma, acinic cell carcinoma, squamous cell carcinoma, oncocytic carcinoma, lymphoepithelial cyst etc which poses a diagnostic dilemma.

Immunohistochemical analysis of cathepsin-D in benign and malignant salivary gland neoplasms. Evaluation of its role as a prognostic indicator.

Salivary gland tumors are histologically the most heterogeneous group of tumors. Traditional diagnostics and grading of these tumors often fail to provide any insight into patient's clinical course. Cathepsin-D is a lysosomal acid protease secreted in increased levels in several malignancies. However, its role in salivary gland tumors has not been studied extensively. The present study aims to assess the expression of cathepsin-D in malignant and benign salivary gland tumors and to compare its expression in these tumors. A total of 40 salivary gland tumors which included 10 cases each of adenoid cystic carcinoma, mucoepidermoid carcinoma, pleomorphic adenoma and Warthin's tumor were evaluated immunohistochemically for cathepsin-D expression. Intergroup comparison of cathepsin-D expression was done between the benign and malignant groups using the Mann-Whitney U-test. Intragroup comparison was also done using Kruskal-Wallis test. A statistically significant difference in the expression of cathepsin-D was observed between the benign and malignant groups. The malignant group showed a considerably higher cathepsin-D expression (mean value 6.284 ± 4.377) when compared to the benign group (mean value 2.281 ± 2.459). The differences in the immunopositivity between the malignant and benign groups were found to be highly significant (P = 0.004). Increased expression of cathepsin-D is observed in the malignant salivary gland neoplasms. This may prove to be a useful marker for the aggressive biologic behavior as well as invasive potential of salivary gland neoplasms.

Simultaneous Expression of PD-1 and PD-L1 in Peripheral and Central Immune Cells and Tumor Cells in the Benign and Malignant Salivary Gland Tumors Microenvironment.

To investigate the differential expression of PD-1 and PD-L1 in salivary gland tumors (SGTs, malignant and benign subtypes) and determine their association with the clinicopathological characterization of the patients. The immunohistochemistry was used to examine PD-1 and PD-L1 expression in specimens from 83 patients with primary SGTs including salivary ductal carcinoma (SDC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (ACC), mucoepidermoid carcinoma (MEC), warthin's tumors (WT), poleomorphic adenoma (PA) and other subtypes. The expression of PD-1 in peripheral and central immune cells (ICs) of MEC, and peripheral ICs of ACC was significantly higher than those with AdCC (P = 0.02, P = 0.02, P = 0.03, respectively). Interestingly, the expression of PD-1 was also observed in peripheral and central malignant tumor cells (TCs), particularly in SDC and ACC. Despite no significant difference in PD-L1 expression of TCs among malignant subtypes, the peripheral and central ICs of ACC and MEC were revealed to express PDL-1 significantly more than those with AdCC (P < 0.05). WTs were rich in PD-1/PD-L1 expressing ICs. However, the tumor microenvironment of PA generally had low levels of PD-1/PD-L1 expression. In general, the expression of PD-1 in peripheral and central TCs was found to be significantly higher in malignant tumors than in benign ones (P = 0.002 and P = 0.003, respectively). The simultaneous presentation of PD-1 and PD-L1 in TCs and ICs of SGTs, their significant association with disease severity as well as the positive correlation between these immune checkpoints may suggest the therapeutic potential of anti-PD-1 and anti-PDL-1 combinational immunotherapy for SGTs.

Results of 301 Parotidectomies: A Twenty-Year Experience of One Single Institution.

To evaluate demographic, clinical, surgical and histopathological results and complications of 301 parotidectomies performed in southern part of Turkey. The results of 297 patients undergoing 301 parotidectomies between 2000 and 2019 were retrospectively reviewed. Four patients underwent bilateral parotidectomy. Age, gender, side and size of lesion, postoperative facial nerve function (FNF) for benign tumors and types of surgery were evaluated. There were 172 male and 125 female patients. The mean age was 52.53 ± 16.67years (range 11-90years). Patients with malignant tumor had higher mean age than the patients with benign diseases (p < 0.001) and the mean age of Warthin tumor (WT) patients was significantly higher than pleomorphic adenoma (PA) (p < 0.001). There was a significant male dominancy in WTs than the PAs (p < 0.001). The mean size of the malignant tumors was significantly higher than the benign tumors (p = 0.012). The mean of cigarette smoking value (pack/year) was higher in WTs than the PAs (p < 0.001). WT incidence was slightly higher than PA in between years 2010 and 2019 (p = 0.272) compared to between years 2000 and 2009. Fine needle aspiration biopsy had asensitivity of 96% and specificity of 78% for the benign tumors. Tumor location (p < 0.001) and tumor size (p = 0.034) had negative effect on the postoperative FNF. The incidence of WT had a significant rise in the last decade. Deep lobe tumors and increased tumor size had effect postoperative FNF. Experience of surgeon ismore important than nerve monitoring to prevent facial paralysis. Partial superficial parotidectomy was available methods for small benign tumors in tail of the parotid gland.

Trend changes in the incidence of benign parotid tumours in the last 30years in a Spanish population.

To study the demographics and clinical characteristics of benign parotid tumours, focusing on the evolution of the incidence of Warthin tumour (WT) in recent years. A retrospective observational study is designed of patients diagnosed with a benign parotid tumour in a single tertiary hospital centre, from 1994 to 2021. The evaluation of the relationship between the different variables, and the changes in tumour incidence, is carried out using an analysis of standardized residuals. The study evaluated 279 patients, and the total of benign parotid tumours was 291. The most frequent type of tumour was pleomorphic adenoma (PA) (52.7%), followed by WT (37.6%). WT was more frequent in men (79%), and PA in women (55.8%). Smoking history is significantly high in patients with WT (83%), as well as mid-age, compared to PA. It seems to be an increase in the proportion of WT compared to PA in recent years. These changes can be concerning tobacco use and older patients at diagnosis in our series.

Discriminating between benign and malignant salivary gland tumors using diffusion-weighted imaging and intravoxel incoherent motion at 3 Tesla

PurposeThe purpose of this study was to retrospectively evaluate the diagnostic performances of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) for discriminating between benign and malignant salivary gland tumors (SGTs). Materials and methodsSixty-seven patients with 71 SGTs who underwent MRI examination at 3 Tesla were included. There were 34 men and 37 women with a mean age of 57 ± 17 (SD) years (age range: 20–90 years). SGTs included 21 malignant tumors (MTs) and 50 benign SGTs (33 pleomorphic adenomas [PAs] and 17 Warthin's tumors [WTs]). For each SGT, DWI and IVIM parameters, mean, skewness, and kurtosis of apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion volume fraction (f) were calculated and further compared between SGTs using univariable analysis. Areas under the curves (AUC) of receiver operating characteristic of significant parameters were compared using the Delong test. ResultsSignificant differences in ADCmean, Dmean and D*mean were found between SGTs (P < 0.001). The highest AUC values were obtained for ADCmean (0.949) for identifying PAs and D*mean (0.985) for identifying WTs and skewness and kurtosis did not outperform mean. To discriminate benign from malignant SGTs with thresholds set to maximize Youden index, IVIM and DWI produced accuracies of 85.9% (61/71; 95% CI: 75.6–93.0) and 77.5% (55/71; 95% CI: 66.0–86.5) but misdiagnosed MTs as benign in 28.6% (6/21) and 61.9% (13/21) of SGTs, respectively. After maximizing specificity to 100% for benign SGTs, the accuracies of IVIM and DWI decreased to 76.1% (54/71; 95% CI: 64.5–85.4) and 64.8% (46/71; 95% CI: 52.5–75.8) but no MTs were misdiagnosed as benign. IVIM and DWI correctly diagnosed 66.0% (33/50) and 50.0% (25/50) of benign SGTs and 46.5% (33/71) and 35.2% (25/71) of all SGTs, respectively. ConclusionIVIM is more accurate than DWI for discriminating between benign and malignant SGTs because of its advantage in detecting WTs. Thresholds set by maximizing specificity for benign SGTs may be advantageous in a clinical setting.

Epidemiological and clinical characteristics of 407 salivary glands neoplasms in surgically treated patients in 2010-2020

INTRODUCTION Tumors of the salivary glands account for approximately 3 to 4% of all head and neck neoplasms. It is estimated that 10-15% of them are malignant. The most common benign tumor is pleomorphic adenoma, while the most common malignant tumors are adenoid cystic carcinoma and mucoepidermoid carcinoma. Neoplasms of the salivary glands are extremely histologically diverse, which results from the complex embryogenesis of the salivary glands. The identified risk factors for tumors of the salivary glands are: ultraviolet radiation, ionizing radiation, viral infections, nicotine and alcohol. MATERIAL AND METHOD The aim of the study was an epidemiological analysis of patients with salivary gland neoplasms, the distribution and histopathological characteristics of individual neoplasms treated at the Department of Otorhinolaryngology of the Medical University of Warsaw in 2010-2020. The diagnoses were analyzed according to the latest WHO 2017 histological classification of salivary gland tumors. In addition, the material was supplemented with data on the 5-year survival rates of patients with malignant neoplasms obtained from the Registry of Marital Status. RESULTS AND DISCUSSION The material contained 407 neoplasms of the salivary glands over a 11-year period, of which malignant neoplasms accounted for 17.4%. The malignant tumors were dominated by: adenoid cystic carcinoma (28,2%), mucoepidermoid carcinoma (12,7%), and acinic cell carcinoma (9,9%). Lymphomas (15,5%) were also a large group. The benign neoplasms were dominated by pleomorphic adenoma (54.1%) and Warthin&apos;s tumor (36%). Tumors of the salivary gland the most often affected the parotid gland (92%). CONCLUSIONS The obtained data are consistent with the general epidemiological data described in the current literature.

Advanced magnetic resonance imaging findings in salivary gland tumors

Salivary gland tumors (SGTs) make up a small portion (approximately 5%) of all head and neck tumors. Most of them are located in the parotid glands, while they are less frequently located in the submandibular glands, minor salivary glands or sublingual gland. The incidence of malignant or benign tumors (BTs) in the salivary glands varies according to the salivary gland from which they originate. While most of those detected in the parotid gland tend to be benign, the incidence of malignancy increases in other glands. The use of magnetic resonance imaging (MRI) in the diagnosis of SGTs is increasing every day. While conventional sequences provide sufficient data on the presence, localization, extent and number of the tumor, they are insufficient for tumor specification. With the widespread use of advanced techniques such as diffusion-weighted imaging, semi-quantitative and quantitative perfusion MRI, studies and data have been published on the differentiation of malignant or BTs and the specificity of their subtypes. With diffusion MRI, differentiation can be made by utilizing the cellularity and microstructural properties of tumors. For example, SGTs such as high cellular Warthin’s tumor (WT) or lymphoma on diffusion MRI have been reported to have significantly lower apparent diffusion values than other tumors. Contrast agent uptake and wash-out levels of tumors can be detected with semi-quantitative perfusion MRI. For example, it is reported that almost all of the pleomorphic adenomas show an increasing enhancement time intensity curve and do not wash-out. On quantitative perfusion MRI studies using perfusion parameters such as Ktrans, Kep, and Ve, it is reported that WTs can show higher Kep and lower Ve values than other tumors. In this study, the contribution of advanced MRI to the diagnosis and differential diagnosis of SGTs will be reviewed.

Squamous Cell Carcinoma Arising in a Parotid Warthin's Tumor: A Case Report and Literature Review.

Warthin's tumor is the second most common benign neoplasm of the parotid gland. Epithelial malignant transformation of Warthin's tumor, especially to squamous cell carcinoma, is a rare event. The authors present a case report of a 57-year-old male patient with a mass in the left parotid gland. This paper documents the appearance of squamous cell carcinoma within Warthin's tumor of the left parotid gland and reviews the other similar features of 12 cases.

Cytokeratin 10 (CK10) expression in cancer: A tissue microarray study on 11,021 tumors

Cytokeratin 10 (CK10) is a type I acidic low molecular weight cytokeratin which is mainly expressed in keratinizing squamous epithelium of the skin. Variable levels of CK10 protein have been described in squamous carcinomas of different sites and in some other epithelial neoplasms. To comprehensively determine the prevalence of CK10 expression in normal and neoplastic tissues, a tissue microarray containing 11,021 samples from 131 different tumor types and subtypes was analyzed by immunohistochemistry. CK10 immunostaining was detectable in 41 (31.3 %) of 131 tumor categories, including 18 (13.7 %) tumor types with at least one strongly positive case. The highest rate of positive staining was found in squamous cell carcinomas from various sites of origin (positive in 18.6 %–66.1 %) and in Warthin tumors of salivary glands (47.8 %), followed by various tumor entities known to potentially exhibit areas with squamous cell differentiation such as teratomas (33.3 %), basal cell carcinomas of the skin (14.3 %), adenosquamous carcinomas of the cervix (11.1 %), and several categories of urothelial neoplasms (3.1 %–16.8 %). In a combined analysis of 956 squamous cell carcinomas from 11 different sites of origin, reduced CK10 staining was linked to high grade (p < 0.0001) and advanced stage (p = 0.0015) but unrelated to HPV infection. However, CK10 staining was not statistically related to grade (p = 0.1509) and recurrence-free (p = 0.5247) or overall survival (p = 0.5082) in 176 cervical squamous cell carcinomas. In the urinary bladder, CK10 staining occurred more commonly in muscle-invasive (17.7 %) than in non-invasive urothelial carcinomas (4.0 %–6.0 %; p < 0.0001). In summary, our data corroborate a role of CK10 as a suitable marker for mature, keratinizing squamous cell differentiation in epithelial tissues. CK10 immunohistochemistry may thus be instrumental for a more objective evaluation of the clinical significance of focal squamous differentiation in cancer.

1053 Primary Acinic Cell Carcinoma in a Young Female: A Case Report

Abstract Background Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 5% of all primary salivary gland malignancies. ACCs predominate in the parotid gland, seen in the fifth and sixth decades of life and has a female predilection. Well-differentiated and low-grade tumours are associated with a favourable prognosis. Case Description We report a case of a 16-year-old female, presenting with a right parotid lump, slowly increasing over the last year. Clinical examination revealed a 1.5cm right parotid nodule with no facial nerve involvement and presence of cervical lymphadenopathy. Past medical history was unremarkable. Findings Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland with presence of reactive lymph nodes bilaterally. Differential diagnoses included Warthin's tumour, which would have been unusual in this age group, and the patient underwent a right partial parotidectomy. Histological examination showed a multinodular appearance with some marked granular cytoplasm with oncolytic and lymphoid infiltrate. Immunohistochemistry was negative for S100, positive with DOG-1. There were widespread PAS-D-resistant granules throughout the tumour cells, with ki67 proliferation index of approximately 5%. Results The tumour was completely excised, and the patient made a full recovery and considered to have a good long-term prognosis. Conclusion This is an unusual case of ACC seen in this age group and gender, where less than 4% of cases of ACC have been reported in patients younger than 20. It is important to consider differential diagnoses of salivary gland pathology, such as ACC in the young female patient.