Impaired intratumoral dendritic cell function and potential predictive value of dendritic cells markers for metastasis in malignant salivary gland tumors

Background: The differentiation between primary and metastatic salivary gland neoplasms (SGNs) helps in determining appropriate management strategies, including the need for additional diagnostic tests, surveillance, or aggressive treatment. The purpose of this study was to identify and quantify the immature and mature dendritic cells (DCs) in metastatic and no metastatic SGNs and determine its association with clinicopathological findings. Material and Methods: Cross-sectional, observational, and descriptive study that includes 33 malignant salivary gland neoplasms [MSGN (6, 18.1% metastatic)], and 22 pleomorphic adenomas (PA), as a control group. Clinical and histopathological characteristics were obtained. Immunohistochemistry for human leukocyte antigen Drelated (HLA-DR), CD1a, CD83, and Ki-67 proteins was done. Positive intra- and peritumoral DCs were counted. Results: Individuals with MSGN had a lower density of intratumoral HLA-DR+ cells than those with PA (p=0.001), Ki-67 immunostaining was significantly higher in MSGN than in PA (6% vs. 1.4%, p<0.001). Metastatic MSGN showed less intratumoral CD1a+ than non-metastatic (3.2 vs. 165.1, p=0.001). No differences in intra- and peritumoral CD83+ cells were found between benign and malignant SGN. Conclusions: These results suggest that the immune-protective function of intratumoral DCs is compromised in MSGNs. DCs markers may represent useful prediction tools for metastases in salivary gland malignancies, with crucial implications in the implementation of appropriate disease management strategies. (AU)

Características operativas de la ecografía en el diagnóstico del Síndrome de Sjögren / Operational characteristics of ultrasound in the diagnosis of Sjögren's syndrome

Antecedentes y objetivo: Determinar las características operativas de la ecografía de glándula salival (EGS) en el diagnóstico del síndrome de Sjögren (SS) en una población de pacientes colombianos con síntomas secos. Materiales y métodos: Estudio de pruebas diagnósticas en pacientes con síntomas secos que asistieron a la consulta de reumatología (2018-2020). Se obtuvieron datos sociodemográficos y clínicos a través de una encuesta, pruebas paraclínicas, oftalmológicas, biopsia de glándula salival menor, flujo salival no estimulado y EGS (puntuación 0-6 basada en De Vita). Se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN) (Stata 15®). Se desarrolló la curva de características operativas del receptor (COR). Resultados: Se incluyó a 102 pacientes (34 con SS y 68 sin SS), edad media ± desviación estándar de 55,69 ± 11,93 años, 94% mujeres. La ecografía positiva (puntuación de 2 o más) fue más frecuente en el grupo de SS, (70,6% vs. 22,1%, p < 0,0001). La sensibilidad fue igual para el grado 2 y 3 (70,59%), con una especificidad mayor (89,71%) para el grado 3 (VPP 77,42% VPN 85,92). La curva COR a partir de la sumatoria de las glándulas por medio de ecografía, fue mejor que las de las glándulas independientes. La curva COR de la ecografía presentó una mayor área bajo la curva (0,72 [0,61-0,82]) que la del análisis histológico (puntuación por focos) (0,68 [0,59-0,78]), p = 0,0252. Conclusión: La EGS es un método útil y confiable para la clasificación del SS. Se podría plantear su uso futuro dentro de los criterios clasificatorios del SS.(AU)

Background and objective: To determine the operational characteristics of salivary gland ultrasound (SGU) in the diagnosis of Sjögren's syndrome (SS) in a population of colombian patients with dry symptoms. Materials and methods: Study of diagnostic tests in patients with dry symptoms who consecutively attended the rheumatology consultation (2018-2020). Sociodemographic and clinical data were obtained through a survey, paraclinical and ophthalmological tests, minor salivary gland biopsy, unstimulated salivary flow and SGU (score 0-6 based on De Vita) were done. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (Stata 15®) were calculated. The receiver operating characteristics (ROC) curve was developed. Results: 102 patients were included (34 SS and 68 non-SS), mean age 55.69 (± 11.93) years, 94% women. Positive ultrasound (score of 2 or more) was more frequent in the SS group, (70.6% vs. 22.1%, P<.0001). The sensitivity was the same for grade 2 and 3 (70.59%), with a higher specificity (89.71%) for grade 3 (PPV 77.42% NPV 85.92). The ROC curve from the sum of the glands by means of ultrasound was better than those of the independent glands. The ROC curve of the ultrasound presented a greater area under the curve (0.72 [0.61-0.82]) than that of the histological analysis (focus score) (0.68 [0.59-0.78]), P=.0252. Conclusion: Salivary gland ultrasound is a useful and reliable method for the classification of SS. Its use could be considered in the future within the SS classification criteria.

Lymphomas affecting the submandibular glands / Linfomas que afectan las glándulas submandibulares

Background: Lymphomas affecting the submandibular glands are very uncommon and few reports are currentlyavailable in the literature. Therefore, the aim of the current study is to describe the clinical and microscopic fea-tures of an original series of lymphomas affecting the submandibular glands.Material and Methods: The pathology files of two institutions were searched for lymphoma cases affecting thesubmandibular glands. The original hematoxylin and eosin, and immunohistochemical slides were revised by apathologist for diagnosis confirmation following the revised 4th edition of the World Health Organization classification of tumours of haematopoietic and lymphoid tissues. Clinical data regarding age, sex, clinical manifestation,treatment, follow-up and status at last appointment were retrieved from the patients’ medical charts.Results: During the period investigated, 16 cases were included in the study. Females predominated (10:6) with amean age of 57.8 years-old. Tumors usually presented as asymptomatic swellings. MALT lymphoma representedthe most common subtype, followed by diffuse large B cell lymphoma and follicular lymphoma. Three patientsdied, one of them affected by plasmablastic lymphoma, one by DLBCL and one by MALT lymphoma.Conclusions: Low-grade B cell lymphomas predominate in the submandibular glands, but DLBCL and other sub-types may also be rarely diagnosed in this salivary gland.(AU)

Malignant salivary gland tumors: agreement between fine needle aspiration biopsy, incisional biopsy and final histopathological diagnostic / Tumores malignos de glándulas salivales: concordancia entre biopsia por aspiración con aguja fina, biopsia incisional y diagnóstico histopatológico final

Background: Incisional biopsy is indicated for intraoral tumors, but it is a contraindicated surgical procedure formajor salivary glands. To avoid complications and facilitate diagnosis, fine needle aspiration biopsy (FNAB) is atype of biopsy widely used for preoperative diagnosis in these glands.Material and Methods: The aim of this study was to analyze the agreement between the diagnosis by FNAB (ma-jor glands), incisional biopsy (minor glands) and histopathological analysis of the surgical specimen in salivarygland tumors from a database (medical records) of patients treated in a cancer treatment reference center in theNortheast region of Brazil.Results: The sample consisted of 110 cases, being 86 of them malignant tumors in major salivary glands (parotidgland=73; submandibular gland=13) and 24 cases in minor salivary glands (palate). The female gender was themost affected (57.3%), especially in patients over 60 years (42.7%). In the TNM classification, 41.8% of the caseswere in T2 at the time of diagnosis, with most of the regional lymph nodes in N0 (85.5%) and 87.3% of the casesin M0. FNAB was able to identify malignant neoplasms in 68.6% of the cases (n=59), while incisional biopsy inpalatal tumors obtained agreement of 75% of the cases (n=18). The analysis revealed that tumors classified as T3-T4 (p=0.012) showed greater agreement between pre- and post-surgical diagnosis.(AU)

Salivary gland ultrasound in clinical practice: What is its real usefulness? / Utilidad en práctica clínica de la ecografía de glándulas salivales

Background: Salivary gland ultrasound (SGU) provides information about structural gland abnormalities that can be graded and used for primary Sjögren's syndrome (pSS) diagnosis. Its potential role as a prognostic marker for detecting patients at high risk of lymphoma and extra-glandular manifestations is still under evaluation. We aim to assess the usefulness of SGU for SS diagnosis in routine clinical practice and its relationship with extra-glandular involvement and lymphoma risk in pSS patients. Methods: We designed a retrospective observational single-center study. Data was collected using the electronic health records of patients referred to an ultrasound outpatient clinic for evaluation over a 4-year period. Data extraction included demographics, comorbidities, clinical data, laboratory tests, SGU results, salivary gland (SG) biopsy, and scintigraphy results. Comparisons were made between patients with and without pathological SGU. The external criterion for comparison was the fulfillment of the 2016 ACR/EULAR pSS criteria. Results: A total of 179 SGU assessments were included from this 4-year period. Twenty-four cases (13.4%) were pathological. The most frequently diagnosed conditions prior to SGU-detected pathologies were pSS (9.7%), rheumatoid arthritis (RA) (13.1%), and systemic lupus (4.6%). One hundred and two patients (57%) had no previous diagnosis (sicca syndrome work-up); of these, 47 patients (46.1%) were ANA positive and 25 (24.5%) anti-SSA positive. In this study, the sensitivity and specificity of SGU for SS diagnosis were 48% and 98% respectively, with a positive predictive value of 95%. There were statistically significant relationships between a pathological SGU and the presence of recurrent parotitis (p=.0083), positive anti-SSB antibodies (p=.0083), and a positive sialography (p=.0351)...(AU)

Antecedentes y objetivo: La ecografía de glándulas salivales (EGS) proporciona información acerca de las anomalías en la estructura glandular, y puede ser utilizado para el diagnóstico del síndrome de Sjögren (SS). Además, su potencial valor pronóstico para detectar pacientes con riesgo de manifestaciones extra-glandulares, así como el riesgo de linfoma se encuentra aún bajo estudio. El objetivo de nuestro estudio es evaluar la utilidad de la EGS para el diagnóstico del SS en la práctica clínica habitual, y su relación con la afectación extra-glandular, así como el riesgo de linfoma en pacientes con síndrome de Sjögren primario (pSS). Métodos: Realizamos un estudio retrospectivo y observacional en un único centro. La información fue recolectada de la historia clínica electrónica del paciente tras un seguimiento de 4 años. Esta información incluye variables demográficas, comorbilidades, datos clínicos, análisis de laboratorio, los resultados de la EGS, biopsia de glándulas salivales y gammagrafía. Se efectuaron comparaciones entre los pacientes que tenían una EGS patológica con aquellos que tenían un resultado normal. El criterio para establecer la comparación fue cumplir los criterios de ACR/ELUAR 2016 para el diagnóstico de pSS. Resultados: Se realizaron un total de 179 EGS durante el período de 4 años. De estas, 24 (13,4%) resultaron ser patológicas. Las enfermedades más frecuentemente identificadas tras realizar la EGS fueron pSS (9,7%), artritis reumatoide (AR) (4,6%) y lupus eritematoso sistémico (LES) (4,6%). Ciento dos pacientes (57%) no tenían diagnóstico previo (estudio de síndrome seca); de estos, 47 (46,1%) tenían ANA positivo y 25 (24,5%) tenían anti-Ro positivo. La sensibilidad y la especificidad de la EGS para detectar el SS en nuestro estudio fueron del 48 y 98%, respectivamente; con un valor predictivo positivo del 95%...(AU)

Adenocarcinoma mucinoso gigante de glándula submandibular: presentación de un caso extremadamente infrecuente / Giant mucinous adenocarcinoma of the submandibular gland. Report on an extremely rare case

El adenocarcinoma mucinoso es una entidad patológica poco frecuente dentro de las neoplasias que afectan a las glándulas salivales. Se presenta el caso de una paciente de 89 años con antecedentes de un aumento de volumen en el cuello. Al examen físico se constató una tumoración que abarcaba toda la región cervical derecha y se extendía desde la región submandibular hasta la región clavipectoral homolateral. El estudio histopatológico confirmó un adenocarcinoma mucinoso de bajo grado. Se efectuó una disección del cuello extendida a piel y luego se reconstruyó la zona con un colgajo miocutáneo de músculo pectoral mayor, debido al defecto generado por la eliminación del gran volumen tumoral.En conclusión, se presenta un caso extremadamente infrecuente de adenocarcinoma mucinoso de glándula submandibular de tamaño gigante. (AU)

Mucinous Adenocarcinoma is a rare pathological entity within neoplasms that affect the salivary glands. The case of an 89-year-old female patient with a history of increased volume in the neck is presented. Physical examination revealed a tumor that covered the entire right cervical region and extended from the submandibular region to the ipsilateral clavipectoral region. The histopathological study confirmed a low grade Mucinous Adenocarcinoma. A neck dissection extended to the skin was performed and then the area was reconstructed with a myocutaneous flap from the pectoralis major muscle due to the defect generated by the removal of the large tumor volume.In conclusion, an extremely rare giant-sized mucinous adenocarcinoma of the submandibular gland is presented.

Tratamiento quirúrgico de la patología tumoral de la glándula parótida. Estudio descriptivo de 263 parotidectomías / Surgical treatment of tumor pathology of the parotid gland. Descriptive study of 263 parotidectomies

Introducción y objetivo: Los tumores salivales representan el 3-10% de los tumores de cabeza y cuello, siendo el 75-80% de origen parotídeo y en su mayoría benignos. La parotidectomía es una técnica quirúrgica que consiste en la exéresis de la glándula parótida. Existen diversos tipos; parotidectomía superficial (PS), parotidectomía superficial parcial (PSP) y parotidectomía total (PT). En esta última, al no respetarse el nervio facial (NF), las complicaciones son más frecuentes. Nuestro objetivo es analizar el resultado (tasa de recidiva y complicaciones) de la parotidectomía como técnica quirúrgica empleada en el manejo de la patología parotídea, así como evaluar qué prueba complementaria es la más eficaz en el diagnostico prequirúrgico de la patología parotídea tumoral. Material y método: Se realiza un estudio retrospectivo incluyendo 263 pacientes tratados mediante PS o PT entre enero de 2004 y diciembre de 2020 en el Hospital Universitario de Fuenlabrada. Se registraron datos demográficos, tiempo de evolución de la lesión, pruebas complementarias, protocolo quirúrgico y complicaciones postoperatorias. Se analiza principalmente la correlación positiva entre las pruebas realizadas prequirúrgicas (PAAF, ecografía, TC y RMN), con el diagnóstico definitivo anatomopatológico obtenido tras examinar la pieza quirúrgica. También se describe la tasa de paresia y parálisis facial y otras complicaciones habidas. Resultados: Se incluyeron 263 pacientes tratados mediante parotidectomía. El tiempo de evolución medio de las lesiones parotídeas fue de 15 meses (DE 19.88). La sensibilidad de la PAAF en nuestro estudio fue de 68.7%. Se realizó ecografía en un 44.10% de los pacientes, TC en un 77.94% y RMN en un 15.20%, mostrando una sensibilidad de 18.05%, 31.21% y 45%, respectivamente. (AU)

Introduction and objetive: Salivary tumors account for 3-10% of head and neck tumors, 75-80% being of parotid origin and mostly benign. Parotidectomy is a surgical technique that consists of exeresis of the parotid gland. There are various types; Superficial parotidectomy (PS), partial superficial parotidectomy (PSP), and total parotidectomy (PT). In the latter, since the facial nerve (FN) is not spared, complications are more frequent. Our objective is to analyze the outcome (recurrence rate and complications) of parotidectomy as a surgical technique used in the management of parotid pathology, as well as to evaluate which complementary test is the most effective in the pre-surgical diagnosis of tumorous parotid pathology. Material and methods: We performed a retrospective study including 263 patients treated by SP or TP between January 2004 and December 2020 at the Fuenlabrada University Hospital. Demographic data, time of lesion evolution, complementary tests, surgical protocol and postoperative complications were recorded. The positive correlation between the pre-surgical tests performed (Fine needle aspiration (FNA), ultrasound, CT and MRI) and the definitive anatomopathological diagnosis obtained after examining the surgical specimen is analyzed. The rate of paresis/facial paralysis and other complications is also described. Results: We included 263 patients treated by parotidectomy. (AU)

Linfoma MALT de glándula parótida. Revisión sistemática / MALT lymphoma of the parotid gland. Systematic review

Introducción y objetivo: Los linfomas de la glándula parótida son una entidad infrecuente. El objetivo de este estudio es realizar una revisión sistemática retrospectiva de la literatura sobre casos clínicos de linfomas MALT parotídeos. Se revisa su epidemiología y clínica más habitual, los métodos diagnósticos y tratamiento empleados y su pronóstico. Método: Revisión bibliográfica sistemática. Resultados: Se seleccionaron 28 estudios originales de casos o series, de los cuales 10 incluyeron más de 25 pacientes. Todos mostraron mayor incidencia en mujeres, en consonancia con su asociación con la presencia de enfermedades autoinmunes, específicamente con el síndrome de Sjögren. Los estudios evidenciaron la dificultad en el diagnóstico diferencial de otras patologías parotídeas. El tratamiento varió entre estudios, sin mostrar ninguno de ellos un claro beneficio respecto de los demás. Discusión: Se trata de un tipo de LNH relacionado principalmente con inflamación autoinmune crónica en el caso de aparición en glándulas salivales. Se presenta como una tumoración asintomática e inespecífica de crecimiento lento. Se diagnostica por su histología y se estudia su extensión mediante TC o RM en la mayoría de los casos. El tratamiento se realiza mediante parotidectomía asociada a quimioterapia y/o radioterapia. La tasa de supervivencia es >80% a los 5 años. Conclusiones: Los linfomas MALT de glándulas salivales son poco habituales y ocasionalmente se diagnostican de manera inadecuada debido a su comportamiento benigno, que mimetiza a tumores más familiares del área parotídea. Su sospecha y distinción son esenciales y no debe olvidarse en el diagnóstico diferencial de masas parotídeas. (AU)

Introduction and objective: The parotid gland lymphomas are encountered unfrequently. The objective of this study is do a retrospective systematic review of the literature on parotid MALT lymphomas, to evaluate its epidemiology, clinical presentation, diagnostic methods, treatment, and prognosis. Method: Systematic review. Results: 28 original studies have been included (case report and case series), 10 of which included more than 25 cases. Studies showed a higher prevalence in women, according to its relationship with autoimmune diseases, Sjögren disease specifically. The studies outlined the difficulty on the differential diagnosis with other parotid diseases. Treatment varied between studies, with no specific benefit for any of them. Discussion: This lymphoma is a type of NHL related to chronic autoimmune inflammation in case of salivary glands localization. It presents as an asymptomatic and non-specific, slow growing mass. It is diagnosed by CT or MRI in the majority of cases. The treatment includes the association of parotidectomy and/or chemotherapy and/or radiotherapy. The 5-year survival rate is >80%. Conclusions: MALT salivary lymphomas are a rare entity that can be easily misdiagnosed by other common benign mases. We must suspect and don't forget this entity from the differential diagnosis diagram. (AU)

Linfoma MALT de glándula parótida. Descripción de un caso / MALT linfoma of the parotid gland. Case report

Introducción y objetivo: El linfoma tipo MALT es un tipo de LNH relacionado principalmente con inflamación autoinmune crónica en el caso de aparición sobre glándulas salivales. Los linfomas de la glándula parótida son una entidad infrecuente. Presentamos un paciente con linfoma tipo MALT de parótida, describiendo sus métodos diagnósticos y de tratamiento más empleados. Descripción: Mujer de 69 años con tumoración asintomática en cola de parótida y visión de estructuras nodulares en imagen de TC y RM con citología por PAAF negativa. Se realiza parotidectomía total hallando el diagnóstico de linfoma MALT de la zona marginal. Se completa tratamiento mediante esquema R-CHOP durante 4 meses, sin signos de recidiva al año. Conclusiones: Los linfomas de glándulas salivales son poco habituales y ocasionalmente sufren un retraso diagnóstico debido a su comportamiento benigno que mimetiza a tumores más familiares del área parotídea. Su sospecha y distinción son esenciales y no deben olvidarse en nuestro diagnóstico diferencial de masas parotídeas. (AU)

Introduction and objective: The parotid gland lymphomas are encountered unfrequently. We present a case report from a MALT lymphoma of the parotid gland, describing its most employed diagnostic and treatment strategies. Description: 69 year old woman with an asymptomatic tumor in the parotid gland tail, showing a nodular image in CT y MRI and with a negative citology by FAAB. We perform a total parotidectomy discovering a marginal zone MALT lymphoma. We complement the treatment with r-chop chemotherapy regimen during 4 months without recurrence signs after 1 year follow up. Conclusions: The salivary gland lymphomas are a rare entity that can be easily misdiagnosed by other common benign mases. We must suspect and don't forget this entity from our differential diagnosis diagram. (AU)

Recommendations for the use of biomarkers for head and neck cancer, including salivary gland tumours: A Consensus of the Spanish Society of Medical Oncology and the Spanish Society of Pathology / Recomendaciones para el uso de biomarcadores para cáncer de cabeza y cuello, incluyendo tumores de glándulas salivares: consenso de la Sociedad Española de Oncología Médica y la Sociedad Española de Patología

The treatment of head and neck and salivary gland tumours is complicated and is constantly evolving. Prognostic and predictive indicators of response to treatment are enormously valuable for designing individualized therapies, which justifies their research and validation. Some biomarkers, such as p16, Epstein–Barr virus, PD-L1, androgen receptors and HER-2, are already used routinely in clinical practice. These biomarkers, along with other markers that are currently under development, and the massively parallel sequencing of genes, ensure future advances in the treatment of these neoplasms.In this consensus, a group of experts in the diagnosis and treatment of tumours of the head and neck and salivary glands were selected by the Spanish Society of Pathology (Sociedad Española de Anatomía Patológica – SEAP) and the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica – SEOM) to evaluate the currently available information and propose a series of recommendations to optimize the determination and daily clinical use of biomarkers.(AU)

El tratamiento de los tumores de cabeza y cuello y de glándulas salivales es complejo, y evoluciona de forma constante. Los indicadores pronósticos y predictivos de respuesta al tratamiento son enormemente valiosos para diseñar terapias individualizadas, lo que justifica su investigación y validación. Algunos biomarcadores como p16, el virus de Epstein-Barr, PD-L1, los receptores de andrógenos o HER-2, ya se utilizan de manera rutinaria en la práctica clínica. Estos biomarcadores, junto con otros marcadores que están actualmente en desarrollo, y la secuenciación masiva de genes, aseguran los futuros avances en el tratamiento de estas neoplasias. En este consenso, un grupo de expertos en el diagnóstico y tratamiento de los tumores de cabeza y cuello y glándulas salivales seleccionado por la Sociedad Española de Anatomía Patológica (SEAP) y la Sociedad Española de Oncología Médica (SEOM) evalúan la información actualmente disponible y proponen una serie de recomendaciones para optimizar la determinación y utilización en la práctica clínica diaria de los biomarcadores.(AU)

Sialoadenitis aguda por administración de contraste yodado / Acute sialadenitis by iodine contrast medium administration

La sialoadenitis aguda es una reacción adversa muypoco frecuente a la administración de contraste yodado,que causa una inflamación autolimitada de las glándulassalivales. Su patogenia no está bien establecida, aunque la insuficiencia renal puede ser un factor de riesgo.El diagnóstico es inicialmente clínico, y debe realizarsediagnóstico diferencial con angioedema, infecciones y litiasis. Ningún tratamiento o profilaxis ha demostrado beneficio hasta el momento. Aunque tiene buen pronóstico,en algunos casos se han descrito complicaciones.Presentamos el caso de un varón de 68 años que presentó inflamación de las glándulas salivales submandibulares tras la realización de una tomografía computariza-da abdominal con administración de contraste yodado.Dado el uso creciente de contrastes yodados en pruebasde imagen y técnicas intervencionistas, es importante conocer posibles reacciones adversas como esta entidad.(AU)

Acute iodide sialadenitis is a rare adverse reactionto iodinated contrast that causes self-limited salivarygland swelling. Its pathogenesis is still unclear, althoughkidney failure may be a risk factor. The diagnosis isinitially clinical but angioedema, infections and lithiasis should be included in the differential diagnosis. Notreatment or prophylaxis was proven to be beneficial.Although its prognosis is benign, associated complications have been reported.We report a case of 68-year-old man with swelling ofthe submandibular salivary glands after the administration of iodine-based contrast media during an abdomi-nal computed tomography examination. Because of thewidespread use of iodinated contrast enhanced imaging and interventional techniques, clinicians should beaware of this issue.(AU)

Stimulated whole salivary flow rate: The most appropriate technique for assessing salivary flow in Sjögren syndrome / Caudal salival total estimulado: la técnica más adecuada para evaluar el flujo salival en el síndrome de Sjögren

Background: We sought to determine the most appropriate method for measuring salivary flow to aid the diag-nosis of Sjögren's syndrome (SS). Specifically, we compared the unstimulated whole salivary flow rate (UWSFR)with the stimulated whole salivary flow rate (SWSFR).Material and Methods: This case-control study comprised one group of 103 patients with SS and a control group of50 healthy people. We measured the UWSFR and SWSFR in both groups according to the guidelines establishedby Navacet (1993).Results: The UWSFR and SWSFR were significantly lower in the patient group compared with the controls ( p <0.01). Among the participants in the patient group, we found a decreased UWSFR in 84 individuals (81.5%) and adecreased SWSFR in 90 individuals (87.4%). We encountered difficulties obtaining saliva in 37 (35.9%) patientsduring the UWSFR test, and in 12 (11.7%) patients during the SWSFR test. There was no significant statisticaldifference in the UWSFR or SWSFR between patients with primary and secondary SS.Conclusions: Compared with the UWSFR, the SWSFR is a more suitable and effective method for measuringsalivary flow in patients with SS, as well as for qualitative analysis of the obtained saliva.(AU)

Prognostic value of the immunohistochemical expression of vascular endothelial growth factors in malignant salivary gland neoplasms: a systematic review and meta-analysis / Valor pronóstico de la expresión inmunohistoquímica de vascular. Factores de crecimiento endotelial en neoplasias malignas de glándulas salivales: una revisión sistemática y un metanálisis

Background: The immunohistochemical expression of vascular endothelial growth factor is a prognostic markerin several cancer types. In salivary gland tumors, the association between vascular endothelial growth factor andprognosis remains unclear. The purpose of this study was to perform a systematic review and meta-analysis to as-sess whether the immunohistochemical expression of vascular endothelial growth factor in patients with salivarygland neoplasms presents prognostic value.Material and Methods: Immunohistochemical studies assessing the predictive value of vascular endothelialgrowth factor in salivary gland neoplasms were systematically reviewed using PubMed, Scopus, Embase, Co-chrane Library, and Web of Science databases. It was assessed any survival rates. The fixed-effect model withan adjusted hazard ratio (HR) and 95% confidence intervals (95% CI) as effect measures were performed in themeta-analysis. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included stud-ies, and the evidence quality was assessed by the Grading of Recommendation, Assessment, Development, andEvaluation (GRADE) system.Results: The immunohistochemical overexpression of vascular endothelial growth factor in patients with salivarygland neoplasms was associated with shortened survival (HR=5.37, 95% CI: 2.67-10.83, P = 0.00001). In addition,the presence of vascular endothelial growth factor was tightly associated with tumor size, lymph node metastasis,clinical stage, perineural invasion, vascular invasion, poor local control of the disease, and recurrence.Conclusions: The immunohistochemical overexpression of vascular endothelial growth factor in patients withsalivary gland neoplasms has prognostic value and was associated with decreased survival time. However, moreprimary well-designed studies are necessary to increase the level of evidence.(AU)

Qualitative mucin disorders in patients with primary Sjögren's syndrome: a literature review

BACKGROUND: It is a common opinion that Primary Sjögren Syndrome (pSS) damages the exocrine glands and determines the reduction of secreted saliva, some studies show that there are qualitative anomalies of the mucins produced in saliva, including MUC7, MUC5B, MUC1. The purpose of this study is to trace all the information useful to establish whether there is a qualitative or quantitative defect of the mucins in the pSS. MATERIAL AND METHODS: We reviewed the literature by looking for publications relevant to the topic in electronic databases. Sixteen articles met the search criteria. The studies were divided into two categories, those that studied the rheological characteristics of the saliva and those that studied the structural and / or metabolism modifications of the muciparous cells in the salivary glands. RESULTS: in Patients with pSS, xerostomia and the reduction of salivary spinnbarkeit are only partially related to the reduction of the unstimulated salivary flow. In pSS, pathological alterations of mucins' chemical-physical properties prevail as a cause of the clinical characteristics. Moreover, in pSS there are structural and metabolism changes in salivary glands' muciparous cells. CONCLUSIONS: There is much evidence that supports the presence of qualitative alterations in the saliva's rheological properties in Patients with pSS, and these are the main cause, more than the reduction of the unstimulated salivary flow, of the disease clinical characteristics - dry mouth and complications in the oral cavity. Therefore we propose to add to the classification criteria of pSS also a qualitative test of salivary glycoproteins

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Agenesia unilateral congénita de glándula lagrimal con sustitución por lipoma. Un caso raro de alacrimia congénita unilateral / Congenital unilateral absence of the lacrimal gland combined with lipoma. A rare case of unilateral congenital alacrima

El propósito de este artículo es describir un caso de agenesia lagrimal congénita unilateral en una niña de 7 años con síntomas oculares, ausencia de secreción lagrimal y una tumoración conjuntival en el ángulo superoexterno del ojo derecho. La agudeza visual era de 20/20 en ambos ojos. El ojo derecho presentaba secreción mucosa, erosiones y filamentos corneales. La anamnesis, la exploración física y las pruebas analíticas descartaron enfermedades sistémicas asociadas a la alacrimia congénita, así como enfermedades reumatológicas, inmunológicas o infecciosas. La resonancia nuclear magnética con diversas técnicas de supresión grasa mostró la ausencia de glándula lagrimal derecha y la presencia de una tumoración compatible con lipoma. Este caso, para nuestro conocimiento, representa la primera comunicación de una agenesia unilateral de glándula lagrimal combinada con un lipoma

The purpose of this report is to describe a case of a unilateral congenital absence of the lacrimal gland in a 7-year-old girl with ocular symptoms, no tear production and a conjunctival tumour at the supero-external angle of the right eye. The visual acuity was 20/20 in both the eyes. The right eye showed mucous secretion, corneal erosions and filaments. Anamnesis, physical examination and clinical tests ruled out systemic diseases associated with congenital alacrima, as well as rheumatic, immunological and infectious diseases. Nuclear magnetic resonance, with various fat suppression techniques, demonstrated the absence of the right lacrimal gland and the presence of a tumour compatible with lipoma. This case, to our knowledge, is the first report of unilateral absence of the lacrimal gland combined with lipoma