Adenoma pleomorfo benigno contralateral en glándulas parótida y submandibular: reporte de un caso / Contralateral benign pleomorphic adenoma in parotid and submandibular gland: report of a case

Se reporta el caso de una paciente de 36 años quien acude a consulta en el servicio de Oncología del Hospital Universitario de Maracaibo, por presentar aumento de volumen en región infraauricular del lado derecho y submandibular del lado izquierdo. Imagenologicamente se evidencia múltiples lesiones nodulares, de tamaño variable en regiones laterales de cuello con extensión a espacios parotídeo y submandibular. Las lesiones se eliminan quirúrgicamente, diagnosticándose en el estudio histopatológico Adenoma Pleomorfo Benigno en ambas patologías. Se realizó una investigación bibliográfica exhaustiva de esta patología para determinar si había sido reportada con estas características, consiguiéndose que es el primer caso en Venezuela y el segundo en el mundo con estas mismas características.

A 36 years old, female, goes for consultation at the Oncology service, University Hospital of Maracaibo, due to swelling on her right infraauricular region and her left submandibular area. The tomography showed different sizes, nodular lesions on the lateral neck areas, extending to parotideal and submandibular spaces. After a surgical procedure and microscopic examination, the final diagnosis of Benign Pleomorphic Adenoma was given for both lesions. A bibliographic search was done, especially to determine, synchronous, contralateral, bilateral cases of this entity. To our knowledge, this is the first case in Venezuela and the second on the world with these features.

[Primary sub-mandibular gland tumours: experience based on 68 cases]. / Les tumeurs primitives de la glande sous-maxillaire: à propos de 68 cas.

UNLABELLED: Sub-mandibulary gland tumours are less common than tumours of the parotid and pose many clinical and therapeutic challengers. OBJECTIVE: We report our experience of sub-mandibular tumours and review the literature. PATIENTS AND METHODS: Retrospective studies of sub-mandibular gland tumours presenting to our department between 1986 and 2000. RESULTS: 68 cases were reviewed comprising 37 benign and 31 malignant tumours (15 females and 33 males). Average age of patient was 46 years and all presented with a sub-mandibular swelling. Clinical suspicion of malignancy was associated with symptom of pain, cervical adenopathy, nerve palsy, skin and/or bone invasion. CAT Scans were performedd to assess tumour extent / invasion. Definitive diagnosis was by complete excision and pathological examination. Pleomorphic adenoma (n= 32) were the most frequent benign tumours. For malignant lesions (n= 31) the most frequent were: Adenoid cystic carcinoma (n= 10), epidermoid carcinoma (n= 5), adenocarcinoma (n= 5), mucoepidermoid carcinoma (n= 3), malignant non Hodgkinien lymphoma (n= 5). Treatment was by total surgical excision of the submandibular gland for the begnin tumours. For the malignant lesions it was associated acording to their extension with other anatomical region or in case of adenopathy with neck dissection. Radiotherapy was performed in 24 cases and chemotherapy in 10 cases. CONCLUSION: Malignity in sub-mandibular gland tumours is more frequent than in the parotid gland. Any delay in diagnosis or inappropriate management may result in a poor prognosis for the patient.

Carcinosarcoma of the submandibular gland: an autopsy case.

Malignant mixed tumors of salivary glands are classified as three types:carcinoma arising in a pleomorphic adenoma, the most common; benign metastasizing pleomorphic adenoma; and carcinosarcoma (true malignant mixed tumor), which is very rare [Ann. Otol. Rhinol. Laryngol. (1982) 91 342]. In carcinoma, both epithelial and soft tissue elements are malignant. In the context of previous reports, we discuss a case of carcinosarcoma of the submandibular gland including the results of postmortem examination.

Cytokeratin-positive interstitial cell neoplasm: a case report and classification issues.

AIMS: Tumours of dendritic/accessory cell origin are rare neoplasms arising in lymph nodes. Among these, tumours derived from cytokeratin-positive interstitial reticulum cells (CIRCs), a subset of fibroblastic reticulum cells, are reported even less frequently. The International Lymphoma Study Group (ILSG) has recently proposed a classification for tumours of histiocytes and accessory dendritic cells in which CIRC tumours are not included. We report a case of a CIRC tumour arising in a submandibular lymph node of a 66-year-old male. METHODS AND RESULTS: The neoplasm was composed of spindle cells with elongated or round nuclei, prominent nucleoli and abundant cytoplasm. These cells were arranged in a diffuse fascicular and vaguely whorled pattern. The tumour cells stained diffusely for S100, vimentin, desmin, lysozyme, and focally for CD68 and cytokeratins 7, 8, 18, CK-AE1 and CK-pool. Electron microscopy was performed for further evaluation on samples taken from the paraffin block; this revealed cytoplasmic projections and rudimentary cell junctions. CONCLUSIONS: Histopathologist should be aware of the existence of tumours deriving from CIRCs, as these cases may be misdiagnosed as metastatic carcinoma. Careful clinical and pathological evaluation is necessary to exclude this possibility.

[Effects of TNM extension and histopathological type of the tumor on long-term survival rates of parotid and submandibular gland cancer].

The effects of TNM extension and histopathological type of the tumor on 5 and 10-year survival rates were analysed in 1,147 cases of parotid cancer and 271 cases of submandibular gland cancer which had been registered from 152 institutes throughout Japan since 1978. Advance of stage decreased the prognosis significantly, and the decrease was more pronounced in submandibular gland cancer. Facial paralysis also decreased the prognosis of parotid cancer significantly. The prognosis was also affected significantly by the histopathological type of the tumor. The 5-year survival rates of adenocarcinoma, epidermoid carcinoma and undifferentiated carcinoma were only about 30% in parotid cancer and about 20% in submandibular gland cancer. In treatment of salivary gland cancer, the therapeutic approach should be individualized in accordance with the tumor extension and its histopathological type. Improvement of accuracy in preoperative diagnosis of salivary gland cancer is of the utmost importance.

[Comparison of the incidence of various tumors of the parotid and submandibular gland]. / Porównanie czestosci wystepowania róznych guzów w sliniance przyusznej i podzuchwowej.

The authors have analyzed 396 cases with parotid and submandibular gland tumors treated surgically in ENT Department of County Hospital Nr 1 in Rzeszów from 1974 to 1994. The most frequent disease was neoplastic tumor located in parotid gland, while the most frequent inflammatory disease was non-specific inflammation caused by a calculus in submandibular gland.

[Tumors of the submandibular triangle]. / Guzy trójkata podzuchwowego.

Analysed material consists of 180 patients with different kind of submandibular triangle tumors, excluded disturbances of the submandibular gland. All these patients were treated in ENT Department of County Hospital No 1 in Rzeszów in 1974-1993. Among 180 patients in 97 (54%) cases, the presence of inflammatory tumors were stated: non specific inflammation in 74 (76%) patients and specific inflammation in 23 (24%) patients. In 10 (6%) patients occurred branchial or dermoid cysts. Neoplastic tumors occurred in 73 (40%), malignant tumors in 64 (86%) patients and benign ones in 9 (12%) patients. Among malignant tumors metastatic ones were stated 41 (64%) cases, while primary tumors in 23 (36%). The histology type of tumors were revealed by histology examination.

[TNM classification system in cancer of the submandibular gland--a comprehensive retrospective study of 271 primary cases].

UNLABELLED: A total of 271 patients with submandibular gland cancer, treated in 149 hospitals in Japan in the period from 1958 to 1991, were retrospectively studied with regard to age, sex, TNM classification (UICC 1987, Geneva), histological diagnosis, therapeutic method and prognosis. The results were the following: 1. 157 males and 114 females 2. Stage I: 52 cases (19%); stage II: 64 cases (24%); stage III: 52 cases (19%) and stage IV: 103 cases (38%). 3. T1: 29 cases (11%); T2:116 cases (43%); T3: 93 cases (30%) and T4: 43 cases (16%). 4. Cervical lymph node involvement: 40%, ranging 25% in adenoid cystic carcinoma and acinic cell tumor, to 62% in undifferentiated carcinoma. 5. Distant metastasis: 11% 6. HISTOLOGY: adenoid cystic carcinoma 37%, adenocarcinoma 20%, mucoepidermoid tumor 16%, carcinoma in pleomorphic adenoma 10%, epidermoid carcinoma 10%, undifferentiated carcinoma 3%, acinic cell tumor 3%. 7. Treatment method: Surgical procedure alone; 51%, Combination of surgery and postoperative radiation; 18%. 8. 5-year and 10-year survival rates were 36% and 11%, respectively. 9. 5-year and 10-year survival rates varied according to the stages, being 76% and 38%, respectively, for stage I, 68% and 20%, respectively, for stage II, 15% and 10%, respectively, for stage III, and 14% and 4%, respectively for stage IV.

Small cell carcinoma of the major salivary glands.

Small cell carcinoma is primarily a pulmonary neoplasm that rarely arises in extrapulmonic sites including salivary glands of the head and neck. Twelve cases of small cell carcinoma of salivary gland origin were retrieved from the Armed Forces Institute of Pathology files. Six tumors occurred in the parotid gland and six in the submandibular gland. Tumors were classified into two categories: those with areas of histologically typical small cell carcinoma (7 cases) and those with areas of typical small cell carcinoma with foci of ductal differentiation (5 cases). Follow-up information was available in all 12 cases. Electron microscopy was done on eight tumors; only one demonstrated round electron dense intracytoplasmic neurosecretory granules. These observations further support evidence in the literature suggesting most of the small cell carcinomas of salivary gland origin are not true neuroendocrine ("oat cell") carcinomas, but actually are small cell ductal carcinomas. These tumors appear to have a better prognosis than small cell carcinoma of the lung or nonsalivary gland sites in the head and neck region, with an estimated 2- and 5-year survival of 70 and 46%, respectively.

Lymphomas of salivary glands.

Primary lymphomas arising in salivary glands are very uncommon. The histologic classification of 40 cases of lymphomas in salivary gland tissue submitted to the British Salivary Gland Tumour Panel is reported, and, for 30 of the patients for whom adequate information was available, the clinical presentation, management, and outcome have been analyzed. Lymphomas in salivary glands represented 1.7% of all reported salivary neoplasms. The majority developed in the parotid glands of patients aged between 50 and 70 years. Only four cases gave a premorbid history compatible with sicca syndrome. In this series, non-Hodgkin's lymphomas predominated; 23 were Grade I, and 13 were Grade II. Treatment regimens were not uniform, but are outlined. Survival ranged from 5 to 111 months. Median survival for the group was 49 months. Prognosis was not influenced by the clinical stage of disease at presentation. Four cases of lymphoma arising in benign lymphoepithelial lesions are included. None had clinical symptoms of sicca complex. Prognosis for this group was found to be as favorable as the others.

Warthin's tumor (cystadenolymphoma) of salivary glands. A clinicopathologic investigation of 278 cases.

This article reviews the detailed clinical and pathologic features of 278 cases of Warthin's tumor (cystadenolymphoma) from the files of the British Salivary Gland Tumor Panel. The tumor was found exclusively in the parotid gland, where it accounted for 14% of the total primary epithelial parotid tumors. The male predominance (1.6:1) was lower than in many earlier reports, and this observation is discussed. Some histopathologic features of both epithelium and stroma were semiquantified, and the presence of ciliated epithelium in a few tumors was confirmed. The Warthin's tumors were subclassified according to the scheme proposed by Seifert and colleagues. No examples of metaplastic Warthin's tumor were seen, but a few tumors were extensively necrotic and probably infarcted. The age distribution of patients with stroma-poor Warthin's tumor supported the concept that this variant develops by progressive adenomatous growth of typical Warthin's tumor. The histogenesis of Warthin's tumor is discussed briefly.