Heterotopic salivary gland tissue in the neck.

Heterotopic salivary gland tissue (HSGT) consists of salivary tissue outside of the major and minor salivary glands and typically presents as a draining sinus and/or asymptomatic nodule of the neck along the lower anterior sternocleidomastoid muscle. There are a limited number of case series exploring this rare entity. To further delineate the clinicopathologic characteristics of this lesion, we present 11 cases of HSGT in the neck, many with cutaneous involvement. Anatomic pathology files from Lifespan-affiliated hospitals (Rhode Island Hospital and Miriam Hospital) were retrospectively reviewed for all cases meeting criteria for HSGT from 1983 through 2005, and 11 patients were identified: 4 female and 7 male, ages 5 months to 64 years, with 8 patients younger than 18 years; 7 patients presented with a draining sinus. Of note, 8 of 11 cases occurred on the right side. In general, microscopic examination revealed mucinous and serous salivary glandular structures with an associated duct; no cytologic atypia was observed. All cases stained positive for smooth muscle actin and calponin, highlighting a myoepithelial layer similar to that seen in minor and major salivary glands. As in our series, most cases of cervical HSGT occur near the anterior sternocleidomastoid muscle with a right-sided predilection. Cases generally present by early childhood, although 3 cases in our series were diagnosed in adulthood. Although cancers arising in these lesions are fairly uncommon, most clinically apparent foci of HSGT are excised. This entity should be considered in the dermatologist's differential diagnostic considerations for a draining sinus and a lateral, especially right-sided, neck mass.

Increased expression of eotaxin-3 distinguishes between eosinophilic esophagitis and gastroesophageal reflux disease.

Differentiating eosinophilic esophagitis from gastroesophageal reflux disease is important given their pathogenetic differences and responses to therapy. Eotaxins are a family of chemokines important for activation and recruitment of eosinophils mediated by their receptor, chemokine receptor-3 (CCR-3). Interleukin 5 (IL-5) is a key cytokine involved in many steps of eosinophil production and recruitment. The aim of this study was to compare the messenger RNA expression of the eotaxins, CCR-3, and IL-5 between well-characterized groups of patients with eosinophilic esophagitis, patients with gastroesophageal reflux disease, and healthy individuals. This was a retrospective study using esophageal biopsies from 33 patients with eosinophilic esophagitis, 20 patients with gastroesophageal reflux disease, and 17 healthy controls. Parameters studied included demographic features, presenting symptoms, endoscopic findings, histopathologic features, and messenger RNA levels of eotaxins 1, 2, and 3, CCR-3, and IL-5 by quantitative real-time polymerase chain reaction using formalin-fixed, paraffin-embedded tissue. Patients with eosinophilic esophagitis were predominantly males (M/F=3:1), with a mean age of 15.9 years and a mean eosinophil count of 55 per x400 high-power field. Patients with gastroesophageal reflux disease had a mean age of 31.5 years and a mean eosinophil count of 5.8 per high-power field. Total intraepithelial eosinophil and lymphocyte counts, the presence of superficial eosinophil clusters, microabscesses, and basal cell hyperplasia were all significantly associated with eosinophilic esophagitis as opposed to gastroesophageal reflux disease (P<.0001). The mean expression levels of eotaxin-3 were markedly elevated in patients with eosinophilic esophagitis as compared with the gastroesophageal reflux disease and healthy control groups (731+/-276, 31+/-12, and 1.5+/-0.4 pg/ng beta-actin, respectively; P<.001). Mean expression levels of eotaxins 1 and 2, IL-5, and CCR-3 were also significantly increased in the patients with eosinophilic esophagitis, albeit at lower levels than eotaxin-3. In conclusion, our results highlight the important contribution of eotaxin-3 in the pathogenesis of eosinophilic esophagitis. Determination of eotaxin-3 levels by real-time polymerase chain reaction on paraffinized, formalin-fixed tissue may be a useful test in the differentiation of eosinophilic esophagitis from gastroesophageal reflux disease.

Spiradenocylindrocarcinoma: a malignant hybrid tumor.

BACKGROUND: Eccrine spiradenomas and cylindromas are benign, slowly growing, cutaneous adnexal neoplasms, recently hypothesized to arise from a common pluripotential cell; malignant variants are rare. We found 48 cases of malignant spiradenomas and 33 cases of malignant cylindromas reported in the English literature. Benign tumors demonstrating both spiradenomatous and cylindromatous features have been infrequently reported. Recent immunohistochemical studies of these two tumors have provided compelling evidence that these two tumors may merely represent a single tumor type with a spectrum of histological features. CASE REPORT: We describe two cases of a malignant variant of this rare hybrid tumor occurring in a 62-year-old male and a 72-year-old female. CONCLUSION: We propose the term 'spiradenocylindrocarcinoma' to describe malignant tumors with features of both a spiradenoma and a cylindroma. In conjunction with histological features of malignancy, p53 and Ki-67 immunohistochemical staining may provide helpful clues in determining the malignant potential of this tumor. Further studies are needed to clarify the biologic behavior of such lesions.