Giant pleomorphic adenoma of the submandibular gland. Case report.

Salivary glands are sites for a great variety of tumors. The parotid gland is the most common site followed by the submandibular gland. The pleomorphic adenoma represents the 60-70% of all tumors involving the major salivary glands, while the submandibular gland is involved in 8% of cases. The pleomorphic adenoma of the submandibular gland is rare and can present difficulty in diagnosis. The heterogeneous histology, a possible malignant transformation, an incomplete capsule that can determine a recurrence, are the most important characteristics of pleomorphic adenoma. A complete surgical removal of the tumor is the treatment of choice. In the case presented, the mass showed an unusual vascularization and remarkable dimensions.

[Rhino-sinusal endoscopy as a diagnostic and therapeutic treatment in patients undergoing a bone marrow transplantation]. / Endoscopia rino-sinusale quale metodica diagnostica e terapeutica nei pazienti sottoposti a trapianto di midollo osseo.

Immunodepressed subjects appear to present as a common adverse event the infections complication of paranasal sinuses which can lead to an unfavourable clinical evolution spreading the infection to encephalic and endo-orbital tissues. The patients described by the authors present a common clinical history of neoplastic disorders concerning the haemopoietic tissue with an indication for bone marrow transplantation. These patients also demonstrated clinical-radiological evidence of rhino-sinusal impairment with specific maxillary sinus involvement. The clinical condition obliged us to reach a final diagnosis of the origin of rhino-sinusal involvement which clearly appeared by performing imaging diagnostic examinations in order to rapidly establish the correct therapy. The resolution of the rhino-sinus complication allows these patients to follow on the treatment for their own initial pathology. In fact, in order to resume the treatment against haemoblastic disorders, an essential step is to approach the paranasal sinus affection. Endoscopy, in the cases reported, permitted us to obtain a correct diagnosis and to develop a correct antimicrobic therapy, achieving the drainage of the maxillary sinus as well. Endoscopy achieved the same results as radical surgery of the maxillary sinus by the Caldwell-Luc approach, proving less aggressive and reducing operative timing, postoperative recovery timing and intra and post operative haemorrhagic complications. Moreover, endoscopy characteristics present a specific validity in patients with severe general conditions, which are described in the examined group, reducing time for diagnosis and therapy resulting specific to solve the rhino-sinus complication and also particularly important in order to interfere less with the delicate medical therapy for the primary pathology by the sample examined.

[Lymph node metastasis of adenoid cystic carcinoma]. / Metastasi linfonodali nel carcinoma adeno-cistico.

BACKGROUND: The adenocystic carcinoma (ACC) of the head and of the neck is rather uncommon. It is characterized by a very slow biological behaviour, which leads to locoregional recurrences and distant metastasis. Most reports concentrate on the unpredictable long-term behaviour of this tumor, whereas lymph nodes metastasis are not usually discussed in detail. The aim of this study was to evaluate the difficulties connected with the lymph node metastasis in ACC. METHODS: A group of 33 patients from 1980 to 1998, was observed. These patients have been subjected to surgical treatment in the Maxillo-Facial Surgery Department of the Policlinico-Umberto I of Rome. RESULTS: Among 33 patients with ACC, 10 patients (30%) revealed, initially or during observation, cervical lymph node metastasis, which is a most common event in male subjects (70%). The lymph node involvement is much more common in carcinomas localized in the parotid and in the sublingual glands with a solid rather than a tubular histologic pattern. Direct correlation between age and metastasis lymph node involvement have not been documented. CONCLUSIONS: Surgery for node disease has a very little impact on the locoregional and on the distant metastasis evolution of the tumor. Thus, our protocol of treatment of lymph nodes metastatic lesions follows the trend of most of the international authors, considering that the neck dissection should be performed only with a lymph adenopathy clinically evident or strongly suspected.