Histology of the major salivary glands.

Major salivary glands are characterized by the presence of numerous excretory units that consist of acini and a peculiar duct system. Under normal conditions, sebaceous glands are annexed to the duct system in the parotid and the submaxillary glands. The excretion of the saliva is assisted by the myoepithelial cells, which play an important role in the morphology of several kinds of salivary gland tumors. Interstitial lymphocytes give rise to the formation of lymph nodes in the parotid gland. Heterotopic salivary tissue is found in many locations throughout the head and neck. Age-induced variations and reactive changes include oncocyte proliferation, fatty infiltration, squamous and mucous metaplasia, hyperplasia, atrophy, and regeneration. An analysis of the normal salivary gland structure permits a morphogenetic approach to an understanding of the variability in histologic types of salivary gland tumors.

Primary prostatic Wilms' tumor.

The first case of primary Wilms' tumor of the prostatic gland is described. It occurred in a 32-year-old man. Histologically, it consisted of a triphasic tumor; tubular and glomeruloid structures were identified, among prominent blastematous sheets and in an edematous stroma. No teratomatous components were encountered. We propose that this prostatic primary, nonteratomatous Wilms' tumor can arise from persistent, nephrogenic, blastematous rests in the prostate, in relation to the Wolffian duct system.

Hypopharyngeal sebaceous carcinoma: a case report.

A hypopharyngeal squamous-cell carcinoma with sebaceous differentiation is reported. In the primary as well as the metastatic lymph nodes, the tumor showed basaloid, squamous, and sebaceous cells. In addition, immunostaining for S-100 protein and vimentin manifested scattered cells showing cytoplasmic processes suggesting myoepithelial cells. An exhaustive review of the literature revealed only one similar case previously reported. The probable origin from the minor salivary glands is discussed.

Lymphoid cells in lymph nodes and peripheral blood of patients with squamous cell carcinoma of the head and neck.

Fifty-five patients with squamous cell carcinoma of the head and neck were evaluated immunologically by measuring the level of T cells (E-RFC) and high affinity subset T cells (E-29) in the peripheral blood and peritumorous lymph nodes. A significant decrease (p less than 0.05) in mean percentage of E-29 was observed in cancer patient peripheral blood. In peritumorous lymph nodes, there was no difference in terms of total T cells or of high affinity subset T cells, as compared to non-malignant lymph nodes, or between tumor-free and metastatic lymph nodes. Macrophage content was much higher in metastatic than in tumor-free lymph nodes (p less than 0.05) and these macrophages frequently appeared to be more active when tested in phagocytosis of sheep red blood cells sensitized with IgG or IgM + C.

Cytochemistry of Reed-Sternberg cells in lymph node imprints.

Cytochemical reactions were examined in lymph node imprints from a group of 53 previously untreated patients with histologically proven Hodgkin's disease. In 40 of 51 cases investigated, Reed-Sternberg (R-S) cells, irrespective of the cytologic appearances and the histologic types, showed moderate to strong reactions with acid phosphatase (ACP). In 12 cases ACP activity was present in more than 25% of the R-S cells. The reaction consisted of formation of small- to medium-sized granules, which were located close to the nuclei on a diffusely positive background or irregularly distributed throughout the cytoplasm. In three cases, a coarse granular reaction product with periodic acid-Schiff was present. R-S cells were positive to the naphthol-AS acetate esterase and beta-glucuronidase reactions in four and two cases, respectively. Alkaline phosphatase and naphthol-AS-D-chloroacetate esterase reactions were completely negative. Our results have revealed a pattern of staining in the diagnostic R-S cells similar to that in its morphologic variants; this supports the view that these cells may derive from a common primitive cell. Moreover, the quality and quantity of the ACP reaction product shows that R-S cells differ from both neoplastic histiocytes of malignant histiocytosis and neoplastic lymphocytes of T-cell lymphomas. This study confirms that R-S cells lack definite cytochemical characteristics of each of supposed progenitor cells: histiocytes and T-lymphocytes.

Role of immunohistochemistry in diagnosis of nasopharyngeal tumours.

To evaluate the usefulness of immunocytochemistry in the differential diagnosis of nasopharyngeal tumours, 35 undifferentiated nasal carcinomas were examined with a panel of monoclonal antibodies against a wide variety of epithelial and non-epithelial antigens. The results were compared with those obtained from a series of nasopharyngeal tumours comprising three squamous cell carcinomas, six lymphomas, one rhabdomyosarcoma, and one yolk sac tumour. All of the carcinomas were positive with at least one of the antiepithelial markers and negative for the leucocyte common antigen and were clearly distinguishable from the nasopharyngeal lymphomas, which gave the opposite staining pattern. It was concluded that such a panel of monoclonal antibodies would be extremely useful for the differential diagnosis of nasopharyngeal tumours, particularly with small or technically inadequate biopsies.

Synovial sarcoma of the head and neck: an account of four cases and review of the literature.

Four cases of Malignant Synovioma of the head and neck are reported. It is a rare tumour with only 76 published cases in the world literature. Study of these 76 cases allows identification of the clinical features of this tumour and also highlights the problems of histological diagnosis. The study shows that the most effective treatment is radical primary surgery in association with post-operative radiotherapy and chemotherapy.

So-called branchiogenic carcinoma is actually cystic metastases in the neck from a tonsillar primary.

In 1974, we reported on six patients with squamous cell carcinoma arising in the tonsillar area who presented with a characteristic form of cystic nodal metastasis. This study reports on an additional 21 patients with this entity. Treatment of these patients included removal of the cystic metastasis with or without radical neck dissection and irradiation of Waldeyer's ring. Two patients have died of unrelated disease and two were lost to follow-up, but the remainder are alive without disease 2 months to 12 years following initial diagnosis. We believe that cystic metastases from tonsillar squamous cell carcinomas have often been mistaken for either primary squamous cell carcinomas of branchiogenic origin or with branchial cleft cysts. The distinctive histological features of cystic metastases reviewed after its correct identification can lead to the discovery of an unsuspected primary lesion and result in specific treatment options.

Relationship between laryngoceles and laryngeal carcinomas.

Because X-ray evaluation of the larynx is an unreliable method of detecting laryngoceles, a study based on the systematic measurement of the ventricular depth in surgical specimens was carried out to determine the frequency of laryngoceles and their relationship to laryngeal carcinomas. The frequency of laryngoceles was found to be about 2% in the normal larynx. The frequency in laryngeal cancer specimens was about 18%. This difference demonstrated the role of cancer in the genesis of laryngoceles. A close relationship between the ventricular diverticuli and the tumors was observed on microscopic examination in half of the laryngeal carcinomas associated with laryngoceles. These carcinomas can be considered to have developed on the laryngoceles. Depending upon the degree of tumor spread and the number of laryngoceles involved, different types of carcinoma developing in laryngoceles can be recognized. This particular form of tumor can be misinterpreted as an ulcerated vestibular tumor, in which case inappropriate treatment may be tried.

Superficial extending carcinoma of the hypopharynx: report of 26 cases of an underestimated carcinoma.

Advanced ulcerating and infiltration tumors are commonly found in the hypopharynx, whereas early well-defined lesions are rarely diagnosed. The pathologic reports of 242 uniformly studied surgical specimens after total pharyngolaryngectomy for cancer of the hypopharynx were reviewed. The histologic analysis of 26 cancers (10.7%), which were recorded as having an entire or predominant superficial type of spreading, demonstrated that also in the hypopharynx a "superficial extending carcinoma" (SEC) may occur. SEC of hypopharynx was pathologically defined as a poorly or moderately differentiated squamous cell carcinoma, generally located in the pyriform sinus, which spreads superficially. It was limited to the mucosa (2.9%), but more frequently early infiltrated the underlying muscle or gland structures (6.2%), regardless of the presence of lymph node metastases or lymph vessels invasion. Although the concept that SEC of the hypopharynx may be an expression of a generalized disease of the mucosa must be carefully considered in surgical management, it appeared that this carcinoma in its "pure" intramucosal form may be associated with a good prognosis and a long survival.

Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract carcinomas: study of 1,713 cases during a 15-year period.

A prospective study of 1,713 patients with squamous cell carcinoma of the head and neck submitted to neck dissection between 1957 and 1973 is presented. We confirm the prognostic significance of the histological analysis of the nodal metastasis. Capsular rupture is the most important factor regardless of the primary site or tumor size. The presence of tumor emboli within lymphatics, the number of invaded nodes, and the number of nodes with capsular rupture are of significance though to a lesser extent. Classification of the clinical characteristics or the nodes provided, in 70% of the patients, a good prediction of histological involvement. In the clinical estimation of histological invasion, an important parameter is the size of the largest node detected, and we suggest this characteristic should be included in the TNM classification of UICC.

Squamous cell carcinoma of the upper aerodigestive tract associated with well-differentiated carcinoma of the thyroid gland.

The association of squamous cell carcinoma of the upper aerodigestive tract with well-differentiated thyroid carcinomas has rarely been reported in the literature. We report 10 cases illustrating this occurrence. In eight cases, the thyroid carcinoma was discovered accidentally on histological examination of a single neck node, a neck node dissection specimen, an unexpectedly found thyroid nodule, or a systematically resected thyroid lobe, all during surgical treatment of an upper aerodigestive tract carcinoma. In the other two cases, metastatic thyroid neck nodes appeared during the follow-up of a patient with an upper aerodigestive tract carcinoma. No case of upper aerodigestive tract carcinomas was found during the follow-up of thyroid cancer patients. In most cases, adequate thyroid cancer surgery was performed simultaneously or later. Prognosis was essentially determined by the upper aerodigestive tract cancer.

Olfactory esthesioneuroma: a report of 40 cases.

Olfactory esthesioneuroma is a rare malignant tumor arising in the olfactory epithelium. Forty cases observed at the Institut Gustave-Roussy from 1956 to 1987 are reported. This tumor usually grows slowly and is usually local, but it is important to be aware of the possibility of lymph node involvement (17%) and, particularly, of rapid development of distant metastases (25%), usually within 6 months. CT scan, and more recently, NMR have proved to be of value in choosing the surgical approach. In view of the usual point of departure, a combined neurosurgical and transfacial approach seems to be a satisfactory approach for obtaining oncological control of the lesion. The role of chemotherapy is discussed. The main prognostic factors seem to be the size of the lesion, the intracranial extension, and the lymph node involvement.

Basaloid squamous carcinoma of the head and neck. Immunohistochemical comparison with adenoid cystic carcinoma and squamous cell carcinoma.

Basaloid squamous carcinoma (BSC) is a rare distinct variant of squamous cell carcinoma of the head and neck region. This entity may commonly pose diagnostic difficulties, especially on small biopsy material. We report the clinicopathological characteristics of 12 new cases and compare their immunohistochemical features with those of solid adenoid cystic carcinomas and conventional squamous cell carcinomas. Our results show that neoplastic BSCs and squamous cell carcinomas do not react to vimentin and S100 protein, while adenoid cystic carcinomas manifest both. The BSCs, however, are S100 protein-positive in intratumoral dendritic Langerhans' cells that are lacking in squamous cell and adenoid cystic carcinomas. Our findings indicate that the immunohistochemical differences between BSC and adenoid cystic carcinoma could assist in their differential diagnosis.

Undifferentiated carcinoma of nasopharyngeal type of tonsil.

A review of 2262 squamous cell carcinomas of the tonsillar region seen at the Institut Gustave-Roussy, Villejuif, France, from 1970 to 1986 showed 1837 well- and poorly differentiated squamous cell carcinomas and 425 undifferentiated squamous cell carcinomas. Eighteen patients with undifferentiated squamous cell carcinomas presented histologic characteristics of undifferentiated carcinomas of nasopharyngeal type. Radiosensibility and radiocurability (complete sterilization with 70 Gy administered) was found in this group with an excellent long-term control of local disease (77% at 10 years actuarial). Epstein-Barr virus-related serologic tests were performed for seven patients. Four of them presented the serologic anti-Epstein-Barr virus titer patterns, generally associated with undifferentiated carcinomas of nasopharyngeal type (1280 to 5120 for viral capsid antigen/IgG and 40 to 320 for viral capsid antigen/IgA). These observations confirm that undifferentiated carcinomas of the nasopharyngeal type may arise outside the nasopharynx.

Glutathione and cysteine levels in human tumour biopsies.

There is evidence that some human tumours could be treated with a combination of buthionine sulfoximine and hypoxic cell sensitizers. However, clinical application of this technique requires a prior knowledge of the level of non-protein bound sulfhydryl (NPSH) compounds in these tumours. The present study provides data on the levels of glutathione (GSH) and cysteine (CYS) in human tumour biopsies from the cervix and from the head and neck. The NPSH compounds were measured by high performance liquid chromatography. The median GSH values were 20.5 nmol/mg protein (cervix) and 23 nmol/mg protein (head and neck) while the median CYS values were 4.4 (cervix) and 4.2 nmol/mg protein (head and neck). The values varied widely from one patient to another.

What's new in histological classification and recognition of naso-pharyngeal carcinoma (N.P.C.).

The author makes a short review of the different histological classifications of N.P.C. used up to date, their validity and their reliability. He stresses the difficulties of recognizing the non-keratinizing carcinoma (W.H.O. type II) as a pure form of N.P.C. The A.C.I.F. test seems to be the best way to identify undifferentiated carcinomas (U.C.N.T.) in difficult cases. The lymphoid stroma of U.C.N.T. interpreted as the host reaction to the carcinoma invasion is currently studied and may perhaps provide a way to assess prognostic factors.

Paragangliomas of the head and neck. Immunohistochemical analysis of 16 cases in comparison with neuro-endocrine carcinomas.

Sixteen cases of paragangliomas of the head and neck including 8 of the vagal body, 3 of the carotid body, 2 jugulotympanic, 2 vagal or jugulotympanic and 1 of the larynx were analysed. Clinically, 13 tumors were benign, 2 showed local aggressivity and 1 showed metastases. All tumors were tested with antisera directed against neuron-specific enolase (NSE), chromogranin A (CGA), S-100 protein, neurofilaments (NF), glial fibrillary acid protein (GFAP) and cytokeratin (CK). Immunohistochemical results were compared with those of 5 cases of neuroendocrine carcinoma (NC) (1 of the oral vestibule, 1 of the larynx, 1 Merkel-cell tumor of the skin and 2 medullary thyroid carcinomas). Immunoreactivity for NSE and/or CGA was always positive in all paragangliomas and NC. S-100 protein was positive in sustenticular cells in all cases of paragangliomas and focally in two cases of NC. NF and GFAP were focally positive in 3 and 2 paragangliomas respectively; and in 1 NC. CK was constantly negative in all cases of paraganglioma and constantly positive in all cases of NC. Antibody anti-CK is the single most useful immunomarker for differential diagnosis between paraganglioma, frequently benign neoplasms and NC commonly aggressive in the head and neck. These findings are consistent with the current concepts of the neuroendocrine system.

Metastatic papillary endometrial carcinoma of the tongue. Case report and review of the literature.

Tongue metastases are exceptional, with a frequency of 0.1% to 0.2% in autopsy series of patients with disseminated cancer. A case of secondary papillary endometrial carcinoma of the tongue is reported as the first sign of metastasis in a 78-year-old white woman treated 7 years before by complete hysterectomy and radiotherapy. The lesion presented as a 3 x 3-cm submucosal mass of the dorsum of the tongue. Fine-needle aspiration and excisional biopsy established the diagnosis. Metastases to the lungs, liver, and bone developed 3 months later, and she died 6.5 months after initial diagnosis. A review of reports of 77 lingual metastases showed that the mean age was 57 years, with a male predominance. The lung, kidney, and skin were the most common primary sites. The tongue was the first site of metastases in 61% and the first sign of the primary malignant neoplasm in 15% of the cases. Average survival was 10 months.

Prognostic value of the prelaryngeal node in laryngeal and hypopharyngeal carcinoma.

The role in tumor spread and the prognostic value of metastasis in a prelaryngeal node were investigated in 124 cases of laryngeal and hypopharyngeal carcinoma selected from about 900 total laryngectomies and pharyngolaryngectomies. Metastasis in a prelaryngeal node was noted in 26 cases: 22 without capsular rupture (N+) and 4 with capsular rupture (N+R+). Vascular embolism (E+) was never noted. Patients with a metastatic prelaryngeal node had a tumor of the piriform sinus in 13 cases (50%), a transglottic tumor in 6, glotto-subglottic in 3, glottic in 2 and supraglottic in 2. They also more frequently had involvement of the cervical nodes (81%) and of the thyroid gland. The 5-year survival in these patients is very poor: only 3 patients (11.5%) were alive and free of disease. These data demonstrate the role of prelaryngeal nodes in tumors that affect the hypopharynx and the antero-inferior portion of the larynx and that directly reach this node through the anterior lymphatic peduncle.