Sialolithiasis of minor salivary gland in labial mucosa: a clinical finding / Sialolitíase de glândula salivar menor na mucosa labial: um achado clínico

Introduction: sialolithiasis is the most common form of obstructive sialadenitis caused by a mixture of different calcium phosphates and an organic matrix. It is one of the most common salivary gland diseases, often attributed to the submandibular gland, with no relation to age or gender. However, it is rarely reported in the minor salivary glands. Objective: the present study aims to report auncommon clinical finding case of a sialolithiasisof minor salivary gland in labial mucosa. Case report: a 43-year-old female patient presented with a single, yellow and asymptomatic nodule in the labial mucosa at clinical examination. The clinical hypotheses were lipoma and fibrous hyperplasia. The lesion was biopsied, and the histopathological analysis showed a mineralized tissue. The final diagnosis was sialolithiasis and the patient remained under follow-up (8 months) without relapse. Conclusion: this case shows that sialolithiasis should be included in the diagnostic hypotheses when occur in a minor salivary glands area and emphasizes the importance of a complete clinical examination since it was not complaint of the patient.(AU)

Introdução: a sialolitíase é a forma mais comum de sialadenite obstrutiva causada por um composto de diferentes produtos, como fosfato de cálcio e matriz orgânica. É uma das doenças mais comuns das glândulas salivares, geralmente atribuídas à glândula submandibular, sem relação com idade ou sexo. No entanto, raramente é relatada nas glândulas salivares menores. Objetivo: reportar um achado clínico incomum de sialolitíase em glândula oral menor na mucosa labial. Relato de caso: uma paciente do sexo feminino, de 43 anos, apresentou nódulo único, amarelo e assintomático na mucosa labial durante o exame clínico. As hipóteses clínicas foram lipoma e hiperplasia fibrosa. A lesão foi encaminhada para biópsia e a análise histopatológica mostrou um tecido mineralizado. O diagnóstico final foi de sialolitíase e o paciente permaneceu em acompanhamento por 8 meses sem recidiva. Conclusão: este caso mostra que a sialolitíase deve ser incluída nas hipóteses diagnósticas de lesões em áreas de glândulas salivares menores e enfatiza a importância de um exame clínico completo, pois não se tratava da queixa principal da paciente.(AU)

Palatal Pleomorphic Adenoma in a Pediatric Patient: Case Report / Adenoma Pleomorfo Palatino en un Paciente Pediátrico: Reporte de Caso

Pleomorphic adenoma is the most common benign neoplasm of salivary glands. Their common location is in parotid gland, however, a lower percentage of these tumors might occur in minor glands. The epidemiology of this tumor shows that adults are the most affected, with rare occurrence in children or adolescents. We present the case report of pleomorphic adenoma located on the palate of a 10 year old. Excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed ductal structures surrounded by plasmacytoid mioepithelial cells within a myxoid stroma, the final diagnosis corresponded to Pleomorphic Adenoma. Early detection and excision of this lesion in children are important to minimize potential recurrences or malignant transformation.

El adenoma pleomorfo es la neoplasia benigna más común de las glándulas salivales. Su localización común está en glándula parótida, sin embargo, un bajo porcentaje de estos tumores puede ocurrir en glándulas menores. La epidemiología de este tumor muestra que los adultos son los más afectados, con rara ocurrencia en niños o adolescentes. Presentamos el caso de un adenoma pleomorfo localizado en el paladar de un niño de 10 años. La biopsia excisional de la lesión seguida de examen histopatológico de la muestra de biopsia reveló estructuras ductales rodeadas por células mioepiteliales plasmocitóides dentro de un estroma mixoide, siendo el diagnóstico final adenoma pleomorfo. La detección temprana y la excisión de esta lesión en los niños es importante para minimizar las recidivas potenciales o la transformación maligna.

Minor intraoral salivary gland tumors: a clinical-pathological study / Neoplasias intraorais de glândula salivar menor: estudo clínico-patológico

ABSTRACT Objective To evaluate the clinical-pathological profile of patients with minor salivary gland neoplasms. Methods A retrospective study of specific cases diagnosed as benign and malignant tumors of the minor salivary glands was performed. The data were collected from medical records of patients seen at a hospital over a period of 15 years. The sample was made up of 37 cases. For the pathological study, slides containing 5μm thick sections stained with hematoxylin and eosin were used. The data were tabulated using descriptive statistics. Results Malignant neoplasms represented 70.3% of cases. The mucoepidermoid carcinoma was the most common neoplasm (45.9%), followed by pleomorphic adenoma (24.4%). Most patients were female (70.3%), aged between 71 and 80 years. The palate (67.6%) and the retromolar region (10.8%) were the most affected sites. Conclusion Mucoepidermoid carcinoma was the most common tumor in minor salivary glands. These tumors are more common in females aged over 40 years. The palate was the most common affected site.

RESUMO Objetivo Avaliar o perfil clínico-patológico de pacientes com neoplasias de glândula salivar menor. Métodos Foi realizado um estudo retrospectivo de casos específicos diagnosticados como neoplasias benignas ou malignas de glândula salivar menor. Os dados foram coletados dos prontuários dos pacientes atendidos em um hospital no período de 15 anos. A amostra final foi de 37 casos. Para o estudo histopatológico, foram usadas lâminas contendo secções com 5μm de espessura, coradas pela técnica de hematoxilina e eosina. Os dados foram tabulados de forma descritiva. Resultados As neoplasias malignas representaram 70,3% dos casos. O tipo histológico mais prevalente foi o carcinoma mucoepidermoide (45,9%), seguido do adenoma pleomórfico (24,4%). A maioria dos pacientes era do sexo feminino (70,3%), com idade entre 71 e 80 anos. O palato (67,6%) e a região retromolar (10,8%) foram os sítios mais acometidos. Conclusão O carcinoma mucoepidermoide foi o tumor mais comum das glândulas salivares menores. Estes tumores foram mais comuns em mulheres com mais de 40 anos. O palato foi o sítio mais acometido.

The Significance of Ectopic Germinal Centers in the Minor Salivary Gland of Patients with Sjogren's Syndrome

We investigated the clinical and biological significance of germinal centers (GC) present in the minor salivary glands of patients with Sjogren's syndrome (SS). Minor salivary gland tissue biopsies from 93 patients with SS were used to identify GC-like structures, which were confirmed by CD21-positive follicular dendritic cell networks. Patients were compared based upon sociodemographics, glandular and extraglandular manifestations, and laboratory findings including autoantibody profiles, complement, and immunoglobulin levels; EULAR SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) were also measured. GC-like structures were observed in 28 of 93 SS patients (30.1%). Mean focus scores and CRP levels were significantly higher in GC-positive patients than in GC-negative patients; GC-positive patients also exhibit a higher prevalence of rheumatoid factor and anti-SS-A/Ro antibodies compared to GC-negative patients. No differences in glandular or extra-glandular manifestations were evident between groups. In conclusion, SS patients with GC-like structures in the minor salivary glands exhibited laboratory profiles significantly different from those of their GC-negative counterparts. Long-term follow-up of these patients will be necessary to determine whether these laboratory abnormalities are predictive of clinical outcomes.

The Significance of Ectopic Germinal Centers in the Minor Salivary Gland of Patients with Sjogren's Syndrome

We investigated the clinical and biological significance of germinal centers (GC) present in the minor salivary glands of patients with Sjogren's syndrome (SS). Minor salivary gland tissue biopsies from 93 patients with SS were used to identify GC-like structures, which were confirmed by CD21-positive follicular dendritic cell networks. Patients were compared based upon sociodemographics, glandular and extraglandular manifestations, and laboratory findings including autoantibody profiles, complement, and immunoglobulin levels; EULAR SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) were also measured. GC-like structures were observed in 28 of 93 SS patients (30.1%). Mean focus scores and CRP levels were significantly higher in GC-positive patients than in GC-negative patients; GC-positive patients also exhibit a higher prevalence of rheumatoid factor and anti-SS-A/Ro antibodies compared to GC-negative patients. No differences in glandular or extra-glandular manifestations were evident between groups. In conclusion, SS patients with GC-like structures in the minor salivary glands exhibited laboratory profiles significantly different from those of their GC-negative counterparts. Long-term follow-up of these patients will be necessary to determine whether these laboratory abnormalities are predictive of clinical outcomes.

Clinicopathological characteristics and perineural invasion in adenoid cystic carcinoma: a systematic review / Características clinicopatológicas e invasão perineural do carcinoma adenoide cístico

INTRODUCTION: Adenoid cystic carcinoma is the most frequent malignant tumor of the submandibular gland and the minor salivary glands. It is a malignant neoplasm that, despite its slow growth, shows an unfavorable prognosis. OBJECTIVES: The aim of this study was to perform a systematic review of the literature on Adenoid cystic carcinoma in the head and neck region and its clinicopathological characteristics, with emphasis on the perineural invasion capacity of the tumor. METHODS: A systematic search of articles published between January 2000 and January 2014 was performed in the PubMed/MEDLINE, SciELO, Science Direct, and Scopus databases. RESULTS: Nine articles were selected for this systematic review. These demonstrated that the female gender was more often affected and that malignant tumors showed a high rate of distant metastasis, recurrence, and a low survival rate. The presence of perineural invasion ranged from 29.4% to 62.5% and was associated with local tumor recurrence. CONCLUSION: Adenoid cystic carcinoma is commonly characterized by the presence of pain, high rate of recurrence, metastasis, and a low survival rate. Reporting studies with patient follow-up is of utmost importance for a better clinical-pathological understanding and to improve the prognosis of this pathology. .

INTRODUÇÃO: O carcinoma adenoide cístico (CAC) é o tumor maligno mais frequente da glândula Submandibular e das glândulas salivares menores. Sendo uma neoplasia maligna, apesar de ter crescimento lento, apresenta um prognóstico desfavorável. Objetivos: O objetivo deste trabalho foi realizar uma revisão sistemática de literatura sobreo carcinoma adenóide cístico na região de cabeça e pescoço e suas características clínico-patológicas com ênfase na capacidade de infiltração perineural do tumor. MÉTODO: Uma busca sistemática de artigos publicados entre janeiro de 2000 a janeiro de 2014 foi executada nas bases de dados PubMed/MEDLINE, SciELO, Science Direct e Scopus. RESULTADOS: Nove artigos foram selecionados para realização da revisão sistemática. Nestes, o sexo feminino foi o mais afetado e o tumor maligno apresentou uma alta taxa de metástase a distância, recidiva e baixa taxa de sobrevida. A presença de invasão perineural variou entre 29,4% a 62,5% e foi relacionada à recidiva local do tumor. CONCLUSÃO: O CAC é comumente caracterizado pela presença de dor, alta taxa de recidiva, metástase e baixa sobrevida. A realização de estudos com acompanhamento dos pacientes é de extrema importância para uma melhor avaliação clinico-patológica visando melhorar o prognóstico da doença. .

Pleomorphic Adenoma of Hard Palate: A Case Report and Review of Literature.

Pleomorphic adenoma is a benign mixed tumor, which is composed of myoepithelial and epithelial cells. A fibrous capsule separates these cells from the surrounding tissues. Pleomorphic adenoma has unusual histopathologic features. It is the most common benign tumor affecting both major and minor salivary glands. Parotid salivary gland is affected mostly in the major group, and palate is the most common site affected in minor salivary glands. The upper lip is the second most common site followed by buccal mucosa. Less than 3% of the salivary gland tumors account for head and neck tumors. In few cases, benign pleomorphic adenoma may turn malignant also. In this case report, a female patient aged 32 years who reported with a complaint of painless swelling in the palate is presented.

Mucocele de las glándulas Blandin-Nuhn, aspectos patológicos y terapéuticos, a propósito de dos casos clínicos / Mucocele of the glands of Blandin-Nuhn

Las glándulas de Blandin-Nuhn son un grupo de pequeñas glándulas salivales mucoserosas, ubicadas en el espesor de los haces musculares de la zona anterior de la cara ventral de la lengua. Los mucoceles de las glándulas de Blandin-Nuhn son poco frecuentes. Se revisa la literatura y se presentan dos casos de mucocele de las glándulas de Blandin-Nuhn, ambos casos eran lesiones exofíticas, indoloras, una de ellas asociada a trauma. Los mucoceles de las glándulas salivales linguales anteriores deben ser resecados hasta el plano muscular para evitar la recidiva. Como esta lesión puede ser confundida con otras patologías, se recomienda su estudio histopatológico para evitar diagnósticos errados.

The Blandin-Nuhn glands are a small group of mucous serous salivary glands, located in the thickness of the muscle bundles of the anterior ventral side of the tongue. Mucocele of the glands of Blandin-Nuhn has been reported as unusual. We review the literature and present two cases of mucocele of the glands of Blandin-Nuhn, both cases were exophytic lesions, painless, one associated with trauma. Mucoceles of the salivary glands should be resected up to the muscular plane to avoid recurrence. Because this lesion may be confused with other diseases, it is recommended an histopathological exam to avoid misdiagnosis.

Pleomorphic adenoma of the soft palate: Myoepithelial cell predominant.

The pleomorphic adenoma is the most common salivary gland tumor. A remarkable morphological diversity can exist from one tumor to the next. We present here a case of pleomorphic adenoma of minor salivary glands of the soft palate which had predominantly myoepithelial cells with minimal stroma, ductal cells, or tubular elements.

Benign hyperplasia of duct-associated lymphoid tissue: Report of a case and review of literature.

Focal lymphoid tissue is ubiquitously present in the oral mucosa and serves as a barrier for entrapment of antigens. The mucosa-associated lymphoid tissue is generally dispersed and sometimes associated with the ducts of the minor salivary glands. Proliferation of the duct-associated lymphoid tissue (DALT) is rarely reported, though probably of common occurrence. We report a case of benign hyperplasia of DALT in the buccal mucosa of a 58-year-old male. The histogenesis and pathological implications of this tissue are discussed and the need for recognition of this entity is stressed.

Pleomorphic adenoma with extensive squamous metaplasia and keratin cyst formations in minor salivary gland: a case report

Pleomorphic adenoma (PA), the most common salivary gland tumor, accounts for 54 to 65 percent of all salivary gland neoplasias and 80 percent of the benign salivary gland tumors. It most frequently affects the parotid gland, followed by the submandibular and the minor salivary glands. Microscopically, mucous, sebaceous, oncocytic and squamous metaplasia, sometimes with the formation of keratin pearls, may be present, but the latter rarely results in the formation of extensive keratin-flled cysts lined by squamous epithelium. Extensive squamous metaplasia can be mistaken for malignancy, including mucoepidermoid carcinoma and squamous cell carcinoma. Here, we present an unusual case of PA with extensive squamous metaplasia and keratin cyst formations in a minor salivary gland, and discuss its microscopic features, including the immunohistochemical characteristics, and differential diagnosis of this uncommon presentation.

Adenoma pleomorfo o tumor mixto en paladar: reporte de un caso / Pleomorphic adenoma or mixed tumor of the palate: report of a case

Entre los tumores de las glándulas salivales, el más frecuente es el adenoma pleomorfo o tumor mixto (5,6). El 50 por ciento de los tumors de las glándulas salivales menores son mixtos, de los cuales un 55 por ciento se localizan en el paladar, siendo más habitual en la unión del paladar duro y blando(2). Predominan en adultos y en el sexo femenino(6).

Carcinoma mucoepidermoide de glândulas salivares menores / Mucoepidermoid carcinoma of minor salivary glands

Introdução: Os carcinomas mucoepidermoides (CME) representam cerca de 5% de todos os tumores das glândulas salivares. Trata-se de uma lesão agressiva e deve ser considerada como hipótese de diagnóstico em lesões proliferativas da mucosa oral. O diagnóstico precoce e o correto manejo dessa neoplasia são fatores determinantes do prognóstico. Ressecção local ampla e eventualmente a radioterapia pós-operatória são o tratamento de escolha. Objetivo: Relatar o caso de uma paciente com carcinoma mucoepidermoide de cavidade oral, exteriorando-se pela boca, sendo submetida a exérese cirúrgica e radioterapia, evoluindo para óbito no quarto mês do início do tratamento. Relato do Caso: CT, 47anos, branca, foi encaminhada ao serviço de ORL do HSJA após episódio de sangramento importante em cavidade oral. Relatou o surgimento de uma massa com crescimento rápido e expansivo em topografia de fossa canina há +/- 06 meses, associado a emagrecimento de 10 kg. Paciente desidratada, hipocorada, apresentando tumoração pediculada de +/- 06 cm, consistência firme, indolor à palpação, sangrante. Etilista e tabagista crônica. Linfonodos cervicais não palpáveis. Diante do caso optou por fazer a ressecção cirúrgica do tumor e realizar o exame histopatológico que confirmou carcinoma mucoepidermoide de glândulas salivares menores. A paciente foi encaminhada ao serviço de radioterapia; porém, abandonou o tratamento e evoluiu com óbito 4 meses após. Comentários Finais: Neste caso, o crescimento rápido e agressivo da lesão, o tamanho do tumor e o abandono do tratamento proposto foi determinante no prognóstico da paciente.

Introduction: The Mucoepidermoid Carcinomas (MEC) represent about 5% of all tumors in the salivary glands. It is an aggressive lesion and must be considered as a diagnosis hypothesis in the oral mucosa proliferative lesions. The early diagnosis and the correct management of this neoplasm are key factors for the prognosis. Wide local resection and eventually postoperative radiotherapy is the choice treatment. Objective: To report the case of a patient with mucoepidermoid carcinoma of oral cavity, exteriorizing through the mouth and being submitted to surgical exeresis and radiotherapy that evolved to death on the fourth month from beginning of the treatment. Case Report: CT, 47 years old, white woman was forwarded to the ORL service of the HSJA after a critical bleeding episode in oral cavity. She reported the appearing of a mass with fast and expansive growth in a topography of canine fossa for +/- 06 months, associated to the loss of 10 kg. Patient dehydrated, pale with pediculated tumoration of +/- 06 cm, firm consistency, painless upon palpation and bleeding. Chronic alcoholic and smoker. Non-palpable cervical lymph nodes. Faced with the case we opted for a surgical resection of the tumor and the performance of histopathological exam that confirmed mucoepidermoid carcinoma of minor salivary glands. The patient was sent to the radiotherapy service; but she abandoned the treatment and evolved with death 4 months after. Final Comments: In this case, the fast and aggressive growth of the lesion, the size of the tumor and the abandonment of the proposed treatment was determinant for the patient's prognosis.

Synchronous pleomorphic adenoma and periapical cyst: clinical case report / Adenoma pleomorfo e cisto periapical sincrônicos: relato de caso clínico

The pleomorphic adenoma or mixed benign tumor is the most common benign neoplasia of the salivary gland in human beings. It preferentially occurs in the superficial lobe of the parotid gland. In the oral cavity, associated with the minor salivary glands, it has a greater predilection for the palate region, with slight predisposition in women between the 3rd and 4th decades of life. The radicular cyst is an odontogenic inflammatory cyst resulting from pulp lesions caused by traumas or caries. In spite of being relatively common, there are no reports of association with salivary gland tumors. The aim of this work is to report a case of a 36-year-old woman patient, who presented with synchronous development of a pleomorphic adenoma and periapical cyst within the same region. The option taken was to perform enucleation of both lesions,followed by local curettage. The patient has been followed-up clinically and radiographically for around 18 months without signs of recurrence.

O adenoma pleomórfico ou tumor misto benigno é a neoplasia benigna mais comum primária de glândula salivar. Ocorre preferencialmente no lobo superficial da glândula parótida. Na cavidade oral, associado com as glândulas salivares menores, tem uma maior predileção para a região do palato, com ligeira predisposição em mulheres entre a 3 ª e 4 ª décadas de vida. O cisto radicular é um cisto odontogênico inflamatório decorrente de lesões causadas por traumas ou cárie. Apesar de ser relativamente comum, não há relatos de cistos periapicais associados com tumores de glândula salivar. O objetivo deste artigo é relatar um caso de uma paciente de 36 anos de idade com desenvolvimento sincrônico de adenoma pleomorfo e cisto periapical em uma mesma região. A opção tomada foi a de realizar a enucleação de ambas as lesões, seguido de curetagem local. A paciente está sendo acompanhada clínica e radiograficamente por cerca de 18 meses sem sinais de recidiva.

Tumor mixto benigno en paladar blando: revisión de la literatura y reporte de un caso / Benign mixed tumor in the soft palate: review of the literature and report of a case

Los tumores de glándulas salivales son relativamente infrecuentes y representan aproximadamente entre el 3% y el 10% de las neoplasias de la región de cabeza y cuello. El tumor mixto benigno (TMB) o adenoma pleomórfico (AP) es el tumor benigno más común de las glándulas salivales. Entre el 34% y el 86% de los casos se presentan en la glándula parótida. El paladar duro resulta la localización más frecuente para tumores de glándulas salivales menores intraorales. Las lesiones que involucran el paladar blando son infrecuentes. En este trabajo se realiza la presentación de un caso clínico de tumor mixto benigno en paladar blando acompañado de una minuciosa revisión bibliográfica.

Pathological study of benign and malignant salivary gland tumors

To carry out a retrospective analysis of all benign and malignant tumors of major and minor salivary glands which were diagnosed at King Hussein Medical Center during the years between 2000 and 2006. A total of 127 patients diagnosed to have salivary gland tumors were retrieved from our histopathology data records between 2000 and 2006. Most patients were originally treated at King Hussein Medical Center, and some at one of the peripheral military hospitals. All cases were analyzed according to their sex and age distribution as well as the frequency of various histopathological types and their anatomical sites. Of the 127 cases 84.3% of tumors were benign and 15.7% were malignant. The mean age of the benign neoplasms was 43.3 years, and most of these tumors were seen between the fourth and sixth decade of life. The mean age for the malignant neoplasms was 51.1 years, and most cases were in the sixth decade of life. There was a male predominance in both benign and malignant salivary gland neoplasms. Among the benign salivary gland tumors, the most frequent histological type was pleomorphic adenoma [57.9%] followed by Warthin's tumor [35.5%]. Adenoid cystic carcinoma and mucoepidermoid carcinoma were the most frequently encountered malignant tumors accounting for 90% of all malignant tumors. The most commonly involved salivary gland for benign and malignant tumors was the parotid gland. Of the minor salivary gland tumors, the most frequently affected site was the palate [65%], and the most frequent tumor encountered was pleomorphic adenoma [55%]. Salivary gland tumor is a subject of considerable interest because of its not uncommon occurrence and varied histological pattern. This study describes the pathological features of salivary gland tumors in Jordan. The findings are in agreement with results of most previously published research studies

Cystadenoma: a rare tumor originated in minor salivary gland / Cistadenoma: um tumor raro em glândula salivar menor

Cystadenoma of salivary glands is an uncommon benign neoplasm that presents intraluminal papillary projections. The authors describe one case of cystadenoma located in the buccal mucosa and highlight its histomorphological features and differential diagnosis.

O cistadenoma de glândula salivar é uma neoplasia benigna incomum, que exibe projeções papilíferas intraluminais. Os autores descrevem um caso de cistadenoma localizado na mucosa jugal, discutindo os aspectos histomorfológicos e o diagnóstico diferencial desse tumor.

Ploidy studies of pleomorphic adenomas and minor salivary gland carcinomas of the palate

Los estudios de ploidía son usados como herramienta en el diagnóstico y pronóstico de tumores. El objetivo del presente estudio fue evaluar el contenido de ADN de adenomas pleomorfos (PA) y carcinomas de glándulas salivales de paladar.Se seleccionaron 12 casos de tumores de glándulas salivales de paladar de los archivos de la Cátedra de Anatomía Patológica de la Facultad de Odontología de la Universidad de Buenos Aires (1966-2001). Seis casos correspondieron a Adenomaspleomorfos y seis a adenocarcinomas. Se evaluaron las areas mixoides y epiteliales de los PA. En todos los casos de PA obtuvimos en los sectores epiteliales, un contenido elevado de DNAdel orden de 4C. En tanto las areas mixoides de los PA revelaron ploidas de 2C. Los resultados mostraron tres rangosdiferentes de contenidos de ADN. Laos sectores mixoides de los PA evidenciaron valores en el rango 2C, Llos sectores epiteliales de los PA fueron en un rango 4C y los adenocarcinomas mostraron valores anueploides. Se han encontradodiferencias en el contenido de DNA en los AP entre las áreas epiteliales y mixoides. Esto permitiría suponer la existencia de diferentes poblaciones celulares, con grado de agresividaddiferente. El contenido de ADN y su carácter aneuploide podrían ser de utilidad pronóstica en los carcinomas de glándulas salivales menores.