Morphological analysis and lipid composition of the stable fly Stomoxys calcitrans salivary glands reinforce important features of feeding behaviour.

Stomoxys calcitrans L. (Diptera: Muscidae), the stable fly, is a hematophagous insect of great veterinary importance, because it is a mechanical vector of diverse pathogens in livestock. The saliva of blood-feeding insects presents important pharmacologically active molecules that impair blood clotting, promote vasodilation and modulate the host immune system response, crucial processes for successful feeding. These properties also enable pathogens' transmission. In the present work, we describe an efficient protocol to dissect S. calcitrans salivary glands, their morphological characteristics and lipid profile. The mean length of the tubular gland is 3.23 mm with a bulbous posterior end and a narrow anterior end. Histological analysis revealed a monolayer of large polygonal epithelial cells with voluminous nuclei and high lipid content in their cytoplasm. Ultrastructural analysis showed that the epithelium is rich in mitochondria, free ribosomes, Golgi complex cisternae, presenting a great extension of rough endoplasmic reticulum that contains an electron-dense material. Lipid analysis by thin-layer chromatography showed that neutral fatty acids and phosphatidylcholine are predominant in the fly salivary glands. Lysophosphatidylcholine, an important signalling biomolecule involved in different metabolic processes, including host's immunomodulation and pathogens proliferation and differentiation, is also present.

Stomoxys calcitrans L. (Diptera: Muscidae), a mosca­dos­estábulos, é um inseto hematófago de grande importância veterinária, uma vez que é vetor mecânico de diversos patógenos que infectam animais da pecuária. A saliva de insetos que se alimentam de sangue apresenta importantes moléculas farmacologicamente ativas que impedem coagulação sanguínea, promovem vasodilatação e modulam o sistema imune do hospedeiro, processos cruciais para uma alimentação bem sucedida. Tais propriedades também permitem a transmissão de patógenos. No presente trabalho, nós descrevemos um protocolo eficiente para dissecar as glândulas salivares de S. calcitrans, suas características morfológicas e perfil lipídico. O comprimento médio da glândula tubular é 3.23 mm com uma porção posterior bulbosa e porção anterior estreita. Análises histológicas revelaram uma monocamada de células epiteliais largas e poligonais com núcleos volumosos e alto conteúdo lipídico em seus citoplasmas. Análises ultraestruturais mostraram um epitélio rico em mitocôndria, ribossomos livres, cisternas do complexo de Golgi, apresentando uma grande extensão de retículo endoplasmático que contém um material eletrodenso. A análise lipídica mostrou que ácidos graxos neutros e fosfatidilcolina predominam nas glândulas salivares da mosca. Lisofosfatidilcolina, uma importante biomolécula sinalizadora envolvida em diferentes processos metabólicos, incluindo imunomodulação do hospedeiro e proliferação e diferenciação de patógenos, também se encontra presente.

Necrotizing sialometaplasia: systematic review and meta analyses over the past 46 years

Objectives: The aim of this study was to characterize the main characteristics of this disease in relation to diagnosis, clinical aspects, progression and treatment as well as correlating them with remission time. Material and Methods: A systematic search was performed following the guidelines given by PRISMA and the Joanna Briggs Institute. PubMed, Web of Science and Scopus were the databases used. Results: The final analysis resulted in 108 articles with 173 clinical cases. The longest remission time for signs and symptoms (>7 weeks) was registered among male patients (p = 0.02) and outside the oral cavity; however no significant correlation was observed (p>0.05). A high risk of bias was the most common rating among the articles analyzed (55%); followed by moderate (27%) and low (18%). The lack of standardization in clinical case report descriptions made it difficult to gain a thorough knowledge of the essential characteristics of the NS patho-logical processes. Conclusion: It is recommended that publications follow the standards recommended by the literature; in addition, studies using advanced technologies to better understand NS's pathological path are recommended so as to propose effective treatments for this disease. (AU)

Cytomegalovirus in Adenoma and Carcinoma Lesions: Detecting Mono-Infection and Co-Infection in Salivary Glands.

Salivary glands' neoplasms are hard to diagnose and present a complex etiology. However, several viruses have been detected in these neoplasms, such as HCMV, which can play a role in certain cancers through oncomodulation. The co-infections between HCMV with betaherpesviruses (HHV-6 and HHV-7) and polyomaviruses (JCV and BKV) has been investigated. The aim of the current study is to describe the frequency of HCMV and co-infections in patients presenting neoplastic and non-neoplastic lesions, including in the salivary gland. Multiplex quantitative polymerase chain reaction was used for betaherpesvirus and polyomavirus quantification purposes after DNA extraction. In total, 50.7% of the 67 analyzed samples were mucocele, 40.3% were adenoma pleomorphic, and 8.9% were mucoepidermoid carcinoma. Overall, 20.9% of samples presented triple-infections with HCMV/HHV-6/HHV-7, whereas 9.0% were co-infections with HCMV/HHV-6 and HCMV/HHV-7. The largest number of co-infections was detected in pleomorphic adenoma cases. All samples tested negative for polyomaviruses, such as BKV and JCV. It was possible to conclude that HCMV can be abundant in salivary gland lesions. A high viral load can be useful to help better understand the etiological role played by viruses in these lesions. A lack of JCV and BKV in the samples analyzed herein does not rule out the involvement of these viruses in one or more salivary gland lesion subtypes.

Trypanosoma cruzi infection modulates secreted phospholipase A2 expression in the salivary glands of Rhodnius prolixus.

Phospholipases A2 (PLA2) comprise a superfamily of enzymes that specifically catalyze hydrolysis of the ester bond at the sn-2 position of glycerophospholipids, generating lysophospholipids and fatty acids. In Rhodnius prolixus, one of the main vectors of the Chagas's disease etiologic agent Trypanosoma cruzi, it was previously shown that lysophosphatidylcholine, a bioactive lipid, found in the insect's saliva, contributes to the inhibition of platelet aggregation, and increases the production of nitric oxide, an important vasodilator. Due to its role in potentially generating LPC, here we studied the PLA2 present in the salivary glands of R. prolixus. PLA2 activity is approximately 100 times greater in the epithelium than in the contents of salivary glands. Our study reveals the role of the RpPLA2XIIA gene in the insect feeding performance and in the fatty acids composition of phospholipids extracted from the salivary glands. Knockdown of RpPLA2XIIA significantly altered the relative amounts of palmitic, palmitoleic, oleic and linoleic acids. A short-term decrease in the expression of RpPLA2III and RpPLA2XIIA in the salivary glands of R. prolixus was evident on the third day after infection by T. cruzi. Taken together, our results contribute to the understanding of the role of PLA2 in the salivary glands of hematophagous insects and show that the parasite is capable of modulating even tissues that are not colonized by it.

A systematic review of the perspectives of botulinum toxin use on the quality of life of neurological patients with drooling.

OBJECTIVE: To investigate the effectiveness of botulinum toxin in the salivary glands of patients with neurological impairment and drooling and its impact on the quality of life. MATERIALS AND METHODS: This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD 42,023,435,242) and conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic search was performed in the PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and clinical trial databases until August 2023, no language restriction. Cohort studies and randomized clinical trials of patients diagnosed with drooling and neurological impairment who used botulinum toxin on the salivary gland were included, which evaluated subjective quality of life parameters. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and Risk of Bias 2 tools. The certainty of the evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Eight studies involving 317 patients were included. All studies, through subjective parameters, suggested the effectiveness of botulinum toxin in reducing drooling, resulting in an improvement in the quality of life. Three studies demonstrated improvements in swallowing and four in cases of respiratory diseases. Two clinical trials had a high risk of bias, whereas one had low risk. The five cohort studies that were evaluated had a high risk of bias. The certainty of the evidence was considered low. CONCLUSIONS: Based on the patient/caregivers' perception of improvement in drooling, dysphagia, and respiratory symptoms, it can be inferred that botulinum toxin application reduces subjective drooling in neurologically compromised patients. Its impact contributes to the general well-being and quality of life. CLINICAL RELEVANCE: Injection of botulinum toxin into the salivary glands can be considered an alternative technique to surgical or medicinal approaches in reducing drooling. It is effective, less invasive and without significant side effects. It promotes a positive impact on the well-being and quality of life of neurological patients.

Dendritic cell subpopulations in carcinoma ex-pleomorphic adenoma: A multicenter study.

OBJECTIVE: Carcinoma ex-pleomorphic adenoma (CEXPA) represents a malignant transformation from a recurrent or primary pleomorphic adenoma (PA), and the immune response may be essential in this process. Therefore, in this study, we aimed to identify and quantify subpopulations of dendritic cells (DCs) in CEXPA, residual PA in CEXPA (rPA), and PA. MATERIALS AND METHODS: A multicenter study was performed collecting salivary gland tumor (SGT) samples from three Oral and Maxillofacial Pathology Centers. A tissue microarray containing 41 samples of CEXPA and 22 samples of PA was included in this study and submitted to immunohistochemical reactions against CD1a, CD83, CD207, and Ki67 antibodies. RESULTS: Both PA and rPA showed a higher quantification of CD207+ and CD83+ cells when compared to CEXPA (p < 0.001 and p < 0.01, respectively). There was also a difference when comparing the cell proliferation index between PA/rPA and CEXPA using the Ki-67 marker (p = 0.043). However, there was no difference in the DC population regarding clinical parameters such as sex, anatomical location, size, and metastases (p > 0.06). CONCLUSIONS: Immunohistochemical profile of DC subpopulations and cell proliferation biomarkers in SGTs can contribute as an important tool in the differentiation of benign and malignant tumors or detection of initial areas with malignant transformation.

Diagnóstico y tratamiento de extravasación salival asociado a glándulas salivales BlandinNuhn: Reporte de caso clínico y revisión de la literatura / Diagnosis and treatment of salivary extravasation associated with BlandinNuhn salivary glands: Clinical case report and literature review

Los mucoceles son lesiones de extravasación salival asociados a la ruptura de los conductos que generalmente se asocian con trauma. Son azuláceos, con aspecto traslúcido, fluctuantes a la palpación, expansivos y de crecimiento rápido. Mayoritariamente se manifiestan en población joven. El sitio más común de localización es la mucosa de labio inferior, sin embargo, pueden presentarse en cualquier zona que contenga glándulas salivales menores, como vientre de lengua, donde se encuentran las glándulas Blandin-Nuhn. La frecuencia de las lesiones asociadas a éstas glándulas es del 2.25% reportándose aproximadamente 400 casos hasta la fecha. La finalidad de ésta publicación es la descripción de una patología infrecuente, así como realizar una revisión a la literatura. Se presenta el caso de una niña de tres años con historia de aumento de volumen congénito en el dorso de la lengua sin síntomas compatibles con mucocele, se realiza biopsia excisional bajo anestesia general. El resultado del estudio histopatológico reporta: fenómeno de extravasación de mucosa. Paciente evoluciona satisfactoriamente. Estas lesiones expansivas pueden repercutir en el desenvolvimiento normal de la vida de las personas causando dislalia, disfagia y disnea. El tratamiento de este tipo de lesiones en la infancia favorece a un adecuado desarrollo del habla y mejora las condiciones de alimentación.

Mucoceles are salivary extravasation lesions associated with rupture of ducts that are generally associated with trauma. They are bluish, translucent in appearance, fluctuating on palpation, expansive and fast growing. They mostly occur in young people. The most common site of location is the mucosa of the lower lip, however, they can occur in any area that contains minor salivary glands, such as the belly of the tongue, where the Blandin-Nuhn glands are located. The frequency of lesions associated with Blandin-Nuhn's glands is 2.25%, with approximately 400 cases reported to date. The purpose of this publication is the description of an uncommon pathology, as well as a review of the literature. The case of a three-year-old female with a history of congenital volume increase at the dorsum of the tongue without symptoms compatible with mucocele is reported, an excisional biopsy was performed under general anesthesia. The result of the histopathological study reports: extravasation mucus phenomenon. Patient evolves satisfactorily. These expansive lesions can affect the normal development of people's lives, causing dyslalia, dysphagia and dyspnea. Treatment of this type of injuries in childhood favors adequate speech development and improves feeding conditions.

Evaluation of the biological function of ribosomal protein S18 from cattle tick Rhipicephalus microplus.

Rhipicephalus (Boophilus) microplus, also known as the cattle tick, causes severe parasitism and transmits different pathogens to vertebrate hosts, leading to massive economic losses. In the present study, we performed a functional characterization of a ribosomal protein from R. microplus to investigate its importance in blood feeding, egg production and viability. Ribosomal protein S18 (RPS18) is part of the 40S subunit, associated with 18S rRNA, and has been previously pointed to have a secondary role in different organisms. Rhipicephalus microplus RPS18 (RmRPS18) gene expression levels were modulated in female salivary glands during blood feeding. Moreover, mRNA levels in this tissue were 10 times higher than those in the midgut of fully engorged female ticks. Additionally, recombinant RmRPS18 was recognized by IgG antibodies from sera of cattle naturally or experimentally infested with ticks. RNAi-mediated knockdown of the RmRPS18 gene was performed in fully engorged females, leading to a significant (29 %) decrease in egg production. Additionally, egg hatching was completely impaired, suggesting that no viable eggs were produced by the RmRPS18-silenced group. Furthermore, antimicrobial assays revealed inhibitory activities against gram-negative Escherichia coli and gram-positive Staphylococcus aureus bacteria, affecting bacterial growth. Data presented here show the important role of RmRPS18 in tick physiology and suggest that RmRPS18 can be a potential target for the development of novel strategies for tick control.

Pleomorphic Adenoma of the Nasal Vestibule: An Atypical Presentation.

Introduction: We introduce the third case reported in the literature of an atypical presentation of pleomorphic adenoma located in the nasal vestibule of a young patient who assisted at our clinic. Case Report: A young man with no important medical history consulted due to a painless mass-type slow-growth lesion associated with right nasal obstruction. He underwent surgical management and complete resection of the mass. The pathological study revealed a pleomorphic adenoma, confirmed by immunohistochemistry. Conclusion: This case confirms that pleomorphic adenomas can occur anywhere in the head and neck, even in areas without upper air-digestive tract mucosa.

Experimental apical periodontitis alters salivary biochemical composition and induces local redox state disturbances in the salivary glands of male rats.

OBJECTIVES: The objective was to evaluate the effects of experimental apical periodontitis on the inflammatory, functional, biochemical, and redox parameters of the parotid and submandibular glands in rats. MATERIALS AND METHODS: Twenty 12-week-old male Wistar rats were randomly divided into two groups (n = 10): a control group and apical periodontitis group. After 28 days, the saliva was collected for salivary flow rate and biochemistry composition. Both glands were sampled for quantification of the tumor necrosis factor-alpha (TNF-α) and biochemical analyses of redox state. RESULTS: TNF-α concentrations were higher in both salivary glands adjacent to the periapical lesions in animals with apical periodontitis and also compared to the control group. The apical periodontitis group increased the salivary amylase, chloride, potassium, calcium, and phosphate. The total oxidant capacity increased in the parotid gland adjacent to the periapical lesions in the same rat and compared to the control group. Conversely, the total antioxidant capacity of the parotid glands on both sides in the apical periodontitis group was lower than that in the control group. Furthermore, glutathione peroxidase activity increased in the submandibular gland adjacent to the apical periodontitis group compared to the control group. CONCLUSIONS: Experimental apical periodontitis alters salivary biochemical composition, in addition to increasing inflammatory marker and inducing local disturbances in the redox state in the parotid and submandibular glands of male rats. CLINICAL RELEVANCE: Apical periodontitis could exacerbate the decline in oral health by triggering dysfunction in the salivary glands.

Tomographic evaluation of the glands and lymph nodes of the cervical region in the crab-eating fox (Cerdocyon thous).

The present study aimed to determine references of normality of computed tomographic (CT) images of mandibular and parotid salivary glands (PSGs), medial retropharyngeal and mandibular lymph nodes and thyroid gland of 10 clinically healthy crab-eating foxes, Cerdocyon thous. The location, shape, homogeneity of the parenchyma, and length, height, width and pre- and post-contrast attenuation values were evaluated. The anatomical structures in the crab-eating foxes studied here presented anatomical landmarks similar to those described for domestic dogs, and showed a regular shape and homogenous parenchyma, except for the PSGs, that showed predominantly heterogeneous parenchyma. The thyroid gland topography in the crab-eating fox, though very similar, is not identical to the domestic dog and the presence of isthmus between the lobes was not detected. The values obtained from crab-eating foxes are within the normal range, although in the upper limits of dogs. There was a significant difference in the attenuation values between the right and left lobes of the thyroid gland, being greater in the left thyroid lobe. CT attenuation values ranges for this neotropical canid can be incorporated into routine staging procedures in the veterinary care of the crab-eating foxes. Furthermore, the CT images obtained were similar to those of healthy dogs, and the information obtained can be considered as initial tomographic references of normality in the cervical structures of the crab-eating fox, in order to aid in the diagnosis of future diseases that can affect this neotropical canid.

Initial evaluation and external validation of 68Ga-PSMA-11 PET/CT in tubarial gland characterization.

INTRODUCTION: Radiotracer 68Ga-PSMA-11 used in PET/CT scans allows for identification and localization of gland tissue. It allows for their consideration in clinical scenarios and to design further and stronger research to answer pertinent questions regarding their function and implications. We aimed to externally validate first reported findings of location, size, and ligand uptake of the tubarial glands using 68Ga-PSMA-11 PET/CT. MATERIALS AND METHODS: A cross-sectional study was performed with 68Ga-PSMA-11 PET/CT studies of patients with prostate cancer confirmed diagnosis from the database of the Radiology Department from 2018 to 2022. The maximum cephalocaudal length (CCL) in the tubarial glands and the Maximum Standardized Uptake Value (SUVmax) of major glands were recorded. RESULTS: A total of 202 patients were included (mean age 67.43 ± 8.5). The mean CCL of the tubarial glands was 37.38 ± 9.84 and a SUVmax of 6.56 ± 2.14. The rest of the glands were as follows: parotid 15.12 ± 4.43, submandibular 16.82 ± 5.43 and sublingual 5.84 ± 3.24. No differences were found between laterality. A weak correlation between age and SUVmax of tubarial glands was identified. Tubarial glands had a similar 68Ga-PSMA-11 uptake to that of sublingual glands. CONCLUSION: This study corroborates the existence of a conglomerate of glands in the nasopharynx roof, near the posterolateral pharyngeal recess. It serves as validation in a different population with similar results in previous research. Without 68GA-PSMA-11 PET/CT the abundance, configuration and potential clinical relevance of these glands would probably not have been identified. Radiotracer uptake was similar amongst the major salivary glands, with a more similar uptake to that shown by the sublingual gland.

Efeitos imediatos da fotobiomodulação na produção de saliva / Immediate effects of photobiomodulation on saliva production

RESUMO Objetivo Verificar os efeitos imediatos da fotobiomodulação na produção do fluxo salivar e a correlação dos dados demográficos, antropométricos e de uso de medicamentos. Método Participaram do estudo 100 indivíduos saudáveis, com idade entre 18 e 76 anos (média 27,2 anos), divididos de forma randomizada em grupo experimental e grupo placebo. Foram realizadas as avaliações das medidas antropométricas, autopercepção da produção de saliva e a sialometria. Na sequência, realizou-se a irradiação do LASER no comprimento de onda infravermelho (808 nanômetros) com 100 miliwatts (mw) de potência em cinco pontos intraorais: nas glândulas sublingual e bilateralmente nas submandibulares e parótidas, nas doses 9, 18 e 24 joules (J). A sialometria foi repetida após cada aplicação. O grupo controle recebeu os mesmos procedimentos com equipamento placebo. Resultados Houve associação estatística na autopercepção de redução da saliva no grupo experimental para a dose de 24J e na sialometria e na redução do fluxo salivar para as doses 18J e 24J e aumento para 9J, em ambos os grupos. Não houve associação quando comparado entre os grupos experimental e placebo. A análise de regressão multinomial múltipla revelou que a redução ou o aumento do fluxo salivar independe das variáveis demográficas, antropométricas e uso de medicamentos. Conclusão A ação bioinibitória da fotobiomodulação sobre as glândulas salivares saudáveis ocorreu em dose de 18J e 24J, já ação bioestimulante na dose 9J, independe das variáveis demográficas, antropométricas e uso de medicamentos. A autopercepção da redução do fluxo salivar ocorreu em 24J.

ABSTRACT Purpose To verify the immediate effects of photobiomodulation on the production of salivary flow and the correlation of demographic, anthropometric and medication use data. Methods The study included 100 healthy individuals, aged between 18 and 76 years (mean 27.2 years), randomly split into an experimental group and a placebo group. Assessments of anthropometric measurements, self-perception of saliva production and sialometry were performed. Next, LASER irradiation was carried out at an infrared wavelength (808 nanometers) with 100 milliwatts (mw) of power at five intraoral points: on the sublingual glands and bilaterally on the submandibular and parotid glands, at doses of 9, 18 and 24 joules (J). Sialometry was repeated after each application. The control group received the same procedures with placebo equipment. Results There was a statistical association in the self-perception of reduced saliva in the experimental group for the 24J dose and in sialometry and in the reduction in salivary flow for the 18J and 24J doses and an increase to 9J, in both groups. There was no association when comparing the experimental and placebo groups. Multiple multinomial regression analysis revealed that the reduction or increase in salivary flow is independent of demographic, anthropometric and medication use variables. Conclusion The bioinhibitory action of photobiomodulation on healthy salivary glands occurred at a dose of 18J and 24J, while the biostimulant action happened at a dose of 9J, regardless of demographic, anthropometric variables and medication use. The self-perception of reduced salivary flow occurred at 24J.

Avaliação das manifestações clínicas e microscópicas dos linfomas em glândulas salivares maiores / Assessment of clinical and microscopic manifestations of lymphomas in major salivary glands

Os subtipos de linfomas não Hodgkin representam 2,8% de todos os novos casos de câncer no mundo, sendo o terceiro grupo mais comum de neoplasias malignas da região de cabeça e pescoço. As glândulas salivares maiores representam o terceiro sítio extranodal mais acometido pelo linfoma na região da cabeça e pescoço; entretanto, nas glândulas salivares maiores é muito raro, representando aproximadamente 1,7­3,1% de todas as neoplasias das glândulas salivares, acometendo a maioria dos casos as glândulas parótidas (79%), seguidas pelas glândulas submandibulares (18%) e sublinguais (1%). Os subtipos mais comuns são linfoma do tecido linfoide associado à mucosa (MALT), o linfoma folicular (FL) e o linfoma difuso de grandes células B (DLBCL), e a frequência destas neoplasias está associado com a ocorrência simultânea de condições sistêmicas que predispõem ao desenvolvimento de neoplasias linfoides como a Síndrome de Sjögren (SS). Entretanto, a literatura sobre linfomas em glândulas maiores permanece muito escassa e impede que conheçamos de forma apropriada as características destes pacientes. Assim, o objetivo deste estudo é avaliar as manifestações clínicas e microscópicas dos linfomas em glândulas salivares maiores. Para isto, foram recuperados de forma retrospectiva dos arquivos de patologia de algumas instituições todos os casos diagnosticados como linfomas acometendo estes sítios anatômicos. Foram coletados os dados clínicos referentes ao sexo, idade, localização, apresentação clínica, tempo de evolução, status, estadiamento e ocorrência da SS, e as informações histopalógicas foram coletadas de blocos de parafina e lâminas em hematoxilina e eosina e imuno-histoquímicas acessíveis. Os resultados obtidos foram avaliados de forma descritiva. As séries compreenderam de 7 casos de linfomas em glândula sublingual, 16 casos em glândula submandibular e 12 casos em glândula parótida. Clinicamente, os linfomas apresentam-se como aumento de volume assintomático, sendo os subtipos mais frequentes os de células B maduras de baixo grau (MALT, FL, MCL), mas subtipos de alto grau também foram observados (LDGCB, SOE). Dois pacientes, um de linfoma de células do manto (LCM) e outro de LDGCB,SOE em glândula sublingual apresentaram como doença disseminada, e apenas três casos de linfoma MALT em glândula parótida apresentam a SS. O tratamento dependeu do microscópico e estágio do tumor, variando de cirurgia, regimes quimioterápicos com R-CHOP e radioterapia. O prognóstico foi favorável principalmente para os casos de baixo grau (MALT,FL), e apenas dois pacientes de sublingual (LDGCB,SOE, MCL) e três de submandibular (LDGCB,SOE, linfoma plasmablastico e MALT) faleceram após o diagnóstico. Neste estudo concluímos que os linfomas em glândulas salivares maiores são afetados principalmente por neoplasias de células B maduras de baixo grau (MALT, FL, MCL) e esses pacientes devem passar por uma avaliação sistêmica criteriosa para determinar se a doença se trata de uma neoplasia primária ou disseminada.

Non-Hodgkin's lymphomas account for 2.8% of all new cancer cases worldwide and are the third most common group of malignant neoplasms in the head and neck region. The major salivary glands represent the third most common extranodal site affected by lymphoma in the head and neck region; however, in the major salivary glands it is very rare, representing approximately 1.7-3.1% of all salivary gland neoplasms, affecting most cases in the parotid glands (79%), followed by the submandibular glands (18%) and sublingual glands (1%). The most common subtypes are mucosa- associated lymphoid tissue lymphoma (MALT), follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL), and the frequency of these neoplasms is associated with the simultaneous occurrence of systemic conditions that predispose to the development of lymphoid neoplasms such as Sjögren's Syndrome(SS). However, the literature on lymphomas in major glands remains very scarce and prevents us from properly understanding the characteristics of these patients. Therefore, the aim of this study was to evaluate the clinical and microscopic manifestations of lymphomas in the major salivary glands. To this end, all cases diagnosed as lymphomas affecting these anatomical sites were retrospectively retrieved from the pathology archives of a number of institutions. Clinical data was collected on gender, age, location, clinical presentation, time of evolution, status, staging and occurrence of SS, and histopathological information was collected from paraffin blocks and slides in hematoxylin and eosin and accessible immunohistochemistry. The results obtained were evaluated descriptively. The series comprised 7 cases of lymphomas in the sublingual gland, 16 cases in the submandibular gland and 12 cases in the parotid gland. Clinically, the lymphomas presented as asymptomatic enlargement, with the most frequent subtypes being low-grade mature B-cells (MALT, FL, MCL), but high- grade subtypes were also observed (LDGCB, SOE). Two patients, one with mantle cell lymphoma (MCL) and the other with LDGCB,SOE in the sublingual gland presented with disseminated disease, and only three cases of MALT lymphoma in the parotid gland presented with SS. Treatment depended on the microscopic subtype and stage of the tumor, ranging from surgery to chemotherapy regimens with R-CHOP and radiotherapy. Prognosis was mainly favorable for low-grade cases (MALT,FL), and only two sublingual patients (LDGCB,SOE, MCL) and three submandibular patients (LDGCB,SOE, plasmablastic lymphoma and MALT) died after diagnosis. In this study we conclude that lymphomas in the major salivary glands are mainly affected by low- grade mature B-cell neoplasms (MALT, FL, MCL) and these patients should undergo a careful systemic evaluation to determine whether the disease is a primary or disseminated neoplasm.

Clinical manifestations of I-131 induced salivary gland dysfunction in patients with thyroid carcinoma

Aim: To carry out a retrospective analysis of the frequency and severity of clinical signs of radioiodine (131I)-induced damage to the salivary glands in the early and long-term post-radiation periods, and identify risk factors for their occurrence in patients with differentiated thyroid carcinomas. Methods: A total of 330 patients underwent thyroidectomy with dissection of lymphatic nodes. One month after surgery, all the patients received radioiodine therapy. The dose and number of courses varied depending on the stage and morphological type of the tumor. In the late post-radiation period, the patients were surveyed with the use of a standard questionnaire, which allowed retrospective assessment of the nature and severity of symptoms of radiationinduced damage, as well as the time of their onset/subsidence. Results: Radiation-induced sialoadenitis of the salivary glands was observed in 51.2% of patients treated with 131I. The main symptoms included pain and discomfort in the salivary glands (51.2% of patients), swelling (48.8%), transient or permanent dry mouth (38%), and distortion of taste (38%). There were statistically significant correlations between the presence and severity of the main clinical symptoms of salivary gland irradiation. A significant relationship (r = 0.91, p < 0.001) was found between swelling of the salivary glands and the feeling of pain or discomfort, which was indicative of inflammation and retention of saliva. Conclusion: The main factors influencing the formation of chronic radiation-induced sialoadenitis and the severity of the inflammatory process included the tumor stage, the total dose of radiopharmaceuticals, and the duration following radioiodine therapy

Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review

Purpose: This systematic review analyzed the clinical behavior and odds of malignancy of the palatal recurrent pleomorphic adenomas. Methods: Systematic review of patients with recurrent pleomorphic adenoma arising in the palate. Database search: MEDLINE, Scopus, Web of Science, Cochrane, EMBASE, Virtual Health Library, Google Scholar, and OpenGrey. A binomial logistic regression was performed to assess the odds of detecting recurrence five, 10 and 20 years after the treatment of primary tumor. Results: Thirteen studies (n = 18 patients) out of 336 were included. The recurrent pleomorphic adenoma in palate was more common in females (61.6%), average age was 49 years old (range 9-73 years old). Four patients progressed to malignant transformation. The odds ratio (OR) of detecting a recurrence at 10 (OR = 5.57; 95% confidence interval - 95%CI 1.13-27.52), and 20 years (OR = 18.78; 95%CI 3.18-110.84) after treatment of primary pleomorphic adenoma was significantly higher than at one-year follow-up. Conclusions: The recurrence of pleomorphic adenoma in palate remains a rare event of late occurrence. It mainly affects middle-aged female and carries a risk of malignant transformation. Although uncommon, patients with palatal pleomorphic adenoma should be warned about the possibility of recurrence or malignant transformation of tumor at advanced ages.

Análise da aplicabilidade da ultrassonografia no diagnóstico de sialolitíase nas glândulas salivares maiores / Analysis of the applicability of ultrasound in the diagnosis of sialolithiasis in the major salivary glands

Sialolitíase é caracterizada pela formação de estruturas calcificadas (sialolítos ou cálculos) nos parênquimas ou ductos das glândulas salivares maiores (GSM). Exames radiográficos ou de tomografia computadorizada (TC) podem ser utilizados na detecção dessas estruturas, embora apresentem limitações para a detecção de sialolítos pouco mineralizados, assim como para a diferenciação de tecidos moles. A ressonância magnética (RM) apresenta boa acurácia para o diagnóstico de alterações em GSM ou de cálculos salivares mineralizados ou não, porém, seu uso na prática clínica é limitado devido ao seu alto custo financeiro e a baixa disponibilidade. A ultrassonografia (US) tem sido descrita como uma ótima alternativa de exame por imagem para a avaliação das GSM, devido ao seu custo reduzido, obtenção de imagem em tempo real, boa resolução da imagem e pela não utilização da radiação ionizante. O objetivo deste trabalho é analisar a aplicabilidade da ultrassonografia na detecção de sialolitíase em GSM. Foi realizada uma revisão de literatura sobre o uso da US na avaliação de sialolitíase. Nesta revisão foram coletados dados sobre os autores, ano de publicação, tipo de estudo realizado, qual GSM foi avaliada, o valor diagnóstico da US (acurácia, sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo), principais características ultrassonográficas das sialolitíases, dados clínicos relevantes e outras informações adicionais. Cálculos salivares, únicos ou múltiplos, com tamanho maior que 2 mm, foram bem detectados pela US, assim como tampões mucosos não mineralizados. Cálculos menores que 1 mm foram mais difíceis de serem visualizados na US sendo a técnica de sonopalpação, associada com o uso de suco de limão ou ácido ascórbico intraoral importante nesses casos. A acurácia, sensibilidade, especificidade, valor preditivo positivo e valor preditivo e negativo foram satisfatórias. Eventuais alterações parenquimais foram bem visualizadas através da US. Dados clínicos e ultrassonográficos foram importantes no estabelecimento dos diagnósticos diferenciais. A ultrassonografia, portanto, pode ser considerada como um método de imagem adequado para a avaliação inicial das sialolitíases nas GSM, tanto em indivíduos adultos como em crianças.

Sialolithiasis is characterized by the formation of calcified structures (sialoliths or stones) in the parenchyma or ducts of the major salivary glands (GSM). Radiographic or computed tomography (CT) examinations can be used to detect these structures, although they present limitations for the detection of poorly mineralized sialoliths, as well as for the differentiation of soft tissues. Magnetic resonance imaging (MRI) has good accuracy for diagnosing alterations in GSM or mineralized or non-mineralized salivary stones, however, its use in clinical practice is limited due to its high financial cost and low availability. Ultrasonography (US) has been described as an excellent imaging alternative for the evaluation of GSM, due to its reduced cost, real-time image acquisition, good image resolution and the non-use of ionizing radiation. The objective of this work is to analyze the applicability of ultrasound in detecting sialolithiasis in GSM. A literature review was carried out on the use of US in the evaluation of sialolithiasis. In this review, data were collected about the authors, year of publication, type of study carried out, which GSM was evaluated, the diagnostic value of US (accuracy, sensitivity, specificity, positive predictive value, negative predictive value), main ultrasound characteristics of sialolithiasis, relevant clinical data and other additional information. Salivary stones, single or multiple, larger than 2 mm in size, were well detected by US, as well as non-mineralized mucous plugs. Stones smaller than 1 mm were more difficult to visualize in the US, with the sonopalpation technique, associated with the use of lemon juice or intraoral ascorbic acid, being important in these cases. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were satisfactory. Any parenchymal alterations were clearly visualized using US. Clinical and ultrasound data were important in establishing differential diagnoses. Ultrasonography, therefore, can be considered as a suitable imaging method for the initial assessment of sialolithiasis in GSM, both in adults and children.

Basal cell adenocarcinoma of the soft palate: A closer look for an exceedingly rare salivary gland tumor.

Basal cell adenocarcinoma (BCAd) is an extremely rare primary biphasic carcinoma of the salivary glands with few well-documented cases reported in the literature. Herein, we report a rare case of a 44-year-old male patient who presented an oral medicine service with an erythematous nodular lesion on the soft palate, measuring 1.5 cm in its largest diameter, with a 5-year duration. The clinical diagnosis was pleomorphic adenoma, and an excisional biopsy was performed. Histopathological analysis revealed a biphasic infiltrative tumor composed of a mixture of central ductal cells and abluminal basal cells with slight atypia arranged in solid, trabecular, tubular and cribriform growth patterns in a loose stroma. The peripheral cells show a palisading arrangement with round hyperchromatic nuclei and scanty cytoplasm. Occasional mitotic figures were seen. Few spindle-shaped cells suggestive of myoepithelial cells were present in the stroma surrounding the basaloid tumor nests. The diagnosis was BCAd. The patient was referred to a head and neck service and has been followed up for 8 months with no signs of recurrence. In conclusion, although the diagnosis of BCAd can be challenging due to its rarity and morphological overlap with other salivary gland lesions, a meticulous morphological assessment is key for accurate diagnosis, especially in cases originating from minor salivary glands. Surgical excision with a wide safety margin is the treatment of choice and long-term follow-up is recommended to monitor possible recurrences.

Intraosseous mucoepidermoid carcinoma of the mandible.

Background: Mucoepidermoid carcinoma starts in the salivary glands and accounts for 5%-10% of all salivary gland tumours. Its intraosseous occurrence is rare and only accounts for 2%-3% of all mucoepidermoid carcinomas. This neoplasm often follows a long and indolent course. Also, given its ambiguous presentation and similarities to other dental pathologies, it often has a late diagnosis. In this instance, we present the case of a patient with an asymptomatic mandibular lesion, who underwent mandibular resection and reconstruction with fibula free flap. Case report: A 32-year-old male patient reported discomfort when chewing, which was attributable to a self-detected mass localised in proximity to teeth 47 and 48. The lesion presented as a slight swelling without clear expression in the oral cavity mucosa. The rest of the physical examination revealed no abnormalities. Both the panoramic radiograph and computed tomography of the maxillary bones revealed lytic lesions in proximity to teeth 47 and 48, close to the mandibular angle. An incisional biopsy was performed, for which the pathological anatomy showed low-grade mucoepidermoid carcinoma. A resection was then performed, which involved a right hemimandibulectomy with ipsilateral cervical lymphadenectomy. The reconstruction was performed with a right fibula-free flap. Upon histological evaluation of the surgical specimen, an intermediate-grade mucoepidermoid carcinoma was found. The patient presented good post-operative evolution. Following a multidisciplinary assessment, the use of adjuvant radiation therapy was deemed necessary. The patient currently presents good evolution and has regular check-ups. Conclusion: Intraosseous mucoepidermoid carcinoma is a rare salivary gland tumour. Given its low frequency, there are no studies that accurately describe its biological behaviour and prognosis.

Characterization of Salivary Gland Pain: A Review of the Literature / Caracterización del Dolor de Glándulas Salivales: Revisión de la Literatura

SUMMARY: The salivary glands in pathological conditions produce countless different clinical presentations, and due to their complex neuroanatomy, their pain symptoms vary widely. However, in the literature to date, few studies characterize salivary gland pain. The aim of this study was to conduct a literature review concerning the clinical characteristics of pain in various salivary gland pathologies. A literature review was done through a systematic search of scientific articles in the Web of Science (WoS), MEDLINE, Scopus, and Elton B. Stephens Company (EBSCO) databases. The free terms "salivary gland", "parotid gland", "submaxillary gland", "sublingual gland", and "pain" were used along with the Boolean operators OR and AND. The search yielded a total of 1896 articles, of which 60 fulfilled the inclusion criteria and were ultimately included in this review. It is described that pain is a nonspecific symptom of a glandular pathology and is characterized mainly by the location of the pain, which is correlated with the anatomical location of the affected salivary gland. Among the painful salivary gland pathologies, we found inflammatory disorders, including infections, obstructions, disorders secondary to hyposalivation; systemic autoimmune diseases; neoplasms, and neuropathic pain disorders. The diagnosis and management of salivary gland pain require knowledge of the causes and mechanisms of the pain, and it is to recognize the signs and symptoms of salivary gland disorders to be able to diagnose and treat them.

Las glándulas salivales en condiciones patológicas producen un sinfín de presentaciones clínicas diferentes, y debido a su compleja neuroanatomía generan variaciones en su sintomatología dolorosa. Sin embargo, en la literatura hasta ahora son escasos los estudios que caracterizan el dolor de glándulas salivales. El objetivo de este estudio fue realizar una revisión de la literatura respecto a las características clínicas del dolor en diversas patologías de glándulas salivales. Se realizó una revisión de la literatura, a través de la búsqueda sistemática de artículos científicos en las bases de datos Web of Science (WoS), MEDLINE, Scopus y Elton B. Stephens Company (EBSCO). A través de los términos libres: "salivary gland", "parotid gland", "submaxillary gland", "sublingual gland", "pain", junto con los operadores booleanos OR y AND. La búsqueda arrojó un total de 1896 artículos, de los cuales 60 cumplieron los criterios de inclusión y fueron finalmente incluidos en esta revisión. Se describe que el dolor es un síntoma poco específico para la patología glandular y está caracterizado principalmente por la localización del dolor, el cual se correlaciona con la ubicación anatómica de la glándula salival afectada. Dentro de las patologías dolorosas de glándulas salivales encontramos los trastornos inflamatorios, incluidas infecciones, obstrucciones, trastornos secundarios a hiposalivación; enfermedades sistémicas autoinmunes; neoplasias y trastornos de dolor neuropático. El diagnóstico y manejo del dolor de glándulas salivales requiere del conocimiento de las causas y mecanismos del dolor, siendo necesario reconocer los signos y síntomas de los trastornos de glándulas salivales para ser capaces de diagnosticarlos y tratarlos.