ABSTRACT
Neuroendocrine tumors (NET) are a heterogeneous group of malignancies with a broad spectrum of histomorphologies, tissue origins, and clinical outcomes, which arise from neural crest cells with neuroendocrine differentiation. Salivary gland tumors account for 3-6% of all head and neck neoplasms, while large cell neuroendocrine carcinomas (LCNEC) of the salivary gland are extremely rare, with few cases reported in literature, and only 5 cases involving submandibular gland. The rarity of these tumors in salivary glands is probably related to the scarcity of neuroendocrine cells in this tissue, whose presence is still a matter of debate. Regardless of their low frequency, it is imperative to differentiate these tumors from the much more common squamous cell carcinomas and metastatic NETs, due to different therapeutic approach and prognosis. In this paper, we report the case of a 21-year-old man, with a LCNEC involving a submandibular gland followed by several recurrences over the years. In addition, we include a comprehensive review of the available literature on this topic.
Subject(s)
Carcinoma, Large Cell/diagnostic imaging , Carcinoma, Neuroendocrine/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Submandibular Gland Neoplasms/diagnostic imaging , Carcinoma, Large Cell/pathology , Carcinoma, Large Cell/therapy , Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/therapy , Humans , Male , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/therapy , Submandibular Gland/diagnostic imaging , Submandibular Gland/pathology , Submandibular Gland Neoplasms/pathology , Submandibular Gland Neoplasms/therapy , Young AdultABSTRACT
INTRODUCTION: The regional healthcare system of the Lombardy Region pay great attention to monitoring the effectiveness and quality level with which its services. The aim of this paper is to describe the method adopted by the Lombardy Region to create a governance tool for the healthcare system that would be applied within hospitals to create value at financial-economic level, to achieve continuous quality improvement and to increase patient/customer satisfaction levels. It was called: Piano Integrato del Miglioramento dell'Organizzazione (PIMO), i.e. Integrated Plan for Hospital Improvement. METODS: The approach for the definition of the PIMO was based on: the Plan Do Check Act methodology; the management requirements introduced by the UNI EN ISO 9001:2008 and UNI EN ISO 9004:2005 standards; the regulations and indications made for the Public Administration; the Guidelines for planning and monitoring improvement proposed by the CAF (Common Assessment Framework). RESULTS: The evaluation of the scores for all the health structures shows a good level of quality and qualifies PIMO as a strategic tool for hospitals. CONCLUSIONS: It will be necessary to allow this tool to operate for some time in order to make an overall assessment of the results achieved.