[Updated S2k AWMF guideline on obstructive sialadenitis]. / Aktualisierte AWMF-S2k-Leitlinie zur obstruktiven Sialadenitis.

The update of this guideline was an important step to define standards for the use of sialendoscopy and other emerging minimally invasive techniques for the therapy of sialolithiasis and other obstructive salivary gland diseases. The current actualization was necessary to adapt the diagnostic and therapeutic algorithms to the current scientific knowledge. In this article they are presented in a shortened version with a focus on conservative therapeutic measures which are especially relevant for daily practice.

Chronic parotitis: not another SPINKosis.

INTRODUCTION: Pancreatitis and parotitis share several etiological, pathohistological and functional similarities. It arose from recent pancreatitis research that some cases of chronic pancreatitis are associated with mutations of the serine protease inhibitor, Kazal type-1 (SPINK1). We tested the hypothesis that the pancreatitis-associated N34S mutation of SPINK1 is also a risk factor for chronic parotitis. METHODS: Reverse-transcriptase polymerase chain reaction was used to investigate SPINK1 transcription in the parotid gland. Forty-five blocks of formalin-fixed, paraffin wax-embedded tissues with chronic parotitis of unknown cause were analyzed for the SPINK1-N34S mutation. RESULTS: The SPINK1 gene is transcribed in the parotid gland. Two of the 45 patients (4.4%) with chronic parotitis carried the N34S mutation heterozygously. Of 82 healthy blood donors, 3 subjects (3.7%) were identified as carrying this mutation heterozygously (p = 0.83). CONCLUSION: The SPINK1-N34S mutation is not associated with chronic parotitis.

First report of parotid gland metastasis in multiple enchondromatosis with secondary CHOSA (G-III).

Chondrosarcomas constitute the second-most-frequent malignant bone tumors, representing about 10% of all malignant bone tumors. The most frequent localizations comprise the trunk, pelvis and limbs. Metastatic disease usually occurs in the lung; metastases to other localizations are seen occasionally. Manifestation in the head and neck area, either as primary tumor or metastasis, is very rare. A case of parotid gland metastasis in multiple enchondromatosis secondary chondrosarcoma (CHOSA) G-III of the left femoral bone is presented. A 79-year-old male patient reported to our clinic with a rapidly progressing mass in the left parotid gland. A superficial parotidectomy was performed and the entire tumor resected. Histopathological examination revealed nodular infiltration of the parotid by chondrosarcoma consistent with metastatic disease. Review of the literature shows that this is the first report of such a case.

Malignant sialogenic tumours of the larynx.

Laryngeal manifestations of malignant sialogenic neoplasias are rare. This paper documents the clinical features, treatment, biological behaviour and prognosis of 15 cases of malignant sialogenic tumours of the larynx that were reviewed in a retrospective clinical and histopathological study. The 15 cases of malignant sialogenic tumours of the larynx were diagnosed at the University Hospital, Eppendorf, over a period of 33 years (1965-1998). Forty per cent were adenoid cystic carcinomas, 33 per cent mucoepidermoid carcinomas and 27 per cent were poorly differentiated adenocarcinomas. Local tumour resection, if necessary in combination with bilateral neck dissection and post-operative radiotherapy, was associated with a five-year survival rate in 80 per cent of the mucoepidermoid carcinoma cases. Adenoid cystic carcinoma was associated with a less favourable five-year survival rate of 33 per cent. Low-differentiated adenocarcinomas were associated with the least favourable prognosis with a five-year survival rate (25 per cent). The prognosis for these tumours is thus poorer than for squamous cell carcinomas with the same localization and TNM status.

Value of minor salivary gland biopsy in diagnosing Sjögren's syndrome.

OBJECTIVE: Minor salivary gland biopsy is suggested for diagnosing Sjögren's syndrome in patients with clinical signs of sicca syndrome. This biopsy is mainly examined on the basis of the semiquantitative morphologic criteria without taking into account the detection of characteristic myoepithelial sialadenitis (MESA). DESIGN: The role of minor salivary gland biopsy in the diagnosis of Sjögren's syndrome as a possible detection method for MESA was examined in a retrospective study. METHODS: Minor salivary gland biopsies were obtained from 32 patients between 1986 and 1996. Twenty-two patients fulfilled the criteria for primary and 10 patients for secondary Sjögren's syndrome based on the catalogue of the European Study Group on Diagnostic Criteria for Sjögren's Syndrome. The histopathologic assessment was based on the histomorphologic MESA criteria, that is, parenchymatrophy, interstitial lymphocytic cell infiltration, and myoepithelial cell islands. RESULTS: The histopathologic assessment revealed normal minor salivary glands in 37.5% of the cases and chronic sialadenitis in 59.4% of the patients. Only one female patient (3.1%) had changes characteristic of MESA. CONCLUSION: Minor salivary gland biospy is therefore an unsuitable method for detecting MESA if the pathomorphologic correlative of MESA is used to confirm the diagnosis of Sjögren's syndrome.