Uncommon Coexistence of Pleomorphic Adenoma and Warthin's Tumor in a Painfully Swollen Left Parotid Gland: A Surgical Case Report.

BACKGROUND Benign pleomorphic adenoma is the most common primary tumor of the salivary glands and mainly arises in the parotid gland. Warthin's tumor, or papillary cystadenoma lymphomatosum, represents <30% of benign parotid tumors. The simultaneous occurrence of multiple parotid tumors is rarely described - depending on the corresponding histology (different/identical), the time of their occurrence (synchronous/metachronous), as well as their location (unilateral/bilateral), multiple parotid tumors can be further sub-classified. CASE REPORT We describe the case of a 54-year-old female patient with progressive and painful swelling of the left parotid gland for the last 6 months. During extra-oral examination, a bulging, displaceable mass of approximately 3 cm was determined. A subsequent MRI (magnetic resonance imaging) examination revealed a multifocal lesion but failed to provide a decisive clue as to the tumor entity of the lesion, and a lateral (superficial) parotidectomy was performed. Postoperative histomorphological interpretation allowed the final pathological diagnosis of synchronous, unilateral occurrence of a pleomorphic adenoma as well as a Warthin's tumor. CONCLUSIONS This report presents a rare case of synchronous unilateral parotid tumors and supports that benign pleomorphic adenoma and Warthin's tumor are the most common associations. Since clinical examination, MRI imaging, and even cytological assessment could be misleading in the detection of synchronous ipsilateral multiple parotid gland tumors, our report also highlights the importance of timely and accurate diagnosis with histopathology to plan surgery and to exclude malignant transformation, which is a rare but important association with both types of primary salivary gland tumor.

Evidence of ubiquitous in vivo and in vitro expression of pro-apoptotic Smac/DIABLO protein in meningioma cell lines.

Although meningiomas are one of the most common tumors in the central nervous system, the adjuvant treatment for recurrent or malignant meningiomas is not satisfactory. An intense interest in evaluating new molecular markers that may serve as potential therapeutic targets exists. Changes in apoptosis mechanisms play important roles in tumor pathogenesis. One pro-apoptotic protein is Smac/DIABLO, which neutralizes the inhibitors of apoptosis (IAPs). As Smac/DIABLO has not been previously analyzed in meningiomas, We investigated the expression of Smac/DIABLO and survivin in primary meningioma cultures in vivo and in vitro. Expression of Smac/DIABLO, survivin and single-stranded (ss)DNA in vivo were determined immunohistochemically in 100 meningioma surgical specimens, dura and normal human cortex. The expression of the apoptotic enzymes in vitro was analyzed after RNA and protein isolation of all meningiomas via Western blotting and PCR. All examined meningiomas and normal cerebral cortex displayed intense positive cytoplasmic Smac/DIABLO immunoreactivity. Survivin and ssDNA were expressed in all surgical specimens and showed weak staining overall. Examination of Smac/DIABLO protein via Western blotting showed distinct signals in the cytoplasmic extracts. PCR analysis displayed no changes of Smac/DIABLO and survivin expression in different meningioma grades, normal human cortical cortex or dura. Constant high-level Smac/DIABLO respectively low-level survivin expression in meningiomas and normal brain demonstrate similar apoptotic behavior of meningiomas compared to normal brain tissue. These findings indicate no pathological overexpression of survivin in meningiomas as is evident in several other cancer types impeding apoptosis.