Mycobacterial tuberculosis superimposed on a Warthin tumor.

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.

Brucella melitensis infection within warthin tumor of the parotid gland.

Brucellosis is a zoonotic systemic infectious disease, and multiorgan involvement is commonly seen, but involvement of the neck is a rare presentation of brucellosis. Granulomatous infections of the parotid gland are extremely rare. Warthin tumor is a well-known benign neoplasm of the salivary glands. In this report, we describe a Warthin tumor associated with Brucella melitensis in the same parotid gland.

Alkanindiges hongkongensis sp. nov. A novel Alkanindiges species isolated from a patient with parotid abscess.

A bacterium was isolated from the abscess pus of a 72-year-old patient with Warthin's tumor and parotid abscess. The cells were aerobic, non-motile, Gram-negative but difficult to be destained, non-sporulating, coccobacillus. The bacterium grew poorly on sheep blood agar and MacConkey agar as non-hemolytic colonies of 0.5 mm in diameter after 24h of incubation at 37 degrees C in ambient air. Growth was enhanced by Tween 80. It produces catalase but not cytochrome oxidase. Sequencing of the cloned 16S rRNA PCR products of the bacterium revealed three different 16S rRNA gene sequences, with 12 - 31 bp differences among them. Phylogenetic analysis showed that the bacterium is closely related to Alkanindiges illinoisensis, with 5.0 - 5.9% differences between the 16S rRNA gene sequence of the bacterium and that of A. illinoisensis. Tryptophan auxotrophic strain of Acinetobacter trpE27 transformed with DNA extracted from the bacterium was unable to grow on tryptophan deficient medium, indicating that the bacterium was not a strain of Acinetobacter. The G+C content of the bacterium (mean +/-SD) was 46.9+4.3%. A new species, Alkanindiges hongkongensis sp. nov., is proposed, for which HKU9T is the type strain. Isolates with "small colonies" that are apparently Acinetobacter-like species should be carefully identified. Growth enhancement with aliphatic hydrocarbons should be looked for and 16S rRNA gene sequencing performed in order to find more potential cases of Alkanindiges infections, as well as to define the epidemiology, clinical spectrum, and outcome of infections associated with this genus.

Parotid neoplasms: diagnosis, treatment, and intraparotid facial nerve anatomy.

The demographics of parotid neoplasms in different populations have been reported by various centres. In this investigation, we reviewed retrospectively all the in-patient and out-patient charts and records of 108 patients who were diagnosed with parotid neoplasms and received parotidectomies in our department from 1 January 1993 to 15 April 2000. Patient age, gender, tumour pathology, fine-needle aspiration cytology results, and the intraparotid anatomy of the facial nerve were noted. We showed that despite the difference between our Taiwanese and previously studied patient populations, both populations had a similar distribution, diagnosis and treatment of parotid neoplasms, although the incidence of parotid tuberculosis was higher in our patient group. In addition, the facial nerve anatomy within the parotid gland had three main branching patterns in the upper and lower division.

Mycobacterium tuberculosis infection within Warthin's tumor: report of two cases.

We report two patients with Warthin's tumor who were also infected with Mycobacterium tuberculosis. Case 1 was a 75-year-old woman with Warthin's tumor and multiple small epithelioid granulomas with caseous necrosis involving the submandibular gland. This patient died of tuberculous meningitis 4 months after biopsy. Case 2 was a 78-year-old man with a 10-year history of a parotid mass which had enlarged rapidly over 2 months. Surgical excision revealed Warthin's tumor and epithelioid granulomas involving the left parotid gland. DNA extracted from paraffin sections was amplified by nested polymerase chain reaction (PCR) with primer sets for the mycobacterial 65-KDa antigen gene. Restriction enzyme digestion of the PCR products could differentiate Mycobacterium tuberculosis from other mycobacteria in both cases. Although the histogenesis of lymphoid components of Warthin's tumor is controversial, the frequent prevalence of inflammation or necrosis and our present findings suggest these components have a similar behavior to regional lymph nodes.

Detection of Epstein-Barr viral genome in tumor cells of Warthin's tumor of parotid gland.

The presence of Epstein-Barr virus (EBV) DNA-sequences in specimens of Warthin's tumor in the parotid gland was studied. Using an in situ hybridization technique, EBV genome was detected in distinct cell types in routinely processed tissues. The authors' results indicated that EBV is frequently present in the cytoplasm (possibly because of a chronic, productive infection) of neoplastic cells of multiple/bilateral Warthin's tumor (MBWT) (86.7%), and only occasionally of solitary Warthin's tumor (SWT) (16.7%). In addition, EBV genome has often been documented in the cytoplasm of ductal cells (75% of MBWT and 33.3% of SWT), and occasionally of acinar cells (16.7% of both MBWT and SWT) of residual normal salivary gland tissue surrounding both MBWT and SWT. The almost constant presence of EBV DNA in tumor cells of MBWT, as opposed to the occasional finding in SWT, suggested a strong association between infection of cells with this virus and the development of multiple/bilateral lesions. The positivity of ductal epithelium supported speculations about the role of ductal cells as a histogenetic precursor of the tumor. This was the first report on the detection of EBV genome in Warthin's tumor.

Undifferentiated carcinoma with lymphoid stroma of the parotid gland.

A rare undifferentiated carcinoma with lymphoid stroma (UCLS) of the parotid gland is described in a white Turkish patient. The raised serum IgG to Epstein-Barr virus capsid antigen suggests a causal relationship between Epstein-Barr virus and this type of salivary gland carcinoma. Some clinical features are briefly reviewed.

Epstein-Barr virus infection in carcinoma of the salivary gland.

Undifferentiated carcinoma of the parotid gland contains clonal Epstein-Barr virus episomes without ladder arrays of restriction enzyme fragments representing virion DNA. Analysis of Epstein-Barr virus transcription in situ in parotid carcinoma specimens revealed that the EBER RNAs, latent membrane protein mRNA, and the BamHI-A rightward reading frame, BARF0, are expressed in the malignant epithelial cells.

Epstein-Barr virus (EBV)-associated undifferentiated carcinoma of the parotid gland.

A case of undifferentiated carcinoma of the salivary gland occurring in the parotid gland of a southern Chinese was reported. Tumour cells showed immunofluorescence for Epstein-Barr virus (EBV)-associated nuclear antigen, and DNA hybridization demonstrated the presence of EBV-DNA in tumour tissue. The findings in this case, together with previous reports, suggest a causal relationship between EBV and salivary gland carcinoma. The relationships between EBV and undifferentiated epithelial tumours of the salivary glands, nasopharynx and thymus are also discussed.

Oral cancer in children under 15 years of age. A clinicopathological and virological study.

11 malignant tumours of the oral region in children under 15 years of age were diagnosed in Finland during the 20-year period from 1961 to 1980; the age adjusted annual incidence rate being 0.31 per 1,000,000 children. 5 cases were intraoral cancer and 5 cases malignant tumours of the major salivary glands. The formalin-fixed tumours were studied using the in situ DNA hybridization technique for Adenovirus, group II, Epstein-Barr and human papillomavirus, type 16. For the first time, evidence was provided for the presence of Epstein-Barr virus in a malignant salivary gland tumour, implicating a possible etiological role for this virus in salivary gland neoplasms.

Malignant lymphoepithelial lesion.

A case of undifferentiated carcinoma arising from benign lymphoepithelial lesion (BLEL) of the parotid gland was studied by light and electron microscopy. Histopathologically, the carcinoma was composed of pleomorphic anaplastic cells showing an undifferentiated type among abundant lymphoid tissue forming germinal center. Among the prominent lymphoid tissue, epithelial hyperplasia, dysplasia, and squamous metaplasia of the duct epithelium were found. Dysplastic epithelium revealed a transition with carcinomatous component in some areas. On the electron microscopic observation, the tumor cells were poorly differentiated, possessing desmosomes and intracytoplasmic filaments. The patient is alive and well 2 months after resection of the tumor, but has a high titer of serum Epstein-Barr virus capsid antigen in IgG. Eighty five cases of the malignant lymphoepithelial lesion (MLEL) including the present case are summarized.

[Possible relation between viruses and oromaxillofacial tumors. IV. Presence of the herpes antigen and anti-herpes antibodies in patients with tumors of the parotid gland]. / Relations possibles entre virus et tumeurs bucco-maxillo-faciales. Note IV. Présence de l'antigène herpétique et des anticorps anti-herpétiques chez des malades porteurs de tumeurs de la glande parotide.

The presence of herpesvirus antigen and of antiherpesvirus antibodies was detected in 46% and in 36.3%, respectively, of the patients bearing parotid gland tumors. Very high titers of antiherpesvirus antibodies were found in 70.6% of the patients with nasopharyngeal carcinoma.

[Possible relation between viruses and oromaxillofacial tumors. III. Demonstration of the SV40 antigen and anti-SV40 antibodies in patients with tumors of the parotid gland]. / Relations possibles entre virus et tumeurs bucco-maxillo-faciales. Note III. Mise en évidence de l'antigène SV40 et des anticorps anti-SV40 chez des malades ayant des tumeurs de la glande parotide.

SV40 antigen was detected in 7 of 13 malignant tumors developed in the head and neck region. Specific complement fixing antibodies were found in all the patients with the SV40 antigen present in the parotid gland tumoral cells. Incidence of the anti-SV40 complement fixing antibodies in parotid gland tumor bearing patients was of 69.6%.

[Possible relation between viruses and oromaxillofacial tumors. V. Demonstration of hemagglutination-inhibiting anti-BK virus antibodies in patients with tumors of the parotid gland]. / Relations possibles entre virus et tumeurs bucco-maxillo-faciales. Note V. Mise en évidence des anticorps inhibiteurs de l'hémagglutination anti-virus BK chez des malades porteurs de tumeurs de la glande parotide.

Anti-BK-virus hemagglutination inhibiting antibodies were revealed in 81.8% of the patients with parotid gland tumors. Results of the investigations conducted on oromaxillofacial tumors including the parotid gland ones are discussed from the point of view of the presence of viral antigens (herpes-, SV40 and BK-viruses) and of specific antibodies. Possible implication of the papova viruses in the etiopathogenesis of the parotid gland tumors in humans are also discussed.

The structure of the termini of the Epstein-Barr virus as a marker of clonal cellular proliferation.

The linear virion form of Epstein-Barr virus (EBV) DNA has variable numbers of direct tandem 500 bp repeats at each terminus. The terminal restriction endonuclease fragments and the fused terminal fragments in the intracellular episomal form are heterogeneous in size, and vary by increments of 500 bp. The structure of the termini of EBV in carcinomas of the nasopharynx and the parotid gland was compared with the EBV termini in monoclonal and polyclonal tissues or cell lines. A single band representing the EBV joined termini was detected in each of the carcinomas and in the monoclonal lymphoid proliferations. Polyclonal cell lines contained multiple forms of the joined termini. The detection of a homogeneous episomal population suggests that EBV-associated epithelial malignancies are clonal expansions of a single EBV-infected progenitor cell.