[Cervical giant tumor in a 56-year-old female patient]. / Zervikaler Riesentumor bei einer 56-jährigen Patientin.

We report the case of a 56-year-old female patient with a giant tumor on the left side of the neck, which appeared to be localised outside the large salivary glands. Due to the extensive vascularisation seen on MRI, digital subtraction angiography was performed. To reduce intraoperative bleeding, the vasculature was embolized. The tumor was resected together with the submandibular gland, since a connection between gland and tumor could not be excluded intraoperatively. Histology showed a pleomorphic adenoma with an intact capsule and no indication of malignancy. Pleomorphic adenomas are typical tumors of the salivary glands; however, they can also occur outside the gland. The tumor and its pseudocapsule must be fully resected to prevent recurrence.

Angiogenic and lymphangiogenic microvessel density in recurrent pleomorphic adenoma.

BACKGROUND: Recurrent pleomorphic adenoma (RPA) is an uncommon and challenging disease. The aim of this study was to determine if there is a difference between RPA and the pleomorphic adenoma (PA) without recurrence related to tumor blood and lymphatic vascularization. Moreover, we compared the microvessel density (MVD) between cell-rich areas (predominance of epithelial cells) and cell-poor areas (predominance of myxoid and chondroid areas) of the stroma of PA and RPA. In addition, immunohistochemical staining for the Ki-67 antigen was conducted simultaneously to evaluate cell proliferation in PA and RPA. METHODS: A total of 19 cases of PA and 24 cases of RPA, blood, and lymphatic vessels were analyzed by immunohistochemical technique using the antibodies CD34, CD105, D2-40, and Ki-67. RESULTS: Comparing no recurrent with recurrent tumor, no significant difference was found in terms of lymphatic vessel density, MVD, and proliferation index. When MVD and proliferation index were compared with different areas in cellular composition (cell-rich and cell-poor areas), there was a significant difference in PA, as well as in RPA. CONCLUSION: This study shows that although RPA presents more aggressive clinical behavior than PA, there is no difference between tumor blood and lymphatic vascularization, suggesting that there is no correlation between vascularity and risk of recurrence. Furthermore, vascularized stroma in PA, as well as RPA, depends on the proportion of the cellular composition.

Inmunohistochemical expression of PCNA, p53 and bcl-2 in pleomorphic adenomas / Expresión inmunohistoquímica de PCNA, p53 y bcl-2 en adenomas pleomórficos

The aim of the study was to determine the immunohistochemical expression of the PCNA, p53 and bcl-2 proteins in pleomorphic adenomas. Nineteen specimens of pleomorphic adenomas were selected for analysis by the streptavidin-biotin-peroxidase method with antibodies againstp53, PCNA and bcl-2 proteins. It was observed weak labeling for p53 in 12 cases (63.1 percent) andforPCNA in 8 (42.1 percent). With respect to the bcl-2 labeling index, o no expression of this protein was detected in 12 cases, corresponding to 63.1 percent of the sample. Based on these findings, it was concluded that p53 and PCNA can favour the proliferative activity of pleomorphic adenomas, whereas bcl-2 probably does not effectively participate in the pathogenesis of this tumor.

El objetivo del estudio fue determinar la expresión inmmunohistoquímica de las proteínas PCNA, p53 y bcl-2 en adenomas pleomórficos. Fueron seleccionados 19 especímenes de adenomas pleomórficos para análisis a través del método de la estreptavidina-biotina-peroxidasa con anticuerpos contra las proteínas p53, PCNA y bcl-2. Fue observada leve marcación para p53 en 12 casos (63,1 por ciento) y para PCNA en 8 (42,1 por ciento). Con relación al índice de marcación para bcl-2, ono fue detectada en 12 casos (63,1 por ciento) expresión de esta proteína. En base a los resultados, se concluyó que las proteínas p53 y PCNA pueden favorecer la actividad proliferativa de adenomas pleomórficos, y por otro lado, la bcl-2 probablemente ono participaría efectivamente de la patogenia de este tumor.

Identification of feeding arteries to establish the intra- or extraparotid location of jugulodigastric nodules: value of color Doppler sonography.

OBJECTIVE: The objective of our study was to determine the value of color Doppler imaging as an adjunct to gray-scale sonography to reveal the intra- or extraparotid origin of jugulodigastric nodules of uncertain location. SUBJECTS AND METHODS: Forty nodules in the jugulodigastric area from 38 patients were imaged with gray-scale, color, and power Doppler sonography. Nodules receiving vessels from salivary glands were assumed to be intraglandular; those accepting vessels from paraparotid spaces were considered to arise from outside the gland. Imaging results were correlated with biopsy and surgical findings. RESULTS: In 38 of 40 cases, color and power Doppler sonography displayed discrete feeding arteries leading to the nodules: 25 nodules had one supplying artery, nine received two arteries, and four had three or more arteries. Intraparotid nodules received vessels from the gland in 20 cases. In two cases, the source of vessels was indeterminate. In two malignant tumors, multiple arteries derived from both the parotid and the neck spaces. All 14 extraparotid nodules received the arterial supply from paraparotid spaces. Color Doppler sonography enabled prediction of the intraglandular location of the nodules in 91% of cases and the extraglandular location in 87.5% of cases. The correct diagnosis was achieved in 34 of 40 nodules, with a global accuracy of 85%. CONCLUSION: Color Doppler sonography can help to assess the intra- or extraparotid location of jugulodigastric nodules. In practice, this technique can support the diagnosis when gray-scale sonography raises doubts about the origin of a jugulodigastric nodule.

Anterior facial vein and submandibular gland together: predicting the histology of submandibular masses with CT or MR imaging.

PURPOSE: To test the hypothesis that the relationship of the anterior facial vein to the submandibular salivary gland and a mass in the submandibular fossa could help identify the origin of the mass at computed tomography (CT) or magnetic resonance (MR) imaging. MATERIALS AND METHODS: Thirteen patients with 14 palpable submandibular masses, surgical and histologic confirmation, and contrast material-enhanced CT images (12 patients) or MR images (one patient) that showed the anterior facial vein were identified with review of files from 1985 to 1997. Six patients had submandibular gland disease: three with primary neoplasms, two with metastatic tumor invading the gland, and one with chronic sialoadenitis. Eight patients had masses arising outside the gland (seven with lymphadenopathy, one with a plexiform neurofibroma). RESULTS: The anterior facial vein did not separate primary tumors, tumors invading the gland, or lobulations of the enlarged gland from the body of the gland. The vein was identified between enlarged lymph nodes and the gland. The vein did not separate the gland from the neurofibroma, but this tumor was medial to the gland; the vein runs lateral to the gland. CONCLUSION: The anterior facial vein is a useful landmark in determining the origin of a submandibular mass. Primary disease of the gland is never separated from the gland by the vein. The vein does separate lymphadenopathy from the gland and, theoretically, separates the gland from soft-tissue tumors lateral to the gland.

Salivary gland tumours: is colour Doppler imaging of added value in their preoperative assessment?

Using a Toshiba SSA-270A Colour Duplex Scanner, 15 patients with suspected parotid and submandibular gland tumours had preoperative duplex scanning done. Peak systolic doppler shifts (fmax) were recorded and their vascularity was also subjectively scored. There were no arteries identified within the substance of contralateral normal glands. All recordings were analysed retrospectively and an independent histological assessment of tumours was made. Pleomorphic adenomas (n = 9) had a median peak systolic frequency (fmax) of 0.8 kHz, while adenolymphomas (n = 4) had a fmax of 1.65 and the two malignant tumours had fmax of 4.5 (P = 0.007 Kruskal-Wallis test). There appears to be a strong correlation between the fmax and the subjective vascular score (Corr 0.92). Colour duplex scanning is a non-invasive procedure which may be of help in the preoperative assessment of salivary gland tumours.