Benign tumors of the superficial lobe of the parotid gland.

Tumors of the parotid gland are a rare occurrence among head and neck tumors (only 3-8%), and the vast majority are benign. Most benign tumors of the parotid gland are pleomorphic adenoma (PA), followed by Warthin's tumor (WT) and they occur in the superficial lobe. The only reasonable treatment is considered to be total tumor removal, but the appropriate surgical approach remains a matter of controversy. Over time, it went from enucleation to superficial parotidectomy (SP) and then to extracapsular dissection (ECD). SP is often considered to be the "gold standard"; however, the risk of intraoperative damage to the facial nerve (FN) cannot be ignored. Lately, ECD - which does not expose the main trunk of the FN - has been regarded as a safe technique for the treatment of small benign parotid tumors. PATIENTS, MATERIALS AND METHODS: The study retrospectively reviewed all parotidectomies for benign parotid tumors of the superficial lobe performed in the Department of ENT, Municipal Emergency Clinical Hospital, Timisoara, Romania, between January 2014 and December 2018. The following patient data were collected: age; sex; follow-up duration; extension of the resection; use of FN monitoring and lesion features, including position, pathology, and size. Preoperative investigation protocol included a computed tomography (CT) scan to assess the size and location of the tumor helping the treatment planning. The same surgical team performed both standard SP and ECD for the treatment of these tumors. All cases were confirmed as benign parotid tumors. Recurrences of any kind and tumors involving the deep lobe of the gland were excluded from the study. All patients underwent a macroscopically complete resection of the tumor. The main outcome was the postoperative complications in the two groups. Data regarding these complications were recorded on follow-up visits at one, six, 12 and 24 months. RESULTS: Ninety-five patients with benign parotid tumors were operated by the same surgical team at the Department of ENT, Municipal Emergency Clinical Hospital, Timisoara, between January 2014 and December 2018 but only 89 (38 men and 51 women) met the follow-up criteria and were included in the study. Sixteen (18%) patients underwent ECD, and 73 (82%) patients underwent SP as a primary intervention. The mean lesion size for ECD group was 2.0±0.9 cm and 4.2±1.7 cm in the SP group, and it was statistically significant (p<0.05). As expected, the most common type of tumor was PA but the distribution between the groups was different: in the SP group, PA represents 83% (61∕73) of cases but only 44% (7∕16) of cases in the ECD group. Median follow-up time was comparable in the two groups - 33±8 months for the ECD group and 39±11 months for the SP group. There were also differences between the two groups regarding the postoperative complication rate. There were significantly more transient and permanent FN paralysis, transient and permanent great auricular nerve (GAN) dysfunctions and Frey's syndrome (FS) in the SP group. CONCLUSIONS: A comparison between ECD and SP as surgical procedures for the treatment of benign tumors of the parotid seems inappropriate as their indications do not overlap. ECD showed similar effectiveness and fewer side effects than SP and can be considered the treatment of choice for small, superficial and/or marginal tumors located in the lateral lobe of the parotid gland.

[Pleomorphic adenoma of the lacrimal gland in a young girl: a case report]. / Adenoma pleomorfo de glándula lagrimal: reporte de un caso pediátrico.

We present a case of a 13 year old girl with a diagnosis of Pleomorphic Adenoma (PA) located in the lacrimal gland of the left upper eyelid. The patient had a very satisfactory recovery after surgical excision of the tumor, with no recurrence after a two year follow-up. The clinical, radiological and histopathological characteristics of PAs are discussed.

Metastatic Pleomorphic Adenoma in the infratemporal fossa and neck following total parotidectomy after 30 years.

Metastasising pleomorphic adenoma is rare and may occur years after surgical excision of a pleomorphic adenoma (PA). We present a 61-year-old woman with a right infratemporal PA with metastases to the cervical lymph nodes after 30 years following a total parotidectomy. She was treated successfully with a resection of the tumour with combined neck and mandibulotomy approach along with postoperative radiotherapy given subsequently.

The importance of BMP6 marker within the process of epithelial-mesenchymal transition in the pleomorphic adenoma of the salivary gland.

The pleomorphic adenoma is the most frequently encountered tumor of the salivary glands, representing between 45% and 75% of the total number of the tumors of the salivary glands. According to the literature, there are many studies on the immunohistochemical aspects of the myoepithelial cells, present in the pleomorphic adenoma of the salivary gland. A big diversity of mono and polyclonal antibodies, such as the cytokeratins, muscular proteins and other markers, has been used. In our study, we investigated the immunohistochemical aspect of bone morphogenetic protein 6 (BMP6) marker concerning 15 cases of pleomorphic adenomas of the salivary glands. In the immunohistochemical study, we used the paraffin blocks that served for obtaining the sections necessary for the classical histopathological processing by means of the usual stainings. The immunohistochemical study used the enzymatic detection and the LSAB 2 (Labeled Streptavidin-Biotin 2) System technique as the working method. In order to underline the process of epithelial-mesenchymal transition, we also used double sequential immunohistochemical reactions. By the use of the BMP6 marker, we intended to evaluate the reactivity of the various tumor components in the pleomorphic adenomas of the salivary gland, for this marker, taking into consideration its possible involvement in the process of the epithelial-mesenchymal transition. The maximum reactivity for BMP6 was recorded at the level of the normal, excretory, intratubular units, in the luminal cells of the proliferative ductal units, in the myxoid matrix, the cytoplasm of the myxoid stellate cells and the plasmacytoid matrix and the cytoplasm of the chondroid lacunar cells. Some of the cells belonging to the solid, proliferative areas, some of the abluminal cells, that are part of the proliferative ductal units and certain myxoid stellate or plasmocytoid cells contain the S100 protein, which would indicate the existence of some processes of mesenchymal epithelial÷myoepithelial transdifferentiation in the development of this type of salivary tumor. The BMP6 expression is specific to the serous acini salivary cells, which are the most specialized epithelial salivary gland cells. The study demonstrated that the mesenchymal epithelial÷myoepithelial potential of transdifferentiation of the luminal cells that make up the proliferative units is certified by the immunohistochemical expression of some BMP6 purely mesenchymal protein cells.

Imunoexpressão da proteína endonuclease apurínica/apurimidínica (APE-1) em adenomas pleomórficos e carcinomas ex-adenomas pleomórficos / Immunoexpression endonuclease protein apurínica / pyrimidine (APE-1) in pleomorphic adenomas and carcinomas ex pleomorphic adenomas

Introdução: A endonuclease apurínica/apurimidínica (APE-1) é uma proteína essencial para a via do reparo por excisão de bases (BER) do DNA, além de regulação de atividades redox. A capacidade de células malignas em reconhecer e reparar danos no DNA é um mecanismo importante para sobrevivência tumoral, e estudos recentes sugerem que a superexpressão da APE-1 pode se relacionar com o pobre prognóstico em alguns tumores. Objetivo: Analisar a imunoexpressão da APE-1 em Adenomas Pleomórficos (AP) e Carcinomas Ex-Adenomas Pleomórficos (CaExAP) de glândulas salivares. Materiais e Métodos: Foram selecionados 49 tumores fixados em formol e incluídos em parafina (33 AP e 16 CaExAP) que foram submetidos a estudo imuno-histoquímico pela técnica da imunoperoxidase. A imunoexpressão da APE-1 foi avaliada de forma quantitativa pelo percentual de células imunopositivas. Para análise estatística foi adotado nível de significância de 5% (p ≤ 0,05). Resultados: Todos os casos de AP e CaExAP (n=49) foram positivos para APE-1, no entanto, houve maior expressão em CaExAP havendo diferença estatisticamente relevante (p<0,001). Não foi encontrada associação da expressão da APE-1 entre tumores de glândula salivar maior ou menor, entretanto, em AP não encapsulados (Mediana de expressão= 54,2%) houve maior expressão quando comparados a tumores encapsulados (p=0,02). A superexpressão da APE-1 foi constatada principalmente em casos de CaExAP com metástase linfonodal (Mediana de expressão= 90,3% - p=0,002) e padrão invasivo (Mediana de expressão= 89,9% - p=0,003) quando comparados aos casos sem metástase e intracapsulares. Conclusão: Este estudo sugere que a APE-1 encontra-se desregulada nos tumores estudados. A maior expressão da APE-1 está associada com a ausência de cápsula completa em AP e a superexpressão está relacionada com o comportamento mais agressivo do CaExAP. (AU)

Introduction: Apurinic/Apyrimidinic Endonuclease 1 (APE-1) is an essential protein for DNA base excision repair (BER) pathway and regulation of redox activities. The ability of malignant cells to recognize and repair DNA damage is an important mechanism for tumor survival, and recent studies suggest that APE-1 overexpression is related to poor prognosis in some tumors. Purpose: To analyze the immunoreactivity of APE-1 in Pleomorphic Adenomas (PA) and Carcinomas Ex Pleomorphic Adenomas (CaExPA) of salivary glands. Materials and Methods: A total of 49 tumors fixed in formalin and embedded in paraffin (33 PA and 16 CaExPA) underwent immunohistochemical study by the immunoperoxidase technique. APE-1 immunoreactivity was evaluated quantitatively by the percentage of immunopositive cells. For statistical analysis a significance level of 5% (p≤ 0.05) was adopted. Results: All cases of PA and CaExPA (n=49) were positive for APE-1, however, there was a higher expression in CaExPA, with statistically significant difference (p<0.001). There was no association between APE-1 expression and tumors of major or minor salivary gland, however, not encapsulated PA (median expression = 54.2%) showed higher expression when compared to encapsulated tumors (p=0.02). APE-1 overexpression was found mainly in cases of CaExAP with lymph node metastasis (median expression = 90.3% - p=0.002) and invasive pattern (median expression = 89.9% - p=0.003), when compared to cases without metastasis and intracapsular pattern. Conclusion: This study suggests that APE-1 is deregulated in the studied tumors. The increased expression of APE-1 is associated with the absence of complete capsule in PA and it is associated with more aggressive behavior in CaExPA. (AU)

Metastatic pleomorphic adenoma to the supraspinatus muscle: a case report and review of a rare aggressive clinical entity.

We report a case of a 65-year-old female with a recurrent right parotid pleomorphic adenoma (PA) 24 years after initial surgical excision. Positron-emission tomography (PET) and computed tomography (CT) demonstrated an unusual suspicious FDG-avid erosive rim enhancing mass centered in the right supraspinatus muscle. Cytology from CT-guided aspiration of the mass was consistent with a histologically benign PA, and the patient was diagnosed with metastatic pleomorphic adenoma (MPA). The patient later developed diffuse pulmonary metastases and died within 3 months. MPA, although rare, is recognised as a potentially lethal malignant complication of recurrent or longstanding benign PA. As no biochemical or genetic parameters are predictive of malignant change, patients presenting with recurrent PA should be considered for screening for metastatic disease.

Spectrum of Salivary Gland Lesions in a Tertiary Level Hospital.

Salivary gland tumors are relatively infrequent and account for less than 2% of all human tumors. This study was conducted to see the prevalence of patterns of non neoplastic and neoplastic lesions of salivary glands in greater Mymensingh. It was a retrospective study carried out in the department of Pathology, Community Based Medical College Bangladesh from January 2010 to December 2012. Heamatoxylin and eosin stained sections were studied in all cases. Total 98 cases of salivary gland lesions were retrieved and evaluated. Out of them 55 cases were female and 43 were male. Mean age of the cases were 42 years. Among the salivary gland lesions non-neoplastic lesions 24.48% and neoplastic lesions 75.51%. Among neoplastic lesions benign tumor comprises 91.89% and malignant tumor comprises 8.10%.

Clinical features of cystadenolymphoma (Warthin's tumor) of the parotid gland: a retrospective comparative study of 96 cases.

The details of the etiopathogenesis of cystadenolymphoma (Warthin's tumor) are still unclear. To explore the possible risk factors for the development of this tumor, medical records of 81 patients with 96 Warthin's tumors of the parotid glands were compared retrospectively with those of 91 patients with pleomorphic adenoma. The medical history and clinical tumor characteristics of all patients were similar. There were no significant differences between these two patient groups with respect to concomitant diseases, regular medications, and preoperative laboratory findings. However, a significant male predominance of patients with Warthin's tumor could be noted (P<0.05). The male to female ratio was 3.3:1 in patients with Warthin's tumor. Multifocal Warthin's tumor were detected in five cases (6.2%), and 10 patients (12.3%) had bilateral lesions. The odds ratio for the incidence of Warthin's tumor among current smokers compared with never smokers was 8.3 (P<0.0001). Compared with never smokers, clearly higher odds of Warthin's tumor was observed in heavy smokers (more than 30 pack-years) (odds ratio=24.1, P<0.0001) than patients who smoked less than 30 pack-years (odds ratio=4.9, P<0.0001).

Warthin's tumour and smoking.

OBJECTIVE: In an evaluation of our patients with parotid gland neoplasms, we noticed that patients with a Warthin's tumour were heavy smokers. The aim of this study was to confirm earlier findings in the literature concerning a possible association between smoking and the development of a Warthin's tumour. METHODS: A case control study was performed using the clinical records and discharge letters of all consecutive patients with a Warthin's tumour in the pathology database of our hospital covering the last 15 years. Patients with a pleomorphic adenoma and a group of patients visiting our audiology department were used as controls. RESULTS: A smoking history was found in 97.5% of the patients with a Warthin's tumour. Of the patients with a pleomorphic adenoma, 59% had a smoking history; 56.5% of the audiology group had a smoking history. Mean age at the time of the operation was 60.1 years of age in the Warthin's tumour group and 48.6 for the pleomorphic adenoma group. CONCLUSION: The mean age for the development of a Warthin's tumour is ten years older than for a pleomorphic adenoma. Furthermore, the development seems to be closely related to smoking habits.

Tumores das glândulas salivares maiores: estudo restrospecitvo / Major salivary glands tumors: restrospective study

Os Tumores das Glândulas Salivares Maiores estão localizados nas Glândulas Parótida, Submandibular e Sublingual e correspondem a aproximadamente 3 a 5 porcento de todas as neoplasias do segmento cabeça e pescoço. O objetivo do presente trabalho é demonstrar o comportamento dos Tumores Benignos e Malignos das Glândulas Salivares Maiores de pacientes atendidos e tratados no Serviço de Cirurgia de Cabeça e Pescoço do Centro de Oncologia (CEON) do Hospital Universitário Oswaldo Cruz (HUOC) - Universidade de Pernambuco (UPE), no período de Janeiro de 1975 a Janeiro de 2003 (28 anos). Em um total de 153 casos (100 porcento), o sexo feminino foi mais prevalente (61,5 porcento), bem como a 4ª e 5ª décadas de vida. Os tipos histológicos benigno e maligno predominantes foram o adenoma pleomórfico (58,2 porcento) e o carcinoma mucoepidermóide (7,8 porcento), respectivamente. A complicação cirúrgica pós-operatória mais freqüente foi a parestesia do ramo mandibular facial (41,9 porcento), seguida da síndrome de Frey (20,8 porcento). Através de um estudo retrospectivo, foram analisados aspectos etiológicos, clínicos, histopatológicos, diagnóstico diferencial, tratamento e prognóstico, e compararam-se os referidos indicadores com os apresentados na revisão da bibliografia consultada. Demonstram, ainda, sua experiência com a referida patologia, e suas conclusões do material estudado

[Diseases of the lacrimal gland]. / Erkrankungen der Tränendrüse.

Experience with the differential diagnosis of lacrimal gland illnesses is limited in daily practice due to their rarity. It is therefore of particular importance to have guidelines for the practitioner by which he can decide on the application of conservative or surgical therapy, and whether it is necessary to take a biopsy to clarify the diagnosis. There is a wide spectrum of possible illnesses which include systemic diseases, inflammatory disorders, neoplastic, benign and malignant tumors. When a pleomorphic adenoma cannot be excluded, biopsy is contraindicated and complete tumor excision with its capsule is necessary to prevent the possibility of malignant transformation and a negative effect on long-term prognosis. In this overview, special interest is placed on the typical clinical aspects and imaging features of lesions of the lacrimal gland fossa, their differential diagnosis and management.

Role of Epstein-Barr virus and cytomegalovirus in the etiology of benign parotid tumors.

BACKGROUND: Pleomorphic adenomas and Warthin's tumors are the two most common benign parotid tumors. Previous studies investigating the role of viruses in tumorigenesis of these neoplasms have been conflicting. The aim of this study was to determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) might play a role in the pathogenesis of pleomorphic adenomas and Warthin's tumors. METHODS: Paraffin-embedded surgical specimens of 24 pleomorphic adenomas, 10 Warthin's tumors, and 13 normal parotid tissues were obtained from the University of California-San Francisco Pathology Department. Genomic DNA was extracted from the specimens, and primers for connexin 26, a gap junction protein, were used to confirm the integrity of this DNA. The presence or absence of EBV and CMV DNA within the samples was determined with PCR-based assays, in which radiolabeled primers were used for maximal sensitivity of detection. RESULTS: PCR analysis of serially diluted control DNA revealed that using radiolabeled primers, five copies of viral DNA could be detected. By use of this method, we showed that none of the 24 pleomorphic adenomas, 10 Warthin's tumors, or 13 normal parotid samples contained EBV DNA or CMV DNA. CONCLUSIONS: These results do not support CMV or EBV as etiologic factors in pleomorphic adenomas or Warthin's tumors. In addition, normal parotid seems not to harbor either of these viruses. Future studies with larger numbers of specimens are needed to confirm these findings.

Adenoma pleomorfo / Pleomorphic adenoma

El adenoma pleomorfo es una neoplasia benigna y es el tumor más frecuente de aquellos que derivan de los tejidos que forman las glándulas salivales. En años recientes se han publicado casos de transformación maligna de esta neoplasia. En este trabajo se exponen los pincipales resultados de diferentes investigaciones sobre este tema. Asimismo, se revisarán las características clínicas, histogénesis, hallazgos microscópicos, inmunología, transformación maligna, tratamiento y pronóstico

Carcinoma basocelular con diferenciación mioepitelial / Basall cell carcinoma with myoepithelial differentiation

Presentamos un nuevo caso de carcinoma basocelular con diferenciación micepitelial en un varón de 71 años. La tumoración, de 2,5 cm, estaba localizada en el ala nasal izquierda. Se trataba de un carcinoma basocelular típico que infiltraba en profundidad, alcanzando el tejido muscular. En algunas áreas del tumor el citoplasma de las células neoplásicas se hacía homogéneo y eosinofilico, desplazando el núcleo a la periferia. Estas células eran idénticas a las llamadas células hialinas descritas en tumores mixtos y mioepiteliomas de glándula salival y piel. En el estudio inmunohistoquímico presentaban una franca positividad para la actína muscular específica (HHF35) y más débil para la desmína. Ultraestructuralmente la eosinofilia citoplasmática estaba determinada por la presencia de abundantes filamentos finos de tipo actína que desplazaban los escasos tonofilamentos a la periferia. Estas células cumplían todos los criterios para ser etiquetadas como mioepiteliales. En la literatura sólo se han descrito siete casos de carcinoma basocelular con esta peculiar diferenciación (AU)

Siringoma condroide: hallazgos citohistológicos y problemas de diagnóstico en un caso estudiado por PAAF / Chondroid syringoma: Cytological findings and diagnostic problems in a case examined by FNA

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Smoking and the development of Warthin's tumour of the parotid gland.

The smoking history was surveyed in 160 consecutive patients with Warthin's tumour of the parotid gland in order to investigate the relationship between smoking and the development of this tumour. Two hundred cases of middle-aged or elderly normal persons and 163 consecutive patients with pleomorphic adenoma in the parotid gland served as controls. The percentage of smoking in patients with Warthin's tumour (96.3%) was much higher than that of middle-aged or elderly normal persons (25.5%) and in patients with pleomorphic adenoma (26.4%). Moreover, the amount of smoking was greater and the smoking history was longer in patients with Warthin's tumour. When the male and female patients were analysed respectively, the same result was shown. This case-control study suggests that smoking may be one of the aetiologic factors associated with the development of Warthin's tumour.

Recurrent primary pleomorphic adenomas of salivary gland origin: intrasurgical rupture, histopathologic features, and pseudopodia.

BACKGROUND: The rate of tumor recurrence after surgery for benign salivary gland pleomorphic adenoma varies considerably in different clinical settings and seems to depend to a great extent on the surgical technique used. The importance of tumor spillage for subsequent recurrence has recently been questioned. The current follow-up study was undertaken to ascertain whether intrasurgical rupture, tumor spillage, or any histopathologic feature might have had an impact on the rate of recurrence. METHODS: The medical records of all 255 patients operated on for benign salivary gland pleomorphic adenoma between the years 1974 and 1993 at the Department of Otorhinolaryngology, Huddinge University Hospital, were reviewed. All patients alive in April 1995 (n = 230) were sent a simple questionnaire. Two hundred thirteen of these patients received follow-up. All cases of tumor recurrence after surgery or intrasurgical rupture of the tumor capsule were reviewed histopathologically. RESULTS: Two (7.1%) of the 28 patients who had macroscopic capsule rupture during surgery experienced recurrence at a later stage. This was not a statistically higher rate than the 4.1% recurrence rate for the rest of the material. As many as 5 of the 9 primary tumors that subsequently recurred (56%) sent fingerlike tumor extensions or pseudopodia outside the pseudocapsule. The rate of occurrence of such structures was statistically higher than that of the tumors that ruptured during surgery (25%) and the examined uncomplicated cases (8%). CONCLUSIONS: Occurrence of pseudopodia--microscopic fingerlike formations of tumor tissue that extend beyond the main lump of the tumor--is a significant risk factor for local recurrence.

[Somatic mosaicism of p(CTG)n expansion in a case of myotonic dystrophy with parotid tumor].

Myotonic dystrophy (MD) is an autosomal dominant systemic disorder with an unstable expansion of the CTG triplet repeat in the 3'-untranslated region of the gene encoding myotonine protein kinase (DMPK) which maps to chromosome 19q13.3. Somatic mosaicism of CTG repeats in MD has been reported; and it has been observed that CTG repeats in tumor tissues associated with MD are more expanded than the other tissues. It is not rare that parotid tumors are found in patients with MD. We performed Southern blot analysis for tissues from the parotid tumor, the normal parotid gland, the skeletal muscles, and the leukocyte from a 60-year-old patient with MD. CTG repeat was most expanded in the parotid tumor, and the normal parotid gland had longer expansion of CTG repeat than the skeletal muscles. The leukocyte had the shortest expansion of CTG repeat. The expansion of CTG repeat in the parotid tumor may be related to active cell division and may underlie the occurrence of tumors in MD.

Análise da citodiferenciaçäo de linhagens celulares derivadas de adenoma pleomórfico e de mioepitelioma humanos de glândulas salivares: estudo comparativo dos elementos citoesqueléticos e da resposta dessas células à membrana basal reconstituída (Matrigel) / Cytodifferentiation analysis of cell lines derived from human pleomorphic adenoma and human myoepithelioma: a comparative study based on the expression of cytoskeletal components and on the response of these two cell lines to a reconstituted basement

Adenoma pleomórfico e mioepitelioma säo neoplasias de glândulas salivares que exibem aspectos clínicos e histológicos semelhantes. Para avaliar o estágio de diferenciaçäo das células de maior capacidade proliferativa dessas neoplasias, utilizamos linhagens celulares derivadas de adenoma pleomórfico (AP2) e de mioepitelioma (M1). Estudamos a expressäo de proteínas citoesqueléticas, os aspectos subcelulares e a resposta das linhagens à membrana basal reconstituída (Matrigel). Células AP2 mostraram imunomarcaçäo a vimentina e citoqueratina 14, enquanto que células M1 a vimentina, pan-queratina e actina de músculo liso. Estudo subcelular da linhagem AP2 revelou características de células pouco diferenciadas. Célula M1 mostraram aspectos subcelulares de fenótipo mioepitelial bem diferenciado, exibindo feixes de microfilamentos com adensamentos focais. Após uma semana envolvidas por Matrigel, células AP2 exibiram formaçäo de estruturas ductiformes e células M1 organizaram-se em cordöes celulares. Nossos resultados indicam que células AP2 exibem fenótipo epitelial glandular neoplásico pouco diferenciado, enquanto que células M1, fenótipo mioepitelial neoplásico bem diferenciado. Admitindo-se que o adenoma pleomórfico e o mioepitelioma resultem de proliferaçäo neoplástica de células do ducto intercalado de glândulas salivares, o adenoma pleomórfico originar-se-ia de células mais indiferenciadas e permissivas, enquanto que células já comprometidas com a diferenciaçäo no sentido mioepitelial dariam origem ao mioepitelioma