Treatment and prognosis of mucoepidermoid carcinoma in the pediatric age group

Rare tumors in pediatric age group: Single center experience from Saudi Arabia

Rare pediatric tumors are heterogeneous group containing a variety of histopathological diseases, they represent approximately 10% of all childhood cancers. These rare tumors had a diversity of histology and clinical behaviors that pose different challenges to the investigators. Exploring different pediatric rare tumors. The data were reviewed, retrospectively, through the medical records of seven rare pediatric diseases between 2012 and 2019. Giant cell fibroblastoma (GCF) presented as painless swelling in the trunk, positive for CD34 with PTEN gene mutation. Neuroglial heterotopic tissue presented in 7 days old girl with facial asymmetry and bulging in the oral cavity, maximal de-bulking was done, histopathology was positive for GFAP and S100p. Left side neck mass, surgically excised revealed non-metastatic salivary grand mucoepidermoid carcinoma. Follow up without any chemotherapy or radiotherapy for 5 years with complete remission. Mesenchymal chondrosarcoma (MCS) presented in maxillofacial bones by persistent nasal bleeding, HEY1-NCOA2 fusion gene confirmed the diagnosis. Extra-osseous Ewing sarcoma (EES) presented as rubbery painless swelling in the scalp with fusion transcript involving EWSR1-FL11. Juvenile xanthogranuloma (JXG) presented by butter fly like skin patch in the face with foamy histiocytes in upper dermis with few Touton giant cells, extensive systemic involvement of lung and bone marrow. Metastatic ovarian choriocarcinoma with choriocarcinoma syndrome received induction two different lines of chemotherapy and consolidated with autologous stem cell transplant. Seven pediatric rare tumors, with different aspects of challenges in diagnosis and management, despite the absence of formal protocols and rarity of other center experiences.

Prognostic factors in mucoepidermoid carcinoma of the minor salivary glands: A single-center retrospective study

OBJECTIVE

The objective of this study was to investigate the prognostic effects of clinical and histologic findings in patients with mucoepidermoid carcinoma (MEC) of minor salivary glands.

STUDY DESIGN

This retrospective clinical review included 63 patients (30 males, mean age 52.8 years) with minor salivary gland MEC treated at our hospital from 1994 to 2019. Overall survival (OS) or disease-free survival was determined using the Kaplan-Meier limit method. Correlations between different factors and survival rates were assessed using chi-square tests.

RESULTS

The 10-year OS rate was 91.2%. Low- or intermediate-grade MEC had a good prognosis regardless of the surgical margin, whereas high-grade MEC had a poor 10-year OS rate (64.2%). Ten patients developed recurrence or metastasis after primary surgical resection, of whom 6 were diagnosed with a high-grade tumor. The most frequently affected site was the palate, whereas the mandibular gingiva was the most commonly affected site during recurrence. Of 4 patients who received chemotherapy and/or radiotherapy postsurgery, 2 had local recurrence and/or neck lymph node metastasis and 1 died from MEC.

CONCLUSION

Patients with low- or intermediate-grade MEC exhibited satisfactory survival after surgery. In patients with high-grade tumors, it has been suggested that survival rates are poor and do not improve following adjuvant therapy.

Salivary gland epithelial neoplasms in pediatric population: a single-institute experience with a focus on the histologic spectrum and clinical outcome

Salivary gland epithelial neoplasms are rare in children and adolescents, with only a handful of large series having been published. A retrospective study was conducted for 57 cases in patients 20 years or younger. The tumors were located in the parotid (n=36), submandibular gland (n=7), and minor salivary glands (n=14). Nineteen (33%) tumors were pleomorphic adenoma, whereas the remaining (67%) were malignant. The histologic types of carcinomas were mucoepidermoid carcinoma (MEC, n=19, 33%), acinic cell carcinoma (n=7, 12%), adenoid cystic carcinoma (n=6, 11%), secretory carcinoma (mammary analogue) (SC, n=4, 7%), and myoepithelial carcinoma (n=2, 4%). Ninety-three percent (13/14) of the minor and 58% (25/43) of the major salivary gland tumors were malignant. A 7-year-old girl (2%) with a high-grade MEC died from her disease because of uncontrollable locoregional recurrence. Seven patients (16%) developed recurrence including 2 distant metastases from adenoid cystic carcinoma and 6 locoregional recurrences (2 pleomorphic adenomas, 1 SC, 1 myoepithelial carcinoma, 1 adenoid cystic carcinoma, and 1 MEC). The following parameters were associated with decreased disease-free survival in malignant tumors: elevated mitotic index of >4/10 high-power fields (log-rank test, P<.001), and advanced American Joint Committee on Cancer pT (P=.029) and pN stage (P<.001). In conclusion, myoepithelial carcinoma and SC can occur in the pediatric population and should be considered in the differential diagnosis. Salivary gland malignancies in children appear to have better clinical outcome, associated with a 10-year recurrence-free survival rate of 74% and a 10-year disease-specific survival of 94%.

Mucoepidermoid carcinoma of the palate in a 5-year-old girl: case report and literature review

BACKGROUND

Minor salivary gland tumors in children are uncommon. However, despite the low overall incidence, there is a high incidence of malignancy in these young patients which is reported to be above 50 %, with mucoepidermoid carcinoma (MEC) predominating. We hope that this case report will contribute to the enlightenment of the behavior and prognosis of pediatric MEC of palatal minor salivary gland tumors.

CASE REPORT

A 5-year-old girl was admitted to our center with a histologically confirmed MEC of the left hard palate. Primary incision for drainage of a supposed abscess and secondary biopsy had been performed elsewhere 14 days before. After further workup, we excised the tumor and the adjacent bone; clear margins of 10 mm were revealed. Adjuvant therapy was not necessary. The defect was allowed to undergo secondary wound healing. As of the 1-year follow-up, there had been no recurrences.

CONCLUSION

For differential diagnosis, MEC should be considered in cases of soft, slow-growing, painless, pale bluish-purple lumps of the palate even in young patients. Especially for nonresponders to initial treatment, early biopsy is recommended for histological confirmation or exclusion of a minor salivary gland tumor.

Childhood bronchial mucoepidermoid tumors: A case report and literature review

Primary pulmonary neoplasms rarely occur in children, but the majority of those that do are malignant. Mucoepidermoid carcinoma (MEC) represents ~10% of all primary pulmonary malignant tumors. However, MEC is not usually considered in the clinical differential diagnosis in pediatric practice. The present study presents the case of a seven-year-old female with a one-year history of recurrent hemoptysis. Computerized tomography (CT) scans revealed a tumor originating in the right lower lobe bronchus. The patient did not receive any radiation and chemotherapy following a lobectomy on the right lower lung. The tumor was histopathologically determined to be an MEC of the tracheobronchial tree. Subsequent to a six-year follow-up, the MEC was undetectable in this patient, according to the clinical and radiological evidence. The literature with regard to pediatric MEC is also reviewed in this study.

The role of radiation therapy in pediatric mucoepidermoid carcinomas of the salivary glands

OBJECTIVE

To investigate the role of radiation therapy in rare salivary gland pediatric mucoepidermoid carcinoma (MEC).

STUDY DESIGN

A French multicenter retrospective study (level of evidence 4) of children/adolescents treated for MEC between 1980 and 2010 was conducted.

RESULTS

Median age of the 38 patients was 14 years. Parotid subsite, low-grade, and early primary stage tumors were encountered in 81%, 82%, and 68% of cases, respectively. All except 1 patient were treated by tumoral surgical excision, and 53% by neck dissection (80% of high grades). Postoperative radiation therapy and chemotherapy were performed in 29% and 11% of cases. With a median 62-month follow-up, overall survival and local control rates were 95% and 84%, respectively. There was 1 nodal relapse. Lower grade and early stage tumors had better survival. Postoperative radiation therapy and chemotherapy were associated with similar local rates. Patients with or without prior cancer had similar outcomes.

CONCLUSIONS

Pediatric salivary gland MEC carries a good prognosis. Low-intermediate grade, early-stage tumors should be treated with surgery alone. Neck dissection should be performed in high-grade tumors. Radiation therapy should be proposed for high grade and/or advanced primary stage MEC. For high-grade tumors without massive neck involvement, irradiation volumes may be limited to the primary area, given the risk of long-term side effects of radiation therapy in children. Pediatric MEC as second cancers retain a similar prognosis. Long-term follow-up is needed to assess late side effects and second cancers.

Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature

Introduction

Because well-documented cases of mucoepidermoid carcinomas that are of minor salivary gland origin and occur in children and adolescents have rarely been reported, little information regarding their clinical features and biologic behavior is available. This case report represents a retrospective clinical analysis of five minor salivary gland mucoepidermoid carcinomas accessioned from a 35-year period at the Louisiana State University School of Dentistry and combines the data with 15 well-documented cases from the English language literature.

Case presentation

The five mucoepidermoid carcinomas in patients from birth to 19 years of age accounted for 1.3% of the accessioned minor salivary gland neoplasms. There were an additional 15 well-documented cases in the literature. Combining the data for the 20 mucoepidermoid carcinomas resulted in a mean age of 13.5 years and a 2.3:1 female-to-male ratio. Collectively, the hard palate, soft palate, and hard palate/soft palate junction accounted for 85% of the cases. Thirty-five percent of the cases presented as a fluctuant submucosal swelling with surface color alterations. The average duration was five months, and bone involvement occurred in seven cases. A histologic grade of low to intermediate predominated (95%). Surgical removal was the treatment in all cases. Thirteen cases had adequate follow-up of three years or more, and recurrence was documented in only one case. There were no cases of death or metastasis in this series.

Conclusions

In children and adolescents, mucoepidermoid carcinomas have a female predilection and occur most commonly on the hard or soft palate or both. A fluctuant submucosal lump with a bluish color is a helpful diagnostic clue. The histologic grades of most mucoepidermoid carcinomas in the first and second decades of life are low and, to a lesser degree, intermediate. Complete surgical excision is the treatment of choice and results in a recurrence rate of less than 10%.

Primacy of surgery in the management of mucoepidermoid carcinoma in children

BACKGROUND

Epithelial salivary gland neoplasms are rare in children. Malignant tumors account for 30% to 50% of cases in the pediatric age group, with mucoepidermoid carcinoma as the most common histology.

METHODS

A retrospective medical record review was conducted from 1953 to 2007 to identify patients with mucoepidermoid carcinoma at the age of 18 years or younger at the time of diagnosis. Forty-nine patients were identified. Their medical records were examined for presentation, treatment, pathologic features, and outcomes.

RESULTS

Forty-nine pediatric patients with mucoepidermoid carcinoma were identified. The parotid gland (49%) and oral cavity (35%) were the most common subsites. Nodal metastasis was seen in 24% of patients. All patients underwent surgery, and 11 patients (22%) were treated with radiation therapy. The 5-year overall survival was 98%, the 10-year overall survival was 94%, and 10% of patients developed recurrence.

CONCLUSION

Mucoepidermoid carcinoma in children carries a favorable prognosis and can be successfully treated with surgery alone in most cases.

Role of high resolution ultrasound in parotid lesions in children

PURPOSE

A pictorial review of the spectrum of sonographic abnormalities of the parotid gland in children is presented.

METHODS

Two pediatric radiologists performed retrospective review of medical records and imaging findings of all parotid ultrasounds performed in 298 children in the age range of 24 days to 16 years, over a five-year period.

RESULTS

The lesions varied from diffuse glandular abnormalities to discrete solid and cystic lesions. Of the 298 studies reviewed, 148 (49.6%) were normal results, while 150 (50.4%) had abnormalities of parotid gland identified at ultrasonography. These included acute parotitis in 54 (36%) cases, recurrent parotitis in 12 (8%), and intra-parotid abscess in 12 (8%) cases. Among the tumors, haemangioma was the commonest, identified in 16 (10.6%) cases, followed by lymphatic malformation in 3 (2%), Hodgkin's disease 2 (1.3%) and pleomorphic adenoma (1 case). Sialadenosis was identified in 4 (2.6%) cases. Abnormality of the superficial soft tissues was also seen in 25 cases. 12 cases had a lymphatic malformation of the neck, involving the parotid, while 11 cases had a vascular lesion of the cheek, but not involving the parotids directly.

CONCLUSION

High resolution ultrasound remains the first-line imaging modality for evaluation of the parotid gland. It is sensitive in detection of salivary gland abnormalities.

Salivary gland cancer in patients younger than 30 years

Previous research has shown that salivary gland tumors are rare in the young population. A clinical diagnosis has to be made very carefully because the proportion of malignancies is higher in children than in adults. We present a review of cases of malignant salivary gland carcinoma (SGC) in patients younger than 30 years of age. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 17 Registry. A total of 763 patients younger than 30 years with carcinoma of a major salivary gland from 1973 to 2004 were identified within the SEER database. The most common salivary gland cancer was mucoepidermoid parotid gland carcinoma. The incidence of all major salivary gland carcinomas increased with increasing patient age. The 5-year relative survival rate for salivary gland carcinomas in our population was calculated according to the Kaplan-Meier analysis in each age group. Relative 5-year survival was 100% in the 1 patient younger than 1 year, 50.0% in the 1- to 4-year-old group; 87.2% among the 5- to 9-year-olds; 97.0% among the 10- to 14-year-olds; 95.0% among the 15- to 19-year-olds; 95.1% among the 20- to 24-year-olds; and 93.6% in the 25- to 29-year-old group. We found that SGC affects patients of all ages, even children in the first year of life. It is essential for physicians to detect salivary gland neoplasms promptly and to evaluate them thoroughly when they are found in children.

Outcomes of pediatric patients with malignancies of the major salivary glands

BACKGROUND

To report the outcomes and early to long term treatment complications among pediatric patients with major salivary gland malignancies treated at a single institution.

MATERIALS AND METHOD

This study was a retrospective case review set at a tertiary referral cancer center. Patients less than 19 years of age with a diagnosis of a major salivary gland malignancy were identified at the M. D. Anderson tumor database between 1953 and 2006.

RESULTS

A total of 61 patients were identified, with equal gender distribution. The majority of tumors arose in the parotid gland (83%), and the most common pathology was mucoepidermoid carcinoma (46%). Lymphatic metastasis was identified in 37% of patients, nearly all with mucoepidermoid carcinoma. Although 65% of patients had prior treatment elsewhere, more than 75% of patients underwent surgical resection at our institution. External beam radiation was used in 45% of patients, with an average dose of 58.6 Gray. Average patient follow-up was 153 months. The overall survival rate was 93% at 5 years, and 26% developed a recurrence. A second primary was identified in 2 patients. Permanent facial paresis was noted in 7 patients (12%) and xerostomia in 1 patient (4%).

CONCLUSIONS

Survival of pediatric patients with major salivary gland carcinomas is favorable. Adverse outcomes were best predicted by tumor grade, margin status, and neural involvement. Radiation therapy is beneficial for locoregional control of disease, with acceptable long-term treatment sequelae, and without a significant risk for developing second primary tumors. Survivorship issues need to be addressed in this patient population into adulthood.

Juvenile intraoral mucoepidermoid carcinoma

PURPOSE

The purpose of this study was to assess the clinicopathologic, treatment, and outcome features of a series of intraoral mucoepidermoid carcinomas (MECs) affecting children and adolescents.

PATIENTS AND METHODS

Between 1953 and 2006, from 102 intraoral MECs, 9 (8.8%) affected patients under 18 years of age. Clinical data were retrieved from the medical records, the microscopical slides reviewed, and the tumors graded in low, intermediate, and high grades of malignancy.

RESULTS

Five cases occurred in females and 4 in males, with a mean age of 14 years. Seven cases affected the palate, and the other 2 occurred in the buccal mucosa and retromolar area. Most patients presented in initial clinical stages and all cases were surgically treated. Microscopically, 7 tumors were classified as histologically low-grade malignancies. Eight patients did not show tumor recurrence after a mean follow-up of 98.4 months (range, 4 to 278 months), and 1 patient developed local and neck recurrences and died after 15 years of initial treatment.

CONCLUSION

Juvenile MEC are rare tumors, most occur in the palate and present as a low-grade malignancy with excellent prognosis. Although rare, MEC should be considered in the differential diagnosis of intraoral submucous nodule in young patients.

Paediatric intraoral mucoepidermoid carcinoma mimicking a bone lesion

BACKGROUND

Mucoepidermoid carcinoma of the salivary glands occurs most frequently in adults during the fifth and sixth decades of life. Although uncommon, it is the main malignant salivary gland tumour in children, particularly adolescents.

CASE REPORT

A 14-year-old girl presented with a mass in her palate that had had a duration of one year. On panoramic X-ray, a well-delimited radiolucent area was observed on the left maxillary sinus region. The initial clinical diagnostic hypothesis was that this was a central giant cell granuloma. An incisional biopsy was performed and the final microscopic diagnosis was mucoepidermoid carcinoma. The tumour was removed by a wide transoral resection and the patient has been asymptomatic for 4 years.

CONCLUSION

Mucoepidermoid carcinoma in paediatric patients is uncommon, but it must be considered in differential diagnoses of intraoral submucosal mass/nodules in children, particularly in the palate.

Paediatric salivary gland epithelial neoplasms

Salivary gland epithelial neoplasms in children are rare. Clinicians of all disciplines need to have a high level of suspicion when a non-inflammatory single mass lesion presents in the parotid or submandibular glands. There is high likelihood of malignancy when such a mass presents. Surgery is the primary treatment of choice in the majority of cases, with the addition of adjuvant radiotherapy +/- chemotherapy when the diagnosis is a high-grade tumour and/or when the malignancy presents as a large mass or is associated with local tissue invasion. Minor salivary gland neoplasms also present, the oral cavity is most frequent, with pleomorphic adenoma and mucoepidermoid carcinoma being most common, other malignant neoplasms have been reported in other sites.

Clinical characteristics and survival for major salivary gland malignancies in children

OBJECTIVE

Determine presentation and survival rates for malignant pediatric salivary gland neoplasms.

METHODS

All cases of malignant neoplasms involving the parotid or submandibular gland in patients ages birth to 18 years were extracted from the Surveillance, Epidemiology, and End Results database (1988-2001). Variables included age, gender, tumor histology, size, follow-up time, and vital status. Kaplan-Meier survival curves were constructed.

RESULTS

113 primary salivary gland malignancies (103 parotid, 10 submandibular) were identified. Mean age at presentation was 13.2 years. Female:male ratio of 5:4. Mean tumor size was 2.5 cm. Among parotid tumors, there were 44 (43%) mucoepidermoid carcinomas and 35 (34%) acinic cell carcinomas. At a mean follow-up of 69.4 months, 6 (5.8%) patients with parotid malignancy were deceased; none of the submandibular malignancies were fatal. Mean Kaplan-Meier survival for parotid gland lesions was 153 months, with rhabdomyosarcomas exhibiting significantly worse survivals as compared to other malignancies (P < 0.001, log-rank test).

CONCLUSIONS

Both epithelial and mesenchymal tumors present in the pediatric salivary gland. Survival for both parotid and submandibular gland malignancies is good in children.

EBM RATING

C-4.

Mucoepidermoid carcinoma of salivary glands in the pediatric age group: 18 clinical cases, including 11 second malignant neoplasms

BACKGROUND

Salivary gland tumors represent 1% of head and neck tumors, with only 5% of these occurring in patients younger than 20 years. Mucoepidermoid carcinoma (MEC) is one of the most frequent salivary gland cancers among adults and children.

METHODS

This survey was conducted among 34 French pediatric oncology departments. From 1980 to 2000, 18 cases were reported.

RESULTS

Treatment included surgery or radiotherapy, or both. The 5-year survival rate was 93.7%. Eleven patients had been previously treated by radiotherapy and/or chemotherapy for a first malignant tumor, specifically, lymphoid leukemia (n = 4), lymphoma (n = 3), brain tumor (n = 2), sarcoma (n = 1), and retinoblastoma (n = 1).

CONCLUSIONS

MEC is very rare in the pediatric age group. Treatment involves surgical removal of the tumor plus radiotherapy, according to histologic staging. MEC has a good prognosis in young patients. The survival rate does not differ in the subgroup of patients with MEC as a secondary tumor.

Parotid neoplasms in children: experience of diagnosis and management in a district general hospital

Parotid neoplasms are uncommon in children and the available literature is predominantly from specialized centres. This paper highlights our experience at a district general hospital, in the diagnosis and management of parotid neoplasms in children. The case records of all parotidectomies performed in a 26-year period between 1974-1999 were scrutinized and patients aged 18 years and below identified. The demographic data, histology, presentation, investigations, treatment, outcomes and complications were analysed. 545 parotidectomies were performed in 536 patients, in whom 569 neoplasms were diagnosed. Only 12 patients aged 18 and under were identified (2.2%). The relative frequency of individual tumours differed markedly from that in adults. 75% of the tumours were benign. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common tumours. A painless mass was the most frequent clinical presentation and CT sialogram was the most common investigation. Parotidectomy with preservation of the facial nerve was performed in all cases, and adjuvant radiotherapy employed in the case of malignant tumours. All patients were alive and well at the time of last follow up. Transient facial nerve palsy and hypertrophic scars were the most common complications.

Paediatric mucoepidermoid carcinoma of the palate

The purpose of this paper is to review our experience with mucoepidermoid carcinoma (MEC), a rare tumour in minor salivary glands, in a small series of paediatric patients. A retrospective analysis of minor salivary gland tumours seen by one surgeon from March 1991 to December 1999 was undertaken. A total of 58 cases were identified and of these, five (9%) occurred in children. There were 23 cases of MEC, four (17%) of which occurred in patients under the age of 18 who presented with T1 or T2N0M0 low- to intermediate-grade MEC of the palate and adjacent structures. These patients form the basis of this study. All patients were treated with wide local excision, obtaining tumour-free margins, and followed for a mean number of 58 months. None of these tumours invaded bone and resection of bone was not performed in any case as the periosteum was intact and the tumours were low to intermediate grade. To date, all patients remain free of disease. One patient who went elsewhere for treatment, was treated with local resection only, and has also experienced no recurrence. Wide local excision is the treatment of choice for low to intermediate grade MEC of the minor salivary glands in paediatric patients.

Parotid gland mucoepidermoid carcinoma in a 4-year-old child

Salivary gland tumors account for less than 5% of the head and neck neoplasms. Among them, mucoepidermoid carcinoma is the most common malignant salivary gland tumor. About 45% of mucoepidermoid carcinomas occur in the parotid gland, and appear around the fifth decade of life, being unusual in children under 10 years. We report a case of a parotid mass arising in a 4-year-old female, who had no lateral adenopathy. After histological examination, the diagnosis was of a low-grade mucoepidermoid carcinoma of the parotid gland. Three years after surgery no recurrence was observed. As a conclusion, although rare, the presence of a parotid mass with progressive growth in children could correspond to a neoplasm.

Treatment of carcinoma of the parotid gland: the results of a multicenter study

PURPOSE

This study analyzed the prognostic factors for carcinoma of the parotid gland and the role of surgery alone or with radiotherapy in treating these lesions.

METHODS

Forty-five patients with malignant parotid tumors were studied retrospectively. Patients were treated by combined surgery and radiation therapy between 1984 and 1995 at the Maxillo-Facial Departments of the General Hospitals of Bologna and Parma. Resection was conservative when possible, depending on the extent of the tumor. The median follow-up time was 54 months. Data regarding incidence, tumor stage and grade, local control, distant metastases (calculated with the Kaplan-Meier method), and survival were analyzed. Cox's multiple linear regression was used to identify patient and tumor characteristics with the greatest prognostic significance.

RESULTS

The actuarial 5- and 8-year disease-free survival rates were 81% and 62%, respectively. Multivariate analysis showed that tumor stage was a more prognostic variable than tumor grade. Residual microscopic disease at the excision margins was also an important prognostic variable. Laterocervical metastases affected 4 patients (9%), and distant metastases appeared in 8 patients (18%).

CONCLUSIONS

Postoperative irradiation is indicated for patients with stage III and IV disease, patients with positive excision margins, and for patients with lymph node metastases.

Mucoepidermoid carcinoma of the bronchus

Bronchoscopy in a 4.5-year-old girl with recurrent pneumonia showed an exophytic endobronchial mass. Biopsy disclosed microscopic and ultrastructural features of a low-grade mucoepidermoid carcinoma. Complete cure was accomplished by surgical removal of the tumor and right lower lobe.

Tumores malignos de cabeça e pescoço em pacientes com menos de 18 anos de idade

A conduta ideal para os pacientes menores de 18 anos portadores de tumores malignos da região de cabeça e pescoço não é uniforme nos escassos relatos de literatura. Com o objetivo de mostrar e discutir a experiência no atendimento de cinqüenta casos tratados no Serviço de Cirurgia de Cabeça e Pescoço do Complexo Hospitalar Heliópolis, no período de 1978 a 1994, os autores procederam a uma análise retrospectiva de sua casuística. Os tipos histológicos mais freqüentes foram os derivados da linhagem epitelial, 24 casos (48%) e, entre eles, o carcinoma mucoepidermóide. Entre os tumores derivados do tecido mensequimal, os mais freqüentes foram o rabdomiossarcoma e os linfomas. A cavidade oral foi o sítio mais freqüentemente acometido (15 casos, 30%). Entre todos os pacientes, apenas 21 (42%) estavam vivos e sem evidência de doença em atividade por um período que variou de seis meses a 18 anos. Quatorze (28%) pacientes morreram em decorrência de doença não controlada após um período que variou de dez dias a dois anos a contar da data do final do tratamento. De quatorze (28%) pacientes não pudemos obter informações atualizadas de suas condições e foram considerados perdidos de seguimento. Estes tumores não devem ser vistos como neoplasias de adultos localizadas em pacientes pediátricos; devem ser estudados e abordados como uma doença que apresenta características próprias e que exigem, como no adulto, que a primeira intervenção para o diagnóstico ou para o tratamento não seja intempestiva e, de fato, tenha resolubilidade.

Epithelial salivary gland tumors of children and adolescents in southern Portugal. A clinicopathologic study of twenty-four cases

During a 30-year period 24 epithelial salivary gland tumors were diagnosed in children and adolescents less than 18 years of age. The cases were retrieved from a series of 759 consecutive cases of salivary gland tumors (3.2%) from the area corresponding to southern Portugal during the same period of time. The mean age of the patients was 13.4 years, and one case was congenital. There was a slight female predominance (male/female ratio 1:1.7). The parotid gland was affected in most cases (70.8%). Seventeen neoplasms were benign, and the remaining seven were malignant. As in the adult group, pleomorphic adenoma was the most frequent benign tumor (66.6%), with similar histologic findings and clinical course. Mucoepidermoid carcinoma was the prevalent malignant tumor (20.8%), had a high grade of differentiation, and had a favorable outcome. The histologic pattern of the congenital neoplasm was similar to that of adult epithelial-myoepithelial carcinoma.

Comparative histogenesis and morphogenesis of mucoepidermoid carcinoma and pleomorphic adenoma. An ultrastructural study

Current classifications of salivary gland tumors separate mucoepidermoid carcinoma from other neoplasms on the basis of a number of histological features, in particular the lack of participation of neoplastic myoepithelial cells. However, ultrastructural examination of low- and intermediate-grade mucoepidermoid carcinomas and pleomorphic adenomas reveals many common organizational and cellular features. Of prime importance is the relationship of intermediate cells to the luminal cells in mucoepidermoid carcinomas, which is remarkably similar to that seen between modified myoepithelial cells and luminal cells in pleomorphic adenomas. The results suggest that intermediate cells of mucoepidermoid carcinoma are the counterpart of the modified myoepithelial cells of pleomorphic adenoma. The generally accepted hypothesis that the former tumor develops from an excretory duct reserve cell, while the latter originates from an intercalated duct stem cell does not seem to be valid; pleomorphic adenoma and mucoepidermoid carcinoma appear to be closely related morphologically.

Mucoepidermoid carcinoma of the parotid as a second malignant neoplasm in children

Second malignant neoplasms (SMN) in children who have survived their initial encounter with a malignancy have emerged as one of the most troublesome complications in pediatric oncology. Some estimates indicate that as many as 8% to 12% of patients will develop a SMN during a 20-year period. The majority of SMN are osteosarcomas, spindle cell and pleomorphic sarcomas of soft tissues, and hematolymphoid malignancies. We present the clinical and pathologic findings for two children with treated acute leukemias in whom well-differentiated mucoepidermoid carcinomas of the parotid gland developed 6 and 9 years after multidrug chemotherapy and cranial irradiation. Although mucoepidermoid carcinoma has been reported as a complication in adults who received low-dose irradiation as children, these two cases are unique as SMN in the pediatric age population.

Pathologic correlation of the unknown solid parotid mass in children

A parotid mass in a pediatric patient is stated to have an approximately 50% likelihood of being malignant. To evaluate our experience in light of this suggested incidence, we conducted a retrospective study, which included 22 patients treated over an 8-year period, 1979 to 1987. Patients' ages ranged from 16 months to 19 years, and all patients presented with an unknown, solid parotid mass. One patient had a malignancy, mucoepidermoid carcinoma. Eight patients were diagnosed with benign pleomorphic adenoma. Thirteen patients had an inflammatory process consisting of one of the following conditions: cat-scratch disease (4); atypical mycobacteria (4); benign follicular hyperplasia of a lymph node (4); and toxoplasmosis (1). The histologic findings in this series suggest that unknown solid parotid masses that occur in children or adolescents are frequently the result of inflammatory conditions and are not likely to be malignant. We therefore recommend a reconsideration of the reputed estimation of malignancy in the parotid gland in children. The majority of pathologic conditions discovered, however, are still best diagnosed and treated by surgical excision.

Mucoepidermoid tumor: a case report involving the operculum of an erupting permanent second molar

The mucoepidermoid tumor (carcinoma) accounts for approximately 6% to 8% of all salivary gland tumors. Although rare in children, it is the most common "malignant" salivary gland tumor, having been reported in major and minor (intraoral) salivary gland sites as well as in the maxilla and the mandible. In children, as in adults, it most often occurs in the parotid gland, but a significant percentage is found in the palate and retromolar pad area. Presently, there is no unanimity of opinion about whether to consider all mucoepidermoid tumors malignant or what the most appropriate treatment regimen is. The following is a case report of a mucoepidermoid tumor presumably arising from the reduced enamel epithelium in soft tissue overlying an erupting mandibular second molar in an 11-year-old boy. Theoretical origins of intraoral soft tissue mucoepidermoid tumors are discussed, as well as treatment philosophy. The importance of submitting, for microscopic diagnosis, all tissue removed during surgical procedure is illustrated in this case report.

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.

Mucoepidermoid carcinoma in a minor salivary gland in childhood

Salivary gland neoplasms in childhood and adolescence are rare, especially in the minor salivary glands. Vasoformative tumours and pleomorphic adenomas appear to be the most common benign neoplastic salivary gland lesions in the pediatric age group. The distribution of various malignant histological types is not always consistent with that in the adult population, and they appear more often in girls than in boys. Only 17 cases have previously been documented. The clinical and histological picture of a case of palatal mucoepidermoid carcinoma in a 13-year-old girl is presented as well as a review of the literature on malignant salivary gland tumours in childhood.