Submandibular gland pleomorphic adenoma: Histopathological capsular characteristics and correlation with the surgical outcome

Comparisons between partial and total sialoadenectomy for benign submandibular gland tumors: A systematic review and meta-analysis

This study aimed to compare postoperative efficacy and functional outcomes between partial sialoadenectomy (PS) and total sialoadenectomy (TS) in patients with benign submandibular gland (SMG) tumors. We systematically searched PubMed, Web of Science, EmBase, Cochrane Library, China Biomedical Literature, and CNKI from inception to 2024, following PICOS criteria (Population: Adults with benign SMG tumors; Intervention: PS; Comparison: TS; Outcomes: Salivary function, neurological complications, recurrence, operative duration, dry mouth, infection/hematoma; Study design: RCTs/observational studies with ≥ 6-month follow-up). The protocol was prospectively registered (PROSPERO CRD42024595824). Risk ratios (RR) were calculated for dichotomous outcomes, and weighted mean differences (WMD) for continuous outcomes, using random-effects models. Heterogeneity was quantified by I2 statistics and Q tests. Sensitivity analyses included leave-one-out methods, and publication bias was assessed via funnel plots and Egger's test. The analysis of findings was guided by the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework to evaluate evidence certainty, while also considering the size of intervention effects in alignment with GRADE methodology. From 1014 screened studies, 7 studies (3 RCTs, 4 cohort studies) involving 399 patients (PS: n = 188; TS: n = 211) were included. PS demonstrated superior static saliva flow (WMD = 0.24, 95 %CI 0.13, 0.35)and reduced neurological complications (RR = 0.22, 95 %CI 0.10, 0.49), operative duration (WMD = -14.19, 95 %CI -23.4, -4.99), and dry mouth (RR = 0.12, 95 %CI 0.03, 0.49). However, there were no significant differences between the two groups in stimulated saliva flow (WMD = 0.01, 95 %CI -0.01, 0.04), tumor recurrence (RR = 3.23, 95 %CI 0.13, 77.99), postoperative infection (RR = 0.25, 95 %CI 0.03, 2.26), and postoperative hematoma (RR = 0.36, 95 %CI 0.08, 1.72). GRADE revealed moderate-certainty evidence for functional outcomesbut low/very low certainty for neurological complications, recurrence, operative duration, dry mouth, postoperative infection and hematoma. The current results demonstrate that partial sialoadenectomy offers significant advantages over traditional total sialoadenectomy.It is recommended that clinicians consider adopting new surgical procedures for the treatment of benign tumors of the submandibular gland in the future.

[Primary salivary gland tumors from a pathology perspective : Morphomolecular peculiarities and diagnostic and therapeutic challenges]

Similar to tumors of other organs, salivary gland neoplasms were historically viewed as a single neoplastic entity and mostly treated as such. Accordingly, only the clinical tumor stage, and not the histological subtype, was considered to be of significant prognostic impact. However, over the years, several distinct sub-entities have been characterized based on morphological features, such as adenoid cystic carcinoma, mucoepidermoid carcinoma, acinic cell carcinoma, and salivary duct carcinoma. Most importantly, the nosology of salivary gland carcinomas has undergone a dynamic "splitting" on the basis of morphological, immunophenotypic, and molecular characteristics, so that 21 independent carcinomas are now listed in the current World Health Organization (WHO) classification. Moreover, it has become evident that splitting of these carcinoma subtypes no longer represents a "pathologist's hobby," but carries significant prognostic and therapeutic relevance for optimized cancer surgery and potentially systemic therapy. The current review summarizes the major features of salivary gland tumors, both benign and malignant, and gives an account of their classification systems and genetic profiles.

Histopathological comparison of pleomorphic adenomas of the parotid and submandibular gland

OBJECTIVE

The aim of this study was to investigate and compare the histopathological findings in pleomorphic adenomas (PA) of the parotid and submandibular gland with emphasis on the histological subtype and capsular characteristics.

MATERIALS AND METHODS

The histopathological specimens of all patients with PAs of the parotid and submandibular gland between 2000 and 2020 were re-examined by an experienced head and neck pathologist. Patients without representative slides allowing evaluation of the whole periphery of the PA were excluded from our study sample.

RESULTS

Nine hundred and thirty-four patients formed our study sample (327 men, 607 women, male-to-female ratio: 0.53:1). Eight hundred and forty-four cases had a PA in the parotid gland and the remaining 90 in the submandibular gland. Our comparative analysis showed that submandibular PAs are characterized by the consistent presence of an intact anatomical capsule, infrequent occurrence of pseudopodia and satellite nodules, and a low proportion of the high-risk myxoid subtype.

CONCLUSION

Our study highlights significant differences between PAs of the parotid and submandibular glands in their histopathological characteristics. Their differences likely underlie the favorable surgical outcome observed in PAs of the submandibular glands and may explain the propensity of PAs of the parotid glands for local recurrences.

Resection of benign tumours of the submandibular gland with harmonic scalpel-assisted minimally extracapsular dissection

Objective

This study was performed to compare the oncologic and functional outcomes in patients with benign submandibular gland (SMG) tumours after harmonic scalpel-assisted minimally extracapsular dissection (HS-MECD) or total gland excision (TGE).

Methods

In total, 133 consecutive patients who were preoperatively diagnosed with benign SMG tumours (pleomorphic adenoma, Warthin’s tumour, basal cell adenoma, or lymphoepithelial cyst) from 2013 to 2016 were included in this two-centre retrospective study. Sixty-four patients underwent HS-MECD and 69 patients underwent TGE. All tumours were within 4 cm. Surgical variables, complications, functional outcomes, and recurrence rates were evaluated.

Results

The operation time, blood loss, drainage time and volume, and length of hospital stay were significantly lower in the HS-MECD than TGE group. HS-MECD reduced local pain and transient facial nerve paralysis outcomes. Incision scars and facial deformities were less visible according to the visual analogue scale. No significant differences were found in either unstimulated or stimulated whole saliva at 1 month postoperatively, whilst higher unstimulated levels were detected in the HS-MECD group at 6 months. The recurrence rate was similar between the two groups.

Conclusion

For benign SMG tumours of <4 cm, HS-MECD represents a less invasive technique than TGE and affords patients increased postoperative functionality.

Parotid pleomorphic adenomas: Factors influencing surgical techniques, morbidity, and long-term outcome relative to the new ESGS classification in a retrospective study

PURPOSE

To assess long-term results after treatment of parotid pleomorphic adenomas (PPAs) with different surgical techniques, standardized according to the European Salivary Gland Society (ESGS) classification system.

METHODS

We analyzed ESGS categories, occurrence of facial nerve paresis (FNP), Frey's syndrome, histopathology, and recurrences. Surgical modalities were compared, differentiating techniques with and without facial nerve dissection. A strict protocol ensured a postoperative follow-up-period of more than 7 years.

RESULTS

205 patients were included. A complete follow-up was possible in 138 patients, 77 of whom underwent extracapsular dissection (ED) and 61 of whom had other surgical modalities (OSMs). ESGS categories correlated with the extent of surgery, significantly with the risk for FNP and Frey's syndrome, but not with recurrences. Recurrences did not differ significantly between ED and OSMs, whereas the risks for FNP (p < 0.001 each) and Frey's syndrome (p = 0.000) were significantly higher after OSMs in comparison with ED. Young women with a stroma-rich (myxoid) tumor subtype appear to have the greatest risk for recurrences.

CONCLUSION

ED is the treatment of choice for PPAs, if possible, resulting in similar recurrence rates but significantly fewer comorbidities in comparison with more extensive surgery. After the treatment of PPAs, a long-term follow-up is needed, including imaging.

Computerized tomography features and clinicopathological analysis of Kimura disease in head and neck

The aim of the current study was to discuss and analyze computerized tomography (CT) features and clinicopathological characteristics of patients with Kimura disease in head and neck. CT and clinicopathological data of 12 patients with Kimura disease diagnosed between May 2011 and May 2015 were analyzed. The mean age was 43.9 years and the disease course varied from 1 week-20 years. The mean absolute value of eosinophil granulocytes was 1.95×10⁹/l. Multiple nodules were detected in 4 patients with Kimura disease. Main symptoms included multiple enlarged lymph nodes in neck and submaxillary regions. CT imaging of nodular lesions revealed a clear boundary, with moderate to marked homogeneous enhancement. Diffuse mass lesions were observed in 6 patients with Kimura disease. Main symptoms included subcutaneous diffuse soft tissue mass in parotid gland and maxillofacial regions. CT imaging of diffuse mass revealed unclear boundaries, adjacent skin thickness and moderate heterogeneous enhancement. In some cases, the diffuse mass involved soft mass with unclear boundaries. Pathological symptoms of Kimura disease included infiltration of eosinophilia, lymphocytic proliferation, formation of lymphatic follicles and variable degrees of fibrosis and vascular proliferation. Diagnosis of Kimura disease in head and neck regions may be improved based on lesions with clear or unclear boundaries, homogeneous or heterogeneous enhancement, with or without lymphadenectasis and by the presence of peripheral blood eosinophilia. However, a final diagnosis relies on a pathological examination.

Effect of Xylosyltransferase-I Silencing on Implanting Growth of Salivary Pleomorphic Adenoma

BACKGROUND Salivary pleomorphic adenoma is one of the most common salivary gland tumors. It has a relatively high tendency to recur and a high risk of malignant transformation. The present study aimed to study the effect of XT-I gene silencing on the implanting growth of salivary pleomorphic adenoma. MATERIAL AND METHODS Primary cultures of SPA cells and fibroblasts from the same patient were assessed. The adenovirus vector Ad-shRNA-XT-I was constructed and transfected into SPA cells. The expression of XT-I gene and XT-I protein was detected by real-time PCR and Western blot. The contents of proteoglycans were detected. The SPA cells transfected with Ad-shRNA-XT-I (group SPA-XT-I) and Ad-shRNA-HK (group SPA-HK), as well as without transfection (group SPA), were implanted into ADM scaffold with fibroblasts and then transferred into 18 BALB/C-nu nude mice for 3 months. RESULTS Primary cultures showed SPA cells were positive for human CK and S-100 protein and the fibroblasts were positive for human vimentin. The expressions of XT-I gene and protein were decreased by 51% and 51.31%, respectively. The content of proteoglycans was reduced by 48.45%. The results of the implanting growth in vitro and in vivo of nude mice indicated that no tumors grew in the SPA-XT-I group, whereas SPA grew in groups SPA-HK and SPA positive for human a-SMA, S-100 protein, and calponin. CONCLUSIONS XT-I gene silencing effectively inhibited the implanting growth of SPA.