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Gottlieb JB, Joachim M, Leiser Y, Abdelraziq M, Abu El-Naaj I. Polymorphous Low-Grade Adenocarcinoma: A Proposed Reconstruction Protocol Based on Past Surgical Experience. J Craniofac Surg 2019; 30:1228-1230. [PMID: 30817510 DOI: 10.1097/scs.0000000000005328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To propose a reconstructive protocol based on surgical management experience of polymorphous low-grade adenocarcinoma (PLGA) and the location of the primary lesion. METHODS Data on the surgical management and the reconstructive technique of 14 histologically conformed patients with PLGA, all treated by the same surgeon, were analyzed and evaluated. RESULTS Mean follow-up period in our series was 6.2 years. Mean age at diagnosis was 55.5 years and female to male ratio was 2.2:1. The most common presenting sign was a nonpainful lump or mass in an intraoral location. Most patients were managed by wide local excision and reconstruction method varied from primary closure to the use of radial forearm graft. Recurrence appeared in one of the patients in this series, while 2 required further radiation therapy. A protocol for reconstruction of intraoral patients with PLGA is suggested based on our analysis. CONCLUSION Surgical management is the gold standard for PLGA treatment. Neck dissection is recommended only in patients with presurgery fine-needle aspiration confirmed lymph node involvement. The reconstruction depends mainly on location and size of the primary lesion.
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Affiliation(s)
- Jonathan B Gottlieb
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya
| | - Michael Joachim
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya
| | - Yoav Leiser
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa
| | - Murad Abdelraziq
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya
| | - Imad Abu El-Naaj
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Vander Poorten V, Triantafyllou A, Skálová A, Stenman G, Bishop JA, Hauben E, Hunt JL, Hellquist H, Feys S, De Bree R, Mäkitie AA, Quer M, Strojan P, Guntinas-Lichius O, Rinaldo A, Ferlito A. Polymorphous adenocarcinoma of the salivary glands: reappraisal and update. Eur Arch Otorhinolaryngol 2018; 275:1681-1695. [PMID: 29761209 DOI: 10.1007/s00405-018-4985-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 12/29/2022]
Abstract
Although relatively rare, polymorphous adenocarcinoma (PAC) is likely the second most common malignancy of the minor salivary glands (MiSG). The diagnosis is mainly based on an incisional biopsy. The optimal treatment comprises wide surgical excision, often with adjuvant radiotherapy. In general, PAC has a good prognosis. Previously, PAC was referred to as polymorphous low-grade adenocarcinoma (PLGA), but the new WHO classification of salivary gland tumours has also included under the PAC subheading, the so-called cribriform adenocarcinoma of minor salivary glands (CAMSG). This approach raised controversy, predominantly because of possible differences in clinical behaviour. For example, PLGA (PAC, classical variant) only rarely metastasizes, whereas CAMSG often shows metastases to the neck lymph nodes. Given the controversy, this review reappraises the definition, epidemiology, clinical presentation, diagnostic work-up, genetics, treatment modalities, and prognosis of PAC of the salivary glands with a particular focus on contrasting differences with CAMSG.
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Affiliation(s)
- Vincent Vander Poorten
- Department of Oncology-Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium. .,Multidisciplinary Salivary Gland Society, Geneva, Switzerland.
| | - Asterios Triantafyllou
- School of Dentistry, University of Liverpool, Liverpool, UK.,Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK
| | - Alena Skálová
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Göran Stenman
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Pathology and Genetics, Sahlgrenska Cancer Center, University of Gothenburg, Gothenburg, Sweden
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Esther Hauben
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Henrik Hellquist
- Epigenetics and Human Disease Laboratory, CBMR, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Simon Feys
- Department of Oncology-Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Miquel Quer
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Orlando Guntinas-Lichius
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland.,Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Venkata V, Irulandy P. The frequency and distribution pattern of minor salivary gland tumors in a government dental teaching hospital, Chennai, India. ACTA ACUST UNITED AC 2011; 111:e32-9. [PMID: 21176809 DOI: 10.1016/j.tripleo.2010.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 08/02/2010] [Accepted: 08/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Data are not available regarding distribution of minor salivary gland tumors from the specialist pathology setting in India. The purpose of this study was to determine the relative frequency and distribution of minor salivary gland tumors and to compare the data with pertinent studies. STUDY DESIGN The records and archival samples of the Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai, India, served as source material for this retrospective study. All cases with a diagnosis of minor salivary gland tumors recorded between 1971 and August 2008 were retrieved and reviewed. RESULTS A total of 185 minor salivary gland tumors were identified with reference to the latest World Health Organization classification, representing a relative frequency of 1.52% over the study period of 37 years (1971-2008) from 12,147 biopsy samples. Malignant tumors (75%) predominated over benign tumors (25%). The age range was 12-82 years with a mean of 46 years. Mucoepidermoid carcinoma was the most frequent tumor (34%), followed by pleomorphic adenoma (22%), adenoid cystic carcinoma (15%), and polymorphous low-grade adenocarcinoma (10%). The overall gender distribution was almost equal. Palate was the most frequent involved site, followed by alveolar mucosa and floor of the mouth. CONCLUSIONS The present study shows a higher proportion of malignant tumors and a tendency toward male predilection during the past decades. The overall data are consistent with hospital-based studies from Asia and series from other geographic regions.
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Affiliation(s)
- Vani Venkata
- Department of Oral And Maxillofacial Pathology, Tamil Nadu Government Dental College And Hospital, Chennai, India
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Hunter JB, Smith RV, Brandwein-Gensler M. Low-grade papillary adenocarcinoma of the palate: the significance of distinguishing it from polymorphous low-grade adenocarcinoma. Head Neck Pathol 2008; 2:316-23. [PMID: 20614302 PMCID: PMC2807587 DOI: 10.1007/s12105-008-0082-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 08/11/2008] [Indexed: 11/28/2022]
Abstract
Low-grade papillary adenocarcinoma (LGPA) represents a relatively rare histological variant of polymorphous low-grade adenocarcinoma (PLGA). There has been a debate as to whether LGPA is associated with greater aggressive potential compared to PLGA; this is further obfuscated by the fact that diagnostic criteria for LGPA have not been well-defined. We believe that this is the first report of a patient with LGPA who developed metastases to the femur and scalp. We review the published evidence for classifying LGPA as distinct from PLGA. The weight of published data does support the idea that LGPA is oncologically distinct from LGPA. However, as uniform diagnostic criteria are lacking, we suggest a cut-off value of 10% or greater papillary formation as being necessary to separate LGPA from PLGA.
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Affiliation(s)
- Jacob B. Hunter
- Departments of Otorhinolaryngology-Head Neck Surgery, Pathology, Albert Einstein College of Medicine (JH), Montefiore Medical Center, Bronx, New York USA
| | - Richard V. Smith
- Departments of Otorhinolaryngology-Head Neck Surgery, Pathology, Albert Einstein College of Medicine (JH), Montefiore Medical Center, Bronx, New York USA
| | - Margaret Brandwein-Gensler
- Departments of Otorhinolaryngology-Head Neck Surgery, Pathology, Albert Einstein College of Medicine (JH), Montefiore Medical Center, Bronx, New York USA
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Zaharopoulos P. Primary intraosseous (central) salivary gland neoplasms in jaw bones: report of a mucoepidermoid carcinoma of the mandible diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 2005; 31:271-5. [PMID: 15452902 DOI: 10.1002/dc.20114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A case of intraosseous (central) mucoepidermoid carcinoma of the mandible diagnosed by fine-needle aspiration (FNA) cytology, with the diagnosis confirmed by surgical resection of the tumor is presented. Mucoepidermoid carcinoma is the most common histotype of malignant and benign salivary gland tumors, which occasionally arise within the facial bones of mandible and maxilla, besides their ordinary derivation from the major and minor salivary glands of the head and neck regions. This case is unusual in that although tumors of the jaws abound, only rare reports of intraosseous salivary gland-type lesions sampled by FNA exist. The current concepts exploring the intraosseous derivation of salivary gland tumors are presented and certain points on FNA technic for adequate sampling of such lesions are related.
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Affiliation(s)
- Paul Zaharopoulos
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0548, USA.
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Lee VKM, McCaughan BC, Scolyer RA. Polymorphous low-grade adenocarcinoma in the lung: a case report. Int J Surg Pathol 2005; 12:287-92. [PMID: 15306944 DOI: 10.1177/106689690401200313] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although uncommon, it is well recognized that salivary gland-type tumors can occur as primary lung tumors, probably arising from minor salivary-type glands lining the bronchial tree. Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor that usually originates from oral minor salivary glands. There are only 2 reported cases showing metastasis to the lung; however, a primary lung tumor has not been reported so far. In this report we describe the clinical and pathological features of another case of PLGA involving the lung, but in a patient with no evidence of a previous oropharyngeal primary. While our case probably represents another example of metastatic PLGA to the lung, to our knowledge, it is the first description of a PLGA involving the lung in the absence of a history of a previous primary oral salivary gland tumor.
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Affiliation(s)
- Victor K M Lee
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
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