Genomic Alterations in Undifferentiated Malignant Tumors with Rhabdoid Phenotype and Loss of BRG1 Immunoexpression Identified by Fine Needle Aspirates

OBJECTIVE

Evidence shows that the switch/sucrose nonfermenting chromatin remodeling complex plays a critical role in DNA repair, cancer progression and dedifferentiation. BRG1 is one of its key catalytic subunits. While the loss of BRG1 expression by immunocytochemistry has been identified in a subset of malignancies arising in various sites with undifferentiated/rhabdoid morphology and poor prognosis, the underlying basis for its loss is unclear.

METHODS

A retrospective search was conducted in our cytopathology archive for undifferentiated malignant tumors with rhabdoid phenotype and BRG1 loss. Clinical information was obtained from electronic medical records. Next-generation sequencing was performed following macro-dissection of paraffin-embedded cellblock tissue.

RESULTS

Three cases were identified; all presented with widely metastatic disease with no previously diagnosed primary malignancy, and subsequently died within 6 months of initial presentation. Cytologically, the aspirates showed dyshesive and undifferentiated cells with rhabdoid features. Extensive immunocytochemical workup demonstrated immunoreactivity with vimentin only and could not establish a specific lineage. BRG1 expression was absent, while INI1 expression was retained. Two cases harbored deleterious mutations in BRG1/SMARCA4. Pathogenic mutations in TP53 were identified in all tumors.

CONCLUSIONS

BRG1 deficiency reflects underlying mutation in SMARCA4 gene in some but not all cases, suggesting that additional mechanisms may be causing BRG1 silencing. Pathogenic mutations in TP53 in all tumors are consistent with their highly aggressive nature. Recognizing the cytomorphology of this group of neoplasms and confirming their BRG1-deficient status by immunocytochemistry not only has prognostic implications, but may also impart potentially therapeutic value in the near future.

Salivary Duct Carcinoma with Invasive Micropapillary and Rhabdoid Feature Arising in the Submandibular Gland

Salivary duct carcinoma (SDC) is a high-grade malignant salivary gland tumor associated with poor prognosis, frequent recurrence, and metastasis. An 82-year-old man presented at the department of oral and maxillofacial surgery at Tokai University Hospital with a painless swelling in the right submandibular region that had been there for 20 years. On presentation, an elastic hard tumor, 50 × 50 mm in size, was observed in the submandibular region. Diagnostic imaging was performed, and a malignant tumor in the submandibular gland was suspected. The suspected tumor was excised and postoperative radiotherapy and adjuvant-chemotherapy were performed. Despite this treatment, the patient died of multiple metastases 12 months postoperatively. SDCs are often diagnosed as carcinoma ex pleomorphic adenomas and multiple variants and subtypes exist. This case was histopathologically rare in terms of the coexistence of invasive micropapillary and rhabdoid features.

A Case of Nuclear Protein in Testis Midline Carcinoma Arising From the Submandibular Gland Duct in a Pregnant Patient

This report describes the first reported case of a nuclear protein in testis midline carcinoma (NMC) arising from the submandibular gland (SMG) duct in a pregnant woman. A 29-year-old pregnant woman presented with a left-side mass in the floor of the mouth. An NMC arising from the SMG duct was confirmed by excisional biopsy examination. Intensive treatment, including surgery and chemotherapy, was provided without termination of the pregnancy. Additional chemotherapy and radiotherapy were provided after delivery. The treatment was successful. Neither the patient nor her infant had any complications and the patient remained disease free 20 months after her initial surgery. This report describes the successful diagnosis and treatment of a rare presentation of an NMC of the SMG duct in a pregnant woman.

Adenoid Cystic Carcinoma of the Submandibular Gland: A 35-Year Review

OBJECTIVES: To evaluate the treatment results of adenoid cystic carcinoma (ACC) of the submandibular gland at a single institution during a 35-year period.

STUDY DESIGN & SETTING: A retrospective review was performed by examining the records and reviewing the pathology of 22 patients with ACC of the submandibular gland treated at UCLA Medical Center from June 1963 to December 1997.

RESULTS: Seven men and 15 women with an age range of 23 to 85 years (median, 48 years) were treated. Surgical intervention was performed in 21 patients. All patients with advanced tumor size, perineural invasion, microscopically positive surgical margins, or regional neck metastases received postoperative adjunctive therapy, primarily radiotherapy. Follow-up varied from 6 months to 181 months (median, 67 months). Disease-free survival at 3, 5, and 10 years was 66%, 57%, and 41% respectively, whereas overall survival was 76%, 70%, and 37%, respectively (note: 5- and 10-year survival rates are not statistically conclusive due to the small sample size).

CONCLUSIONS: We report fairly high disease-free survival rates in this patient population and a number of prognostic trends are evident. Early diagnosis, wide surgical intervention, and postoperative radiation are associated with a favorable prognosis. Advanced tumor size, positive surgical margins, perineural invasion, and local recurrence of the tumor are associated with an unfavorable prognosis. EBM rating: C.

Epidemiology, Prognostic Factors, and Treatment of Malignant Submandibular Gland Tumors: A Population-Based Cohort Analysis

IMPORTANCE

Malignant tumors of the submandibular gland are uncommon, leading to limited information regarding prognostic factors and difficulty in evaluating treatment modalities.

OBJECTIVE

To investigate the correlates of survival in patients with primary malignant tumors of the submandibular gland.

DESIGN, SETTING, AND PARTICIPANTS

Data from 2626 patients with a diagnosis of primary tumors of the submandibular gland between 1973 and 2011 in the Surveillance, Epidemiology, and End Results database were used in a retrospective population-based cohort analysis. Kaplan-Meier analysis along with multivariate Cox regression analysis was performed to determine prognostic factors in overall survival (OS) and disease-specific survival (DSS).

INTERVENTIONS

Patients were treated with surgery, radiation therapy, both, or neither.

MAIN OUTCOMES AND MEASURES

Overall and disease-specific survival.

RESULTS

We identified 2626 patients with a diagnosis of primary malignant tumors of the submandibular gland, 52.9% male and 47.1% female, with a mean (range) age of 61.3 (7-101) years. Adenoid cystic carcinoma (36.0%) was the most prevalent histologic subtype, followed by squamous cell carcinoma (18.1%), mucoepidermoid carcinoma (16.9%), and adenocarcinoma (13.7%). Kaplan-Meier analysis demonstrated an OS and DSS of 65% and 74%at 2 years, 54% and 67% at 5 years, and 40% and 60% at 10 years, respectively. Multivariate Cox regression analysis revealed independent predictors of OS and DSS to be age (HR, 1.04 [95% CI, 1.03-1.04], P < .001; HR, 1.02 [95% CI, 1.01-1.03], P < .001), sex (HR, 0.69 [95% CI, 0.57-0.84], P < .001; HR, 0.73 [95% CI, 0.56-0.96], P = .02), tumor grade (HR, 1.47 [95% CI, 1.19-1.81], P < .001; HR, 1.67 [95% CI, 1.25-2.25], P = .001), stage at presentation (HR, 1.56 [95% CI, 1.41-1.72], P < .001; HR, 1.96 [95% CI, 1.69-2.28], P < .001), and surgical resection (HR, 0.55 [95% CI, 0.41-0.74], P < .001; HR, 0.51 [95% CI, 0.35-0.75], P = .001).

CONCLUSIONS AND RELEVANCE

We report, to our knowledge, the largest study to date focused on correlates of survival in submandibular gland malignant neoplasms. Multivariate analysis found that older age at diagnosis, high tumor grade, and later stage at presentation were correlated with decreased survival whereas female sex and surgical resection were correlated with increased survival. In addition, a 3-cm tumor cutoff size was demonstrated above which was associated with a significantly less favorable prognosis. Radiation therapy had mixed association with survival, dependent on tumor size and subtype.

Mammary analogue secretory carcinoma: the first submandibular case reported including findings on fine needle aspiration cytology

We present the first case (male, 35 years old) of a mammary analogue secretory carcinoma occurring in a submandibular gland and document findings on fine needle aspiration cytology. On histology, the tumor displayed characteristic features: circumscribed nodules composed of bland, pink to light red neoplastic cells with low proliferative/mitotic activity arranged in tubular, vaguely cribriform, and microcystic structures containing Periodic acid Schiff-positive, diastase-resistant secretory material. Immunohistochemistry showed strong and diffuse positivity for cytokeratin 7, S100 protein, and vimentin, as well as moderate to strong immunoreactivity for c-kit in the majority of tumor cells. A rearrangement of the ETV6 gene on fluorescence in situ hybridization was documented. The patient underwent an ipsilateral selective (levels I-IV) neck dissection which showed metastasis in 3 out of 36 lymph nodes (levels 1-3). Adjuvant radiotherapy was administered. No local recurrence or metastatic disease has been detected during a follow up period of 28 months.

Sonographic appearances of mucosa-associated lymphoid tissue lymphoma of the submandibular gland confirmed with sonographically guided core needle biopsy

A 71-year-old man presented with mucosa-associated lymphoid tissue (MALT) lymphoma of the submandibular gland 52 months after initial diagnosis of MALT lymphoma of the lung. Ultrasonography showed a well-demarcated, markedly hypoechoic, heterogeneous solid mass with linear echogenic strands and hypervascularity. Ultrasound-guided core-needle biopsy demonstrated histological findings of MALT lymphoma. Sonographic features of MALT lymphoma of the submandibular gland are characteristic and ultrasound-guided core-needle biopsy may be a suitable replacement for surgical biopsy.

NUT gene rearrangement in a poorly-differentiated carcinoma of the submandibular gland

NUT midline carcinomas (NMC) are a rare, recently described class of poorly-differentiated tumors that exhibit rapid onset and highly aggressive clinicopathologic behavior. These tumors are defined by rearrangement of the nuclear protein in testis (NUT) gene on chromosome 15q14, most commonly in a balanced translocation with the BRD4 gene on chromosome 19p13.1, resulting in the characteristic BRD4-NUT fusion gene and protein which blocks epithelial differentiation through chromatin binding. NMC frequently involve midline structures of adolescents and young adults and affect the head and neck region in 50% of cases. To our knowledge, only one case has been previously reported involving a salivary gland. Here, we present a case of a NMC of the salivary gland in an adolescent male presenting with an intermittently painful left submandibular mass of 3 months duration.

Fibromatosis of the submandibular region

Fibromatoses are benign tumors that can occur anywhere in the body. They are locally aggressive and tend to recur; they also cause considerable morbidity, particularly when they arise in the head and neck. Fibromatosis in the submandibular region is rare. Here, we present a case of fibromatosis of the submandibular region in a 42-year-old female who presented with a right submandibular mass. The patient underwent complete excision of the fibromatosis, showed negative margins and had no adjuvant therapy. Her recovery was uneventful, and there was no recurrence or neurological deficit 1 year after the operation.

Small cell carcinoma of the submandibular gland: a rare small round blue cell tumor

The presence of small cell carcinoma within the submandibular gland is an uncommon clinical entity. However, other small round blue cell tumors are encountered in the head and neck with greater frequency. These include lymphoma, Ewing's sarcoma, melanoma, esthesioneuroblastoma, and neuroblastoma. A basic knowledge of the immunohistochemical studies available to distinguish each these tumors from one another significantly improves the frequency of accurate and timely initial diagnosis. We report a case of small cell carcinoma of the submandibular gland and review the other common small round blue cell tumors that occur within the head and neck. We utilize an acronym, LEMONS, to organize our review and facilitate improved retention of the differential diagnosis for small round blue cell tumors of the head and neck.

[Prognostic analysis of adenoid cystic carcinoma of major salivary glands of 64 cases]

BACKGROUND & OBJECTIVE

Adenoid cystic carcinoma of salivary glands is a kind of highly malignant tumor, and researches on the tumors originated from major salivary glands are rare. This study was to investigate prognostic factors of adenoid cystic carcinoma of major salivary glands.

METHODS

Clinical records of 64 patients with adenoid cystic carcinoma of major salivary glands followed up for more than 7 years were reviewed. Cumulative survival rate was analyzed by the Kaplan-Meier method. The log-rank test was applied to compare survival rates, and the comparison of the percentage of subjects between two groups was conducted with Chi2 test.

RESULTS

The overall death rate was 57.8%; the cause-specific death rate was 46.9%; the 5-and 10-year cumulative survival rates were 65.63% and 54.52%, respectively; the relapse rate was 34.4%; and the metastasis rate was 45%. Univariate analysis revealed that the factors impacting the prognosis were age, presence or absence of nerve invasion, histological subtypes, clinical stage, positive or negative surgical margin. Patients aged > or = 50, presence of nerve invasion, solid/tubular subtype, advanced clinical stage (stages III and IV), and positive surgical margin had poorer prognosis than those aged < 50, absence of nerve invasion, cribriform subtype, early clinical stage (stages I and II), and negative surgical margin. Multivariate analysis showed that the presence of nerve invasion, solid histological subtype, advanced clinical stage (stages III and IV), and positive surgical margin were independently associated to poor prognosis.

CONCLUSION

Presence or absence of nerve invasion, histological subtype, clinical stage, and positive or negative surgical margin are the independent factors affecting the prognosis of patients with adenoid cystic carcinoma of salivary glands.

[Clinical analysis of salivary malignant pleomorphic adenoma--a report of 95 cases]

BACKGROUND & OBJECTIVE

Malignant pleomorphic adenoma is rare with extensive location, which makes it difficult to evaluate the efficacy of the treatments. This study was to summarize the clinical features of salivary malignant pleomorphic adenoma, and thus to explore the treatment principle and efficacy of the treatment.

METHODS

Clinical data of 95 salivary malignant pleomorphic adenoma patients, treated in Cancer Center, Sun Yat-sen University from May 1970 to Oct. 2000, were analyzed retrospectively. The overall cumulative survival rate was estimated using life table method by SPSS10.0 software. Survival curves were compared with Gehan method.

RESULTS

The 5-, 10-, and 15-year overall survival rates of the 95 patients were (64.9+/-4.9)%, (56.3+/-5.4)%, and (47.8+/-6.1)%, respectively. The 5-and 10-year disease-specific survival rates for the patients received surgery (51 cases), surgery plus radiotherapy (35 cases) were 76.1%, 63.7% and 69.9%, 50.8%, respectively, but the 5-and 10-year disease-specific survival rates for the patients received radiotherapy only, chemotherapy only and radiochemotherapy (4 cases) were all 0.

CONCLUSIONS

Surgery or surgery-dominated multi-modality are the principal treatment modalities for salivary malignant pleomorphic adenoma. The efficacy of surgery and surgery plus radiotherapy is better than non-surgery treatments.

Tumors of the salivary glands in childhood and adolescence

PURPOSE

We report on 52 juvenile and adolescent patients with benign and malignant tumors of the salivary glands. Controlled follow-up was carried out to examine outcome and side effects of therapy.

PATIENTS AND METHODS

The clinical files of 52 patients were evaluated by computer-based methods. Follow-up was comprised of the findings of our clinic as well as those of the primarily consulted physicians and, if possible, up-to-date examinations in our clinic.

RESULTS

Benign tumors had their highest incidence in puberty and postpuberty. Forty patients (20 girls and 20 boys; 77%) had benign growths and 12 patients (9 girls and 3 boys; 23%) suffered from malignant neoplasms. After surgery for benign tumors we saw no postoperative recurrences in long-term follow-up. In the group of malignant tumors, 8 patients (66.7%) survived their disease in the long-term follow-up.

CONCLUSIONS

Salivary gland diseases are rare in childhood and adolescence. Their pattern of incidence differs very much from that of adults. This is particularly true for the malignant parotid tumors that are more frequent in juvenile patients, a fact that has to be considered in diagnosis and therapy.

[Primary sub-mandibular gland tumours: experience based on 68 cases]

Sub-mandibulary gland tumours are less common than tumours of the parotid and pose many clinical and therapeutic challengers.

OBJECTIVE

We report our experience of sub-mandibular tumours and review the literature.

PATIENTS AND METHODS

Retrospective studies of sub-mandibular gland tumours presenting to our department between 1986 and 2000.

RESULTS

68 cases were reviewed comprising 37 benign and 31 malignant tumours (15 females and 33 males). Average age of patient was 46 years and all presented with a sub-mandibular swelling. Clinical suspicion of malignancy was associated with symptom of pain, cervical adenopathy, nerve palsy, skin and/or bone invasion. CAT Scans were performedd to assess tumour extent / invasion. Definitive diagnosis was by complete excision and pathological examination. Pleomorphic adenoma (n= 32) were the most frequent benign tumours. For malignant lesions (n= 31) the most frequent were: Adenoid cystic carcinoma (n= 10), epidermoid carcinoma (n= 5), adenocarcinoma (n= 5), mucoepidermoid carcinoma (n= 3), malignant non Hodgkinien lymphoma (n= 5). Treatment was by total surgical excision of the submandibular gland for the begnin tumours. For the malignant lesions it was associated acording to their extension with other anatomical region or in case of adenopathy with neck dissection. Radiotherapy was performed in 24 cases and chemotherapy in 10 cases.

CONCLUSION

Malignity in sub-mandibular gland tumours is more frequent than in the parotid gland. Any delay in diagnosis or inappropriate management may result in a poor prognosis for the patient.

[Clinical analysis of sixteen cases of lymphoepithelial carcinoma of salivary gland]

BACKGROUND & OBJECTIVE

Lymphoepithelial carcinoma of salivary gland is a rare and special kind of malignant tumor, and has seldom been reported. This study was to summarize the clinical features, treatment and curative effect of this disease according to our experiences.

METHODS

Clinical data of 16 patients with pathologically confirmed primary lymphoepithelial carcinoma of salivary gland, treated in Cancer Center of Sun Yat-sen University from Jan. 1990 to Sep. 2004, were retrospectively analyzed, and survival analysis was performed with Kaplan-Meier method.

RESULTS

The 16 patients with lymphoepithelial carcinoma of salivary gland accounted for 3.6% of all the patients diagnosed as malignant tumors of salivary gland simultaneously in our center. All patients had tumors occurred in unilateral gland, aged 15-57 years, with the female to male ratio of 1:1. All patients were from southern China. Except for 1 patient, the rest 15 had Epstein-Barr virus (EBV) serological tests. The positive rates of EBV-VCA-IgA, EBV-EA-IgA, and EBV-DNA enzyme were 93.3%, 66.7%, and 86.7%, respectively. All patients were treated with surgery, of which 9 received surgery only, 5 received surgery plus postoperative radiotherapy, 1 received surgery plus postoperative chemoradiotherapy, 1 received surgery plus chemotherapy. Four (25.0%) patients had postoperative pathology-proved ipsilateral cervical lymph node metastasis. The 1-, 3-, and 5-year survival rates of the 16 patients were 86.15%, 48.46%, and 24.23%.

CONCLUSIONS

Although lymphoepithelial carcinoma of salivary gland is poorly differentiated, the prognosis of this disease is good. Complete resection plus postoperative radiotherapy is possibly accommodating.

Tumors of the submandibular gland: Clinicopathologic analysis of 23 patients

PURPOSE

Tumors of the submandibular gland are rare, comprising less than 2% of head and neck neoplasia. Both benign and malignant lesions show a mild symptomatology, resulting in late presentation and in advanced stage of disease. The purpose of this article was to report our experience in treating submandibular gland neoplasia during the last 10 years.

PATIENTS AND METHODS

The medical records of all patients with histologically confirmed epithelial tumors of the submandibular gland were retrospectively reviewed. This review found 23 patients with 9 benign and 14 malignant tumors. The collection of data included demographic data, diagnostic procedures, operative and pathology reports, complications, additional treatment, and follow-up.

RESULTS

There were 10 men and 13 women with a mean age of 60 years. Pleomorphic adenoma was the most frequently encountered benign tumor; adenocarcinoma and adenoid cystic carcinoma had an equal presentation in the malignant group of patients. Eleven of the 14 patients with malignant tumors presented in advanced stages of disease (stage III and IV). Surgery was the sole treatment for the benign tumors. There were no recurrences. In the majority of cases, patients with malignant tumors were treated with surgery and postoperative radiotherapy. Eight patients died during the follow-up period, giving a mortality rate of 61.5%.

CONCLUSION

Benign submandibular gland tumors manifest a mild course of disease, and local excision along with the gland is a safe and effective method of treatment. Malignant tumors have a poor symptomatology that results in late diagnosis. Radical surgery and postoperative radiotherapy is the treatment of choice. Prognosis depends on the histopathology and biologic behavior of the specific type of malignant tumor.

Carcinosarcoma of the submandibular gland: an autopsy case

Malignant mixed tumors of salivary glands are classified as three types:carcinoma arising in a pleomorphic adenoma, the most common; benign metastasizing pleomorphic adenoma; and carcinosarcoma (true malignant mixed tumor), which is very rare [Ann. Otol. Rhinol. Laryngol. (1982) 91 342]. In carcinoma, both epithelial and soft tissue elements are malignant. In the context of previous reports, we discuss a case of carcinosarcoma of the submandibular gland including the results of postmortem examination.

[Treatment and clinicopathologic analysis of mucosa-associated lymphoid tissue lymphoma of the salivary glands]

OBJECTIVE

To further understanding of lymphoma of salivary gland through clinicopathologic analysis.

METHODS

Clinical findings, pathologic features, clinical staging, therapy and prognosis of 4 cases were reviewed and clinically analysed.

RESULTS

Different treatment were received by the 4 patients, one had stage IIIA disease and three had stage IE disease. All patients got their illness completely remitted.

CONCLUSION

Mucosa-associated lymphoid tissue lymphoma of the salivary glands is an indolent disease. Different treatments can all result in prolonged remission, and it has better outcome than other NHL.

[Clinical presentation, therapy and prognosis of non-Hodgkin lymphomas of the major salivary glands]

INTRODUCTION

About 5 - 10 % of all Non-Hodgkin-Lymphomas (NHL) present within the major salivary glands. Two etio-pathologically different groups, the (extranodal)-parenchymal NHL and NHL of intra- or periglandular lymphnodes (nodal lymphomas) have to be distinguished. It was the aim of this study to evaluate the clinical presentation, therapy and biological behaviour of these etiopathologically different lymphoma-groups.

MATERIAL AND METHOD

In a retrospective study, therapy and course of disease of 26 patients with a NHL of the major salivary glands were examined (diagnosis and treatment between 1988 and 1996).

RESULTS

Staging results in the group of parenchymal lymphoma always showed the disease limited to the effected gland, whereas nodal NHL presented with a stadium II to IV (Ann-Arbor) at time of diagnosis. Local recurrencies were five times higher in nodal NHL compared to parenchymal NHL. In only one case (7.7 %) of the patients with parenchymal NHL, dissemination was observed. In the group of nodal NHL, a dissemination was observed in 6 patients (46.2 %). 7 of 13 patients (53.8 %) with a nodal NHL died due to lymphoma dissemination, compared to one patient (7.7 %) with a parenchymal NHL.

CONCLUSION

Based on the presented data, the histopathological diagnosis, under special recognition of the particular lymphoma-pathogenesis, constitutes an important prognostic factor in patients with NHL of the major salivary glands.

[About the prognostic value of Her-2 gene-amplification and cell-proliferation in salivary duct carcinoma of the major salivary glands - a pilot-study]

INTRODUCTION

The salivary duct carcinoma (sdc) represents a rare variant of the group of adeno-carcinomas of the salivary glands. Histopathologically, it is marked by solid and cribriform cell nests with central necrosis, displaying distinct similarity with the ductal carcinoma of the breast, where prognosis can be correlated with Her-2 gene-amplification. Based on this histopathological similarity, the prognostic value of Her-2 gene amplification in SDC was examined in the presented pilot-study.

PATIENTS AND METHODS

Four own patients with different clinical courses were examined in regard to their histopathological features, Her-2 gene-amplification and proliferation (Ki67).

RESULTS

Three of the four patients died tumor related 2.4, 5.5 and 8.2 years after initial diagnosis. The remaining patient died tumor-free 6 year after diagnosis (myocardial infarct). The two patients with an early recurrent disease and distant metastasis showed a high Her-2 expression and proliferation (Ki67), compared to the other two patients.

CONCLUSION

In the presented pilot-study a distinct correlation between Her2-gene-amplification, proliferation (Ki67) and clinical course could be observed. Additional analysis to evaluate this aspect seems rectified, especially under recognition of therapy decisions.

[Submandibular pathology as an interdisciplinary problem]

Basing on the own material of 328 patients treated surgically the authors have presented the problem of submandibular space pathology. They have pointed out its interspecialty in diagnosing and treatment. Among 328 patients the presence of inflammatory tumors have been stated in 220 (67.1%) cases, non-specific inflammation in 194 (88.2%) patients and specific inflammation in 26 (11.8%) patients. Neoplasmatic tumors have occurred in 98 (29.9%) patients, malignant tumors in 78 (79.6%) patients and benign ones in 20 (20.4%) patients. Among malignant tumors metastatic ones were observed in 41 (52.6%) cases, while primary tumors in 37 (47.4%) cases. In 3.0% patients developmental anomaly have occurred.

Salivary duct carcinoma: clinical characteristics and treatment strategies

BACKGROUND

Salivary duct carcinoma (SDC) is a highly malignant tumor of the salivary gland.

METHODS

Twenty-six cases observed during the period 1975 to 1994 were selected from the pathology archives of the Instituto Nazionale Tumori of Milan. A review of all the similar cases published in the literature and comparison with the present series was performed.

RESULTS

SDC was mainly a parotid gland tumor diagnosed at an advanced stage. Lymphatic involvement seems to be related to T stage. Distant spread was evidently related to the presence of lymph node metastasis. Surgery with radiotherapy was the standard treatment. The only demonstrable negative prognostic factor was the presence of node metastases (p = 0.01).

CONCLUSIONS

Most patients died of disseminated disease in spite of an aggressive and often successful local-regional treatment. The role of a prophylactic ipsilateral neck dissection and adjunctive systemic treatment should be investigated.

Long-term follow-up of over 1000 patients with salivary gland tumours treated in a single centre

Between 1947 and 1992, 1403 patients with 1432 salivary gland tumours were treated at the Christie Hospital, Manchester. There were 1194 epithelial neoplasms: parotid, 1082 (91 per cent); submandibular, 47 (4 per cent); minor glands, 65 (5 per cent). The commonest histological diagnoses were pleomorphic adenoma (n = 776) and adenolymphoma (n = 159). A total of 244 carcinomas were seen (adenoid cystic carcinoma, n = 75). Treatment was primarily surgical, conservative where possible, and determined by tumour extent and not histology. Adjuvant radiation therapy was used in over half the definitively treated malignancies. The recurrence rate following the treatment of 551 new parotid pleomorphic adenomas was 1.6 per cent at median follow-up 12.5 (range 1-34) years, increasing to 15 per cent in the secondarily referred group (n = 170). For patients with definitively treated primary salivary carcinomas (n = 148), the disease-free survival rate at 5, 10 and 15 years was 58, 47 and 45 per cent respectively. Using multivariate analysis, clinical stage was the most important predictor of survival; the 10-year survival rate for stages I-IV was 96, 70, 47 and 19 per cent respectively.

Metastatic renal cell carcinoma involving Wharton's duct: a case report

This article describes a case of renal cell carcinoma that metastasized to the right Wharton's duct of a 73-year-old man. Metastases of renal cell carcinoma to the oral tissues are rare. Involvement of salivary gland tissue appears to be exceedingly rare, and a metastatic focus localized only in the Wharton's duct never has been reported in the literature.

Case report: pleural encasement secondary to acinar adenocarcinoma of the submandibular gland

We present a case of a 42-year-old male with metastatic pleural encasement of the lung with extension into the mediastinum, resulting from an acinar adenocarcinoma of the submandibular gland diagnosed 30 years previously. The radiographic and CT appearances are presented, with a literature review.

[The diagnosis and treatment of the epithelial salivary gland tumors in children and adolescents]

Sixty-six cases with epithelial salivary gland tumors in children and adolescents, who were less than 16 years old, were analized. Those cases accounted for 3.6% of all epithelial salivary gland tumors in our school. Twenty-five cases (37.9%) were benign tumors, among which pleomorphic adenoma was the most common. Forty-one cases (62.1%) were malignant tumors, in which mucoepidermoid carcinoma was the most common one. Three quarters of cases were in the group over 10 years old. Six cases were in the group less than 5 years old. Among them 5 cases were malignant tumors. The younger the children is, the more possible the malignant tumor is. Two cases with malignant tumors had the history of receiving radiotherapy because of the hemangiomas at the same locations. It indicates that the occurrence of the malignant tumors was related to radiotherapy before. The diagnosis, differential diagnosis and treatment of the tumors were discussed. The initial radical resection of the malignant tumors was emphasized.

[Efficacy of the combination of 5 fluorouracil, adriamycin and cisplatin (FAP protocol) in the treatment of metastatic cylindroma. Apropos of a case with review of the literature]

We report the case of a 43 year-old woman who was submitted to a complete surgical resection of an Adenoid Cystic Carcinoma (ACC) of the submandibular salivary gland which was associated with diffuse lung metastases. Combination chemotherapy with fluoro-5-uracil, adriamycin, and cisplatin (FAP) induced an almost complete disappearance of the chest lesions. The literature about ACC and its chemotherapy is reviewed.

Unusual presentations of lymphangioma

L ymphangioma is a rare but potentially life-threatening disease, particularly in children. Three unusual cases of lymphangioma located in the infratemporal fossa, submaxillary gland, and cervicomediastinal regions are presented. These unusual sites illustrate that lymphangiomas may be found at sites distant from the locations of the embryological lymph sacs. The importance of radiological examination is emphasized. Although there are many modes of therapy for this disease, complete surgical excision when possible is advocated. The literature regarding the embryology, presentation, clinical workup, and current modes of therapy for lymphangioma is reviewed.

Salivary duct carcinoma: a report of nine cases

Nine cases of salivary duct carcinoma are presented. Eight lesions were located in the parotid gland and one in the submandibular gland. Tumor size was greater than 3 cm in four cases (44%), and facial paralysis was observed in five tumors (62.5%). Lymph node metastases were observed macroscopically or microscopically in seven patients. Perineural and lymphatic invasion were detected in eight and seven cases, respectively. Free surgical margins were obtained in eight of the nine patients (88%). Adjuvant postoperative irradiation was delivered in eight patients. Five patients died of disease in spite of the different clinicopathologic characteristics and aggressiveness of the surgery and irradiation. None of the parameters studied correlated with the final outcome.

Long-term treatment in infantile choriocarcinoma

The long-term treatment of a 5 month old boy with precocious puberty secondary to the production of chorionic gonadotropin (hCG) by a choriocarcinoma is described. Of 13 cases of infantile choriocarcinoma reported in the literature, none were successfully treated. The present study describes a partially successful outcome with embolization of a hepatic tumor, irradiation of lung and right submandibular tumors, chemotherapy with methotrexate (MTX), actinomycin D (ACD), cyclophosphamide (CPA) and etoposide (VP16), and splenectomy and hepatic lobectomy. Subsequently, the residual hepatic tumors were treated with high dose melphalan (HDM) followed by reinfusion of unpurged autologous marrow.

True malignant mixed tumor of the submandibular gland

A case of true malignant mixed tumor of the submandibular gland is reported. The submandibular tumor, occurring in a 52-year-old man, started to grow rapidly after a long history without any change in size. Surgical resection was carried out and the resected tumor measured 5.5 cm with a cut surface showing mixed solid structures. Microscopically, the tumor had both carcinomatous and sarcomatous elements, the former consisting of poorly differentiated adenocarcinoma with squamous cell differentiation and the latter consisting of osteosarcoma with chondrosarcomatous and fibrosarcomatous elements. A remnant of benign pleomorphic adenoma could also be identified. Immunohistochemical study demonstrated keratin and epithelial membrane antigen in the carcinoma cells and vimentin in all elements of the osteosarcoma. It is assumed from these clinical and histological findings that the tumor had transformed from a pre-existing benign pleomorphic adenoma.

Salivary duct adenocarcinoma: a high grade malignancy

Salivary duct carcinomas of the major salivary glands have two major distinguishing features. They closely resemble ductal carcinomas of the breast and they are high-grade malignancies. In general, but particularly for carcinomas measuring three or more centimeters in size, the clinical course is one characterized by a resistance to local control, metastases to regional lymph nodes and distant sites, and death within a few years after primary surgical treatment.

Salivary neoplasms: overview of a 35-year experience with 2,807 patients

We have reviewed a 35-year experience with 2,807 patients treated for salivary tumors which arose in the parotid gland (1,695 patients; 70%), submandibular gland (235 patients; 8%), and seromucinous glands of the upper aerodigestive tract (607 patients; 22%). Pleomorphic adenomas comprised 45% of the total, most of which occurred in the parotid gland. The clinical findings and the distribution of patients according to the histology and the site of origin are summarized. Treatment was surgical and the resection was conservative when possible, depending upon the extent of the tumor. The impact of site, histology, grade, and tumor stage on the results is shown.

Salivary gland tumors

A retrospective review of 643 patients with salivary gland tumors seen between 1958-72 is reported. There were 328 malignant and 375 benign tumors. All patients with malignant tumors were assessed in a multidisciplinary head and neck clinic. The median age for developing malignant tumors was 58 and there was a male to female ratio of 1.2:1. For benign tumors the median age was 46 years and the male to female ratio 0.8:1. Overall the primary tumor was controlled by the first planned treatment in 145 (44%) malignant tumors and in 253 (80%) benign tumors. The five and 10 year actuarial survival for malignant tumors was 59.4% and 45.6% respectively.

Malignant lympho-epithelial lesion--the Manitoba experience

A retrospective study was carried out utilizing the Records Department of the Health Sciences Centre, St. Boniface General Hospital, and the Manitoba Cancer Treatment and Research Foundation. Seventeen cases of malignant lympho-epithelial lesion were found. The pathology of all cases was reviewed. There were 12 females and five males. Sixteen cases involved the parotid gland and one the submandibular gland. The ages ranged from 17-65 years with the peak incidence in the fourth decade of life. Fifteen of the patients were Eskimos, all residing in the Northwest Territories; two patients were Caucasian. Most patients were treated with a combined modality of surgery with postoperative radiation. The clinical features, pathology, treatment, and final outcome are reviewed.

Interstitial hyperthermia in combination with brachytherapy

Flexible coaxial cables were modified to serve as microwave antennas operating at a frequency of 915 MHz. These antennas were inserted into nylon afterloading tubes that had been implanted in tumors using conventional interstitial implantation techniques for iridium-192 seed brachytherapy. The tumor volume was heated to 42-45 degrees C within 15 minutes and heating was continued for a total of 1 hour per treatment. Immediately following a conventional brachytherapy dose and removal of the iridium seeds the tumors were heated again in a second treatment. This interstitial technique for delivering local hyperthermia should be compatible with most brachytherapy methods. The technique has proved so far to be practical and without complications. Temperature distributions obtained in tissue phantoms and a patient are described.

[Non-Hodgkin lymphoma associated with a relapse of Hodgkin's disease]

We report the case of a patient treated for Hodgkin's disease (stage IIIEA) by combination of chemotherapy (MOPP regimen) and total nodal irradiation. Five months after the completion of radiotherapy the patient presented with a relapse of his Hodgkin's disease and simultaneous occurrence of diffuse non Hodgkin's lymphoma in a different lymph node territory. The relationship between these two malignancies is discussed and the literature is reviewed.

Sensitivity of a neoplastic epithelial duct cell line from a human submandibular salivary gland to human leukocyte interferon as assessed by an in vitro semi-solid agar technique

A neoplastic epithelial duct cell line from a human submandibular salivary gland, HSG, was assayed by an in vitro semi-solid agar technique for sensitivity to human leukocyte interferon (HuIFN-alpha). The clone which showed the most stable growth and the greatest ability of colony formation in the agar medium, was isolated from the colonies of HSG cells and used in the present study. This clone was designated as HSG-1. As a consequence, cultivation of HSG-1 cells in the agar medium containing HuIFN-alpha of 1000 units/ml resulted in the inhibition of 47.6% of the colony-forming ability of HSG-1 cells, as compared with the untreated control. Addition of increasing concentrations of HuIFN-alpha (between 100 units/ml and 1000 units/ml) in the agar medium caused a linear reduction in the number of the colonies, ranging from 5.2% to 47.6%. Moreover, addition of HuIFN-alpha showed an inhibitory effect on the multiplication of HSG-1 cells in the monolayer culture. These observations strongly suggest that HuIFN-alpha has antineoplastic and antiproliferative effects on HSG-1 cells.

Childhood rhabdomyosarcomas of the head and neck. 2 Case reports on salivary glandular and paraglandular involvement

Rhabdomyosarcoma is an uncommon, aggressive soft tissue malignant tumor, more often seen in children than in adults. During the past 32 years (1949-1980), 48 cases have been diagnosed at the Montreal Children's Hospital of which 20 have involved the head and neck. Recently, two cases involving the salivary glandular and paraglandular tissue were treated. At the present time, the combination of surgery, radiation therapy, and chemotherapy are proving superior to any one modality by itself and have eliminated the necessity of mutilating surgery. Recently, five year survival rates of 75% have been reported.