Biomedical subjects
Publications and source records attributed to R A Cawson.
Mycobacterial disease is an unusual but important condition that should be considered in the differential diagnosis of a discrete parotid gland swelling or mass. The management of this condition involves exclusion of neoplastic disease and combined medical and surgical therapy. We present 5 cases of mycobacterial involvement of the parotid gland and discuss issues surrounding the diagnosis and treatment options.
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The characteristic microscopic appearance of the fusospirochaetal complex in smears from patients with acute necrotizing ulcerative gingivitis has long been regarded as virtually pathognomonic of the disease. Unfortunately there is considerable confusion surrounding the taxonomy of the fusiform organism in the fusospirochaetal complex. The conflicting views appear to be irreconcilable and a re-evaluation of the taxonomy of oral fusiforms is urgently required.
Twenty-six benign oncocytic lesions of the salivary glands, excluding Warthin's tumours, have been reviewed and criteria for their classification as oncocytoma, multifocal nodular oncocytic hyperplasia, diffuse oncocytosis, pleomorphic adenoma with oncocytic change or oncocytic monomorphic adenoma have been proposed. The histological and clinical features of this heterogeneous group of lesions are discussed. This analysis suggests that the majority of lesions initially categorized as oncocytomas were, in fact, either non-neoplastic or, alternatively, oncocytic change in other types of adenoma.
From a total of 323 adenolymphomas in the files of the British Salivary Gland Tumour Panel there were 20 cases (6.2%) which showed extensive necrosis, fibrosis and inflammation. The clinical and microscopical features of this distinctive subtype are described and it is suggested that infarction rather than infection is the more probable aetiological factor. In 40% of these infarcted adenolymphomas there was granuloma formation which mimicked tuberculosis or sarcoidosis and this possibility should be borne in mind when examining lesions in the parotid region.
A 66-year-old woman presented with a giant tumor of the parotid gland, which under a light microscope had a sarcomatous appearance with spindle-shaped myoepithelial cells (malignant myoepithelioma). Histochemical examination showed longitudinal fibrils in the cytoplasm of the myoepithelial cells. Immunohistochemical studies showed positive staining for S-100 protein, vimentin, and actin in the myoepithelial cells. Cytokeratin was seen in the ductular epithelial cells and in the periductular myoepithelial cells, but it was absent from malignant myoepithelial cells. Ultrastructurally, these cells contained several longitudinally oriented slender structures resembling myofilaments without dense bodies. A review of the literature confirms the rarity of malignant myoepithelial carcinoma (myoepithelioma) arising in the parotid gland, and we therefore add another case.
A case of nevus unius lateris and two cases with similar intraoral lesions but no evidence of cutaneous involvement are described. The terminology of papillary intraoral epithelial nevi is discussed, and it is suggested that lesions of this type, confined solely to the mouth, should be called verrucous nevi.
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Primary lymphomas arising in salivary glands are very uncommon. The histologic classification of 40 cases of lymphomas in salivary gland tissue submitted to the British Salivary Gland Tumour Panel is reported, and, for 30 of the patients for whom adequate information was available, the clinical presentation, management, and outcome have been analyzed. Lymphomas in salivary glands represented 1.7% of all reported salivary neoplasms. The majority developed in the parotid glands of patients aged between 50 and 70 years. Only four cases gave a premorbid history compatible with sicca syndrome. In this series, non-Hodgkin's lymphomas predominated; 23 were Grade I, and 13 were Grade II. Treatment regimens were not uniform, but are outlined. Survival ranged from 5 to 111 months. Median survival for the group was 49 months. Prognosis was not influenced by the clinical stage of disease at presentation. Four cases of lymphoma arising in benign lymphoepithelial lesions are included. None had clinical symptoms of sicca complex. Prognosis for this group was found to be as favorable as the others.
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