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A 69-year-old Japanese woman presented with an epithelial-myoepithelial carcinoma of the palate. The tumor was excised and did not show recurrence or metastasis 22 months after surgery. Clinical findings and histologic features of this rare lesion are discussed.
Tumours of the salivary glands are relatively uncommon. In a review of 282 black patients seen at Harare Central Hospital, Zimbabwe, the relative incidence of various tumour types and the age and sex distribution were similar to those reported in other series. There were more tumours of the minor salivary glands than in reported Western series. There were more tumours of the minor salivary glands than in reported Western series. Pain and rapid growth were significant in distinguishing malignant from benign tumours. Malignant tumours were more common in elderly than in young patients.
Acinic cell carcinoma (ACC) is a rare salivary gland tumour, making up 4% of all minor salivary gland tumors. Typically, it is composed of acinic cells although transitional and duct-like cells are also identified. In the present study, a panel of antibodies was applied to eight minor salivary gland ACCs. Antibodies tested were: cytokeratins 7, 8, 13, 14, 18, 19, vimentin and actin (HHF35). Immunohistochemical staining revealed that cytokeratin 8, among the tested antibodies, was the more specific to neoplastic cells with a pattern of distribution quite variable and peculiar. This staining may be useful in the recognition of neoplastic acinic cells.
The histological and clinical behaviour of nine intraoral salivary basal cell adenomas is described. Despite problems in classification, this study confirms the impression that these are all benign salivary gland tumours which respond well to localized excision only.
In conclusion, if a parotid gland mass is bilateral, it is more likely to be Warthin's tumor, especially if it does not enhance. Less likely, it could be lymphoepithelial cyst or necrotic lymph node. A unilateral, non-enhancing mass with a high T2 signal is more likely to be a Warthin's tumor and less likely a necrotic lymph node or first branchial cleft cyst. If the mass is unilateral, shows postcontrast enhancement, has a high T2 signal, and does not invade surrounding tissue planes, it is more likely to be a pleomorphic adenoma. An intermediate to low T2 signal mass-with or without invasion of surrounding tissue planes--is more likely to be a malignant mass such as adenocystic or mucoepidermoid carcinoma. Biopsy is superior and the gold standard for diagnosis and cannot be replaced by MR imaging, however.
Adenomatoid hyperplasia is a rare cause of swelling of the oral minor salivary glands, but is of significance because of its clinical resemblance to salivary gland tumors. The histologic appearance is one of benign hyperplasia and hypertrophy of the minor mucous glands. The clinical and histologic features of 20 new cases are reported, 19 of which occurred in the hard or soft palate. The cause of adenomatoid hyperplasia has hitherto been unclear, but the observation that 14 subjects were tobacco smokers or denture wearers, or both, suggests chronic, local trauma may be an important factor in the development of the condition.
Adenoid cystic carcinomas of salivary glands occur more frequently in women and bear remarkable similarity to adenoid cystic carcinomas of the breast. In addition, breast carcinomas express estrogen and progesterone receptors that impact prognostic significance. This suggests a possible role for sex steroid hormones in the development and progression of salivary gland adenoid cystic carcinoma. On this basis, 12 samples of formalin-fixed, paraffin-embedded salivary gland adenoid cystic carcinomas and 12 samples of normal salivary gland tissue were immunohistochemically evaluated for estrogen and progesterone receptor protein expression. Estrogen receptors were not detected in either group; however, a significantly higher progesterone receptor level was evident in the neoplastic group compared with normal tissue (p < 0.01). These data confirm the presence of progesterone receptors within normal and neoplastic salivary gland tissue. Progesterone receptor expression may be of possible prognostic and therapeutic value in some cases of adenoid cystic carcinoma.
A number of autoimmune diseases predispose to the development of neoplasia. A particularly well-recognized association is the development of lymphoma in Sjögren's syndrome. Although this risk has been estimated to be 44 times that of the general population, few reliable prognostic indexes exist for individual patients. Recent advances in molecular biology have improved our understanding of Sjögren's syndrome and permitted better characterization of the generalized lymphoproliferation associated with the condition. This article reviews the histopathology of the major and minor salivary gland lesions of Sjögren's syndrome and discusses advances in molecular biology that have permitted more accurate prediction of lymphoma development in this group of patients.
Polymorphous low-grade adenocarcinoma is a recently recognized salivary gland carcinoma arising primarily within the oral cavity. Most of these tumors are readily diagnosed; occasionally, however, they may be confused histologically with cellular mixed tumors. The difficulty stems from the bland cytologic nature of cellular mixed tumors and their organizational diversity, together with the irregular pushing growth at their interface with adjacent soft tissues, on histologic examination. Because of this diagnostic problem, we evaluated the use of glial fibrillary acidic protein localization in the differential diagnosis of polymorphous low-grade adenocarcinoma and cellular mixed tumor. Twelve oral polymorphous low-grade adenocarcinomas (polymorphous low-grade adenocarcinoma) and twelve cellular mixed tumors were selected and stained for glial fibrillary acidic protein (glial fibrillary acidic protein) using a strept-avidin-biotin system and examined independently by each investigator. In addition, five tumors with limited material (three cellular mixed tumors and two polymorphous low-grade adenocarcinoma) from the consultation service of one author were evaluated using the same techniques. Two polymorphous low-grade adenocarcinoma stained positive in very focal areas and only in the epithelial component; staining did not occur in the stroma. Fourteen of fifteen mixed tumors focally to diffusely expressed glial fibrillary acidic protein. Only one tumor did not express glial fibrillary acidic protein. In mixed tumors with only focal staining, the most helpful differential diagnostic feature was positive staining of the mesenchyme-like cells adjacent to epithelial nests. We did not find this latter staining pattern in any of the polymorphous low-grade adenocarcinoma.
INTRODUCTION AND METHODS: We performed an immunohistochemical study in four cases of myopitheliomas with objective to realize a profile in respect of differentiation grade by the monoclonal antibodies CK14, vimentin and alph-SMA, besides to investigate the cell proliferation by anti-PCNA, besides, we compare the immunoreactive with glandular normal tissue. RESULTS: In the glandular normal tissue the myoepithelials cells had shown expression for alpha-SMA and CK 14, while that in the ductals cells, only the presence of CK 14 was verified. All the cases was verified positivity for CK 14 and vimentin, however, CK 14 had been present only in epithelioid and fusiform cells, while that the vimentin revealed positive also in the cytoplasm of the plasmocytoid cells. alpha-SMA was not detected in the neoplasic cells. Immunopositivity for the PCNA was observed in more than 75% of the cellular component of the analyzed tumors, independent of the cellular type. CONCLUSIONS: We concluded that it did not have difference in the proliferative activity among the cellular types presents in the myoepitheliomas and, still, the results of this study suggest that the constituent cells of this neoplasia one really represent cells of the mioepitelial ancestry, but in different stages of differentiation.
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A series of 87 salivary glands was examined using an immunogold-silver technique for salivary gland amylase (SGA) and epithelial membrane antigen (EMA) and an indirect immunoperoxidase technique for both antigens. The specimens comprised 21 pleomorphic adenomas, 3 monomorphic adenomas, 25 adenolymphomas, 5 mucoepidermoid carcinomas, 3 acinic cell tumours, 8 adenoid cystic carcinomas, 2 adenocarcinomas and 8 undifferentiated carcinomas. In addition 5 normal salivary glands and 6 salivary glands showing benign lymphoepithelial lesions were included.
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The clinician is almost entirely dependent on the histopathologist to accurately diagnose minor salivary gland tumours, but in some cases the histological interpretation of the specimen is very difficult. Recently it has been demonstrated using immunohistochemical techniques that S-100 protein is present in some salivary gland tissues and its localization has been used as an aid in the differentiation of major salivary gland tumours. To assess its value in the diagnosis of minor salivary gland tumours it was localized in sections from 15 such tumours using both a standard peroxidase-antiperoxidase (PAP) and a newly developed immunogold-silver staining sequence (IGSS) technique. Strong staining for S-100 protein was seen in the nuclei and cytoplasm of the cellular areas and also in the cells in the chondroid and myxoid areas of pleomorphic adenomas. Generally the staining was more intense and widespread with the IGSS method. No staining was observed in any of the other tumour types. We conclude that S-100 protein localization is a valuable aid in the differentiation of minor salivary gland tumours. Furthermore, the IGSS method enables more sensitive 'reading' of the staining reaction.
Benign salivary gland tumours in childhood are rare. We present a case of a pleomorphic adenoma arising in a minor salivary gland within the hard palate, review the literature and discuss the diagnostic and therapeutic features of the condition.
Lipomatosis has not previously been reported in minor salivary glands. Its occurrence in the parotid gland is well recognized. We present the first reported case of lipomatosis of the minor salivary glands in the nasal cavity. We also review the tumours of the minor salivary glands, lipomas and lipomatosis of the parotid, and the few reported cases of lipomas of the sinonasal tract.
A case is reviewed of a giant benign myoepithelioma of the soft palate presenting in an elderly female patient. Due to the large size of the lesion and its mass effect the patient developed dysphagia with subsequent significant weight loss. The clinico-pathological features of this rare tumour are described and the literature reviewed.