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Management of occult metastatic disease from salivary gland neoplasms.

Evaluating salivary gland neoplasms is difficult because of the relatively low incidence of these lesions, their variable locations, and their multiple histologic cell types. Little has been reported on nodal metastases, whether manifest or occult, from these neoplasms. Ninety cases of salivary gland neoplasm are analyzed to provide a clearer understanding of the appropriate approach to occult salivary gland cervical metastases. Manifest regional metastases at the original presentation were absent in 72% (65/90). Few nodal metastases occurred after the primary tumor was controlled (2% [1/56]). Local recurrence (38% [34/90]) and distant metastases (25% [14/56]) were more common. Stage I and II disease was treated by surgical resection of the primary tumor alone; resection was combined with postoperative radiation therapy for stage III disease. Whenever the neck was entered for stage III disease, a conservative neck dissection was incorporated with the resection to reduce the postoperative irradiation field once the neck had been proved N, O histologically. Delayed nodal metastasis was treated by neck dissection alone.

Adenocarcinoma↗

Benign salivary gland neoplasms.

Benign salivary gland neoplasms represent a diverse group of neoplasms with varied clinical behaviors. Successful management of these tumors depends on accurate clinical and diagnostic assessment, followed by appropriate therapeutic intervention. An appropriate understanding of the biologic behavior of each tumor type allows for development of an appropriate treatment plan tailored to the individual patient.

Diagnosis, Differential↗

Recurrent malignant salivary gland neoplasms.

Recurrent salivary gland malignancies present difficult therapeutic decisions and poor prognosis in many instances, and treatment becomes of a palliative nature only. As many of the salivary gland malignancies we see are of the recurrent type, the following study was done to determine the efficacy of a vigorous attempt at retreatment. During the period January 1, 1960, through December 31, 1984, 352 patients with major and minor salivary gland tumors were evaluated at our institution. There were 149 benign lesions and 203 patients with malignant tumors. Of these, 99 patients had recurrent and metastatic tumors that had been treated initially elsewhere. Thirty-three of these patients were able to be treated with curative intent: surgery, 21; surgery plus radiation, 9; radiation therapy alone, 2; and radiation plus chemotherapy, 1. The 5 year survival with no evidence of disease was achieved in three patients with surgery alone and two patients with surgery plus radiation therapy. The group of five patients was comprised of two patients with adenoid cystic carcinomas of the parotid, one with intermediate grade mucoepidermoid carcinoma of the parotid, one, sebaceous cell carcinoma of the parotid, and one, adenoid cystic carcinoma of an accessory salivary gland. The results of this study serve to re-emphasize the relative poor yield of attempts at retreatment of loco-regional recurrence of salivary gland tumors.

Adult↗

Salivary gland neoplasms in children.

Salivary gland neoplasms in children represent an uncommon entity. However, the presence of such a tumor demands an accurate diagnostic evaluation in view of the commonplace occurrence of malignancy. Observation of fluctuant masses and surgical resection of firm masses are the recommended principles of management, with the majority of these neoplasms having a favorable prognosis.

Adolescent↗

Malignant salivary gland neoplasms.

The treatment of salivary gland malignant neoplasms is challenging because of their infrequency, their unpredictable and varied biologic behavior, and their prolonged risk of recurrence. This article covers the pathophysiology of malignant neoplasms of the salivary glands. Emphasis is placed on the more common neoplasms. Histologic classification and management of neoplasms are also reviewed in this article.

Humans↗

Accuracy of frozen-section diagnosis in salivary gland neoplasms.

A retrospective review of 100 patients with major or minor salivary gland neoplasms was conducted to ascertain the accuracy and effect on therapy of frozen-section diagnosis. Of these patients, 23% had malignant and 77% benign neoplasms. Twelve patients benefited by further surgery during the initial operation, and no treatment delay occurred as a result of frozen-section diagnosis. There were four incorrect diagnoses of clinical significance, two false positives (benign tumor called malignant on frozen section) and two false negatives (malignant tumor called benign on frozen section). The accuracy of frozen section for specific pathologic diagnosis was 92%. No unnecessary radical surgery was performed. Frozen-section diagnosis of salivary gland neoplasms in our institution was found to be accurate and useful.

Adenoma, Pleomorphic↗

Salivary gland neoplasms.

Treatment and cure of salivary gland neoplasms requires surgical intervention in most cases. For parotid neoplasms, the most common surgical procedure performed is the superficial parotidectomy with facial nerve preservation. Postoperative radiation therapy is indicated in high-grade salivary gland malignancies and malignancies with increased risk of locoregional recurrence. Primary radiation, including neutron beam techniques, may play a role in certain histologic types or nonoperative candidates. Chemotherapy has yet to result in improvements in survival or quality of life in the treatment of salivary gland malignancy. Advances in radiation therapy techniques, including intensity-modulated radiation therapy, provide opportunities for reduced morbidity.

Chemotherapy, Adjuvant↗

Myoepithelial cells in salivary gland neoplasms.

Archival paraffin sections from normal salivary gland tissue and salivary gland neoplasms were stained by immunoperoxidase technique with a well characterized cytokeratin antibody (PKK1). In normal parotid tissue, myoepithelial cells and peripheral cells of larger ducts were selectively stained. In pleomorphic adenomas, most cells were stained, the staining being somewhat stronger towards the duct lumina. In basal cell adenomas, only cells adjacent to the duct lumina were stained where a differentiation of cells into peripheral and ductal was seen. In adenolymphomas basal cells were stained, and in oncocytomas small elongated cells reacted with the PKK1 antibody. Only a few duct cells in an acinic cell carcinoma were reactive and in mucoepidermoid carcinoma, peripheral epidermoid cells were strongly stained. In adenoid cystic carcinoma, mostly duct cells were stained whereas the peripheral ones remained unstained. Although the intermediate filament protein expression is very stable during tumorigenesis, the staining with the presently used monoclonal antibody in salivary gland neoplasms differed markedly from what could be expected according to current views on the participation of this cell type. This supports our view that cells in tumors should be characterized on the basis of their staining, i.e. state of differentiation and not on their presumed histogenesis.

Adenoma↗

Necrosis in benign salivary gland neoplasms. Not necessarily a sign of malignant transformation.

Necrosis that occurs in a salivary gland neoplasm is usually considered to be an ominous sign, suggesting malignant transformation, particularly in lesions that have had no prior manipulation such as fine-needle aspiration. We describe five pleomorphic adenomas and two canalicular adenomas of salivary gland origin that exhibited necrosis, yet were otherwise benign. All lesions displayed a distinctive histopathologic pattern characterized by a narrow rim of viable tumor tissue at the periphery of the neoplasm combined with a diffuse central region that demonstrated apparent ischemic necrosis. No invasion of adjacent normal tissue was identified, and no recurrence or metastasis has been seen with these lesions. Caution should be exercised in the evaluation of salivary gland neoplasms with central necrosis to avoid misdiagnosis of all such lesions as malignant.

Adenoma↗

Epithelial salivary glands neoplasms in children and adolescents: a forty-four-year experience.

BACKGROUND: Epithelial neoplasms of salivary gland origin are relatively uncommon in children and adolescents. Over a 44-year period, there were 38 cases affecting children under 19 years of age in our Pediatric Hospital-Based Tumor Registry. PROCEDURE: Medical charts of 38 patients with epithelial neoplasms of salivary glands were reviewed. Data collected included demographic, clinical, and histological characteristics. Statistical analysis included descriptive statistics, Student t-test, and Kaplan-Meier method was used for survival analysis. RESULTS: The mean age was 11.8 years. There was a female preponderance of 1.9:1. The parotid gland was affected in most cases (65.8%). Twenty-seven patients had malignant tumors and eleven patients presented benign neoplasms. Pleomorphic adenoma was the most frequent benign tumor (7 out of 11) and mucoepidermoid carcinoma was the most frequent malignancy (17 out of 27). Five-year overall survival rate was 81.6% for patients with malignant tumors. Grade of differentiation was the only significant prognostic factor for patients with mucoepidermoid carcinomas. CONCLUSIONS: Epithelial salivary gland tumors are very rare in children. Surgery is the best option to achieve high cure rates and radiotherapy must have precise indications because of their long-term side effects in young age.

Adenoma↗

Histopathologic grading of salivary gland neoplasms: I. Mucoepidermoid carcinomas.

Histopathologic grading of salivary gland neoplasms has been done with various degrees of success and hence various degrees of acceptance among pathologists and otolaryngologists-head and neck surgeons. Given their histopathologic diversity, three carcinomas--mucoepidermoid, adenoid cystic, and acinic cell--would seem to be suitable candidates for grading. In this, the first of a three-part series, the authors present a three-level grading scheme for mucoepidermoid carcinomas. It combines histocytologic and growth features of the carcinomas that independently or together, in other grading proposals, have shown prognostic value.

Carcinoma↗

Chemotherapy of advanced salivary gland neoplasms.

Fourteen patients with advanced salivary gland malignancies were treated with combination chemotherapy. Five of 13 patients responded to cyclophosphamide and adriamycin and two patients in the responding groups underwent further potentially curable treatment, rendering them disease-free. Three patients with mucoepidermoid carcinoma failed to respond to this regimen, but two of three patients treated with a combination of cisplatinum, bleomycin and methotrexate responded. The potential role for chemotherapy in the treatment of salivary gland malignancies is discussed.

Adult↗

Lymphadenoma: a report of three cases of an uncommon salivary gland neoplasm.

AIMS: Lymphadenoma of the salivary gland is a rare neoplasm that has not been properly characterized. This study describes the clinicopathological features of three cases. METHODS AND RESULTS: All three patients were males, ranging in age from 13 to 57 years. Two presented with a parotid mass, and one a preauricular mass. The tumours were well circumscribed, comprising anastomosing trabeculae, solid tubules, glands or basaloid islands of epithelium with or without cyst formation, accompanied by a prominent lymphoid stroma lacking sinuses. Large reactive lymphoid follicles were found in two cases. The epithelial cells were bland-looking to mildly atypical. Immunostaining demonstrated dual luminal cell and abluminal basal cell differentiation, with the former being often subtle and highlighted only by immunostaining for epithelium membrane antigen or CAM 5.2, and the latter being highlighted by p63 immunostain. CONCLUSIONS: Although there is some variation in the histological pattern from case to case, lymphadenoma is a morphologically recognizable salivary gland adenoma characterized by a dense lymphoid infiltrate. Lack of familiarity with this tumour may lead to misdiagnosis as myoepithelial sialadenitis, lymphoma, metastatic carcinoma in lymph node or lymphoepithelial carcinoma.

Adenolymphoma↗

Incidence of salivary gland neoplasms in Greenland with special reference to an anaplastic carcinoma.

Forty-two salivary gland neoplasms were diagnosed in Greenland 1955--1974. Twenty-five cases were malignant of which 92 per cent were an undifferentiated carcinoma, histologically identical to malignant lymphoepithelial lesion. Age adjusted incidence rates for salivary gland carcinomas 1965--1974 were among the highest on record, significantly higher than in Denmark. Prognosis was poor with a 5-year determinate survival rate of 14 per cent. The majority of previously reported malignant lymphoepithelial lesions of salivary glands have occurred in Arctic dwellers in Alaska and Northern Canda. Virus infection and/or dietary deficiencies may be etiological factors. In the present study secondary nasopharyngeal carcinoma could not always be excluded.

Adenolymphoma↗