[ON THE INTERSTITIUM OF EPITHELIAL TUMOR TYPES OF THE MUCOUS AND SALIVARY GLANDS].
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Hyalinizing clear cell carcinoma is a low-grade indolent and rare salivary gland tumor originally described by Milchgrub et al. in 1994. We herein report a case of this tumor of the base of the tongue. A 66-year-old Japanese woman presented with a large painless mass in the throat. Computed tomography and magnetic resonance imaging revealed a 40x30-mm well-defined ovoid tumor arising from the base of the tongue. She underwent tracheostomy followed by a resection of the tumor via the transmandibular approach combined with a right-sided supra-omohyoid neck dissection. Because the tumor invasion of the surrounding tissue was limited, the surgical defect at the base of the tongue was relatively small, and no reconstructive procedure needed to be performed. The tumor was histopathologically diagnosed as hyalinizing clear cell carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the eighth postoperative day. The patient is currently free from disease 21 months after surgery. The pathology, clinical characteristics, and treatment of hyalinizing clear cell carcinoma are bibliographically reviewed.
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The purpose of this study was to quantify the sonographic images of salivary gland tumors. The study population consisted of 21 pleomorphic adenomas, seven Warthin's tumors and 15 malignant tumors. We selected the region-of-interest within the lesion. We made a contour map and evaluated the complexity of the contour lines using the 2-D box-counting (BC) method. We also evaluated the 2-D distribution of the pixel values by the 3-D BC method and the fractional brownian movement (F BM) model. The fractal dimension by the 2-D BC method of pleomorphic adenoma was significantly larger than that of malignant tumors. The FD by the 3-D BC method of pleomorphic adenoma was significantly larger than both that of Warthin's tumors and that of malignant tumors. The Hurst index obtained by the F BM model of pleomorphic adenoma was significantly lower than that of the malignant tumor.
Polymorphous low-grade adenocarcinoma, also known as terminal duct or lobular carcinoma, was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms including pleomorphic adenomas, variants of monomorphic adenomas, or salivary malignant conditions including malignant pleomorphic adenomas, adenoid cystic carcinomas, and adenocarcinoma not otherwise stated. This neoplasm with few exceptions originates in minor salivary gland tissue of the posterior hard and soft palates or buccal mucosa. It is characteristically slow to enlarge; clinical reports show the neoplasm present for many years before diagnosis. We have evaluated the clinical and microscopic features of 15 cases from the archives of The University of Iowa Surgical Oral Pathology Laboratory and added these to published case reports. A total of 204 cases were evaluated with a female/male ratio of almost 2/1. Forty-nine percent originated in palatal mucosa. Polymorphous low-grade adenocarcinomas arising from pleomorphic adenomas or de novo have been reported within major salivary glands and outside the oral cavity. A 17% recurrence rate was found with a regional metastasis rate of 9%. Five cases had multiple recurrences, and 13 recurrences were at or beyond 5 years after the initial diagnosis. Regional node metastases were identified at the time of initial treatment or at the time of recurrence in 9% of cases in which follow-up data were specified.
OBJECTIVE: Malignant epithelial tumours arising in the jaws are very rare. Adenoid cystic carcinoma (ACC) represents approximately 7.5% of all carcinomas and only a few cases of intraosseous (central) ACC have been reported in the literature. MATERIALS: The salient clinico-pathological features of a case of ACC, bilaterally occurring in the mandible of a young caucasian woman who also had lung metastases are reported to appropriately characterize such unusual lesions and discriminate them from other tumours that more commonly affect the mandible. RESULTS: The patient presented with a painful swelling of the right retro-molar area and paraesthesia of the ipsilateral lower lip and radiological investigations disclosed bilateral radiolucent lesions of the mandible with unequivocal signs of malignancy but without intra-lesional calcifications or association with teeth roots or cystic component. Conventional histological examination disclosed typical ACC with solid and cribriform growth patterns and extensive infiltration of the adjacent tissues. CONCLUSIONS: The diagnosis of intraosseous malignant salivary gland type neoplasms is very difficult in view of their rarity and lack of specific signs and mainly achieved after histological examination and complete clinico-radiological work up. As surgical treatment of the patient was not indicated, due to extensive neoplastic disease, the patient is being controlled with multimodal treatment, including chemo- and radiotherapy and is alive with persistent disease 3 years after the original diagnosis.
At low concentrations of DMBA (½% and 1%) twice as many sarcomas and carcinomas of the salivary glands are induced in male as in female rats. Additional oestrogens reduce neoplasms in males by one half while testosterone doubles them in females. The sex difference disappears at the higher dose levels of the carcinogen (2%).Females are more sensitive than males to the toxic effects of DMBA, though less sensitive to the carcinogenic action.Carcinomas rise to a single peak within 240 days while sarcomas appear as late as 770 days with secondary and tertiary peaks. This difference in pattern of induction may be due to the formation of a fibrous capsule separating persisting DMBA-deposits from the epithelial structures and thus protecting them from carcinogenic risk.
Serum levels of three glycoprotein tumour antigens (carcino-embryonic antigen, CEA; cancer-associated antigen 50, CA-50; gastrointestinal cancer-associated antigen, CA 19-9) were determined on 125 consecutive patients with tumours of the head and neck region. Elevated CEA values (greater than 5 units/ml) were found in 13/70 squamous cell carcinomas, 3/21 benign and 4/18 malignant salivary gland neoplasms. Elevated CA-50 values (greater than 17 units/ml) were found in 19/70 squamous cell carcinomas, 6/18 malignant and 1/21 benign salivary neoplasms. CA 19-9 displayed higher values (greater than 37 units/ml) in 9/68 squamous cell carcinomas, 4/18 malignant and none of 21 benign salivary gland tumours. Combination of CEA and CA-50 analyses increased the proportion of elevated values to 30/70 in squamous cell carcinomas and 10/18 in salivary gland malignancies. In squamous cell carcinomas no correlation between staging or grading and serum levels was detected for any of the markers. Among malignant salivary gland tumours, CA-50 displayed enhanced serum values in 4/6 mucoepidermoid carcinomas. The mean values for CA-50 and CA 19-9 serum levels were significantly higher for malignant salivary gland neoplasms compared to benign tumours. There was a close correlation between CA-50 and CA 19-9 serum levels. Although, the results suggest that at present none of the tumour markers tested have a place alone in the routine examination of patients with tumours affecting the head and neck region, further studies on salivary gland neoplasms and combinations of the tumour markers are justified.
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A monomorphic adenoma (ductal type) of the palatal minor salivary glands is reported. Ultrastructurally, the predominant tumor cells contained zymogenlike dense secretory granules. There was a continuum from tumor cells with little or no secretory granules to ones with increasing numbers of granules. Except for that, the tumor cells shared many of their fine structural features. Histogenetically, the tumor originated from neoplastic proliferations of "undifferentiated" stem cells corresponding to "end-bud" stage of salivary glands embryogenesis. Under neoplastic influences, such cells underwent further cytodifferentiation and functional maturation along the secretory cell lines. In mature salivary glands, such pluripotential cells reside as "reserve" cells in the intercalated ducts.
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We describe six cases of terminal duct carcinoma of the minor salivary glands. All were localized to the oral cavity, without regional nodal or distant metastases. Histologically, five were originally mistaken for adenoid cystic carcinoma; one was interpreted as monomorphic adenoma with areas of adenoid cystic carcinoma. Treatment consisted of wide resection with or without radiation therapy, with no incidence of recurrence or metastasis. The characteristics of this recently described pathologic entity are reviewed. The less aggressive behavior of this tumor compared with adenoid cystic carcinoma should call for less radical therapy, with a favorable prognosis in most cases. Recognition of this tumor as a distinct clinical and pathologic entity is therefore important.
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