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[Basal cell adenocarcinoma of the minor salivary glands of the palate. Case report and review of the literature].

Basal cell adenocarcinoma was first introduced as an entity in the second edition of the WHO's "Histologic Typing of Salivary Gland Tumours" in 1991. This tumor was first described in 1990 by Ellis and Wiskovitch from the Armed Forces Institute of Pathology (AFIP). Basal cell adenocarcinoma accounts for about 2.9% of all salivary gland malignancies. More than 90% of the tumors are situated in the parotid gland. Intraoral manifestations are known from case reports only. Tumors of the palate have been mentioned in three cases. Histologically this tumor can be easily confused with basal cell adenoma and the solid basaloid subtype of adenoid cystic carcinoma. The case presented here is a middle-aged white woman with a basal cell adenocarcinoma of the palate. Therapy consisted of surgical extirpation with three-dimensional safety margins and histologically proven clear resection margins. Knowledge at this point indicates that basal cell adenocarcinoma has a rather high probability of local recurrence (up to 50%) and a mostly lymphogenous metastatic potential for as long as 10 years after removal of the primary tumor. Ten year survival is around 75%.

Adenocarcinoma↗

MALT Lymphoma in Children: Case Report and Review of the Literature.

Mucosa-associated lymphoid tissue (MALT) lymphoma predominantly occurs in adults, and is rare in children. We report a case of MALT lymphoma involving minor salivary gland of the lip in an otherwise healthy 12-year-old boy. This is the second case report of MALT lymphoma of minor salivary gland in an immunocompetent child. Of 24 cases of MALT lymphomas in children reported in the English literature, parotid MALT lymphomas in human immunodeficiency virus (HIV) patients and H. pylori infection-associated gastric MALT lymphomas are the most common. As in adult cases, most MALT lymphomas in the pediatric age group are localized and follow an indolent clinical course, respond well to therapy, and have an excellent outcome.

Antigens, CD↗

The papillary cystadenoma of minor salivary gland origin.

This article reviews the literature of the papillary cystadenoma of minor salivary gland origin and discusses and attempts to clarify the true nature of these lesions. The criteria for diagnosis are presented, and classification of this lesion based on the Histological Typing of Salivary Gland Tumours (World Health Organization) is suggested. In addition, an interesting variant, which we have called the papillary cystadenoma, mucous-cell type, is presented.

Aged↗

Lipofuscin in salivary glands in health and disease.

Lipofuscin granules were observed in normal salivary glands (parotid, submandibular, and minor salivary glands). The pigment was confined mainly to the epithelial cells of the intralobular ducts, but isolated granules were also found in acinar cells and myoepithelial cells. In chronic sialadenitis pigment granules were found in the intralobular epithelial cells and in macrophages in the surrounding ionnective tissue. In benign epithelial tumors pigment granules were observed within neoplastic epithelial cells and in macrophages in the stroma, while malignant tumors displayed pigmented granules only in macrophages in the stroma.

Adenoma, Pleomorphic↗

Necrotizing sialometaplasia. A review of the literature and report of two additional cases.

Necrotizing sialometaplasia is a nonneoplastic, inflammatory, variably ulcerated, occasionally bilateral, self-healing lesion of human salivary glands which is often confused clinically and histologically with squamous cell or mucoepidermoid carcinoma. On the basis of thirty-three documented cases, the lesion occurs primarily in the minor salivary glands of the palate (87.9 percent), with 63.6 percent arising in the fifth and sixth decades (average age 46.0 years, range 22 to 68 years). There is a marked predilection for males (ratio of males to females. 2.7:1) and a questionable predominance in Caucasians (60.6 percent). Numerous etiologic factors have been proposed; however, on the basis of previous animal experimentation, the lesion appears to be infarctive in nature.

Adult↗

Acinic cell tumors of minor salivary glands.

The occurrence of acinic cell tumors in the minor salivary glands of the oral cavity has, until recently, been considered exceptional. However, three recent papers have documented the details of fifty-two such cases. The purpose of the present article is to record the clinical information and histologic findings in six additional, previously unreported, examples of this tumor in the minor salivary glands.

Female↗

Necrotizing sialometaplasia: an early, nonulcerative presentation.

Necrotizing sialometaplasia usually presents as a painless, deeply excavating ulcer and is considered in the differential diagnosis of large palatal ulcers along with mucoepidermoid carcinoma and adenoid cystic carcinoma. This case is presented to illustrate that the early signs and symptoms of necrotizing sialometaplasia may be swelling with a purulent exudate, diffuse, vague pain, and numbness. It also demonstrates the rapidity with which initial signs of healing become apparent. This latter clinically suggests a benign process.

Adult↗

Lobular carcinoma of intraoral minor salivary gland origin. Report of twelve cases.

In an attempt to define more accurately the tumors grouped under the heading of "adenocarcinoma of salivary gland origin," we reviewed the cases in our registry that were classified as adenocarcinoma, carcinoma of salivary gland origin, and infiltrating epithelial salivary gland tumors. Eleven tumors that had certain unique microscopic features in common were identified. These eleven tumors and one that was reviewed in consultation make up the basis of this study. We classified these lesions as lobular carcinoma of salivary gland origin because of their remarkable microscopic resemblance to the breast tumors of the same name. These lesions appear to be of low-grade malignancy and have not recurred or metastasized in any of the eleven cases for which we have follow-up data, at times ranging from 5 to 80 months.

Adult↗

Canalicular adenoma: not a basal cell adenoma.

The evidence that canalicular adenomas and basal cell adenomas are separate entities is presented in this article. The clinical features were studied in a series of 13 previously unreported salivary gland tumors (5 canalicular adenomas and 8 basal cell adenomas) and 99 examples derived from the literature (68 canalicular adenomas and 31 basal cell adenomas). Representative tumors from the new cases and from 66 referred cases were studied by histologic, histochemical, and electron microscopic techniques. The two tumors differ significantly with respect to the age range of affected patients, site of predilection, and morphologic and histochemical features.

Adenoma↗

Characterization of cells in salivary gland lesions by immunohistochemical identification of carcinoembryonic antigens.

Immunohistochemical demonstration of carcinoembryonic antigen (CEA) was reported in normal salivary glands and in pathologic lesions. Staining patterns of CEA and nonspecific cross-reacting antigen-absorbed CEA (NCAa-CEA) were compared. Normal salivary glands disclosed positive staining by CEA on border and luminal sides of acinar cells and occasionally in components secreted into ductal spaces with both antigens used. Chronic obstructive lesions displayed an intense CEA staining in ductlike structures and in material secreted into their lumina in the two antigens used. Pleomorphic adenoma exhibited varying intensities of CEA in neoplastic epithelial cells of ductal structures. In contrast, they showed a slight staining reaction to NCAa-CEA. Squamous-cell carcinomas showed a strong CEA reaction, whereas they showed no reaction or a trace reaction to NCAa-CEA. Positive staining to CEA in squamous neoplastic lesions was related to nonspecific reacting antigens.

Adenoma, Pleomorphic↗

Immunolocalization of keratins in salivary gland pleomorphic adenoma using monoclonal antibodies.

Monoclonal antibodies to keratins (KL1 and PKK1) were tested on paraffin sections in forty cases of pleomorphic adenoma from salivary glands. Squamous cells in the epidermis were positive for KL1, except for the basal cells, which were positive for PKK1. In normal salivary glands, ductal cells were positive for KL1 and PKK1 keratins, whereas KL1 staining of the large excretory ducts was weaker than that of PKK1. Myoepithelial cells were positive only for KL1. In pleomorphic adenoma, the following reactions were noted: a positive staining for KL1 and PKK1 was present in the inner layer of cells within tubular and ductlike structures, a markedly positive staining for KL1 was present in squamous metaplastic cells, and a negative staining reaction with KL1 and PKK1 in spindle-shaped tumor cells was observed within the outer layer. Spindle-shaped or fibroblast-like cells in the stroma, probably myoepithelial in origin, showed an irregular staining expression for KL1 and PKK1.

Adenoma, Pleomorphic↗

HLA-DR antigens in normal, inflammatory, and neoplastic salivary glands.

A monoclonal antibody to HLA-DR antigens that is reactive in formalin-fixed tissues was used with the immunoperoxidase method to evaluate 212 salivary gland lesions (normal, nonspecific, and autoimmune inflammatory, benign, and malignant tumors). Results of immunostaining showed that (1) intercalated ducts, myoepithelial cells, and acinous cells of normal salivary glands express HLA-DR antigens, (2) autoimmune salivary gland disease results in greater HLA-DR expression than that seen in nonspecific inflammatory lesions or normal glands, (3) stromal cells associated with benign and malignant salivary gland tumors express HLA-DR antigens, and (4) numerous benign and malignant salivary gland tumors express HLA-DR antigens. It was of interest that lymphocyte-rich Warthin's tumors displayed epithelial immunoreactivity, whereas oncocytomas devoid of a lymphocytic component were invariably negative. This suggests a lymphocyte-mediated role in salivary epithelial HLA-DR expression. It appears that HLA-DR expression is both a normal and an inducible phenomenon in salivary glands, salivary gland neoplasia, and the desmoplastic host response. There is no discriminatory role in the immunologic detection of HLA-DR for differential diagnosis of salivary gland tumors.

Adenoma↗

Immunohistochemistry and ultrastructure of myoepithelium and modified myoepithelium of the ducts of human major salivary glands: histogenetic implications for salivary gland tumors.

The organization of salivary gland ducts, especially the presence or absence of myoepithelial cells, is central to histogenetic approaches to the classification of salivary gland tumors. Striated and excretory ducts are reported to be devoid of myoepithelial cells but do contain basal cells. To investigate the nature of such basal cells, tissue sections of normal human salivary glands were examined by means of immunohistochemical, ultrastructural, and fluorescent microscopic techniques. With the use of a mouse monoclonal anticytokeratin antibody (3 12C8-1) that, in salivary glands, is specific for myoepithelial cells, these cells associated with acini and intercalated ducts were strongly stained, as were the basal cells of striated and excretory ducts in each case. Ultrastructurally, some basal cells of both striated and excretory ducts had narrow, elongated cellular processes or the main portion of the cell containing parallel arrays of microfilaments with linear densities and micropinocytotic vesicles, whereas in other basal cells tonofilament bundles predominated. A similar range of cytoplasmic features existed in myoepithelial cells associated with acinar and intercalated duct cells. In addition, some duct basal cells have a complement of actin filaments similar to classic myoepithelium of acini and intercalated ducts. Striated and excretory ducts of human salivary glands, therefore, contain fully differentiated and modified myoepithelial cells, both of which express a specific cytokeratin polypeptide that is absent from duct luminal and acinar cells. Differentiation patterns in the intralobular and interlobular ducts suggest that these regions of salivary gland parenchyma cannot be excluded as histogenetic sites for the induction of salivary gland tumors in which neoplastic myoepithelial cells have been shown to have a major role.

Epithelium↗

Acinic cell carcinoma of minor salivary gland origin.

We describe a case of acinic cell carcinoma of the right soft palate in a 65-year-old man. The primary symptom was a painless swelling of the palate, which was partially ulcerated with a granulomatous appearance. Ultrastructurally, the tumor cells were mainly composed of differentiated acinuslike cells containing numerous round secretory granules identical to those in normal serous salivary glands. The tumor cells frequently contained numerous long crystalloid structures in the cytoplasm. Furthermore, tumor cells demonstrating degrees of squamous differentiation were present. These cells contained intracytoplasmic keratin filaments and a few keratohyaline granules. They formed a glandular acinar space in direct contact with the typical acinic cells with secretory granules. These observations suggest that acinic tumor cells have a degree of multipotentiality.

Aged↗