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PubMed1992

Inflammatory pseudotumors of the major salivary glands. Clinicopathologic and immunohistochemical analysis of six cases.

Inflammatory pseudotumor is a pathologic term used to describe reactive, pseudoneoplastic phenomena, which reportedly occur in many parts of the body. Clinicopathologic and immunohistochemical findings in six cases of inflammatory pseudotumor of the major salivary glands are described. All six lesions involved the parotid gland. There were three men and three women affected, with a median age of 72.5 years. All patients presented with a swelling of several months' duration in the parotid region. Five patients were alive and free of tumor at an average of 3.2 years after surgical removal, and one patient was lost to follow-up. The lesions were firm, discrete nodules, grossly described as homogenous yellow-gray tissue. Histologically, all lesions contained a diversified admixture of four histological elements: (a) myofibroblasts, (b) histiocytes, (c) plasma cells, and (d) lymphocytes. Results of immunohistochemical studies showed a biphasic spindle cell population of myofibroblasts and histiocytes with variable staining characteristics for KP-1(CD-3), smooth muscle actin, muscle-specific actin, and vimentin. These findings are in agreement with the concept that inflammatory pseudotumor is a fibroinflammatory lesion with an abundant component of myofibroblastic/fibrohistiocytic elements.

Actins↗

PubMed1982

An atlas of salivary gland disorders.

In the initial evaluation of a possible salivary gland disorder, salivary scintigraphy is a diagnostic and non-invasive examination of function (7). Further definition of anatomical abnormalities may require a panoramic radiograph of teeth and mandible, contrast sialogram, ultrasound, or computerized tomography. However, these latter methods contribute primarily anatomical information, and scintigraphy remains the best assessment of function. Our clinical experience with salivary scintigraphy is summarized in Table 1.

Abscess↗

PubMed2002

Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment.

PURPOSE: Sialadenitis is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine whether Tc-99m pertechnetate salivary gland scintigraphy may be used for objective assessment of salivary gland function in patients with thyroid cancer treated with I-131. PATIENTS AND METHODS: The study group consisted of 71 patients (16 men, 55 women) with a mean age of 44 years (range, 16 to 73 years). Twenty-six (37%) patients were not given any radioiodine, and 18, 16, and 11 patients received doses of 100, 150, or 200 mCi (or higher), respectively. Parotid and submandibular glands were evaluated based on a four-grade scoring system. Correlation between the type of surgery, administered dose, time since therapy, subjective symptoms, and findings of salivary gland scintigraphy were evaluated. RESULTS: Subjective symptoms were questioned in 39 of the 45 patients who received radioactive iodine treatment. Fifty-four percent (21 of 39) of the patients reported xerostomia, of whom 86% (18 of 21) showed salivary gland dysfunction. Objective salivary gland dysfunction was observed in 69% (31 of 45) of patients. In 81% of the patients, the parotid glands were affected; in 13% of the patients, the submandibular glands were affected; and in 6%, both were affected ( < 0.000001). The frequency of salivary gland dysfunction showed a dose dependence to cumulative activity ( = 0.007). A greater complication rate was observed in patients with total thyroidectomy compared with subtotal surgery, although the correlation was not significant ( = 0.625). CONCLUSIONS: Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment is worse in the parotid glands and increases with the total dose.

Adenocarcinoma, Follicular↗

PubMed2000

Various imaging modalities for the detection of salivary gland lesions: the advantages of 201Tl SPET.

The aim of this study was to compare dual-isotope (99Tc(m) and 201Tl) SPET imaging with computed tomography (CT) and magnetic resonance imaging (MRI) in the differentiation of various lesions of the major salivary glands. Twenty-two patients underwent dual-isotope SPET imaging, of whom 12 also had CT and 15 also had an MRI study. The uptake ratio and retention index for 99Tc(m) and 201Tl were calculated by drawing regions of interest on the involved and normal glands. Both CT and MRI were interpreted by two radiologists. All malignant tumours were detected by all three modalities. Warthin's tumours were detected by dual-isotope SPET imaging; however, MRI failed to differentiate Warthin's tumour from pleomorphic adenoma. Of 13 other benign tumours, dual-isotope SPET correctly diagnosed 12. Of 16 tumours showing a cold defect on the 99Tc(m) images, parametric analysis with 201Tl gave an accuracy of 94%, whereas CT gave an accuracy of 70-90%. MRI was 73-91% accurate in differentiating between benign (Warthin's) and malignant tumours. We believe that dual-isotope SPET imaging (99Tc(m) and 201Tl), together with semi-quantitative analysis, is the method of choice for differentiating between various lesions of the major salivary glands.

Adenolymphoma↗

PubMed2001

The utility of SPECT in determining the relationship between radiation dose and salivary gland dysfunction after radiotherapy.

Salivary gland scintigraphy (SGS) is used to depict salivary gland dysfunction after radiotherapy (RT). The aim of this study was to investigate the utility of SGS combined with single photon emission computed tomography (SPECT). Twenty-one patients with a carcinoma of head and neck underwent SGS before and 1 month after RT. After injection of 370 MBq 99Tcm-pertechnetate, a biplanar dynamic acquisition (12 x 1 min) was started, followed by a SPECT acquisition during 4 min. Carbachol was then injected and a second dynamic study (16 x 1 min) was performed, again followed by a SPECT acquisition. The salivary excretion fraction (SEF) was calculated both from the geometric mean planar image for each parotid and from the SPECT data for each transverse plane through the parotids. The RT-induced changes in the SEF (dSEF) were correlated with the mean radiation dose calculated using tomography-based dosimetry. The mean radiation dose to the parotids was 44 Gy (range 4.4-68.1 Gy). The mean range of the variation in radiation dose to the transverse slices within the parotids of a patient was 24 Gy (range 6.2-51.9 Gy). Considering all transverse planes through the parotids in all patients, a linear correlation was found between the dSEF calculated using SGS-SPECT and the radiation dose (r=0.45, P=0.0001). Thirteen patients had a variation in radiation dose within the parotids of more than 20 Gy. In nine of these a significant intra-individual correlation between radiation dose and the dSEF of the transverse parotid slices was found (r range 0.55-0.97; P value range 0.037-0.0001). In conclusion, SGS-SPECT can be used for monitoring radiation-induced parotid gland dysfunction. It offers the unique possibility for the assessment of intra-individual dose-dysfunction curves in patients with large variations in the radiation dose within the parotids.

Adult↗

PubMed2001

Salivary scintigraphy for assessing the protective effect of pilocarpine in head and neck irradiated tumours.

Patients with head and neck cancers can develop salivary hypofunction after radiotherapy. The use of pilocarpine during radiotherapy treatment has been shown to be an effective treatment, although its usefulness is being discussed. The aim of this study was: (1) to determine the value of a semiquantitative scintigraphy method for measuring the uptake and excretory salivary function of patients with head and neck irradiated tumours; and (2) to study the usefulness of pilocarpine as a salivary gland protector during radiotherapy. We prospectively studied 49 patients (mean age 61 years, range 29-87 years) with head and neck cancer in need of radiotherapy. Patients were divided into two groups consecutively: group P (26 patients) received 5 mg of pilocarpine three times per day starting the day before radiation therapy, and group NP (23 patients) received radiotherapy without pilocarpine and were used as the control group. Salivary gland scintigraphy and a visual analogue scale (VAS) of mouth dryness were obtained from each patient before radiotherapy and during the first year after treatment. The most frequent finding after radiotherapy was a quick impairment in parotid and submaxillary excretion (P < 0.001). There were no statistical differences comparing the pilocarpine group against the non-pilocarpine group. Parotid and submaxillary uptake significantly decreased after radiotherapy in both groups (P < 0.001). However, a tendency to recover within the pilocarpine group was observed in both the parotids and the submaxillary glands at 12 months. No differences were found comparing the VAS results in both groups. Strikingly, VAS data did not correlate with salivary gland dysfunction observed by means of scintigraphy. In conclusion, salivary scintigraphy is a useful technique to evaluate objectively the salivary gland function of patients with head and neck irradiated tumours as well as to test the response to pilocarpine. However, despite better results on the salivary uptake at 12 months, pilocarpine did not significantly improve salivary gland function.

Adult↗

PubMed2006

Quantitative evaluation of salivary gland dysfunction after radioiodine therapy using salivary gland scintigraphy.

AIM: The most frequent non-thyroidal complication of high-dose (131)I therapy for thyroid carcinoma is salivary gland dysfunction, which may be transient or permanent. In this study, we assessed radioiodine-induced permanent salivary gland dysfunction using quantitative salivary gland scintigraphy. METHODS: Salivary scintigraphy was performed with (99m)Tc-pertechnetate on 50 thyroid carcinoma patients who had been given radioiodine for thyroid ablation; 20 normal subjects were imaged as the control population. Dynamic scintigraphy was performed and time-activity curves for four major salivary glands were generated. The glandular functional parameters maximum secretion, time at maximum count and uptake ratio of the parotid and submandibular glands were calculated. Correlation of the administered dose and subjective symptoms with findings of salivary gland scintigraphy was evaluated. RESULTS: The maximum secretion and uptake ratio were decreased in 46% and 42% of patients who received radioiodine therapy, respectively. Salivary gland dysfunction correlated well with the administered dose. The parotid glands were more affected than the submandibular glands. Fifty-two per cent of patients were symptomatic, 69.23% of whom showed salivary gland dysfunction. CONCLUSION: Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment was worse in parotid glands and increased with the total dose. The maximum secretion and uptake ratio were found to be sufficiently sensitive to distinguish the severity of the damage.

Adult↗

PubMed1977

Results of the Wilke operation to stop drooling in cerebral palsy.

Bilateral submaxillary gland excision and posterior transplantation of the elongated parotid ducts (as advocated by Wilkie) has proved to be an excellent procedure in the surgical treatment of drooling. I report a series of 20 patients who had excellent results from this, with amelioration of the drooling and minimal postoperative complications.

Adolescent↗

PubMed2007

Sialoendoscopic treatment for radioiodine induced sialadenitis.

BACKGROUND AND OBJECTIVE: The use of radioiodine (RI) for the ablation of residual thyroid tissue and metastatic thyroid cancer lesions after thyroidectomy has become established as standard treatment in the management of differentiated thyroid cancer and subsequent sialadenitis is the most common complication of RI therapy. The purpose of this study was to establish a new treatment modality for RI-induced sialadenitis. METHOD: The study group consisted of 115 patients with a mean age of 47.7 (range, 24-78) years. All patients received RI therapy after total thyroidectomy. The incidence of RI-induced sialadenitis, salivary gland involvement, administered RI dose, treatment modality, and result of treatment by interventional sialoendoscopy were evaluated. RESULTS: The incidence of RI-induced sialadenitis was 18% (21/115), with involvement of the parotid more frequent than the submandibular gland. The average development period of RI-induced sialadenitis was 4.8 months. The average RI dosage for the sialadenitis group was higher than for the nonsialadenitis group, suggesting that RI-induced sialadenitis may be dose related, although the data were not statistically significant because of the small numbers in the high-dose group. Conservative management was effective in 71% (15/21) of the cases, and interventional sialoendoscopy was successful in 50% of those cases that did not respond to conservative treatment. The causes of treatment failure in the remaining cases were a totally obstructed parotid duct and stenosis at the bifurcation site. CONCLUSION: Sialadenitis is the most common complication after RI therapy. Sialadenitis was successfully managed by conservative treatment in most cases, and interventional sialoendoscopy is an alternative method of treatment in selected cases such as in partial ductal stenosis.

Adult↗

PubMed1990

Fine needle aspiration cytology of salivary gland lesions: advantages and pitfalls.

Fine needle aspiration cytology (FNAC) was performed on 52 patients with salivary gland lesions. A definitive cytodiagnosis was possible in 45 cases: a sensitivity of 89% and a specificity of 94% was achieved. The pitfalls of FNAC of salivary gland lesions are reflected by the false positive and false negative rates which were 4%. Errors of cytodiagnosis are due to the morphological variability of these tumours which make sampling and interpretation difficult.

Biopsy, Needle↗

PubMed1995

Diagnostic difficulties in the interpretation of fine needle aspirates of salivary gland lesions: the problem revisited.

Cases of salivary gland lesions (n = 325), mainly neoplastic but including a small number of non-neoplastic lesions, investigated by fine needle aspiration (FNA) and with histological correlation, are reviewed. The review identified a number of differential diagnostic problems which are discussed in some detail. One false-positive and eight false-negative diagnoses had been made resulting in a 99.5% specificity and a 85.5% sensitivity. If type-specific diagnoses are made only when all defined diagnostic criteria are present and if any uncertainty is clearly conveyed to the clinician, FNA is a safe and accurate tool in the investigation of salivary gland lesions.

Biopsy, Needle↗

PubMed1996

Etiologies of the sicca syndrome: primary systemic amyloidosis and others.

BACKGROUND: The sicca syndrome has been defined as the occurrence of xerostomia and xerophthalmia. Sjögren's syndrome is the most common cause of the sicca syndrome; however, these two syndromes are not synonymous and there are many potential etiologies of the sicca syndrome. A less known cause of sicca syndrome is amyloidosis that to date has only been reported in the nondermatology literature. OBSERVATIONS: A 79-year-old man with known amyloidosis presented with persistent xerostomia. He had the classic cutaneous findings of periorbital and "pinch" purpura. A labial biopsy showed diffuse deposition of amorphous eosinophilic material surrounding salivary acini. Apple-green birefringence was noted with Congo red staining and the diagnosis was made of amyloidosis in the minor salivary glands causing xerostomia. CONCLUSIONS: The sicca syndrome can be caused by systemic amyloidosis. Because this fact is not in the dermatologic literature, many dermatologists are not aware of this uncommon presentation. The knowledge of the many causes of the sicca syndrome and an understanding of the differences between this and Sjögren's syndromes are important for any dermatologist.

Aged↗

PubMed1969

Sialography.

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Child↗

PubMed1989

Fine needle aspiration in the diagnosis of salivary gland lesions.

Fine needle aspiration biopsy (FNAB) of salivary glands was performed in 187 patients. In 106 patients with satisfactory FNAB smears who proceeded to surgery, the original cytologic diagnosis was compared with subsequent histopathology. There were 74 benign tumours and 25 malignant tumours. Nineteen of the latter were primary malignant neoplasms of the salivary glands, and 6 were metastatic. The cytologic diagnosis by FNAB correlated exactly with the histologic diagnosis in 95% of benign neoplasms and in 68% of malignant neoplasms, with an overall accuracy of 88%. A false negative diagnosis for malignancy was made in five cases and a false positive diagnosis in one case. Hence the sensitivity for malignancy was 80% and the specificity was 99%. The most frequently misdiagnosed lesions were pleomorphic adenoma and muco-epidermoid carcinoma. FNAB of salivary gland lesions is easy to perform and free of complications, but the cytologic patterns may be difficult to interpret, and considerable experience is necessary in order to achieve a high diagnostic accuracy.

Adult↗

PubMed1975

Experimental allergic sialoadenitis. VII. Reactivity of the parotid gland to antigenic challenge in passively immunized rats.

Rats were passively immunized by an intraperitoneal injection of homologous anti-BSA serum and their salivary glands were challenged 20 min or 24 hours later with BSA by the intraductal route. Immune complex sialoadenitis developed only when challenge was early. It is concluded that immunoglobulins are transferred from the circulation into the salivary glands and are relatively rapidly cleared by a mechanism yet unknown, possibly by salivary flow.

Animals↗

PubMed1986

Immunohistochemical localization of amylase in sialoadenitis and salivary gland tumors.

Immunohistochemical demonstration of alpha-amylase has been made in sialoadenitis-involved tissue and salivary gland tumors, as well as in normal salivary glands. Immunoreactive alpha-amylase with trypsin pretreatment was confined to irregularly staining serous acinar cells in the parotid and submandibular glands, and to demilunes in sublingual glands. In obstructive adenitis, staining was irregular from high to negative in acini in early or intermediate stages. Dilated ductal segments contained cells positive for alpha-amylase in the early stage following obstruction. Pleomorphic adenomas were usually negative for alpha-amylase but in rare cases tumor epithelia stained variably positive; i.e., staining occurred throughout the cytoplasm or at the periphery or apical part of the tumor cells. Luminal cavities of tubular and duct-like structures contained alpha-amylase-positive material. Epithelia in Warthin's tumor were also negative in general; however, scattered single or grouped tumor cells containing alpha-amylase were found. Mucoepidermoid tumors were also negative, though slightly positive cells were found intermingled among the negative squamous and mucous tumor cells. Cystic lesions in mucoepidermoid tumor were sometimes positive in the wall cells together with material secreted into the lumen.

Adenoma, Pleomorphic↗

PubMed1988

Immunohistochemical study of palatal salivary glands of denture wearing patients.

The binding pattern of antibodies against different cytokeratin (CK) polypeptides, tissue polypeptide antigen (TPA), carcinoembryonic antigen (CEA), lactoferrin (Lf), lysozyme (Ly) and secretory component (SC) in palatal glands (PSG) of long-term denture wearing patients has been studied to investigate immunohistochemically the localization of these marker proteins in normal PSG and in denture-induced sialadenitis of PSG. The study included palatal gland biopsies from 28 patients (15 f, 13 m; mean age 59 years), 17 of them with normal PSGs, 8 with focal obstructive sialadenitis, and 3 with diffuse sialadenitis. Presence of CK and TPA was found in all intra- and extraglandular salivary ducts, in the basophilic portions of acini, in some mucous acini, and in all atrophic acini. Increased expression of CEA and Lf was observed in inflammed areas of PSG which, on the other site, were devoid of Ly and SC. In the mucous acini of healthy PSG considerable basal Ly immunoreactivity was seen. SC was localized in almost all ductal cells and in some acinar cells. Appearance of Lf in the ductal cells of PSG indicates an early sign of palatal sialadenitis. Some distinctions in the expression pattern of the marker proteins between the mucous acini of major salivary glands and PSG point to differences in the functional activities of either group of salivary glands.

Denture, Complete, Upper↗

PubMed1989

Epithelial HLA-DR expression in labial salivary glands in Sjögren's syndrome and non-specific sialadenitis.

The expression of the Class II major histocompatibility antigen HLA-DR was quantified in the epithelial cells of labial salivary glands from patients with Sjögrens Syndrome (SS) and compared with similar expression in glands showing non-specific sialadenitis and normal controls. In all glands more duct cells were positive than acinar cells but only in sialadenitis and SS was strong epithelial staining seen. The proportions of duct and acinar cells expressing HLA-DR were increased between normals and sialadenitis (P less than 0.01) and between sialadenitis and SS (P less than 0.001). However, for all cases increased expression of HLA-DR correlated to the increased proportion of inflammatory cells in the gland (P less than 0.01). The results indicate that although HLA-DR is expressed on the epithelial cells in the glandular lesions of SS, this is not specific as it is also seen in sialadenitis. This supports the view that such expression is secondary to an inflammatory infiltrate and may not be of importance in initiating autoimmune tissue damage.

Adolescent↗