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MR has become the examination of choice for imaging salivary gland neoplasms. The improved soft tissue contrast of MR represents a significant improvement over CT, particularly for extension outside the gland. The appearance of various tumors and inflammatory processes is described.
OBJECTIVES: The purpose of this study was to investigate immunohistochemically the expression of tumor-associated glycoprotein 72 (TAG-72) using the monoclonal antibody (MAb) CC49 in salivary gland neoplasia and normal salivary glands in an attempt to determine the potential usefulness of MAb CC49 in diagnostic and therapeutic applications. MATERIALS AND METHODS: Eighty-six specimens (21 benign tumors, 41 malignant, and 24 normal salivary glands), fixed in 10% formalin and embedded in paraffin, were retrieved from the files of the Department of Oral Medicine and Oral Pathology at the Dental School of Aristotle University, Thessaloniki, Greece, and were retrospectively studied with hematoxylin and eosin and with the streptavidin-biotin-complex method using the MAb CC49. RESULTS: Strong immunoreactivity for TAG-72 was observed in salivary duct carcinoma, adenocarcinoma, papillary cystadenocarcinoma, low-grade mucoepidermoid carcinoma, normal submandibular, sublingual, and minor salivary glands. Weak or no immunoreactivity was found in adenoid cystic carcinoma, basal cell adenocarcinoma, polymorphous low-grade adenocarcinoma, and normal parotid gland. CONCLUSIONS: Our results suggest the potential use of MAb CC49 in the differential diagnosis of some salivary gland neoplasms in which their histopathologic features overlap, and in the radiation immunolocalization and immunotherapy of malignant tumors that are localized in the parotid gland.
Radionuclide salivary gland scans were performed on 44 patients using sodium pertechnetate Tc 99m. The accuracy of the scans and their usefulness in the clinical treatment of the patients were reviewed. The scan provided helpful information in 31 of 38 (82%) cases in which adequate follow-up data were available, although it proved diagnostic in only six patients. It was particularly useful in the evaluation of primary salivary gland neoplasms, acute and chronic sialadenitis, and sialolithiasis, as well as in the differential diagnosis of xerostomia. The value of this procedure in the elucidation of a variety of morphologic and functional diseases of these glands warrants its greater application in private otolaryngologic practices.
74 non-selected patients with suspected tumors of the major salivary glands were examined by high-resolution real-time sonography (7 MHz). The different tumors presented with characteristic but nonspecific echomorphological features. Cysts of the salivary glands, intraglandular lymphadenitis, and paraglandular lesions can be distinguished from real tumors of the salivary glands. In case of uncertain palpatory findings the demonstration of an intact echographic texture pattern proves the absence of a tumor. No false negative ultrasound tumor diagnoses were encountered (sensitivity 100%). In salivary-gland neoplasms high-resolution real-time sonography completes the clinical findings and provides important informations about size, number and type of space occupying lesions.
Salivary gland neoplasms are relatively rare. Among the salivary gland neoplasms minor salivary gland neoplasms are often deceptive to the clinician and challenging to the pathologist because of their varied morphology and diverse histopathological pattern. This article documents a case of canalicular adenoma of the upper lip mimicking mucocele and discusses the differential diagnosis of minor salivary gland neoplasms.
Metallothionein (MT) is a protein that has been studied in several tumors as a prognostic factor and as a potential myoepithelial cell marker in breast cancer. The aims of this study were to assess the immunohistochemical staining of MT in adenoid cystic carcinomas of the salivary glands (ACC), and to analyze possible morphological and quantitative variations among the solid, cribriform, and tubular histological subtypes. MT was investigated in 15 cases of ACC using the immunohistochemical technique. All of the cases expressed the MT antigen. This expression was noteworthy in cells depicting myoepithelial differentiation. ACC with predominant tubular pattern presented a significantly lower mean index of MT immunopositivity than did solid or cribriform subtypes, while these two latter groups did not differ in terms of MT expression. Our results suggest that MT may be an important tool for immunolocalization of myoepithelial tumor cells in salivary gland neoplasms.
We present a patient suffering from salivary duct carcinoma in the mobile portion of the tongue, arising from a minor salivary gland; this condition is extremely rare. The patient was a 64-year-old woman who presented with a nonpainful, hard mass in her tongue. An aspiration smear showed cells with very scant cytoplasm and pale oval nuclei containing small, single nucleoli. Scattered clusters of small cells had darkly stained nuclei. Neither necrosis nor cribriform areas were seen. The smears suggested a salivary gland neoplasm; however, definitive diagnosis of salivary duct carcinoma remained difficult. Partial glossectomy was performed with a wide margin. Macroscopic examination revealed an unencapsulated, submucosal tumour infiltrating underlying muscle. Microscopic examination revealed a salivary duct carcinoma with comedonecrosis and relatively few cribriform and papillary areas. This case suggests that it may not be easy to establish a definitive diagnosis of salivary duct carcinoma from an aspiration smear if the salivary duct carcinoma is composed of comedonecrosis surrounded by solid tissue in a noncribriform pattern.
Sebaceous differentiation in the oral mucosa and major salivary duct epithelium is an expected normal finding in humans. These usually asymptomatic and incidental collections of sebaceous cells can also be found in intimate or close relationship with definable classes of salivary gland neoplasms, or as sebaceous neoplasms of salivary glands. The neoplasms are uncommon and are classified as sebaceous lymphadenoma, sebaceous adenoma, and sebaceous carcinoma. The two adenomas have a low recurrence potential; the carcinomas have a biologic behavior like that of ocular sebaceous carcinomas.
An unusual case of canalicular adenomas appearing bilaterally and simultaneously as separate nodules of the right and left upper lip is described. Upon histological examination, both nodules revealed tumor islands within their respective capsules, as well as outside their capsules and extending into normal salivary gland tissues. The article describes this unusual case and reviews the significance of the extracapsular tumor islands. The immunohistochemical profiles of canalicular adenoma and other salivary gland neoplasms with similar histology are compared and discussed.
Canalicular adenoma is a recently classified uncommon salivary gland neoplasm. This biologically benign growth tends to be multifocal and occurs most often in the upper lips of elderly people. Histologically and clinically it differs from the basal cell adenoma, for which it may be mistaken, in a number of ways. Its clinical importance lies in the fact that it may be confused with malignancy. Little information is available regarding the recurrence and long-term follow-up of these tumours, and where available it covers only relatively short periods. We report the recurrence of a canalicular adenoma after an 11.2 year disease-free period.
This case report describes an unusual salivary gland lesion that involved the retromolar area. This lesion presented clinically as an asymptomatic tumorlike nodule that was characterized microscopically by a proliferation of mucous salivary gland tissue. The exact nature of this focal enlargement of accessory salivary gland tissue is not known. Because this lesion cannot be distinguished clinically from a salivary gland neoplasm, it must be excised and examined microscopically.
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Although pleomorphic adenomas (PAs) usually can be diagnosed very accurately with fine-needle aspiration biopsy (FNAB), even this common salivary gland neoplasm can be diagnostically challenging and cause pitfalls in cytodiagnosis. In particular, the presence of either cystic changes or squamous, mucinous, or sebaceous metaplasia can lead to a false positive diagnosis of mucoepidermoid carcinoma (MEC). Here, we present a case of a 70-yr-old man with an asymptomatic left deep lobe parotid mass for which CT-guided FNAB was performed. The FNAB cytology revealed cohesive clusters of squamous epithelial cells, sebaceous cells, oncocytes, macrophages, and rare myoepithelial cells. Characteristic metachromatic fibrillar chondromyxoid stroma, which usually is seen in PAs, was not seen in the aspirate. Although cytodiagnosis of PAs was suggested based on the presence of other cellular components, resection was recommended. The subsequent parotidectomy specimen revealed an encapsulated cystic PA with mixed appendageal differentiation including areas of squamous, mucinous, sebaceous, and oncocytic metaplasia. Chondromyxoid stroma was only focally present. Presence of squamous, mucinous, and/or sebaceous metaplasia, especially in the absence of chondromyxoid stroma, presents the potential for misinterpretation of the FNAB as indicative of malignancy in general and MEC in particular.
The presence of intermediate filament proteins (IFP) in normal salivary gland tissue and investigated by immunohistochemical techniques on frozen sections. Cytokeratins (CKs) were seen in almost all normal epithelial cells. In the parotid gland and in palatal gland tissue, a co-expression of cytokeratin and glial fibrillary acidic protein (GFAP) was seen in some myoepithelial cells, but this was not apparent in the submandibular gland. In some pleomorphic adenomas, carcinomas in pleomorphic adenomas, one mucoepidermoid carcinoma, one mucus-producing adenopapillary carcinoma and one adenoid cystic carcinoma, cells expressing three different IFP classes were found (CKs, vimentin, GFAP). These cells were most often situated peripherally in the tumour cords or ducts. The cytokeratin pattern in these cells, as revealed by mAbs PKK1-3, was similar to that in normal myoepithelial cells. Furthermore, reactivity for a fourth class of IFP, desmin, could be seen in this cell type in two carcinomas in pleomorphic adenomas, and also in a few cells in a pleomorphic adenoma and an adenoid cystic carcinoma. Thus the pattern of IFP expression in salivary gland neoplasms, is very complex, and cannot always be related to the normal tissue.