Oncocytic adenocarcinoma of the submandibular gland

BACKGROUND: Malignant oncocytic tumors rarely occur in major salivary glands and generally account for < 1% of all salivary tumors. There is no difference of both sexes and appearing mainly between 50 and 60 years of age. They comprise oncocytes, which are epithelial cells with abnormally formed cytoplasm and acidophilic granular cytoplasma. In the process of the malignant transformation the coexistence from oncocytic rests and untypical oncocytic carcinoma portions can be seen. The tumors show no capsule and an infiltrative local growth with perineural and vascular expansions. PATIENT AND METHOD: A rare case of a 59-year-old man with malignant oncocytoma is presented. The tumor was found in the left submandibular gland with one enlarged lymph node near by. RESULT AND CONCLUSIONS: A general overview of the available literature and the histological classification of oncocytomas is given. Therapy consists of surgical resection and radiotherapy. Close clinical controls are necessary.     

Oncocytic carcinoma of the salivary glands: A Danish national study

Objectives

To present a Danish national series of oncocytic carcinoma (OC) patients, including data on treatment, recurrence and survival.

Onkozytäre Neoplasien der Parotis Differentialdiagnosen, klinischer Verlauf und Literaturübersicht

Background and objective. Oncocytic neoplasms of the salivary glands are rare. Patients/methods. We report on seven cases of oncocytic neoplasms of the parotid gland (one multifocal nodular oncocytic hyperplasia, five oncocytomas, and one oncocytic carcinoma). Results. While the history, clinical presentation, and histology of all oncocytic neoplasms showed no characteristic differences, intraoperatively the well-differentiated oncocytic carcinoma displayed an infiltrative, locally aggressive growth pattern. A local carcinoma recurring 7 years later corresponded to the primary tumor. There were no metastases. Immunohistochemistry revealed that all oncocytic neoplasms were positive for markers of cytokeratins (Kl-1) and negative for markers of carcinoembryonal antigen (CEA), S-100 protein, and smooth muscle actin (SMA). In contrast to the benign neoplasms, the oncocytic carcinoma showed an increased rate of proliferating cells (MIB-1) and a strongly positive reaction with the antibody MA-903 against high molecular weight cytokeratins. Conclusions. In a review of the literature, we could identify a group of locally aggressive, low-grade oncocytic carcinomas with a considerably better prognosis, similar to that of our case. The therapeutic significance of these findings is discussed.     

Vallecular acinic cell carcinoma in a 9-year-old girl: report of an unusual case

An unusual case of acinic cell tumour of the vallecula is presented. Acinic cell carcinoma occurs usually in the major salivary glands. Minor salivary gland location is unusual and vallecular origin exceptional. This peculiar histologic tumour should now be classified as an low grade carcinoma and adequate treatment has to be initiated. The patient, a 9-year-old girl, had undergone a suprahyoid access for total tumor removal with a bilateral neck exploration. Postsurgical radiotherapy has to be done in case with perineural invasion, invaded margins, node invasion or high grade tumor. The clinical and histopathological findings are discussed in the light of the literature.     

Metachronous bilateral submandibular gland metastases from carcinoma of the breast

Metastases to the salivary glands from distant neoplasms are unusual, with most reported cases involving the parotid gland. Metastatic deposits in the submandibular gland are extremely rare with bilateral involvement not previously reported. We present the case of a patient with advanced breast carcinoma who has had metachronous involvement of both submandibular glands and review the literature on this subject.     

Carcinoma on pleomorphic adenoma in cervical salivary heteropia. Handling of one case and literature review

The presence of salivary tissue outside of the salivary glands, a term called "salivary heterotopia," is not very common. The co-existence of carcinoma expleomorphic adenoma in a salivary heterotopia in the upper third of the neck can be considered unusual. We present an infrequent and clinically unsuspected case of carcinoma expleomorphic adenoma in the upper third of the neck and independent of the salivary glands. The tumour developed within heterotopic salivary tissue, with the histopathological study of the surgical extract being decisive for its diagnosis. The cervical salivary embryogenesis of heterotopias and their oncogenesis is analyzed. Their clinical signs are reviewed to indicate the difficulty in distinguishing the different types of diagnosis from other primary or metastatic tumours so as to assist in choosing the therapy to follow.     

A rare malignancy of the parotid gland: oncocytic carcinoma

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.     

Oncocytic Sialolipoma of the Submandibular Gland

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.     

Malignant salivary gland tumors: squamous cell carcinoma of the submandibular gland in a child.

PURPOSE: Malignant neoplasms of the salivary glands are extremely unusual in the pediatric age group. METHODS: We report an 11-year-old boy who presented with a mass in the left submandibular region and a second mass in the jugularfacial venous angle. RESULTS: Histologic evaluation determined that this was a squamous cell carcinoma of the submandibular gland with metastasis to a cervical node. Review of the literature was undertaken to identify the rate of malignant salivary gland tumors in children. Malignant salivary gland tumors are extremely rare in children. When malignancy does occur, nearly 90% are present in the parotid gland. The submandibular gland is effected in 7.7% of cases. The most common malignancy in salivary glands of children is the mucoepidermoid carcinoma. Squamous cell carcinoma occurs in less than 2% of cases. CONCLUSIONS: Salivary gland tumors are very rare in children in contrast to adults. The proportion of malignant tumors in children is higher than that observed in adults; however, it is not possible to draw conclusions concerning treatment from the few case reports that exist. A higher rate of local recurrence and cervical lymph node metastasis may be expected in children.     

Salivary duct carcinoma of the sublingual gland--a case report

RATIONALE: Pleomorphic adenoma is the most common neoplasm of major and minor salivary gland origin, followed by infectious reasons and sialolithiasis. Less common are adenocarcinomas presented. The salivary duct carcinoma represents a rare variant of the group of adenocarcinomas originated from the salivary glands, especially extremely rare from minor salivary gland origin. CASE REPORT: We report about a 52 year old male patient presenting with painless, non-ulcerating tumor at the floor of the mouth. Since 2 weeks ingestion was painful. Further ENT-investigations including endoscopy and scans (MRT, ultrasound) showed no pathology. In particular, growth of cervical lymph nodes and distant metastases were not revealed. A biopsy showed a rare salivary duct carcinoma of comedo-type originated from the left sublingual salivary gland. The patient underwent an operation: the tumor was extirpated in toto, and, as the pathohistological investigation confirmed, in sano. Additionally a neck dissection at the left side was performed, followed by the radiation of the tumor region and the lymphatic neck regions, after sufficient reconvalescence. The tumor-classification was pT3, pN0. Since 3 years no recurrence of the tumor was confirmed. DISCUSSION: Salivary duct carcinoma is a rare, high-grade malignant epithelial neoplasm, which occurs almost exclusively in the parotid. As presented, it can also occur in minor salivary glands. Histologically it is composed of structures that resemble expanded salivary glands. Comedonecrosis of these structures is a frequent feature. There is some histologic similarity to intraductal carcinoma of the breast. Differential diagnosis comprises adenoid cystic carcinoma, metastases of other adenocarcinomas, such as the carcinoma of the thyroid gland and the comedocarcinoma of the breast. Because of its poor prognosis a rapid and radical therapy is recommended. CONCLUSION: A rare case of a salivary duct carcinoma of sublingual salivary gland origin is presented. Usually the prognosis is poor. The adequate therapy is the complete surgical extirpation including the surgery of the regional lymphatic nodes and the additional radiotherapy.     

Primary squamous cell carcinoma of the submandibular salivary gland

Malignant tumors of the submandibular salivary glands are rare in occurrence, among which primary squamous cell carcinoma of the submandibular salivary gland is unusual and the documented evidence is 2 to 5% among malignant tumors A case of primary squamous cell carcinoma of submandibular salivary gland is being presented for its rarity     

Diffuse hyperplastic oncocytosis of the parotid gland

BACKGROUND: Oncocytes are epithelial cells characterized by an granular, eosinophilic cytoplasma, and a centrally situated, pycnotic nucleus. These cells were first observed by Hamperl 1931 in the salivary glands. Ultrastructural studies have shown that the cytoplasma of these cells is filled with numerous large and bizarre mitochondria. The exact biological significance of oncocytes is unknown - Becker, Donath and Seifert suggest an intracellular metabolic disturbance associated with mitochondriopathy, caused by an age dependent metabolic defect. Oncocytes are not specific for the salivary glands; they are also found in the thyroid gland, parathyroid gland, liver, pancreas, esophagus and the kidney. Solitary oncocytes appear most often as incidental findings in aging salivary tissue, they are present in persons older than 70 years up to 80 %. The diffuse hyperplastic oncocytosis of the parotid gland represents an extremely rare, non-tumorous alteration of the parotid gland. Caused by an extensive metaplasia of acinic and ductal cells nearly the entire gland consists of oncocytes. Clinically it is characterized by swelling of the parotid gland. Oncocytic adenomatous hyperplasia is a different disease. It represents a multifocal oncocytic proliferation of the duct system. In contrast to diffuse oncocytosis remnants of the original salivary tissue with acini and fatty tissue are usually present between the oncocytic nodules. Typical oncocytomas may possibly develop from such oncocytic proliferation by a tendency to confluent growth. METHODS: Cases of diffuse hyperplastic oncocytosis of the parotid gland were identified by literature review. RESULTS: Worldwide diffuse hyperplastic oncocytosis of the parotid gland has been observed in 8 cases (Fig. ) as of today. PATIENT: We report and discuss the case of a 78-year-old male, who was refered to our hospital because of a painless mass of the left parotid gland. MRI showed a tumorous lesion with a diameter of about 5 cm. Lateral parotidectomy was performed. Histology revealed an extremely rare case of diffuse hyperplastic oncocytosis. There has been no recurrence of tumor after 2 years. CONCLUSIONS: Diffuse hyperplastic oncocytosis of the parotid gland is an extremely rare benign disorder, complete excision of the tumor-like lesion is curative. In literature there has been no report of recurrence, malignant transformation or metastasizing illness.     

Endoscopic repair of pediatric traumatic laryngeal injury

With an incidence of less than 3%, salivary gland tumors are rare in the head and neck. The percentage of basal cell adenomas within the group of salivary gland tumors is even less (0.2-2%). Salivary gland tumors occur very rarely in adolescents. The basal cell adenoma commonly affects older persons and occurs most frequently in the major salivary glands. We present the unusual case of a benign basal cell adenoma of the minor salivary glands of the piriform sinus in a 14 year old male patient. Unusual are the age of the patient, the histological type, size and localisation of the tumor.     

Nasopharyngeal Warthin's tumour: a metaplastic lesion

Warthin's tumour arising from minor salivary glands of the nasopharynx is described in a patient with eosinophilic rhinitis and nasal polyposis. The microscopical features of this lesion were indistinguishable from those of Warthin's tumours of the parotid gland. The present case supports the histogenetic theory that the epithelial component of extraparotid Warthin's tumours represents reactive oncocytic metaplasia and hyperplasia induced by chronic inflammation rather than genuine neoplasia. It is suggested that the term Warthin's tumour is preferable to designations indicating neoplasia of these extraparotid lesions which are indistinguishable histologically and ultrastructurally from parotid and juxtaparotid adenolymphomas.     

The interesting case -- case no. 68. Metastasis of a small-cell bronchial carcinoma to the parotid gland

We present a case of a metastasis to the parotid gland from a small cell carcinoma of lung. The patient noted swelling in right parotid region without pain and saw an otorhinolaryngologist. There was no facial nerve palsy. He was admitted to our hospital. The total parotidectomy with facial nerve preserving was performed. The pathological findings indicated small cell carcinoma. After receipt of this report, we examined the lungs. An abnormal shadow could be found in the chest X-rays. CT revealed a lung tumor on a left site which was determined to be small cell carcinoma by transbronchial lung biopsy. Metastasis to the parotid glands from any distant primary site is quite unusual. In most cases of secundary parotid involvement of malignant tumors primary tumors originated from the head and neck region. Primary tumors in the neighborhood are the skin of the head and neck and the mucosa of the upper airway and digestive tract. Distant metastases to the parotid gland have been reported to arise from bronchial carcinoma, renal carcinoma, colonic carcinoma, prostat and breast. The distinction between primary salivary glands tumors and metastases of other primary tumors is difficult often. Histologic and immunhistological methods can be helpful.     

Immunophenotypic comparison of salivary gland oncocytoma and metastatic renal cell carcinoma

OBJECTIVES/HYPOTHESIS: The differential diagnosis of oncocytic neoplasms of salivary glands includes both primary and metastatic tumors, one of which is renal cell carcinoma. This study compared immunohistochemical staining characteristics of oncocytomas arising from salivary gland to metastatic renal cell carcinoma using a panel of markers. STUDY DESIGN: Immunohistochemistry for cytokeratin 7 (CK7), cytokeratin 20 (CK20), epithelial membrane antigen (EMA), vimentin, CD10, and renal cell carcinoma marker (RCC) was performed on 10 oncocytomas and compared with ten metastatic renal cell carcinomas. RESULTS: There were overlapping histologic findings in the oncocytomas and metastatic renal cell carcinomas, with oncocytomas displaying clear cell changes in 2 of 10 cases. CK7 was positive in 9 of 10 oncocytomas and CK20 in 8 of 10 (7/10 stained for both), and vimentin was only weakly positive in 4 of 10 oncocytomas. All oncocytomas were EMA positive, with membranous staining, and all were negative for CD10 and RCC. Metastatic renal cell carcinoma was strongly positive for vimentin, EMA, and CD10 in most cases. RCC and CK7 were variably positive in metastatic renal cell carcinomas (4/10), and only 1 of 10 showed weak staining with CK20. CONCLUSIONS: Salivary gland oncocytomas and metastatic renal cell carcinomas share some similar histologic and immunohistochemical characteristics. CD10 and CK20 were the most useful markers to distinguish metastatic renal cell carcinoma from oncocytomas in the salivary gland, whereas RCC, EMA, CK7, and vimentin are not as useful.     

Bilateral cystic parotid masses and a hypopharyngeal mass: a case report and review of mucosa-associated lymphoid tissue lymphoma in the head and neck

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell lymphoma that was first described in gastric mucosa. Although presentation in the parotid gland is not unusual, bilateral cystic masses and associated hypopharyngeal involvement are rare. We describe an 83-year-old man with a large painless facial swelling; he was otherwise asymptomatic. On examination, bilateral parotid masses and a mass in the hypopharynx were found. Biopsy of the hypopharynx was consistent with MALT lymphoma. The patient was treated with single-agent chemotherapy and had a good initial response. MALT lymphoma occasionally originates within the salivary glands and other sites in the head and neck region. This disease should be considered in the differential diagnosis of cystic or bilateral parotid masses and hypopharyngeal masses.     

Bilateral oncocytoma of the parotid gland

Oncocytic neoplasms are a group of rare tumours that mostly affect the parotid gland (80%), sometimes affect the submandibular gland (9%) and rarely affect the intraoral minor salivary glands. The incidence of oncocytic neoplasms represents approximately 1% of parotid neoplasms and bilateral presentation is very rare. Herein we describe a single case involving bilateral presentation of oncocytoma of the parotid glands.     

Solitary fibrous tumor with pseudo-lipoblasts involving the sublingual gland: report of a case and review of the literature

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms uncommonly occurring in the salivary glands. In rare instances, SFTs can contain mature fat, atrophic fat, or vacuolated cells previously termed ‘pseudo-lipoblasts’, which may be misinterpreted as a feature of malignancy. We report an unusual tumor with pseudo-lipoblasts occurring in the sublingual gland. The tumor exhibited a prominent hemangiopericytic pattern, bland cytology, and immunohistochemical and morphologic features consistent with that of an SFT. A review of 15 cases of SFTs of the salivary glands is presented. Emphasis is laid upon the histologic differential diagnosis and the clinical features of these tumors.     

Oncocytic carcinoma of the soft palate in childhood: A case report

Objective: to described an oncocytic carcinoma of the soft palate in childhood. Method: case report, review of the world literature, and discussion. Results: in this report, an uncommon presentation of oncocytic carcinoma in the soft palate which has not been described previously in childhood is described. Conclusion: oncocytic carcinomas are rare tumors that usually appear between 50 and 60 years of age. They are very rare in childhood, and are mainly found in parotid glands. A soft palate oncocytic carcinoma in childhood has not been described before.