جستجوی مقالات مرتبط با کلیدواژه « pleomorphic adenoma » در نشریات گروه « پزشکی »

Atypical pleomorphic adenoma (PA) is an uncommon tumor, more frequent in submandibular and parotid glands. PA is classified as atypical when it presents hypercellularity, necrosis or hyalinization, dysplasia, capsular violation or distant metastases.

Case Report:

We described a case of a 39-year-old female presented with a slowly growing mass involving the soft palate. A life-threatening bleeding from PA with hemorrhagic shock occurred and required ligation of the external carotid artery with tracheotomy. A transoral en-bloc excision of the mass (70 x 50 x 40 mm) was performed. Pathological exam demonstrated an atypical PA, with hypercellular fields and myoepithelial and squamous differentiation.

An appropriate diagnostic evaluation and a prompt intervention are essential to avoid dangerous complications, even for benign neoplasms.

Salivary gland tumors are rare and account for only 2-3% of head and neck tumors, most of which are benign. Pleomorphic adenoma is the most common salivary gland tumor. This tumor mostly involves the parotid gland. However, if it occurs in the minor salivary glands, the palate is the most common site, followed by the lips, buccal mucosa, floor of the mouth, tongue, tonsils, pharynx, retromolar trigone, and gingiva. It usually presents as a slow-growing, painless submucosal mass on the hard palate. For a definitive diagnosis, it is necessary to perform a preoperative core biopsy for histopathological examination and Computed Tomography to evaluate the erosion of the hard palate and the severity of the erosion. We aim to describe the clinical, and radiological features, as well as the management of this rare localization of pleomorphic adenoma. In this case, a 30-year-old Iranian male patient with pleomorphic adenoma of the small salivary glands of the hard palate with the chief complaint of painless swelling on the left side of the palate for the past 5 years was reported. Although pleomorphic adenoma is a common entity, it is still a challenging tumor for pathologists, radiologists and surgeons. Various histological and topographic features make this tumor unique. Computed tomography and correct histopathological diagnosis are necessary to establish an appropriate surgical treatment, to achieve complete removal of the lesion through extensive local excision with periosteum or bone removal if involved to prevent recurrence.

Huge head and neck tumors are known to cause difficult ventilation and difficult intubation. Edentulous mouth can result in difficult mask ventilation. Head and neck tumor resections can also present hemodynamic challenge, due to their proximity to large vessels.
We herein report a clinical case of difficult ventilation due to large parotid tumor in an edentulous patient.

The expression of estrogen receptors in salivary gland tissue has been observed in some studies. Considering the histological similarity of salivary gland and breast tissue, as well as the prominent role of this receptor in the pathogenesis, treatment and prognosis of breast tumors, the aim of this study was to compare the immunohistochemical expression of estrogen receptor in pleomorphic adenoma (PA) and normal salivary gland tissue and assess its possible role in salivary gland tumors. In this descriptive-analytical study, 26 samples of PA and 12 samples of normal salivary gland tissue were selected. Immunohistochemical staining was performed by standard invision method for estrogen receptor. The results were evaluated semi-quantitively as the percentage of nuclear and cytoplasmic stained cells separately by Mann- Whitney, Kruskal-Wallis and Fisher exact tests. All PA samples showed negative nuclear staining for estrogen receptor, but its expression was observed in the cytoplasm of ducts in 27% of tumors and in 59% of normal salivary gland tissue samples, but the difference was not statistically significant. In addition, no association was found between estrogen receptor expression and independent variables such as the type of stroma or the degree of cellularity in PA, age, sex and location of the specimen. It seems that the expression of estrogen receptor does not play an effective role in the development and progression of PA tumor. However, its occurrence in the normal salivary gland ducts is considered and further studies in this field seem to be necessary.

Statement of the Problem: 

Salivary gland tumors represent about 3% of the head and neck tumors. Pleomorphic adenoma (PA) is the most common benign salivary gland tumor.

This study was conducted to investigate and describe some clinical and histopathological aspects of salivary pleomorphic adenomas with special reference to the epithelial and mesenchymal components.

One hundred tissue samples diagnosed as PA were sourced from archival tissue blocks between 2009 and 2019 in this retrospective study. Some clinical and demographic features, including age, sex, tumor size, and tumor location were recorded. This study included only samples taken by excisional biopsy. Then, the samples were histologically classified into three subtypes according to the proportion of epithelial and stromal components. The demographic and clinicopathological variables were statistically analyzed using Chi-square test or Fisher’s exact test, considering a significance level of 5% (p< .05).

In the present study, most cases (61%) were found in females, representing a female–male ratio of 1.6:1. The peak incidence was seen in the 4th and 5th decades of life. In 87% of cases, PA occurred in major salivary glands. There was a significant difference between the age of the patient and squamous metaplasia (p= 0.036). There was also a significant difference between the size of tumor and the amount of myxoid stroma (p= 0.021). Extensive myxoid stroma was mostly seen in tumors larger than 3.37cm (p= 0.001). In addition, there was a statistically significant difference between capsular invasion and the development of squamous metaplasia (p= 0.001).

 In this study, there was a significant correlation between the gland type and capsular features and between the size of tumor and rate of squamous metaplasia. A detailed clinical and histopathological analysis of PAs may provide a better insight to the pathophysiology of the lesion, tumor cell differentiation, and prognostic factors.

The active vitamin D metabolites have anticancer effects on many human neoplasms. The vitamin D receptors have been detected in salivary glands tissue. This study aimed to evaluate the serum level of vitamin D in patients with malignant and benign salivary gland tumors.In this retrospective and cross-sectional study, 151 participants, including 42 patients with benign, 42 malignant salivary gland tumors, and 67 healthy subjects, participated. The serum level of vitamin D was measured using an enzyme-linked immunosorbent assay (ELISA).The mean serum level of vitamin D was 42.7 ng/mL in patients with benign tumors, 40 ng/mL in malignant tumors, and 36.7 ng/mL in the control group. There was no significant difference between the mean vitamin D level and vitamin D status in patients with salivary gland tumors and normal controls (P=0.2). There was a significant positive correlation between vitamin D level and age in the control group (P=0.04).The results showed a high prevalence rate of vitamin D deficiency/insufficiency in salivary gland tumors and normal subjects, with no significant difference. Therefore, the serum level of vitamin D might not play a significant role in the pathogenesis of these tumors, similar to many human cancers. However, further prospective studies are recommended focusing on specific tumors and considering other interventional factors.

There is no consensus on the prevalence of salivary gland tumors (SGTs) in Iran. Thus, we systematically reviewed the literature about the prevalence of SGTs in Iran and applied the last world health organization (WHO) classification.

The systematic literature search was performed in EMBASE, Scopus, PubMed MEDLINE, Google Scholar, Scientific Information Database (SID), and Magiran; we searched for "salivary gland," "tumor," "prevalence," and "Iran" until 1 March 2021. The studies included were written in the English and Farsi languages. The weighted mean prevalence of SGTs was calculated as prevalence (%) * (N/the sum of all N). We used the unpaired Two-sample T-test to compare the weighted means.

A total of 17 studies, including 2870 patients, were selected for the data synthesis. The weighted mean prevalence of benign and malignant tumors was 66% (95% CI: 59-73) and 34% (95% CI: 27-41), respectively. The patients' mean age was reported in 10 out of the 17 studies. The weighted mean age of the patients was 40 (95% CI: 37-42) and 49 (95% CI: 43-55) years for benign and malignant tumors, respectively (P=0.01). Pleomorphic adenoma (PA), followed by Warthin's tumor (WT), was the most prevalent benign tumor. Moreover, the most common malignant tumors were mucoepidermoid carcinoma (MEC) and adenoid cystic carcinoma (AdCC).

More than one-third of SGTs in Iran were malignant, which is higher than the reports from Middle Eastern countries. Information about risk factors and the burden of SGTs in Iran is insufficient. Thus, further well-designed longitudinal studies are warranted.

Pleomorphic adenoma is a benign salivary gland tumor that is frequently seen in the parotid gland. It is very rare in minor salivary glands. The case we present is a case of pleomorphic adenoma originating from the buccal minor salivary gland, which is very rare in this localization.

Ultrasound is the initial imaging modality for the detection of salivary gland tumors. There is an argument for evaluating multiple characteristics for predicting tumors using this imaging modality because no single sonographic feature is adequate for differentiating between benign and malignant tumors. This study aimed to examine clinical and sonographic characteristics of major salivary gland masses using B-mode ultrasound and color Doppler and check the sensitivity and specificity for each parameter.
Instruments &

 Sixty-two patients with parotid and submandibular salivary gland tumors underwent preoperative ultrasonic and postoperative histopathological evaluation. Different characteristics were examined, such as tumor shape, size, echotexture, internal calcification, cystic changes, clarity of the boundaries of the Lesion, lymph node enlargement, as well as the distribution of blood supply in the lesion by color Doppler.

Histopathological examination revealed that 18 of 62 tumors were malignant and the rest 44 tumors were benign, and 68.2% of benign cases were pleomorphic adenomas. Mucoepidermoid carcinoma accounted for 61.1% cases. There was a significant difference between the malignant and benign tumors in calcification in the lesion, echogenicity, posterior echo enhancement, vascularity, and significant result in the shape of the lesion and homogeneity status (p<0.01).

Pleomorphic adenoma and mucoepidermoid carcinoma are the most frequent benign and malignant tumors, respectively. Older age and female gender are associated with a higher frequency of malignant salivary gland tumors.

Pleomorphic adenoma is the most common salivary gland tumor. This tumor mostly involves the parotid gland; however, if it occurs in the minor salivary glands, the palate would be the most common site. This lesion is more prevalent in patients with 40 to 60 years of age. Regarding the literature, the incidence of giant pleomorphic adenoma of the palate in young patients is considered a rare finding. Hereby, we present a rare case of pleomorphic adenoma of the palate, with an astonishing size, found in a 27-year-old patient. Furthermore, the surgical treatment of this lesion is described. This case was effectively treated with surgical curettage and tumor resection, emphasizing the significance of early detection in order to minimize complications. Surgical treatment, was beneficial to help the patient resume to normal life. Additionally, the clinical, radiological, and histopathological aspects and potential surgical treatments are discussed.

Statement of the Problem: 

Heat shock protein 27 (HSP27) plays important roles in many cellular processes and has been implicated in different types of diseases such as cancers.

This study aimed to evaluate the serum level of HSP27 in patients with salivary gland tumors and to determine its possible correlation with the prognosis of the disease.

This cross-sectional study was performed on 60 patients with salivary gland tumor including 16 pleomorphic adenoma, 33 adenoid cystic carcinoma, 6 mucoepidermoid carcinoma, 5 acinic cell carcinoma, and 28 healthy control subjects. The control cases were healthy blood donors who matched the study group in age and sex. Serum samples were obtained from the clotted blood and HSP27concentrations were measured with sandwich enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed by using one-way ANOVA, post Hoc test, independent sample t-test, and ROC analysis. A p value of less than 0.05 was considered as significant.

The mean serum level of HSP27 was 3956.1±3830.1 (pg/ml) in patients with malignant salivary gland tumor, which was significantly higher than that in benign salivary gland tumor (752.2±485.6) and healthy controls (602.3±575.8) (p< 0.001). However, there was no significant difference in the HSP27 serum levels between the patients with benign salivary gland tumors and healthy controls (p= 0.2). No association was detected between the mean serum levels of HSP27 and clinicopathologic factors such as age, sex, stage and nodal metastasis (p> 0.05), except for the tumor size (p= 0.04).

The HSP27 concentration increased in patients with malignant salivary gland tumors. Moreover, the HSP27 level was correlated with tumor growth, invasiveness, and diagnosability. Yet, larger clinical studies are required to explore its prognostic value.

Proliferation markers have been used to determine the behavior and prognosis of benign and malignant tumors; this study was aimed to compare the immunohistochemical (IHC) expression of proliferating cell nuclear antigen (PCNA) and novel marker minichromosome maintenance complex component 7 (MCM7) in common salivary gland tumors including pleomorphic adenoma (PA), mucoepidermoid carcinoma (MEC), and adenoid cystic carcinoma (AdCC), to find a possible significant correlation between benign and malignant tumors.

In this cross‑sectional study, a total of 90 cases, including 30 PAs, 30 MECs, and 30 AdCCs, were collected.The IHC expressions of PCNA and MCM7 were evaluated.Their expressions were compared with each other and between benign and malignant tumors. Statistical analysis was performed by Chi‑square and Tukey’s test. P value was considered 0.05.

Out of 30 cases of PA, 28 cases (93.3%) were PCNA positive and 28 cases (93.3%) were MCM7 positive. In the AdCC cases, 29 cases (96.6%) were PCNA positive and 29 cases (96.6%) were MCM7 positive.In the MEC cases, all cases (100%) were PCNA positive and 23 cases (76.6%) were MCM7 positive.The labeling index (LI) of MCM7 and PCNA was evaluated, and this index was lower in MCM7 LI than PCNA in all tumors.The MCM7 and PCNA expression showed a significant difference in PA and MEC (P < 0.001).

PCNA expression was higher than MCM7 expression in salivary gland tumors. However, more studies are needed to evaluate the malignant activity of these tumors with group of markers such as MCM family members.

Pleomorphic adenoma (PA), mucoepidermoid carcinoma (MEC), and adenoid cystic carcinoma (AdCC) are the most common benign and malignant salivary gland tumors. Cyclooxygenase‑2 (COX‑2) is a key regulatory enzyme that its overexpression in various tumors is correlated with progression, metastasis, and apoptosis inhibition. Vascular endothelial growth factor (VEGF) is a potent angiogenic mediator that has an important role in neoplastic angiogenesis. The aim of this study was to immunohistochemically analyze the expression of COX‑2 and VEGF and to compare the expression of benign and two malignant salivary gland tumors with varied structures.

In this cross‑sectional study, 90 specimens including 30 cases of each tumor were retrieved. Immunohistochemical staining of COX‑2 and VEGF was performed for all the samples. The percentage of positive tumor cells and staining intensity was evaluated by two pathologists blindly. Data were analyzed by Chi‑square and Gamma test and P < 0.05.

A statistically significant difference was noted between the expression and intensity of COX‑2 and VEGF in PA, MEC, and AdCC (P < 0.05). A significant correlation was observed between COX‑2 and VEGF expression in MEC and AdCC (P < 0.05). However, no significant correlation was found between the expression and intensity of COX‑2 and VEGF with histologic grade and lymph node metastasis in MEC and AdCC (P < 0.05).

High expression of VEGF and COX‑2 in malignant tumors compared to PA suggested the role of both markers in malignant transformation. The significant correlation of VEGF expression with COX‑2 may represent the role of COX‑2 in tumor angiogenesis by modulating VEGF production.

Various surgical approaches to parapharyngeal space (PPS) tumors are introduced to obtain complete removal with the preservation of the surrounding structures in parapharyngealneoplasms. Here, we will discuss the main techniques and their outcome.   This retrospective study was conducted on 78 patients undergone either transoral, transcervical or a combination of these two approaches for the resection of PSS tumors from January 2010 to January 2015. A number of 33 male and 45 female patients with the mean age of 40.9 ± 9.1 were evaluated. 42.3% of the patients were asymptomatic at the initial presentation. Pleomorphic adenoma and schwannoma were a permanent diagnosis in 61(78.2%) and 11(14.1%) patients, respectively. PPS tumors were resected using transoral, transcervical and combined approaches in 35(44.8%), 33(42.3%) and 10 (12.9%) cases, respectively. Recurrence occurred in 10 patients all of whom had apre-styloid pleomorphic adenoma, operated transcervical (P< 0.0001).Three cases of tenth nerve palsy occurred in schwannomas which were operatedtranscervically (P=0.04). Mean hospital stays were 2.11,3.69, and 4.9 days after transoral, transcervical and combined approaches, respectively (P= 0.001). Transoral, transcervical and combined approaches are all able to provide adequate visualization with comparable outcomes.

Paxillin is a major cytoskeletal protein aberrantly deregulated in various human cancers and involved in tumor growth and invasion. However, the clinicopathological and prognostic significance of paxillin in salivary gland tumors (SGTs) is still unclear.

This study was conducted to evaluate the relationship between paxillin expression and clinicopathological features of patients with SGTs.

In this retrospective study, 50 paraffin-embedded tissue samples which were histologically confirmed as benign (pleomorphic adenoma, PA) or malignant (mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma, ACC) SGTs, and 19 specimens from those with normal salivary gland (NSG) as a control group were assessed for paxillin expression using the immunohistochemistry. The paxillin expression in our samples was scored based on the extent and intensity of immunoreactivity and compared with histological type, clinical stage, and distant metastasis.

 High paxillin expression was identified in 66% of SGTs whereas all patients with NSG showed low expression (p< 0.0001). Although the expression of paxillin in patients with benign and malignant tumors is similar, there is a significant difference between patients with PA, MEC, and ACC with that of the NSG (p< 0.0001). Paxillin expression was not correlated with clinicopathological features of patients

 High expression of paxillin was observed in tumoral tissues compared with the controls that establish an important role of paxillin in SGTs but its prognostic role was unclear and need further evaluation.

Pleomorphic adenomas are benign neoplasms of salivary glands. The simultaneous homolateral occurrence of these tumors in salivary glands is exceedingly rare.   Case Report: An adult female presenting to our OPD with the swelling of right-sided preauricular and submandibular regions was diagnosed with the pleomorphic adenoma based on fine needle aspiration cytology. The patient was subjected to the excision of both swellings under general anesthesia. Postoperative facial nerve functions were within normal limits and final histopathology confirmed pleomorphic adenoma involving both the sites. A pertinent detailed literature review of English and non-English studies was indicative of only nine such cases.   Simultaneously occurring pleomorphic adenoma involving homolateral parotid and submandibular glands is a rare phenomenon that should be kept in mind when examining the swelling of the unifocal salivary gland.

Pleomorphic adenoma is the most prevalent salivary tumor, 65% of which occur in major glands. This tumor varies in terms of size depending on the gland where it is located. The most common sites of the minor salivary glands are the palate, lips, cheeks, and throat. Palatal pleomorphic adenoma is laterally located, rarely crossing the midline. This tumor is painless with slow growth rate, which often appears in the fourth or fifth decade of life with female predominance. The tumor may enlarge with delayed treatment. This study aimed to present the case of a 51-year-old woman with an oversized mass on the palate (diameters: 8.5x5.5x2.5 cm), which extended from the anterior portion of the hard palate to the soft palate with a slow growth rate within 10 years. The case definition was accompanied by the determined surgical treatment.

CD44 is a transmembranous proteoglycan, with a main role of cell adhesion to other cells and to extracellular matrix involved in the preservation of three‑dimensional structure of organs. Pleomorphic adenoma (PA) is a common benign salivary gland tumor, composed of myoepithelial and ductal components. Carcinoma ex‑PA (CXPA) is malignant transformation of the epithelial elements in PA. The aim of this study was to evaluate CD44 expression by immunohistochemistry in these two tumors and normal salivary gland near these tumors. In this cross‑sectional immunohistochemical study, 40 paraffin blocks (formalin fixed, paraffin embedded) with thirty belonging to PA and ten blocks of CXPA and 18 paraffinized blocks of normal salivary glands’ tissue adjacent to tumoral tissue (13 in the vicinity of PA and 5 in the vicinity of CXPA) were selected. Immunohistochemical expression of CD44 was observed and compared with each other. For data analysis, we used Chi‑square, Kruskal–Wallis, and Mann–Whitney tests and the quantity of P values wasconsidered 0.05. There was a significant difference in CD44 expression frequency between PA, CXPA, and normal salivary glands with higher expression noted in CXPA. Furthermore, expression frequency of CD44 in adjacent normal salivary gland of CXPA was significantly higher than PA. There was no significant difference in the expression of CD44 with respect to lymph node metastasis. Higher expression of CD44 in CXPA might illustrate CD44’s role in malignant transformation of PA.

Salivary gland neoplasms account for 0.5-2% of all tumors worldwide, and can display a remarkable range of morphological diversity between different tumor types. The aim of this retrospective study was to present the clinico-pathologic characteristics of salivary gland neoplasms in a tertiary referral hospital in northwest region of Nigeria. Clinical and histopathological records of patients with salivary gland lesions that presented to the department of Dental and Maxillofacial Surgery only, Usmanu Danfodiyo University Teaching Hospital Sokoto, between January 2013 to December 2017, was evaluated. Data concerning age, gender, location and type of salivary gland lesion, and histologic subtypes were collected. A total of 76 cases of salivary gland neoplasms were retrieved and analyzed. There were 35 (46.1%) males and 41 (53.9%) females with M:F of 1.2:1. Mean±SD age of 31.04±18.9, and range 1-73 years was observed. 53 (69.7%) cases were benign while 23 (30.3%) were malignant. Most of the benign and malignant cases were seen in the 4th decade of life. 23 (30.3%) lesions were seen in the parotid gland with 18 (23.7%) benign and 5 (6.6%) malignant. In the minor salivary glands, 15 (19.7%) lesions were observed in the palate with 4 (5.3%) benign and 11 (14.5%) malignant. Of the benign cases, pleomorphic adenoma was the most frequent 41 (53.9%) while mucoepidermoid carcinoma was the most occurring malignant case (12 (15.8%)). A distribution ratio of 1.9:1.3:1:2.2 for parotid, submandibular, sublingual, and minor salivary gland neoplasms was encountered. The peak incidences of benign and malignant tumors were in the 4th decade, which is different from Caucasians.

Cyfra 21 is a serum-soluble fragment of cytokeratin19. Increased Cyfra 21 serum levels and their benefit as a tumor marker have been shown in some malignancies. This study aimed to evaluate the serum levels of Cyfra 21 in patients with benign and malignant salivary gland tumors.
In this cross-sectional study, the serum level of Cyfra 21 in 44 patients with malignant salivary gland tumors and 16 cases of pleomorphic adenoma were compared with 28 healthy controls using enzyme-linked immunosorbent assay (ELISA). Data were analyzed statistically using the Kruskal Wallis test, analysis of variance (ANOVA) and Spearman’s correlation tests.
Mean serum levels of Cyfra 21 were 0.135 ± 0.285 ng/ ml in the control group, 0.167 ± 0.142 ng/ ml in patients with pleomorphic adenoma and 1.059 ± 3.251 ng/ml in patients with malignant salivary gland tumors. There was no significant difference among groups. Cyfra 21 levels did not correlate with location of tumor, clinical stage or cigarette smoking.
Results of the present study showed no significant difference in Cyfra 21 serum level in salivary gland tumors compared with normal individuals. In addition, Cyfra 21 serum level was not sufficiently sensitive to function as a tumor marker in salivary gland tumors.