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Management of salivary gland adenoid cystic carcinoma: institutional experience of a case series
Tincani, Alfio José;Del Negro, André;Araújo, Priscila Pereira Costa;Akashi, Hugo Kenzo;Martins, Antonio Santos;Altemani, Albina Milani;Barreto, Gilson;
Sao Paulo Medical Journal , 2006, DOI: 10.1590/S1516-31802006000100006
Abstract: context and objective: salivary gland tumor management requires long-term follow-up because of tumor indolence and possible late recurrence and distant metastasis. adenoid cystic carcinoma (acc) accounts for 10-15% of such tumors. the aim here was to evaluate surgical and clinical management, staging and follow-up of acc patients in one academic institution. design and setting: retrospective study at head and neck service, universidade estadual de campinas. methods: data on 21 patients treated between 1993 and 2003 were reviewed. management utilized clinical staging, histology and imaging. major salivary gland tumor extent was routinely assessed by preoperative ultrasonography. diagnosis, surgery type, margin type (negative/positive), postoperative radiotherapy and recurrence (presence/absence) were evaluated. results: there were eleven major salivary gland tumors (52.3%), seven submandibular and four parotid. ten patients (47.7%) had minor salivary gland acc (all in palate), while the submandibular was the most frequently affected major one. diagnoses were mostly via fine-needle aspiration (fna) and incision biopsy. frozen sections were used for six patients. there was good ultrasound/fna correlation. sixteen (76%) had postoperative radiotherapy. one (4.7%) died from acc and five now have recurrent disease: three (14.2%) locoregional and two (9.5%) distant metastases. conclusion: adenoid cystic carcinoma has locally aggressive behavior. in 21 cases, of acc, the facial nerve was preserved in all except in the few with gross tumor involvement. treatment was defined from physical examination, imaging, staging and histology.
Adenoid cystic carcinoma of the parotid gland: Anastamosis of the facial nerve with the great auricular nerve after radical parotidectomy  [cached]
Bahadir Osman,Livaoglu Murat,Ural Ahmet
Indian Journal of Plastic Surgery , 2008,
Abstract: Adenoid cystic carcinoma of the parotid gland is a rare and slowly growing, but highly malignant tumor. Surgical resection of a malignant parotid tumor should include resection of the facial nerve when the nerve is involved in the tumor. Facial nerve reconstruction is required after nerve resection. A 14 year-old female presented with complaints of painless enlargement of the right parotid gland and facial asymmetry. Physical examination revealed a firm mass in the region of the parotid gland as well as right facial paralysis. Biopsy obtained from the mass showed an adenoid cystic carcinoma of the parotid gland. A radical parotidectomy with a modified radical neck dissection was carried out. Grafting material for the facial reconstruction was harvested from the great auricular nerve. The proximal main trunk and each distal branch of the facial nerve were coapted with the greater auricular nerve. The patient received radiotherapy after surgery and was seen to achieve grade IV facial function one year after surgery. Thus, the great auricular nerve is appropriate grafting material for coaptation of each distal branch of the facial nerve.
Adenoid cystic carcinoma of the parotid metastasizing to liver: case report
K Harish, SR Mangala Gouri
BMC Cancer , 2004, DOI: 10.1186/1471-2407-4-41
Abstract: We report a 60 year old female patient who presented with adenoid cystic carcinoma of the parotid gland. She underwent a total conservative parotidectomy followed by adjuvant radiotherapy. While on follow up, patient developed multiple liver metastases which manifested three years later. Patient lived for another two years before she died of her disease.Although distant metastases of adenoid cystic carcinoma develop frequently, isolated metastasis to liver is unusual. Even after manifestation of distant metastasis, patients can be expected to live for a number of years. Palliative chemotherapy can be considered in symptomatic cases while the usefulness of metastatectomy is controversial.Adenoid cystic carcinoma (ACC) is a rare malignant neoplasm of the salivary gland. Salivary gland neoplasms constitute 3% of cancers of all sites, of which, 10–15% are malignant [1,2]. Though ACC is the most common malignant tumor of the submandibular, sublingual and minor salivary glands, it accounts for only 15% of parotid cancers [3]. They are generally slow growing and spread relentlessly to adjacent structures. Hematogenous spread is more common than lymphatic spread, the common sites of metastasis being the lung, bone and viscera [4,5]. We present a case of multiple liver metastases occurring 3 years after surgery for ACC of the parotid gland. The primary therapy, metastasis and outcome of ACC are discussed.A 60 year old woman presented with a small swelling beneath the right ear lobe of 4 months duration. The swelling measured 2 × 1 cm placed in the superficial part of the parotid and was not fixed. There was no facial nerve palsy or palpable cervical nodes. A fine needle aspiration cytology (FNAC) was carried out which showed the lesion to be ACC [6]. The clinical staging was T1, N0, M0. The patient underwent a total conservative parotidectomy after metastatic work up. Histopathology revealed ACC with cribriform pattern and perineural invasion (Figure 1). 60 Gy adjuvant exter
Prognostic value of expression of molecular markers in adenoid cystic cancer of the salivary glands compared with lymph node metastasis: a retrospective study  [cached]
Lee Seok Ki,Kwon Min Su,Lee Yoon Se,Choi Seung-Ho
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-266
Abstract: Background Adenoid cystic cancer arising in the salivary glands has distinctive features such as perineural invasion, distant metastasis, and a variable prognosis. In salivary gland cancer, c-kit, EGFR, and VEGF are representative molecular markers that may predict remnant and recurrent tumors. In this study, the expression of c-kit, EGFR, and VEGF in adenoid cystic cancer was evaluated, and the relationships between the expression of these markers and the clinical findings were investigated. Methods The medical records of 48 patients who were treated for parotid adenoid cystic cancer from January 1990 to January 2006 were reviewed. The tumor location, size, histological subtypes, perineural invasion, the resected margin status, and lymph node metastasis were assessed. Immunohistochemical staining and semiquantitative analysis of c-kit, EGFR and VEGF were performed. The relationship between the expression of each marker and the clinicopathological factors were analyzed. Results Positive c-kit immunostaining was present in 45 patients (94%), with weak positivity (+1) in 23, moderate positivity (+2) in 19 and strong positivity (+3) in three. Positive EGFR immunostaining was observed in 27 (56%), with weak positivity (+1) in 19 and moderate positivity (+2) in eight with no strong positive staining. Positive VEGF immunostaining was present in 42 patients (88%) with weak positivity (+1) in 12, moderate positivity (+2) in 17, and strong positivity (+3) in 13. Only the expression of VEGF was significantly higher in parotid gland tumors than in any other gland (P = 0.032). Marginal involvement was associated with strong VEGF expression (P = 0.02). No marker was significantly correlated with recurrence or the survival rate. Lymph node status was related to the survival rate. Conclusions The expression of c-kit, EGRF, and VEGF had no predictive value for recurrence or the prognosis of adenoid cystic cancer. Only the lymph node status was related to the prognosis.
Mitochondrial Mutations in Adenoid Cystic Carcinoma of the Salivary Glands  [PDF]
Suhail K. Mithani,Chunbo Shao,Marietta Tan,Ian M. Smith,Joseph A. Califano,Adel K. El-Naggar,Patrick K. Ha
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0008493
Abstract: The MitoChip v2.0 resequencing array is an array-based technique allowing for accurate and complete sequencing of the mitochondrial genome. No studies have investigated mitochondrial mutation in salivary gland adenoid cystic carcinomas.
A 20-Year Retrospective Study of Salivary Gland Adenoid Cystic Carcinoma in a Sample of Iranian Patients  [PDF]
M. Khalili,F. Salamat
Journal of Dentistry of Tehran University of Medical Sciences , 2009,
Abstract: Objective: The aim of the present study was to investigate the demographic and pathological aspects of adenoid cystic carcinomas (ACC) in an Iranian sample based on a 20-year archive review.Materials and Methods: In this descriptive study, tumors of the head and neck registered between 1980 and 2000 were evaluated and cases of ACC were selected. Patients’ medical records and pathology reports were reviewed. Variables such as age, sex, duration of disease,symptoms, site of tumor involvement and tumor diameter as well as pathologic features were recorded. Analysis was performed using chi-square and t-tests; P<0.05 was considered as the level of significance.Results: ACC was the most common malignant tumor followed by mucoepidermoid carcinoma and adenocarcinoma NOS. A total of 120 ACCs were found, of which 50.8% occurred in females and 49.2% in males. Patients’ ages ranged from 5 to 90 with a mean of 49.2 (SD=15.9) years. In 60.9% of cases, minor salivary glands were involved and the palate was the most common site. The greatest tumor diameter was between 2-15cm with a mean of 4.6 cm (SD=2.9). The most prevalent histologic appearance was cribriform, followed by tubular pattern. No significant relation was observed between lymph node metastasisand patients’ age, sex, disease duration, greatest tumor diameter and site of involvement.Conclusion: Our findings were relatively similar to other reports from different parts of the world. Further analytic and case-control studies are recommended to gain a better understanding of different aspects of ACC.
MALIGNANT SALIVARY GLAND TUMORS  [PDF]
Violeta Trandafir,Daniela Trandafir,Eugenia Popescu
Jurnalul de Chirurgie , 2010,
Abstract: Malignant salivary gland tumors make up 6% of all head and neck tumors. Several types of cancer can develop in these glands. Only malignant tumors of the salivary glands are discussed in this paper. The diagnosis and treatment of salivary gland malignancies remain complex, with challenging problems for maxillo-facial surgeon. Scientists have found few risk factors that make a person more likely to develop salivary gland cancer. Salivary gland cancer is uncommon, and there is no widely recommended screening schedule for this cancer. CT scanning or MRI is useful for determining the extent of large tumors, for evaluating extraglandular extension, for determining the actual depth of parotid tumors, and for discovering other tumors in one gland or in the controlateral gland. Fine-needle aspiration biopsy (FNAB) is a valuable diagnostic adjunct in evaluation of head and neck masses but its role in evaluation of salivary gland tumors is controversial. There are also discussed some histologic findings about mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, carcinoma ex-pleomorphic adenoma, squamous cell carcinoma and adenocarcinoma developed in salivary glands. Carefully planned and executed surgical excision is the primary treatment for all malignant tumors of the salivary glands. The principles of surgery vary with the site of origin. The extent of surgery is based on the size of the tumor, local extension and neck metastases. Staging of malignant salivary gland tumors is important for predicting prognosis and for accurate comparison of treatment results.
Salivary Gland Tumors in Maxillofacial Region: A Retrospective Study of 130 Cases in a Southern Iranian Population  [PDF]
Mahmoud Shishegar,Mohamad J. Ashraf,Negar Azarpira,Bijan Khademi,Basir Hashemi,Amir Ashrafi
Pathology Research International , 2011, DOI: 10.4061/2011/934350
Abstract: Tumors of the salivary glands are uncommon head and neck neoplasia. We conducted a retrospective study of 392 cases over the last 6 years in Shiraz, south of Iran, to investigate the clinicopathological features of these tumors in Iranian population. The age of the patients ranged from 8 to 85 years, with the mean age years and male-to-female (M?:?F) ratio was 1.02?:?1. For benign tumors, there was a propensity towards females, whereas the malignant tumor was more common in males. The ratio of benign tumors to malignancies was 2.19?:?1. Pleomorphic adenoma (PA) was the most common tumor and accounted for 85% of all benign tumors, followed by Warthin's tumor (8.6%). Of the 125 malignancies, adenoid cystic carcinoma (40%), mucoepidermoid carcinoma (24%) and invasive squamous cell carcinoma (16%) were the most common histological types. Most of the salivary gland tumors (75%) originated from major salivary glands and the remained (25%) originated from minor glands. The parotid gland was the most common site both in benign and malignant tumors. Most of our findings were similar to those in the literature, with some variations. The salivary tumors slightly predominated in males. Adenoid cystic carcinoma and mucoepidermoid carcinoma constituted the most common malignancies. 1. Introduction Salivary gland tissues are diffusely distributed in the upper aerodigestive tract. The parotid, submandibular, and sublingual glands are the major salivary glands. Minor salivary glands are present in many sites, such as the lips, gingiva, cheek, palate, tongue, oropharynx, paranasal sinuses, and parapharyngeal space. Salivary gland tumors are relatively uncommon lesions accounting for 3–6% of all head and neck neoplasms [1]. The global incidence of these tumors is 0.4–13.5 per 100,000 persons annually [2–4]. These neoplasms composed heterogeneous groups of tumors with variable histological pictures. The site, patient age, and sex distributions of different types of salivary gland neoplasms vary with race and geographic location. The incidence of these tumors is different in between geographic areas and ethnic groups [2, 3, 5]. In the English literature, there is little report [1] on salivary gland tumors in Iranian population. The aim of this study was to analyze the relative frequency, location, patient sex, and age of salivary gland tumors in the southern Iranian population over the last 6 years. 2. Material and Methods This study included patients with primary epithelial salivary gland neoplasms between 2004 to 2009, who underwent operations in the Department of
Salivary gland tumors in a Brazilian population: a retrospective study of 124 cases
Vargas, Pablo Agustin;Gerhard, Renê;Araújo Filho, Vergílius J. F.;Castro, Inês Vieira de;
Revista do Hospital das Clínicas , 2002, DOI: 10.1590/S0041-87812002000600005
Abstract: salivary gland tumors constitute a highly heterogeneous histopathologic group. there are few epidemiological studies of large series of benign and malignant salivary gland tumors in brazil. material and methods: hospital records of 124 patients with salivary gland tumors diagnosed from january 1993 to december 1999 were reviewed. the patients were analyzed according to gender, age, size, location, and histopathology of the tumor. results and conclusions: patients with benign and malignant tumors presented with a mean age of 47.7 and 48.8 years, respectively. the frequency of benign tumors was 80% (n = 99) and malignant tumors 20% (n = 25). tumors were localized in the parotid gland 71% (n = 88), in the submandibular gland 24% (n = 30), and in the minor salivary glands 5% (n = 6). the most common benign tumors were pleomorphic adenoma in 84% (n = 84) and warthin's tumor in 13% (n = 13). among malignant tumors, mucoepidermoid carcinoma was the most common in 52% (n = 13), adenoid cystic carcinoma occurred in 20% (n = 5), and carcinoma ex pleomorphic adenoma was detected in 12% (n = 3).
Salivary gland tumors in a Brazilian population: a retrospective study of 124 cases  [cached]
Vargas Pablo Agustin,Gerhard Renê,Araújo Filho Vergílius J. F.,Castro Inês Vieira de
Revista do Hospital das Clínicas , 2002,
Abstract: Salivary gland tumors constitute a highly heterogeneous histopathologic group. There are few epidemiological studies of large series of benign and malignant salivary gland tumors in Brazil. MATERIAL AND METHODS: Hospital records of 124 patients with salivary gland tumors diagnosed from January 1993 to December 1999 were reviewed. The patients were analyzed according to gender, age, size, location, and histopathology of the tumor. RESULTS AND CONCLUSIONS: Patients with benign and malignant tumors presented with a mean age of 47.7 and 48.8 years, respectively. The frequency of benign tumors was 80% (n = 99) and malignant tumors 20% (n = 25). Tumors were localized in the parotid gland 71% (n = 88), in the submandibular gland 24% (n = 30), and in the minor salivary glands 5% (n = 6). The most common benign tumors were pleomorphic adenoma in 84% (n = 84) and Warthin's tumor in 13% (n = 13). Among malignant tumors, mucoepidermoid carcinoma was the most common in 52% (n = 13), adenoid cystic carcinoma occurred in 20% (n = 5), and carcinoma ex pleomorphic adenoma was detected in 12% (n = 3).
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