Research progress in molecular pathology of salivary gland carcinoma and clinical application / 国际生物医学工程杂志

Salivary gland cancer includes a group of heterogeneous malignant tumors. The latest WHO classification of head and neck tumors divides salivary gland cancer into 22 histopathological subtypes. The most common clinical subtypes include mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary duct carcinoma, acinar cell carcinoma and secretory carcinoma, etc. The histomorphology of the subtypes of salivary gland cancer overlaps, making diagnosis and differential diagnosis difficult. The main treatment for salivary gland cancer is tumor resection and postoperative radiotherapy as appropriate. Even in cases of local progression, recurrence and metastasis, the treatment options available are limited, mainly palliative treatment. Accurate determination of tumor receptor expression, genome and pathway changes is the key to changing the prognosis of patients with local progression or distant metastasis. In this paper, the known genetic mutations, amplifications and protein expression profiles of common salivary gland cancer histological subtypes was summarized, and the significance of the above-mentioned molecular genetic changes for disease diagnosis, future research and personalized targeted therapy was analyzed.

Carcinoma adenoquístico de las glándulas salivales / Adeno cystic carcinoma of salivary glands

Antecedentes: el carcinoma adenoquístico es el tumor maligno más frecuente de las glándulas sub-maxilar y menores. A pesar de su lento crecimiento y diseminación regional, muestra un pronóstico desfavorable debido a su tardía diseminación a distancia. Objetivo: analizar la serie propia a la luz de la bibliografia. Material y métodos: 44 pacientes con una edad media de 52,47 años y predominio del género femenino. De ellos, el 61,3% fueron tumores de glándula salival menor, 20,4% de submaxilar y 18,2% de parótida. En todos se realizó resección completa del tumor, seguida de vaciamiento cervical en el 34%. En el 43,2%, la cirugía fue seguida de Co60 radioterapia. El seguimiento medio de la muestra fue 52,5 (1-120) meses. Resultados: la curva de recurrencia acumulada fue del 36,8% a 5 años. La supervivencia global fue del 60 y 36% a 5 y 10 años, respectivamente, y se vio afectada con significación estadística por los márgenes insuficientes de la resección, el requerimiento de radioterapia adyuvante y el estadio. El análisis multivariado demostró que solo los márgenes insuficientes conservaron su significación estadística para la supervivencia y una tendencia desfavorable para el intervalo libre de enfermedad. Conclusiones: la extensión de la cirugía al cuello y la radioterapia adyuvante dependieron del estadio, los márgenes quirúrgicos, el compromiso nervioso, la presencia de adenopatas positivas y el subtpo histológico.

Background: adenoid cystic carcinoma is the most frequent malignant tumor of submaxillary and mi-nor salivary glands. Despite its slow growth, it shows an unfavorable prognosis because of its distant disseminaton. Objective: to analyse our series of patents in relaton to the literature. Materials and methods: 44 patents with mean age 52.47 years female gender. Of them, 61.3% were of minor salivary glands, 20.4% of submaxillary gland, and 18.2% the parotid gland. All patents underwent complete resecton of the tumor followed by neck dissecton in 34%. Co60 radiotherapy was administered to 43.2%. Mean follow up was 52.5 (range, 1-120) months. Results: 5-year recurrence rate was 36.8%. At 5 and 10 years, overall survival was 60 and 36%,respect-vely. Close surgical margins, requirement of adjuvant radiotherapy and stage significantly afected survival rate. The multivariate analysis showed that close margins was statstically significant for survival and associated with an unfavorable tendency for disease-free interval. Conclusions: extenton of surgery to the neck and adyuvant radiotherapy was dependent of stage, clear surgical margins, neural invasion, positive nodes in the neck and hystological subtype.

Good Response of a Salivary Duct Carcinoma to Androgen Deprivation Therapy / 대한내과학회지

Salivary duct carcinoma (SDC) is a rare, aggressive tumor. Androgen deprivation therapy (ADT) has been shown to have beneficial effects on SDC-expressing androgen receptors (ARs). A 69-year-old male with a right neck mass presented to our clinic. Computed tomography (CT) of the neck revealed a mass (6 cm diameter) on the right parotid gland, and enlarged lymph nodes. Examination of a needle biopsy sample identified SDC-expressing ARs. We performed total parotidectomy with bilateral neck dissection and concurrent postoperative chemoradiotherapy (total 66 Gy) with cisplatin (35 mg/m2), followed by another two cycles of chemotherapy (cisplatin 60 mg/m2, 5 FU 750 mg/m2). Post-treatment neck CT indicated that no residual tumor tissue remained; however, chest CT indicated recurrence in the right axilla. We initiated ADT with bicalutamide and leuprolide. Five months later, the axillar tumor tissue had almost disappeared. Our case demonstrates that ADT is effective for SDC of ARs. Therefore, clinicians should consider ADT in recurrent or metastatic SDC of ARs.

Secondary Membranous Nephropathy with Salivary Gland Cancer / 대한신장학회지

We report here on a rare case of membranous nephropathy occurring concurrently with salivary gland cancer. A 67-year-old woman was admitted to our department for nephrotic syndrome. She was diagnosed with membranous nephropathy and this was initially managed with steroids and cyclophosphamide, which started in 2003 and continued for about 10 months, without deriving any therapeutic benefits. During the treatment, the patient was diagnosed with salivary gland cancer when an incidental salivary gland mass was discovered in 2005. The patient's urinary protein level began to decrease following resection of the malignant mass. The clinical findings represent an interesting case of secondary membranous nephropathy that was diagnosed prior to the incidental discovery of malignancy.

Treatment Results of Major Salivary Gland Cancer by Surgery with or without Postoperative Radiation Therapy

OBJECTIVES: This is to report treatment results of major salivary gland cancer by surgery with or without postoperative radiation therapy (PORT). METHODS: Between March 1995 and January 2006, 94 patients with primary major salivary cancer underwent curative surgical resection at Samsung Medical Center. The parotid gland was the most commonly involved (73, 77.7%), followed by the submandibular and the sublingual. Neck dissection was added in 28 patients, and PORT was individually recommended to those with risk factors. Seventy-five (79.8%) patients received PORT. PORT volume included primary tumor bed and pathologically involved regional lymphatics, and no additional effort was made for elective nodal irradiation. The median total doses were 56.0 Gy to primary site and 58.7 Gy to regional lymphatics. RESULTS: After median follow-up of 49 months, 21 patients had relapsed: 20 in PORT; and one in surgery alone group. As the first site of failure, distant metastasis was the most common (17 patients). Local recurrence occurred in three, and regional relapse in one. The lung was the most common site (10 patients), followed by the bone, and the brain. Five-yr disease free survival (DFS), local control, and overall survival (OS) rates were 74.4% and 94.7%, 96.0% and 100%, and 78.2% and 100% in PORT and surgery alone groups, respectively. On multivariate analysis, DFS was significantly affected by pN+ (hazard ratio [HR], 3.624; P=0.0319), while OS was by pN+ (HR, 7.138; P=0.0034) and perineural invasion (HR, 5.073; P=0.0187). CONCLUSION: Based on our experience, the patients with early stage major salivary gland cancer with low risk can be effectively treated by surgery alone, and those who with risk factors can achieve excellent local and regional control by adding PORT. Omitting elective neck irradiation in patients with N0 disease seems a feasible strategy under accurate clinical evaluation. An effort is needed to decrease distant metastasis through further clinical trials.