ABSTRACT
Abstract Introduction Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. Objective To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands Methods This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). Results The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p < 0.001), clinical stage (p < 0.001), compromised surgical margins (p = 0.013), and chemotherapy (p < 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011). Conclusion Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.
Resumo Introdução Os tumores malignos das glândulas salivares são entidades patológicas incomuns, representam menos de 5% das neoplasias de cabeça e pescoço. O prognóstico dos pacientes com tumores malignos das glândulas salivares é altamente variável e alguns fatores clínicos podem influenciar significativamente a sobrevida global. Objetivo Analisar as características clinicopatológicas e sociodemográficas que influenciam a sobrevida em pacientes com tumores malignos das glândulas salivares. Método Este estudo retrospectivo analisou sexo, idade, etnia, nível de escolaridade, localização do tumor, tamanho do tumor, envolvimento linfonodal, metástase distante, margens, tipo de tratamento, estado civil, método de acesso à assistência médica e sobrevida global em 15 anos de 193 pacientes com tumores malignos das glândulas salivares. Foram usados os testes X2, log-rank Mantel-Cox, regressão multinomial e regressão logística de Cox (SPSS 20.0, p < 0,05). Resultados Os tipos histológicos mais comuns foram adenocarcinoma (32,1%), carcinoma adenoide cístico (31,1%) e carcinoma mucoepidermoide (18,7%). A taxa de sobrevida global em 15 anos foi de 67,4%, com média de 116 ± 6 meses. A análise univariada revelou que sexo masculino (p = 0,026), idade > 50 anos (p = 0,001), origem de referência do sistema público de saúde (p = 0,011), estádio T (p = 0,007), estádio M (p < 0,001)), estágio clínico (p < 0,001), margens cirúrgicas comprometidas (p = 0,013) e quimioterapia (p < 0,001) foram associados a um prognóstico ruim. As análises multivariadas também mostraram que a idade > 50 anos foi associada independentemente a um prognóstico ruim (p = 0,016). O nível de escolaridade foi o único fator mais prevalente em pacientes idosos (p = 0,011). Conclusão Pacientes com tumores malignos das glândulas salivares acima de 50 anos apresentam pior prognóstico e associação independente com baixo nível de escolaridade.
ABSTRACT
Sebaceous carcinoma of the salivary gland is an extremely unordinary malignancy occurring mainly in the parotid gland. Sebaceous carcinoma arising in the submandibular gland is exceptional and only three cases have been reported in the literature. We herein present a unique case of sebaceous carcinoma of the submandibular gland, the first to be reported in literature in South Korea. An 85-year-old man visited our hospital complaining of a progressively enlarging submandibular mass with tenderness and ipsilateral facial palsy. We performed a wide excision of the mass with superficial parotidectomy and modified neck dissection. Microscopic and immunohistochemical examinations demonstrated sebaceous carcinoma of low grade differentiation. Further adjuvant radiotherapy was rejected and the patient was followed up for five months. The optimal treatment of sebaceous carcinoma of the salivary gland is still not established due to the rarity of the disease. When more cases are reported, the clinicopathologic characteristics will be better understood.
Subject(s)
Aged, 80 and over , Humans , Facial Paralysis , Korea , Neck Dissection , Parotid Gland , Radiotherapy, Adjuvant , Salivary Gland Neoplasms , Salivary Glands , Submandibular Gland Neoplasms , Submandibular GlandABSTRACT
OBJECTIVE: To analyze the value of fine needle aspiration and the rates of postoperative complications in patients undergoing resection of the submandibular gland. METHODS: we analyzed the records of patients treated with resection of the gland from January 1995 to December 2008. The data collected included age, gender, findings on clinical history, surgical procedure, results of fine needle aspiration (FNA), pathological diagnosis and complications. RESULTS: 117 patients were studied, aged 12-89 years (mean 48), 70 women and 47 men. Thirty-nine patients (33.3%) were affected by inflammatory diseases (28 patients with lithiasis), 70 had benign tumors, and malignant tumors, eight. Regarding FNA, the sensitivity and specificity were 85.7% and 100%, respectively. Nine patients (7.7%) had temporary paralysis of the marginal mandibular nerve and one had permanent paralysis. CONCLUSION: resection of the submandibular gland is a safe procedure, with low complication rates.
OBJETIVO: Analisar o valor da punção aspirativa por agulha fina e os índices de complicações pós-operatórias em pacientes submetidos à ressecção da glândula submandibular. MÉTODOS: foram analisados os prontuários de pacientes tratados com a ressecção da glândula, de janeiro de 1995 a dezembro de 2008. Os dados coletados foram: idade, sexo, achados na história clínica, procedimento cirúrgico, resultados da punção por aspiração com agulha fina (PAAF), diagnóstico anatomopatológico e complicações. RESULTADOS: foram estudados 117 pacientes, com idade variando de 12 a 89 anos (média, 48 anos), sendo 70 mulheres e 47 homens. Trinta e nove pacientes (33,3%) foram acometidos por doenças inflamatórias (28 pacientes com litíase), 70 tiveram tumores benignos e oito tumores malignos. A respeito da PAAF, a sensibilidade e especificidade foram de 85,7% e 100%, respectivamente. Nove pacientes (7,7%) tiveram paralisia temporária do nervo mandibular marginal e um apresentou paralisia definitiva. CONCLUSÃO: a ressecção da glândula submandibular é um procedimento seguro, com baixa taxa de complicações.
Subject(s)
Humans , Salivary Gland Calculi , Sialadenitis , Submandibular Gland , Submandibular Gland Diseases , Submandibular Gland NeoplasmsABSTRACT
Oncocytic neoplasm of the head and neck region accounts for approximately 1% of all salivary gland tumors, but only 5% of oncocytic neoplasm is malignant. Oncocytic carcinoma arising in the submandibular gland is exceedingly rare. We encountered a sixty seven-year-old male patient who presented with multiple mass in the right neck. Fine needle aspiration biopsy revealed a salivary gland tumor of predominantly oncocytic form, and a differential diagnosis included oncocytic adenoma or mucoepidermoid carcinoma. A right submandibular gland resection and modified radical neck dissection were performed. Histologically, the tumor cells showed nuclear pleomorphism, and stromal invasion, which were compatible with oncocytic carcinoma. After surgery, the entire neck region was irradiated. Seventeen months after the initial surgery, multiple metastases to the bone and lung were detected from the incidental pathologic bone fracture of the right humerus; palliative chemotherapy was performed to resolve this. We report a case of oncocytic carcinoma in the submandibular gland with a review of literature.
Subject(s)
Humans , Male , Adenoma , Biopsy , Biopsy, Fine-Needle , Carcinoma, Mucoepidermoid , Diagnosis, Differential , Fractures, Bone , Head , Lung , Lymphatic Metastasis , Neck , Neck Dissection , Neoplasm Metastasis , Salivary Glands , Submandibular Gland , Submandibular Gland NeoplasmsABSTRACT
ObjectiveTo explore the characteristic CT features of benign and malignant submandibular gland lesions.Methods CT scans of 75 cases of submandibular gland lesions verified pathologically after surgery were analyzed retrospectively,including 38 cases of pleomorphic adenoma,22 cases of malignant tumors,11 cases of chronic submaxillaritis,2 cases of myoepithelioma,1 case of neurilemoma and 1 case of hemangioma.Results ( 1 ) All 38 cases of submandibular gland pleomorphic adenoma only occupied a part of submandibnlar gland.Thirty five lesions were on the edge of submandibular gland.The edge of 33 lesions were smooth and the density of 30 lesions were even.Thirty three lesions were slightly or moderately enhanced and 10 lesions showed “target sign” on enhanced CT.( 2 ) There were 22 cases of submandibular gland malignant tumors.Three lesions of lymphoma located at the edge of submandibular gland with smooth edge and even density,and showed mild to moderate enhancement.The remaining 19 lesions showed rough edge and uneven density.Eighteen of the 19 lesions showed ill-defined boundary,2 of the 18 lesions invaded most of submandibular gland and 16 of the 18 lesions invaded the whole submandibular gland.Seventeen lesions were unevenly enhanced,thickened,cirvilinear vessels were seen in 12 of the 17 lesions.Nine cases were accompanied with swollen lymph nodes ( minor diameter greater than 1.0 cm) in neck.(3)There were 11 cases of chronic submaxillaritis,which showed enlargement of the whole submandibular gland with relative smooth edge and relative clear boundary.Most of lesions were moderately and evenly enhanced.Six cases were companied with submandibular duct lithiasis and dilatation.All of 11 cases were accompanied with lymph node enlargement in neck.(4) Two cases of myoepithelioma demonstrated irregular ring enhancement on CT;one case of neurilemoma showed obvious cystic changes and slight enhancement on the edge;1 case of hemangioma showed multiple phleboliths and prolonged contrast enhancement.ConclusionsMost of submandibular gland benign and malignant lesions show some degree of characteristic CT findings.It is relatively difficult to discriminate between lymphoma and submandibular gland pleomorphic adenoma.
ABSTRACT
Papillary cystadenocarcinoma originated from salivary gland is a lower grade neoplasm that rises most commonly in major salivary glands, although involvement of lip, palate, buccal mucosa and tongue has also been described. Papillary cystadenocarcinoma was first defined in 1991 by WHO. Until then, it was classified as an atypical type of adenocarcinoma. We experienced a case of papillary cystadenocarcinoma of the submandibular gland, so we report this case with a review of the literature.