Interpretation and comparison of international guidelines for salivary gland malignancy in 2021 / 中华口腔医学杂志

In order to provide evidence-based recommendations on the management of salivary gland malignancy (SGM), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) formulated and updated SGM clinical practice guidelines respectively in 2021.The two guidelines are interpreted and compared in this article from six perspectives including preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, follow-up evaluations and recurrent-metastatic diseases' management of SGM, which has guiding significance for diagnosis and treatment of SGM in China.

Carcinoma del conducto salival: estudio clínico/patológico e inmunohistoquímico de 5 casos / Salivary duct carcinoma: a clinicopathologic and inmunohistochemical study of 5 cases

El carcinoma del conducto salival es un tumor epitelial maligno agresivo, que involucra principalmente a la glándula parótida, con características histológicas semejantes al carcinoma ductal de glándula mamaria. El propósito de este trabajo fue presentar los resultados clínico-patológicos de cinco casos de carcinoma del conducto salival primario de glándula parótida y evaluar la expresión de Ki67. Histológicamente, el carcinoma del conducto salival presentó nidos epiteliales con patrones papilar, sólido y cribiforme, comedonecrosis tanto en la lesión primaria como en los nodos linfoides metastásicos y, además, invasión perineural. Se demostró con Ki 67 una alta proliferación celular en cuatro (80 %) de los cinco casos estudiados. Se concluyó que: el carcinoma del conducto salival es una lesión maligna de mal pronóstico, raramente informado en la literatura odontológica, con características histológicas semejantes a las del carcinoma ductal de alto grado de la mama; la comedonecrosis es un signo específico de esta enfermedad; puede desarrollarse "de novo" o en un adenoma pleomórfico preexistente; su diagnóstico diferencial histopatológico es fundamental para planificar su tratamiento y determinar su pronóstico, a pesar de su tratamiento quirúrgico y radioterapia postoperatoria es un tumor agresivo con alta proliferación celular, infiltración perineural, recurrencias y metástasis.

Salivary duct carcinoma is an aggressive malignant epithelial tumor, primarily involving the parotid gland, with histologic features similar to ductal carcinoma of the breast. The purpose of this work was to report the clinicopathological results of five cases of primary salivary duct carcinoma of the parotid gland and evaluate the expression of Ki67. Histologically, salivary duct carcinoma presented epithelial nests with papillary, solid, and cribriform patterns, with comedonecrosis in both the primary lesion and the metastatic limph nodes, and perineural invasion. A high cell proliferation was demonstrated with Ki67 in four (80 %) of the five cases studied. We concluded that: salivary duct carcinoma is a malignant lesion with a poor prognosis, rarely reported in the dental literature, with histological characteristics similar to those of high-grade ductal carcinoma of the breast; comedonecrosis is a specific sign of this disease; may develop "de novo" or in a pre-existing pleomorphic adenoma; its differential histopathological diagnosis is essential to plan its treatment and determine its prognosis; despite its surgical treatment and postoperative radiotherapy, it is an aggressive tumor with high cell proliferation, perineural infiltration, recurrences and metastasis.

Incidental Discovery of Acinic Cell Carcinoma of the Oral Mucosa with Metachronous Adenoid Cystic Carcinoma of the Upper Lip / Hallazgo Incidental de Carcinoma de Células Acinares de la Mucosa Oral con Carcinoma Adenoide Quístico Metacrónico del Labio Superior

ABSTRACT: Multiple salivary gland tumors represent an unusual event characterized by the development of composite lesions originated from minor or major salivary glands. These neoplasms can be categorized into three perspectives: Histologic type, time of appearance and topographic distribution. We report an unusual case of a 73-year-old black man with an acinic cell carcinoma (ACC) of the oral mucosa discovered incidentally during surgical removal of an adjacent mucocele. Approximately one year after the first consultation, the patient was seen at the local cancer reference center with a third lesion that was diagnosed as an adenoid cystic carcinoma (AdCC) of the upper lip. The patient underwent surgical reconstruction of the treated areas and has been free of the disease for the past year. To our knowledge, the combination of ACC and AdCC in intraoral sites has not been reported in the literature.

RESUMEN: Los tumores de glándulas salivales múltiples representan un evento inusual caracterizado por el desarrollo de lesiones compuestas, originadas en glándulas salivales menores o mayores. Estos neoplasmas se pueden categorizar en tres perspectivas: tipo histológico, tiempo de aparición y distribución topográfica. Reportamos un caso inusual de un hombre negro de 73 años con un carcinoma de célula acínica (ACC) de la mucosa oral descubierta incidentalmente durante la extirpación quirúrgica de un mucocele adyacente. Aproximadamente un año después de la primera consulta, el paciente se presentó en el centro de referencia del cáncer local con una tercera lesión que fue diagnosticada como carcinoma adenoide quístico (AdCC) del labio superior. El paciente se sometió a la reconstrucción quirúrgica de las áreas tratadas y durante el último año no ha presentado recurrencia de la enfermedad. De acuerdo a nuestro conocimiento la combinación de ACC y AdCC en sitios intraorales no se ha informado en la literatura.

Sensibilidad y especificidad de la punción aspirativa, con aguja fina, de tumores de glándulas salivales mayores en el Hospital Oncológico María Curie / 2 SENSIBILITY AND SPECIFICITY WITH FINE NEEDLE ASPIRATION OF MAJOR SALIVARY GLANDS TUMORS

Los tumores de glándulas salivales son una causa frecuente de consulta en servicios de cabeza y cuello. Para arribar a diagnostico es necesario realizar estudios por imágenes, citológicos a través de la punción aspirativa con aguja fina (PAAF) y anatomía patológica. Objetivo: Evaluar la eficacia de la PAAF en los tumores de glándulas salivales mayores en nuestro medio, teniendo en cuenta los beneficios de ésta y el avance en las técnicas de diagnóstico por imágenes; ¿Estas podrían reemplazar al método citológico? Métodos: Estudio descriptivo y retrospectivo en base a las historias clínicas de los pacientes con tumores de glándulas salivales mayores a quienes se les realizo PAAF, y que posteriormente fueron sometidos a cirugía. Resultados: Se revisaron 113 historias clínicas de pacientes con tumores de glándulas salivales entre Junio de 2010 y Febrero de 2017, se excluyeron 37 (32,7%), quedando incluídos en este estudio 76 pacientes (67,3%). La PAAF hizo diagnóstico en un 84,2% de los pacientes. Sensibilidad del 93% y especificidad del 75%. Conclusión: La PAAF es una prueba sencilla, pero de utilidad limitada en el diagnóstico de tumores de glándulas salivales mayores en nuestro caso debido a la baja especificidad. Es útil para planificar la terapéutica cuando se sospecha la presencia de un tumor maligno, en especial para poder comunicar al paciente y la familia la conducta terapéutica, incluso tomar decisión en pacientes con alto riesgo quirúrgico

Salivary gland tumors are a frequent cause of consultation in head and neck services. In order to arrive at the diagnosis, it is necessary to perform imaging, cytological studies through fine needle aspiration (FNA) and pathological anatomy. Objective: To evaluate the efficacy of FNA in major salivary gland tumors in our setting, taking into account the benefits of FNA and progress in diagnostic imaging techniques; could they replace the cytological method? Methods: Descriptive and retrospective study based on the medical records of patients with tumors of the major salivary glands who underwent FNA and who were subsequently submitted to surgical intra and postperative biopsy. Results: A total of 113 clinical records of patients with salivary gland tumors were reviewed between June 2010 and February 2017, 37 (32.7%) were excluded, and 76 patients (67.3%) were included in the study. The FNA was diagnosed in 84.2% of the patients. Sensibility was 93% and specificity 75%. Conclusion: FNA is a simple test, but of limited utility in the diagnosis of tumors of the major salivary glands in our case due to the low specificity. It is useful to plan the therapeutics when the presence of a malignant tumor is suspected, especially to be able to communicate to the patient and the family the therapeutic behavior, even to make decision in patients with high surgical risk

Cáncer oromaxilofacial en niños: Parte II tumores odontogénicos y de glándulas salivales malignos / Maxillofacial cancer in children: Part II malignant odontogenic and salivary gland tumors

A nivel mundial, la información acerca de tumores malignos del territorio maxilofacial que afectan a niños es limitada. La mayoría de los resportes consiste principalmente en datos de la población adulta. Las neoplasias malignas originadas del aparato odontogénicos y glándulas salivales son lesiones que con cierta frecuencia pueden afectar a la población infantil. Los tumores odontogénicos malignos son entidades sumamente raras que, correspondiendo a menos del 5 % del total de tumores odontogénicos. Los sarcomas odontogénicos, si bien son poco frecuentes, corresponden a los tumores odontogénicos malignos más comunes en la infancia. Las neoplasias malignas de glándulas salivales corresponden al 35­60 % de los tumores de gándulas salivales en la infancia, siendo el más común de ellos el carcinoma mucoepidermoide. En general, el pronóstico de estas entidades es positivo sobre todo si es acompañado de un diagnóstico oportuno. A pesar de la baja frecuencia que presenta este grupo de patologías, no es menos cierto que es necesario saber con precisión cuales son los tejidos orales desde los cuales se pueden originar neoplasias malignas en los niños y tener una breve referencia diferencial entre ellos.

Globally, information about the maxillofacial malignant tumors affecting children is limited. Most reported data consists mainly of studies in the adult population. Malignant neoplasms arising from odontogenic apparatus and salivary glands are lesions that frequently can affect children. Malignant odontogenic tumors are extremely rare entities, corresponding to less than 5 % of all odontogenic tumors. Odontogenic sarcomas, although they are rare, correspond to the most common malignant odontogenic tumors in childhood. Malignant salivary gland neoplasms correspond to 35­60 % of tumors of salivary glands during childhood and the most common of these is mucoepidermoid carcinoma. In general, the prognosis of these entities is positive especially when there is a timely diagnosis. Despite the low frequency presented by this group of diseases, the fact remains that it is necessary to know precisely what the originating oral tissues are which can cause malignancies in children and have a brief reference differential between them.

Carcinoma mucoepidermoide de las glándulas salivares en Brasil: resultados clinicopatológicos y una breve revisión / Mucoepidermoid carcinoma of the salivary glands in Brazil: clinicopathological outcomes and a brief review

The biological features and the clinical behavior of the mucoepidermoid carcinoma are varied and not known yet. The aim of present paper was to analyze the potential prognostic factors affecting the survival of patients diagnosed with primary mucoepidermoid carcinoma of head and neck. A retrospective study was conducted in 16 patients treated between 1990 and 2008 in the General Hospital of Riberirao Preto, USP Medicine School, Brazil. The following variables were studied: age, sex, anatomical location, tumor size, clinical stage, histological degree, relapse, metastasis, involved surgical edges ant treatment on the clinical-pathological results. The survival curves were designed using the Kaplan-Meier method and the statistic analysis was made using the log-rank test. The 68.7 percent of patients was of male sex, all patients were between 13 and 83 years old. The 75 percent of tumors was located in the great salivary glands, the 56.3 percent in the parotid glands ones, the mucoepidermoid carcinomas of low degree and of II stage were the 37.5 percent. The surgical resection was carried out in all patients. The follow-up period in present study fluctuates between 6 and 217 months. The general rate of 5- y years or 10-years survival was of 85.6 percent whereas the rates of disease-free survival were of 81.8 percent at 5 years and of 68.2 percent at 10 years. The were statistically significant influences of the tumor size (p = 0.05), presence of metastasis (p = 0.04) and of the primary anatomical location (p = 0.04) on the rates of disease-free survival. The results obtained show the significance of the primary anatomical location of the tumor, of its size and of the presence of metastasis in the survival of mucoepidermoid carcinomas(AU)

Las características biológicas y el comportamiento clínico del carcinoma mucoepidermoide son muy variados y aún poco conocidos. El propósito de este estudio fue analizar los factores pronósticos que puedan afectar la supervivencia de los pacientes con diagnóstico de carcinoma mucoepidermoide primario de cabeza y cuello. Se realizó un estudio retrospectivo de 16 pacientes tratados entre 1990 y 2008 en el Hospital General de Ribeirao Preto, Escuela de Medicina USP, Brasil. Se estudiaron las variables: edad, sexo, localización anatómica, tamaño del tumor, estadio clínico, grado histológico, recidiva, metástasis, bordes quirúrgicos comprometidos y tratamiento, sobre los resultados clínico-patológicos. Las curvas de supervivencia fueron construidas utilizando el método de Kaplan-Meier y el análisis estadístico fue realizado mediante la prueba del log-rank. Se constató 68,7 por ciento de pacientes del sexo masculino, todos los pacientes comprendidos en las edades entre 13 y 83 años. El 75 por ciento de los tumores se localizó en las glándulas salivales mayores, 56,3 por ciento en parótida, los carcinomas mucoepidermoides de bajo grado y estadio II con 37,5 por ciento. La resección quirúrgica fue realizada en todos los pacientes. El período de seguimiento en este estudio varió entre 6 y 217 meses. La tasa general de supervivencia, tanto a los 5 como a los 10 años fue de 85,6 por ciento, mientras que las tasas de supervivencia libre de enfermedad fueron de 81,8 por ciento a los 5 años y de 68,2 por ciento a los 10 años. Se demostró la existencia de influencias estadísticamente significativas del tamaño del tumor (p = 0,05), presencia de metástasis (p = 0,04), y de la localización anatómica primaria (p = 0,04) sobre las tasas de supervivencia libre de enfermedad. Los resultados obtenidos demuestran la importancia de la localización anatómica primaria del tumor, de su tamaño y de la presencia de metástasis, en la supervivencia de los carcinomas mucoepidermoides(AU)

Linfoepitelioma de glândulas salivares maiores: relato de caso / Lymphoepithelioma of major salivary glands: case report

O linfoepitelioma de glândulas salivares maiores é um tumor maligno e raro, principalmente no ocidente. No presente artigo, descrevemos o caso de uma paciente do sexo feminino, com linfoepitelioma de parótida, que recidivou precocemente depois de cirurgia isolada e alcançou remissão depois de quimiorradiação. A paciente encontra-se no 19º mês de seguimento clínico, sem sinais de recidiva ou sequelas do tratamento. A literatura pertinente ao assunto foi revisada.

Lymphoepithelioma of major salivary glands is a rare malignant tumor, affecting mainly the population of Western countries. In the present paper, we report the case of a female patient with parotid lymphoepithelioma, which recurred early after surgery. The patient achieved remission after chemoradiation and has been followed up for 19 months with no evidence of relapse and sequelae of treatment. Additionally, we reviewed the relevant literature related to this topic.

A retrospective study of 18 cases of adenoid cystic cancer at a tertiary care centre in Delhi.

Context: Adenoid cystic carcinoma (ACC) is a rare neoplasm that usually arises from the salivary, lacrimal, or other exocrine glands. It is characteristically locally infiltrative in nature and has a tendency toward local recurrence, high propensity for perineural invasion, and prolonged clinical course. Aim: To analyze the presentation and natural history of cases of adenoid cystic tumors of salivary glands in our institution; and to compare with the existing literature. Design and Setting: Retrospective study at the Department of Radiotherapy. Materials and Methods: Data on 18 patients of ACC of the salivary glands treated between 2004 and 2008 were reviewed with respect to clinical presentation, stage, and histology. Results: There were 8 cases of major salivary gland tumors (47%), of which 2 were in the submandibular and 6 were involving the parotid. Ten patients (53%) had minor salivary gland involvement. Two patients had metastasis at the time of presentation. All patients underwent surgery. Radiotherapy was delivered to 16 patients and chemotherapy to 6 patients (concurrent, n = 3 and adjuvant, n = 3) and no adjuvant therapy was given to 2 patients. All patients were alive at a median follow-up of 3 years. No patient developed local or distant failure during the study duration. Conclusion: ACC has locally aggressive behavior. Radiotherapy adjuvant to surgery improves local control in locally advanced disease. Longer follow-up is mandatory in view of incidence of late metastasis.

Neoplasias de glândulas salivares / Salivary glands neoplasms

Introdução: As neoplasias de glândulas salivares representam um raro e variado grupo de tumores com diferentes características. A programação terapêutica depende de um adequado diagnóstico a fim de se evitar complicações ou procedimentos desnecessários. Objetivo: Revisão da literatura com ênfase nos mais recentes avanços diagnósticos e terapêuticos. Método: Foi realizada consulta eletrônica nas bases de dados MEDLINE, OVID, PubMed e SciELO para artigos publicados entre os anos de 1997 e 2007. Conclusão: O adequado diagnóstico das neoplasias de glândulas salivares é complexo e cabe ao otorrinolaringologista/cirurgião de cabeça e pescoço a investigação do subtipo histológico para o adequado tratamento. Muitas vezes os exames diagnósticos se confrontam, exigindo avaliação cuidadosa caso-a-caso.

Introduction: Salivary glands neoplasms represent a rare and diverse group of tumors with different characteristics. To avoid complications and unnecessary procedures, the treatment depends on an accurate diagnosis. Objective: Review the literature emphasizing the latest advances in diagnosis and treatment. Method: An electronic research was performed on MEDLINE, OVID, PubMed and SciELO databases articles in a period between 1997 and 2007. Conclusion: The proper diagnosis of salivary glands neoplasms is complex, and the otorhinolaryngologist/head and neck surgeon needs to investigate the histological subtype to ensure ideal treatment. Frequently, diagnostic exams conflict, and careful case by case evaluation is required.

Carcinoma mucoepidermóide de glândula sublingual: relato de caso clínico / Mucoepidermoid carcinoma of sublingual salivary gland: report of case

Os tumores das glândulas salivares maiores correspondem a aproximadamente 3 a 5% de todas as neoplasias da cabeça e pescoço. O carcinoma mucoepidermóide (CME) é o tumor maligno de glândula salivar mais frequente na cavidade bucal, ocorrendo preferencialmente no gênero feminino, entre a 3º e 4º décadas de vida. Trata-se de uma lesão agressiva, que se apresenta clinicamente por meio de um aumento de volume com aspecto nodular, de consistência sólida, fixo à palpação, variando entre as tonalidades de azul, vermelho ou púrpura. O processo diagnóstico é feito por meio de uma associação entre os exames clínico e complementar, sendo a biópsia essencial para a sua conclusão. O carcinoma mucoepidermóide pode ser classificado quanto ao seu grau de diferenciação em baixo, intermediário e alto grau. Um recente sistema utilizando cinco achados histopatológicos parece ser o ideal para realizar essa classificação. O tratamento é cirúrgico e consiste em exérese total da lesão, sendo o prognóstico favorável.

The major salivary glands tumors are 3 to 5 % of all the head and neck neoplasms. The mucoepidermoid carcinoma is a malignant tumor of salivar gland most frequent in the oral cavity, preferential in females, between 3th and 4th decades of life. One is about an aggressive injury, where the main clinical aspects include a nodular form, solid and fixed consistence increase the touch, varying among the blue shades to the red or purple. The process diagnosis is made through an association among the clinical and complemental exams, being the biopsy essential for the dignosis conclusion. The mucoepidermoid carcinoma can be classified as his differentiation degree in low, intermediate and high-grade. A recent system using five histopathological founds seems to be the ideal to accomplish that classification. Treatment usually surgical, include complete resection of the lesion, being the favorable prognostic.

Reclassificaçäo das neoplasias de glândulas salivares / Reclassification of salivary gland neoplasms

Foram reclassificadas 80 neoplasias de glândulas salivares nas disciplinas de Estomatologia e Patologia Bucal da Faculdade de Odontologia de Araçatuba - UNESP, correspondentes ao período compreendido entre 1966 e 1997. A reclassificaçäo do diagnóstico histológico inicial baseou-se na Classificaçäo da Organizaçäo Mundial da Saúde (OMS) para Tumores de Glândulas Salivares de 1991. O estudo comparativo do diagnóstico das neoplasias antes e depois da reclassificaçäo (OMS, 1991) revelou que o diagnóstico inicial foi modificado em 15 casos (18,75 por cento). De maior significado clínico foi a constataçäo de que a reclassificaçäo possibilitou verificar alteraçäo do diagnóstico inicial de neoplasia benigna para maligna em 6 casos (40 por cento), fato que determina mudança no planejamento terapêutico, no prognóstico e, por conseguinte, na sobrevida dos pacientes

Estudo imuno-histoquímico do carcinoma adenóide cístico de glândula salivar menor / Immunohistochemical study of minor salivary gland's adenoid cystic carcinoma

A expressäo de um painel de anticorpos, constituídos pelas citoqueratinas 7, 8, 10, 13, 14, 18 e 19, vimentina e HHF-35, foi estudada em 21 casos de carcinomas adenóide císticos de glândula salivar menor, de diferentes sub-tipos histológicos, utilizando-se a técnica da imunohistoquímica, pelo método da estreptpavidina-biotina. Os resultados mostraram que nos tumores cribriformes, as células luminas das estruturas ductais foram positivas para as citoqueratinas 7, 8, 14, 18 e 19 e negativas para a vimentina e HHF-35, enquanto as células externas dos ductos, as células que revestiam os espaços pseudo-císticos e as células periféricas dos cilindros foram negativas para as citoqueratinas testadas e positivas para a vimentina e HHF-35. Nos tumores tubulares, enquanto as células internas dos ductos mostraram-se positivas para as citoqueratinas 7, 8, 14, 18 e 19 e negativas para vimentina e HHF-35, as células periféricas das estruturas ductais, apresentaram-se sempre positivas para a vimentina e HHF-35 e ocasionalmente positivas para a citoqueratina 14. Nas neoplasias do subtipo sólido, observou-se positividade esporádica das células, especialmente para as citoqueratinas 7 e 14, bem como para a vimentina. Os nossos achados mostraram que o carcinoma adenóide cístico, de um modo geral, mimetiza, em seu perfil imuno-histoquímico, o segmento de ducto intercalado da glândula salivar normal, apresentando variaçöes que sugerem diferentes graus de diferenciaçäo para os seus três subtipos histológicos. Os tumores tubulares representam a variante mais diferenciada, os tumores sólidos, o subtipo menos diferenciado, e os tumores cribiformes, neoplasias de um grau intermediário de diferenciaçäo entre aquele visto nas outras duas variantes histológicas

Tumores de glándulas salivares mayores / Tumors of mayor salivary glands

Los tumores de glándulas salivares (GS) representan entre el 3 y 6 por ciento de los tumores de cabeza y cuello y menos del 1 por ciento de la patología quirúrgica general. Su baja incidencia determina, a veces, diagnósticos incorrectos, porque no se piensa en esa posibilidad y por otra parte, la ubicación anatómica de estas glándulas próximas a troncos vasculares mayores, pares craneanos y mucosa oral hacen difícil su tratamiento, el que habitualmente es de naturaleza quirúrgica. El objetivo de esta revisión es actualizar el conocimiento de los métodos diagnósticos y precisar las tendencias actuales de tratamiento de los tumores de GS mayores, con el propósito de facilitar su pesquisa y su derivación por el médico general y así optimizar su tratamiento a nivel de especialistas

Carcinoma de células acinares de glândula salivar: estudo de 16 casos com correlaçäo clínico-patológica / Acinic cells carcinoma of the salivar glands: study of sisteen cases with clinicopathologic correlation

Dezesseis casos de carcinoma de células acinares (CCA) de glândulas salivares foram estudados, e seus diferentes aspectos clíncio-patológicos foram analisados. Três graus histológicos distintos foram observados pela análise do pleomorfismo celular, atividade mitótica e presença de necrose. O estudo revelou haver correlaçäo entre o prognóstico e a gradaçäo da neoplasia em alto e baixo grau de malignidade. Outros fatores importantes no prognóstico foram estadiamento clínico e a forma de tratamento, sendo a ressecçäo cirúrgica radical o tratamento da escolha