Tumores de glándulas salivales: enfrentamiento diagnóstico inicial / Salivary gland tumors: initial diagnostic confrontation

It is described that salivary gland tumors account for up to 3-6% of head and neck tumors, 80% of these being located in the parotid gland. Broadly speaking, the smaller the gland, the greater the probability of malignancy. The most common clinical manifestation in tumor pathology is the appearance of a painless mass. Indicators of malignancy should be considered: chronic volume increase or rapid growth, facial paralysis, cranial nerve involvement, ulceration, and cervical lymphadenopathy. Ultrasonography should be the first imaging study, however, it provides limited information. MRI is the exam of choice for salivary gland tumors, whereas CT and PET-CT allow the study of local and remote invasion. FNA is controversial, it is not indicated for all patients, in parotid tumors a cytological examination is usually not necessary prior to surgery. Excisional biopsy is not recommended due to the risk of tumor seeding, neural damage, and salivary fistula. The goal of treatment in gland tumors is the removal of the glands, associated with lymph node dissection and adjuvant radiation therapy in indicated cases. The general practitioner must comprehensively address these pathologies to achieve a timely referral to the specialist. (AU)

Salivary Gland Disorders in Children and Adolescents: A 15-year Experience

Abstract Introduction Diseases of the salivary glands are rare in children and adolescents, with the exception of viral-induced infections. Objective To determine the clinical course of the disease, the diagnostic procedures, the treatment and the outcome of all children and adolescents affected with salivary gland diseases at our clinic over a period of 15 years. Methods A retrospective chart review including a long-term follow-up was conducted among 146 children and adolescents treated for salivary gland disorders from 2002 to 2016. Results Diagnosing acute sialadenitis was easily managed by all doctors regardless of their specialty. The diagnosis of sialolithiasis was rapidly made only by otorhinolar- yngologists, whereas diagnosing juvenile recurrent parotitis imposed difficulties to doctors of all specialties - resulting in a significant delay between the first occurrence of symptoms and the correct diagnosis. The severity-adjusted treatment yielded improve- ments in all cases, and a full recovery of 75% of the cases of sialolithiasis, 73% of the cases of juvenile recurrent parotitis, and 100% of the cases of acute sialadenitis. Conclusions Due to their low prevalence and the lack of pathognomonic symptoms, salivary gland diseases in children and adolescents are often misdiagnosed, resulting in an unneces- sarily long period of suffering despite a favorable outcome following the correct treatment.

Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review)

Abstract Background: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. Main body of the abstract: We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. Conclusion: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.

The learning progression of diagnostic sialendoscopy / Progressão do aprendizado da sialoendoscopia diagnóstica

ABSTRACT INTRODUCTION: Sialendoscopy is becoming the gold standard procedure for diagnosis and treatment of Salivary Gland Inflammatory Diseases. OBJECTIVE: To evaluate the learning progression of a single surgeon to implement and perform diagnostic sialendoscopy: to estimate how many procedures were necessary to achieve better results; if it was higher rate of complications in the beginning. METHODS: Retrospective analysis involving 113 consecutive sialendoscopies performed from 2010 to 2013. According to a descriptive analysis of the factors related to surgeon's experience, the casuistic was divided into two groups: group (A) comprising the first 50 exams, and group (B) the last 63. Groups were then compared concerning demographic and peri-operative aspects. RESULTS: In Group A, failure to catheterize papilla were 22% versus 3% in B (p = 0.001). Failure to complete examination was 30% in group A versus 6% in B (p = 0.001), and necessity to repeat exams was 22% in group A versus 10% in B (p = 0.058). The complication rates were 18% in group A, and 10% in B (p = 0.149). Operative time was slightly shorter in group B (56 versus 41 min, p = 0.045). CONCLUSION: We found better outcomes after the first 50 diagnostic sialendoscopies. Complication rates were statistically the same between early and late groups of experience with sialendoscopy.

RESUMO INTRODUÇÃO: A sialoendoscopia vem se tornando o procedimento de referência para o diagnóstico e o tratamento das doenças inflamatórias da glândula salivar. OBJETIVO: Avaliar a progressão de aprendizado de um mesmo cirurgião para implementação e realização da sialoendoscopia diagnóstica: verificar quantos procedimentos foram necessários para a obtenção de resultados melhores e se houve ocorrência de maior taxa de complicações no início do aprendizado. MÉTODO: Análise retrospectiva envolvendo 113 sialoendoscopias consecutivas realizadas de 2010 a 2013. De acordo com uma análise descritiva dos fatores relacionados à experiência do cirurgião, a casuística foi dividida em dois grupos: grupo (A), compreendendo os primeiros 50 exames; e grupo (B), os últimos 63. Em seguida, os grupos foram comparados, levando em consideração os aspectos demográficos e perioperatórios. RESULTADOS: No grupo A, a não realização do cateterismo papilar foi de 22% vs. 3% em B (p = 0,001). A não realização de um exame completo foi de 30% no grupo A vs. 6% em B (p = 0,001), e a necessidade de repetir o exame foi de 22% no grupo A vs. 10% em B (p = 0,058). Os percentuais de complicações foram 18% no grupo A e 10% em B (p = 0,149). O tempo operatório foi ligeiramente menor no grupo B (56 vs. 41 minutos, p = 0,045). CONCLUSÃO: Verificamos melhores desfechos após as 50 primeiras sialoendoscopias diagnósticas. Os percentuais de complicações foram estatisticamente semelhantes entre os grupos inicial e avançado de experiência com a sialoendoscopia.

Mucocele de las glándulas Blandin-Nuhn, aspectos patológicos y terapéuticos, a propósito de dos casos clínicos / Mucocele of the glands of Blandin-Nuhn

Las glándulas de Blandin-Nuhn son un grupo de pequeñas glándulas salivales mucoserosas, ubicadas en el espesor de los haces musculares de la zona anterior de la cara ventral de la lengua. Los mucoceles de las glándulas de Blandin-Nuhn son poco frecuentes. Se revisa la literatura y se presentan dos casos de mucocele de las glándulas de Blandin-Nuhn, ambos casos eran lesiones exofíticas, indoloras, una de ellas asociada a trauma. Los mucoceles de las glándulas salivales linguales anteriores deben ser resecados hasta el plano muscular para evitar la recidiva. Como esta lesión puede ser confundida con otras patologías, se recomienda su estudio histopatológico para evitar diagnósticos errados.

The Blandin-Nuhn glands are a small group of mucous serous salivary glands, located in the thickness of the muscle bundles of the anterior ventral side of the tongue. Mucocele of the glands of Blandin-Nuhn has been reported as unusual. We review the literature and present two cases of mucocele of the glands of Blandin-Nuhn, both cases were exophytic lesions, painless, one associated with trauma. Mucoceles of the salivary glands should be resected up to the muscular plane to avoid recurrence. Because this lesion may be confused with other diseases, it is recommended an histopathological exam to avoid misdiagnosis.

Benign hyperplasia of duct-associated lymphoid tissue: Report of a case and review of literature.

Focal lymphoid tissue is ubiquitously present in the oral mucosa and serves as a barrier for entrapment of antigens. The mucosa-associated lymphoid tissue is generally dispersed and sometimes associated with the ducts of the minor salivary glands. Proliferation of the duct-associated lymphoid tissue (DALT) is rarely reported, though probably of common occurrence. We report a case of benign hyperplasia of DALT in the buccal mucosa of a 58-year-old male. The histogenesis and pathological implications of this tissue are discussed and the need for recognition of this entity is stressed.

Punción aspirativa con aguja fina (PAAF) en glándulas salivales: indicación y análisis de 785 casos / Fine needle aspiration (FNA) biopsy on salivary glands: indication and analysis of 785 cases

La indicación de la PAAF como método diagnóstico en glándulas salivales no es considerada esencial por todos los autores, debido a los buenos resultados obtenidos por la clínica, los estudios con imágenes y la posibilidad de arribar a un diangóstico en el acto quirúrgico con la anatomía patológica por congelación. Pese a ello, la mayoría de los profesionales considera que la PAAF de glándulas salivales permite evitar cirugías innecesarias en un importante número de casos, al establecer el diagnóstico diferencial entre patologías inflamatorias y neoplásicas y arribar a la cirugía, cuando es necesario, con un adecuado diagnóstico prequirúrgico y el conocimiento de la patología por parte del paciente. Se analizan los resultados de 785 PAAF de glándulas salivales, realizadas por palpación y bajo ecografía. Se exponen las concordancias y discordancias citológicas y anatomopatológicos, la sensibilidad y especificidad, las dificultades diagnósticas y las ventajas del método.

Punción aspirativa con aguja fina (PAAF) y estudio histológico de fragmentos titulares en glándulas salivales mayores / Fine needle aspiration biopsy and histologic study of major salivary gland fragments

Objetivo: estudiar la efectividad de los extendidos y fragmentos obtenidos a través de la PAAF en glándulas salivales mayores. Se realizó una revisión de la literatura sobre PAAF y estudio de fragmentos titulares en glándulas salivales. Se punzaron 21 masas en glándulas salivales mayores y los resultados fueron comparados con el estudio anatomopatológico de la pieza quirúrgica en caso de que estuviera indicado. Se realizaron 21 PAAF y se obtuvo 15 extendidos satisfactorios (71 por ciento). El resultado de las PAAF sugirió la presencia de 9 tumores benignos, tres lesiones infecciosas, una lesión linfoproliferativa y 2 metástasis. Fue posible tomar fragmentos con la PAAF en 5 casos y en4 fueron efectivos en el diagnóstico. Se evitó realizar cirugías innecesarias en 4 casos (26 por ciento). El uso combinado de extendidos citológicos y fragmentos obtenidos por PAAF es una alternativa valiosa para el diagnóstico preoperatorio de lesiones que afectan glándulas salivales mayores; de todas maneras hacen falta más estudios sobre el uso combinado de ellos

Mucocele of the glands of Blandin-Nuhn: report of 2 cases

This report describes two cases of mucocele of the glands of Blandin-Nuhn [the anterior lingual salivary glands]. Both patients were males, aged 19 and 24 years, respectively. There was no history of trauma in either case as possible initiating cause. In one patient, there was interference with speech, mastication and deglutition. In the other case, the patient had a previous surgery for removal of the sublingual gland the but the swelling recurred. Treatment of the two mucoceles was by excision of the involved glands. Histologically, one case was an extravasation mucocele and the other was a retention mucocele

Compromiso de las glándulas salivales en la enfermedad HIV/Sida / Salivary glands involvement in HIV/AIDS disease

La enfermedad de las glándulas salivales asociada al HIV es definida como la presencia de aumento del tamaño de la glándula asociado o no a xerostomía. Esta patología es más habitual en niños que en adultos. La enfermedad de las glándulas salivales asociada al HIV incluye lesiones linfoepiteliales y quistes que comprometen el tejido glandulas y/o los ganglios linfáticos, síndrome símil-Sjogren, síndrome de linfocitosis T CD8 difuso y neoplasias. Este artículo incluye una revisión de la epidemiología, la fisiopatología, las manifestaciones clínicas, la metodololgía diagnóstica y los diagnósticos diferenciales de la enfermedad de las glándulas salivales asociada al HIV

Inflamación de glándulas salivales, revisión bibliográfica / Salivary glands inflammation: a review of the literature

Las glándulas salivales son estructuras pares, simétricas y localizadas junto a la rama y el cuerpo de la mandíbula, involucran glándulas parótida (saliva serosa), submaxilar (predominantemente serosa) y sublingual (predominantemente mucosa). Además existen numerosas glándulas salivales menores en la superficie de la mucosa bucal, yugal, palatina y sublingual de la cavidad bucal (300-400 aproximadamente) que producen saliva mucosa. El objetivo de esta revisión bibliográfica es hacer una reseña sobre los diversos proceos infecciosos que afectan las glándulas salivales, los diferentes enfoques diagnósticos y pautas de tratamiento. Los trastornos infecciosos de las glándulas salivares entran en el área de responsabilidad de la odontología, todo facultativo debe estar familiarizado con estos tratornos, las técnicas de diagnóstico aplicables y estar en capacidad de referir aquellos casos que son competencia de los especialistas.

Role of fine needle aspiration cytology in the diagnosis of swelings in the salivary gland regions: a study of 712 cases

A mass in the salivary gland region often presents a diagnostic challenge with regard to its site of origin [salivary versus nonsalivary], benign or malignant nature, and tissue-specific diagnosis. The present study describes the utility of fine-needle aspiration [FNA] cytology in the diagnosis of these lesions. Subjects and Over a 6-year period [January 1994 to December 1999], 712 patients aged between 6 months and 91 years [median, 37 years] were subjected to FNA of swellings in their salivary gland regions. Male:female ratio was 1.28:1. The swellings were mostly located in the parotid [323 cases], submandibular [343 cases], and upper cervical region [27 cases]. Swellings of oral [5 cases] and sublingual [2 cases] sites were rare. The lesions diagnosed by FNA cytology were compared among the major salivary glands. Cytologic diagnoses were correlated with histology in 45 cases. Benign nonneoplastic lesions were the most common [73%], followed by neoplasms [20%], and those with atypical cytology [1%]. Cytologic material was inadequate in 6% cases. Parotid gland region was involved more frequently by neoplasms [27.1%] than the submandibular gland region [13.7%, p < 0.0001]. Inflammatory processes affected the submandibular gland region more commonly [42.0%] than the parotid [32.6%, p = 0.0164]. Pleomorphic adenoma was the most common neoplasm [61.5%], followed by Warthin's tumor [12.6%]. Malignancies accounted for 10.5% of neoplasms. Frequency of involvement of parotid by Warthin's tumor [16.7%] was significantly higher than that of submandibular gland [2.3%, p = 0.0191]. However, the submandibular gland was more commonly affected by malignancy than the parotid gland [p = 0.0003]. Sensitivity, specificity, and diagnostic accuracy of FNA cytology for all neoplastic lesions of the salivary gland were 94.6, 75.0, and 91.1%, respectively. The corresponding figures for malignancies were 60.0, 95.0, and 91.1%, respectively. FNA cytology is very useful for the diagnosis of salivary gland lesions. However, sampling and interpretation errors may occur. The low specificity for the diagnosis of neoplasms as a whole and the poor sensitivity for malignancies found in our study can be attributed to the relatively small number of benign nonneoplastic and malignancy cases with available histopathologic diagnoses

Neurofibromatosis de glándulas salivales / Neurofibromatosis of the salivary glands

La neurofibromatosis se clasifica dentro de un grupo de desórdenes neurocutáneos que tiene en común el comprometer la piel y el sistema nervioso. Debido a que ambos órganos se originan de la lámina ectodérmica del embrión. se les ha conferido el nombre de enfermedades neurocutáneas. Se ha propuesto 8 variedades de neurofibromatosis, entre las cuales las más conocidas son la tipo 1 o periférica (enfermedad de von Recklinghausen) y la tipo 2 o central (schwanoma del nervio acústico bilateral). Se presenta el caso de un paciente de sexo masculino de 8 años de edad, sin antecedentes familiares, con un cuadro de aumento de volumen de la hemicara izquierda, de lenta progresión que, además, presentaba manchas café con leche distribuidas en tórax y abdomen y una lesión cutánea cervical. El estudio imagenológico con tomografía computarizada (TC) y resonancia nuclear (RN) demostraron una lesión expansiva de la región submaxilar y parotídea izquierda, mal delimitada, y que comprometía el espacio parafaríngeo. Se realizó una parotidectomía total con diagnóstico histopatológico de un neurofibroma plexiforme de nervio facial. Se efectúa una revisión bibliográfica del tema, con énfasis en el pronóstico tanto de la lesión como del paciente. Se analizan los métodos diagnósticos y terapéuticos actuales para dicha patología

Efeitos da xerostomia e do tratamento com 4NQO no desenvolvimento de candidose na língua de rato / Effects of xerostomia and treatment with 4-NQO on the development of candidosis on the rat tongue

A candidose é a micose mais comum da boca, estando associada a fatores predisponentes locais ou sistêmicos. Neste estudo verificamos o desenvolvimento da candidose em ratos portadores de carcinoma de lingua. É controvertido na literatura a ocorrência e a relevância da infecçäo por Cândida em lesöes bucais como liquen plano, leucoplasias e carinomas espinos celulares. De acordo com alguns trabalhos, a maior presença de Candida em leucoplasias está associada a maior severidade de displasias epiteliais (RENSTRUP, 1970; JONES & RUSSEL.,1973; ZHANG et al.,1994). Ratos normais e sialoadenectomizados foram pincelados com 4NQO por 4 meses e posteriormente acompanhados até o desenvolvimento de carinoma de língua. Suspensäo de C. albicans foi entäo inoculada na boca de ratos normais e portadores de carcinoma e a ocorrência de candidose verificada histologicamente após 24 e 48h. Nos mesmos períodos, leveduras foram recuperadas da boca de todos animais e os dados foram expressos em ufc/ml.

Doencas das glandulas salivares / Salivary glands diseases

As doencas das glandulas salivares podem ser divididas em neoplasicas (benignas e malignas), obstrutivas, infecciosas, de origem sistemica e sialoses. A maior parte das doencas acometem as duas maiores glandulas salivares, quais sejam, a parotida e a submandibular. Os tumores de glandulas salivares apresentam uma grande variedade de tipos histopatologicos, sendo o mais frequente o adenoma pleomorfico. A parotida apresenta peculiaridades anatomicas de fundamental importancia para o tratamento cirurgico das neoplasias, descritas neste trabalho. Procuramos abordar as doencas mais comuns com maiores detalhes, esclarecendo o aspecto diagnostico e terapeutico

A ultra-sonografia no diagnóstico das doenças das glândulas salivares / Ultrasonography in diagnosis of the salivary glands diseases

A literatura é revisada sobre o uso da ultra-sonografia no diagnóstico das doenças das glândulas salivares, abordando os principais aspectos ultra-sonográficos destas doenças, bem como as indicaçöes do médico. Três casos clínicos säo relatados usando a ultra-sonografia como exame complementar, mostrando ser este um método de alta sensibilidade para o diagnóstico das doenças salivares

Biopsia por aspiración con aguja fina de glándula salival. Experiencia en el Instituto Nacional de Cancerología de México / Fine needle aspiration of salivary gland. experience at he Instituto nacional de Cancerologia de Mexico

La biopsia por aspiración con aguja final de glándula saliva es un procedimiento fácil, seguro y económico que en muchas circunstancias permite un diagnóstico rápido con molestias mínimas para el paciente y con sensibilidad de 81-100 por ciento y especificidad de 94-100 por ciento. En este trabajo revisamos 237 biopsias por aspiración con aguja fina de glándula salival realizadas en un periodo de ocho años en el Instituto Nacional de Cancerología (INCan), México. En 185 pacientes se obtuvieron aspirados satisfactorios y en 144 casos de efectuó correlación con diagnóstico de histopatología. Se encontraron 65 (45 por ciento) verdaderos positivos, 62 (43 por ciento) verdaderos negativos, 11 (8 por ciento falsos negativos, seis (4 por ciento) falsos positivos. La sensibilidad fue de 85.52 por ciento, la especificidad de 91.17 por ciento, el valor predictivo positivo de 91.54 por ciento, el valor predictivo negativo de 84.93 por ciento y la eficiencia de 88.19 por ciento (p< 0.001). Nuestros resultados fueron similares a los obtenidos en 14 series publicadas previamente de biopsia por aspiración con aguja fina de glándula salival