Metastasizing mixed tumor of salivary glands. A clinicopathologic and flow cytometric analysis.

Among salivary gland neoplasms are a group of rare tumors that are histologically identical to benign mixed tumors that inexplicably metastasize; they have been called metastasizing mixed tumor (MZMT) of salivary glands. We report the clinicopathologic features and flow cytometric findings for 11 cases of MZMT. At the time of discovery of metastatic disease, the patients, six women and five men, ranged in age from 20 to 83 years. Primary sites of involvement included the parotid gland (eight cases), submandibular gland (two cases), and the nasal septum (one case). With one exception, all the patients had at least a single recurrences of their primary mixed tumor, but two or more recurrences were the norm before development of metastatic foci. The metastases were discovered from six to 52 years following the occurrence of the primary tumor. Metastatic deposits were identified in bone, lung, regional lymph nodes, skin, kidney, retroperitoneum, oral cavity, pharynx, calvarium, and central nervous system. The metastases either occurred simultaneously with an episode of recurrent mixed tumor (n = 5) or from 5 to 29 years after a recurrence (n = 6). The treatment of the primary, recurrent, and metastatic neoplasms was surgical excision. Follow-up, ranging from 8 months to 16 years following the diagnosis of MZMT, revealed seven patients to be alive without disease (64%) and two dead of causes unrelated to metastatic disease (18%). Two patients (18%) died as a direct result of metastatic tumor at 3 and 2 years after metastasis of their mixed tumors. Flow cytometric analysis revealed a diploid DNA cell population in the primary and/or metastatic tumors in nine cases. Aneuploid DNA cell content was identified in two of the cases. DNA ploidy levels and cell proliferation rates were compared with those of conventional benign mixed tumors and also with malignant mixed tumors. Retrospective analysis of histologic parameters (mitotic rate, cellular pleomorphism, infiltrative growth, vascular or lymphatic invasion) and flow cytometric analysis failed to identify criteria to predict the development of metastasis in these neoplasms.

Unusual multiple metastases from malignant pleomorphic adenoma of the parotid gland.

A case of malignant pleomorphic adenoma of the left parotid gland which metastasized to the kidney and multiple subcutaneous sites is presented. The patient presented as an acute emergency due to spontaneous rupture of the kidney containing metastasis. All the distant metastatic lesions were confined to the right side of the body.

Malignant mixed tumour arising from minor salivary gland tissue of the right parapharyngeal space with metastasis to the scalp.

A case of malignant mixed tumour arising from minor salivary gland tissue in the right parapharyngeal space with metastasis to the scalp is described. Both the clinical presentation and the histological picture were unusual. The simultaneous discovery of the primary parapharyngeal tumour and its scalp metastasis, the relatively young age of the patient (43 years-old), the origin of the tumour in minor salivary gland tissue, and the presence of a benign stromal component in the metastasis are features not commonly described in the three entities covered by the term "malignant mixed tumour". We believe this case represents a distinct variant, whose behaviour and progression have not been previously well documented.

Benign metastasizing pleomorphic adenoma of salivary gland: diagnosis of bone lesions by fine-needle aspiration biopsy.

Two cases of benign salivary gland pleomorphic adenomas metastatic to bone (benign-metastasizing pleomorphic adenomas) diagnosed by fine-needle aspiration biopsy are presented. Both primary tumors were slightly atypical cytologically but neither case demonstrated features of carcinoma. The metastatic lesions contained benign epithelial, myoepithelial, and stromal components. In both cases the clinical history was either not known by the radiologist or not communicated to the cytopathologist interpreting the case, and a primary tumor of bone was the leading clinical diagnosis. Obtaining pertinent clinical history and comparing the cytomorphology of the bone aspirate with the primary parotid tumor allowed for an accurate diagnosis in both cases. The differential diagnosis with primary bone tumors is discussed and the importance of clinical history is emphasized.

Malignant mixed tumor of the salivary gland with bone metastasis: a case report and literature review.

Malignant mixed salivary tumors are rare, accounting for 2%-10% of all mixed salivary tumors. Rarer still are metastasis from a malignant mixed salivary tumor. A case of malignant mixed salivary tumor occurring in the parotid gland and presenting as a parapharyngeal mass; with asymptomatic multiple bony metastasis is presented with a brief review of literature.

Implantation of parotid pleomorphic adenoma in the upper neck.

This paper presents a case of pleomorphic adenoma from an abnormal site in the right upper neck in a patient surgically treated 4 years previously for pleomorphic adenoma of the right parotid gland. The lack of normal salivary tissue in the neck growth oriented us towards a diagnosis of implantation tumor, resulting from surgery of the parotid mass, rather than towards one of heterotopic tumor. The literature concerning salivary heterotopias and salivary tumors arising from heterotopic foci is also reviewed.

Metastasizing pleomorphic adenoma of the nasal septum.

Pleomorphic adenoma is the most common benign tumor of glandular tissue occurring in the head and neck region. There have been several reports of metastasis of this benign-appearing tumor from the salivary glands to distant sites, suggesting hematogenous spread and implantation. Although occurrence of pleomorphic adenoma on the nasal septum has been described, to our knowledge this is the first reported case of recurrent septal pleomorphic adenoma with histologically benign tissue in an enlarged metastatic ipsilateral submandibular lymph node, suggesting lymphatic spread. The literature concerning the subject is reviewed. Wide septal excision and modified neck dissection is the recommended treatment.

Submandibular gland tumors. Adverse histologic factors and therapeutic implications.

We reviewed our 41-year experience with tumors of the submandibular gland to determine what factors influence outcome and their implications for treatment. The most common benign neoplasm was pleomorphic adenoma (21), while among malignant tumors the adenoid cystic variety (37) predominated. For the 86 patients who had malignant tumors, the 2- and 5-year survivals by the life table method were 82% and 69%, respectively. For patients with malignant tumors, histology, size, perineural invasion, and prior treatment did not affect overall survival. Factors adversely affecting outcome were extraglandular soft-tissue extension and lymph node metastasis. Local-regional control was enhanced in patients with soft-tissue extension if they were treated by surgery followed by radiotherapy rather than by surgery alone.

Metastatic salivary pleomorphic adenoma.

Pleomorphic adenomas of the salivary gland are usually regarded as benign tumours. We report a case in which a solitary pulmonary metastasis arose from a pleomorphic adenoma of the right parotid gland. The mechanism of metastasis is discussed.

[Intra-mandibular salivary tumors. Apropos of 3 cases of malignant tumor]. / Les tumeurs salivaires intra-mandibulaires. A propos de 3 observations de tumeurs malignes.

Three cases of intra-mandibular salivary tumors are presented. Two patients died (one with local recurrence, the other with metastasis). 69 cases have been reported in the literature. The lesions present as a progressive swelling of the mandible, with a frequent nervous involvement. The histologic diagnosis is difficult. Mucoepidermoid tumors are the more frequent (71%) but all salivary tumors can be found. An aggressive clinical behavior with local recurrences and/or metastasis (more than 30%) justify a radical treatment.

Benign mixed tumor of the mandible 17 years after the occurrence of a similar lesion in the parotid gland.

Presented is a salivary tumor occurring in the posterior mandible. This tumor was preceded by a mixed tumor of the ipsilateral parotid gland, which was removed surgically 17 years earlier. The actual connection between the two lesions is discussed, but the true relationship can only be speculative. The mandibular lesion may represent a recurrence of the parotid tumor, a second primary tumor, or may possibly be metastatic in origin.

Malignant mixed salivary tumor presenting as a mandibular metastasis.

A rare case of a central mandibular metastatic mixed salivary gland tumor is reported which presented following a 45-year history of recurrent benign mixed salivary gland tumor of the parotid gland on the same side. The mandibular tumor included a predominantly benign mixed salivary gland component as well as frankly invasive adenocarcinoma. The clinicopathologic features of the mandibular and residual parotid tumors suggested that the metastatic event may have occurred prior to the development of frank carcinoma in the parotid tumor.

A case of metastasizing benign pleomorphic adenoma of the parotid.

A 69-year-old man who had a 50-year history of recurrent benign pleomorphic adenomas of the parotid presented with a further recurrence and a skull nodule. Biopsy of the skull nodule was consistent with a metastasis of a benign pleomorphic adenoma.