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Tumors of the parotid gland are a rare occurrence among head and neck tumors (only 3-8%), and the vast majority are benign. Most benign tumors of the parotid gland are pleomorphic adenoma (PA), followed by Warthin's tumor (WT) and they occur in the superficial lobe. The only reasonable treatment is considered to be total tumor removal, but the appropriate surgical approach remains a matter of controversy. Over time, it went from enucleation to superficial parotidectomy (SP) and then to extracapsular dissection (ECD). SP is often considered to be the "gold standard"; however, the risk of intraoperative damage to the facial nerve (FN) cannot be ignored. Lately, ECD - which does not expose the main trunk of the FN - has been regarded as a safe technique for the treatment of small benign parotid tumors., Patients, Materials and Methods: The study retrospectively reviewed all parotidectomies for benign parotid tumors of the superficial lobe performed in the Department of ENT, Municipal Emergency Clinical Hospital, Timişoara, Romania, between January 2014 and December 2018. The following patient data were collected: age; sex; follow-up duration; extension of the resection; use of FN monitoring and lesion features, including position, pathology, and size. Preoperative investigation protocol included a computed tomography (CT) scan to assess the size and location of the tumor helping the treatment planning. The same surgical team performed both standard SP and ECD for the treatment of these tumors. All cases were confirmed as benign parotid tumors. Recurrences of any kind and tumors involving the deep lobe of the gland were excluded from the study. All patients underwent a macroscopically complete resection of the tumor. The main outcome was the postoperative complications in the two groups. Data regarding these complications were recorded on follow-up visits at one, six, 12 and 24 months., Results: Ninety-five patients with benign parotid tumors were operated by the same surgical team at the Department of ENT, Municipal Emergency Clinical Hospital, Timişoara, between January 2014 and December 2018 but only 89 (38 men and 51 women) met the follow-up criteria and were included in the study. Sixteen (18%) patients underwent ECD, and 73 (82%) patients underwent SP as a primary intervention. The mean lesion size for ECD group was 2.0±0.9 cm and 4.2±1.7 cm in the SP group, and it was statistically significant (p<0.05). As expected, the most common type of tumor was PA but the distribution between the groups was different: in the SP group, PA represents 83% (61∕73) of cases but only 44% (7∕16) of cases in the ECD group. Median follow-up time was comparable in the two groups - 33±8 months for the ECD group and 39±11 months for the SP group. There were also differences between the two groups regarding the postoperative complication rate. There were significantly more transient and permanent FN paralysis, transient and permanent great auricular nerve (GAN) dysfunctions and Frey's syndrome (FS) in the SP group., Conclusions: A comparison between ECD and SP as surgical procedures for the treatment of benign tumors of the parotid seems inappropriate as their indications do not overlap. ECD showed similar effectiveness and fewer side effects than SP and can be considered the treatment of choice for small, superficial and/or marginal tumors located in the lateral lobe of the parotid gland.

We present a case of a 13 year old girl with a diagnosis of Pleomorphic Adenoma (PA) located in the lacrimal gland of the left upper eyelid. The patient had a very satisfactory recovery after surgical excision of the tumor, with no recurrence after a two year follow-up. The clinical, radiological and histopathological characteristics of PAs are discussed., (Copyright © 2018 Sociedad Española de Anatomía Patológica. All rights reserved.)

Metastasising pleomorphic adenoma is rare and may occur years after surgical excision of a pleomorphic adenoma (PA). We present a 61-year-old woman with a right infratemporal PA with metastases to the cervical lymph nodes after 30 years following a total parotidectomy. She was treated successfully with a resection of the tumour with combined neck and mandibulotomy approach along with postoperative radiotherapy given subsequently.

The pleomorphic adenoma is the most frequently encountered tumor of the salivary glands, representing between 45% and 75% of the total number of the tumors of the salivary glands. According to the literature, there are many studies on the immunohistochemical aspects of the myoepithelial cells, present in the pleomorphic adenoma of the salivary gland. A big diversity of mono and polyclonal antibodies, such as the cytokeratins, muscular proteins and other markers, has been used. In our study, we investigated the immunohistochemical aspect of bone morphogenetic protein 6 (BMP6) marker concerning 15 cases of pleomorphic adenomas of the salivary glands. In the immunohistochemical study, we used the paraffin blocks that served for obtaining the sections necessary for the classical histopathological processing by means of the usual stainings. The immunohistochemical study used the enzymatic detection and the LSAB 2 (Labeled Streptavidin-Biotin 2) System technique as the working method. In order to underline the process of epithelial-mesenchymal transition, we also used double sequential immunohistochemical reactions. By the use of the BMP6 marker, we intended to evaluate the reactivity of the various tumor components in the pleomorphic adenomas of the salivary gland, for this marker, taking into consideration its possible involvement in the process of the epithelial-mesenchymal transition. The maximum reactivity for BMP6 was recorded at the level of the normal, excretory, intratubular units, in the luminal cells of the proliferative ductal units, in the myxoid matrix, the cytoplasm of the myxoid stellate cells and the plasmacytoid matrix and the cytoplasm of the chondroid lacunar cells. Some of the cells belonging to the solid, proliferative areas, some of the abluminal cells, that are part of the proliferative ductal units and certain myxoid stellate or plasmocytoid cells contain the S100 protein, which would indicate the existence of some processes of mesenchymal epithelial÷myoepithelial transdifferentiation in the development of this type of salivary tumor. The BMP6 expression is specific to the serous acini salivary cells, which are the most specialized epithelial salivary gland cells. The study demonstrated that the mesenchymal epithelial÷myoepithelial potential of transdifferentiation of the luminal cells that make up the proliferative units is certified by the immunohistochemical expression of some BMP6 purely mesenchymal protein cells.

We report a case of a 65-year-old female with a recurrent right parotid pleomorphic adenoma (PA) 24 years after initial surgical excision. Positron-emission tomography (PET) and computed tomography (CT) demonstrated an unusual suspicious FDG-avid erosive rim enhancing mass centered in the right supraspinatus muscle. Cytology from CT-guided aspiration of the mass was consistent with a histologically benign PA, and the patient was diagnosed with metastatic pleomorphic adenoma (MPA). The patient later developed diffuse pulmonary metastases and died within 3 months. MPA, although rare, is recognised as a potentially lethal malignant complication of recurrent or longstanding benign PA. As no biochemical or genetic parameters are predictive of malignant change, patients presenting with recurrent PA should be considered for screening for metastatic disease.

Salivary gland tumors are relatively infrequent and account for less than 2% of all human tumors. This study was conducted to see the prevalence of patterns of non neoplastic and neoplastic lesions of salivary glands in greater Mymensingh. It was a retrospective study carried out in the department of Pathology, Community Based Medical College Bangladesh from January 2010 to December 2012. Heamatoxylin and eosin stained sections were studied in all cases. Total 98 cases of salivary gland lesions were retrieved and evaluated. Out of them 55 cases were female and 43 were male. Mean age of the cases were 42 years. Among the salivary gland lesions non-neoplastic lesions 24.48% and neoplastic lesions 75.51%. Among neoplastic lesions benign tumor comprises 91.89% and malignant tumor comprises 8.10%.

The details of the etiopathogenesis of cystadenolymphoma (Warthin's tumor) are still unclear. To explore the possible risk factors for the development of this tumor, medical records of 81 patients with 96 Warthin's tumors of the parotid glands were compared retrospectively with those of 91 patients with pleomorphic adenoma. The medical history and clinical tumor characteristics of all patients were similar. There were no significant differences between these two patient groups with respect to concomitant diseases, regular medications, and preoperative laboratory findings. However, a significant male predominance of patients with Warthin's tumor could be noted (P<0.05). The male to female ratio was 3.3:1 in patients with Warthin's tumor. Multifocal Warthin's tumor were detected in five cases (6.2%), and 10 patients (12.3%) had bilateral lesions. The odds ratio for the incidence of Warthin's tumor among current smokers compared with never smokers was 8.3 (P<0.0001). Compared with never smokers, clearly higher odds of Warthin's tumor was observed in heavy smokers (more than 30 pack-years) (odds ratio=24.1, P<0.0001) than patients who smoked less than 30 pack-years (odds ratio=4.9, P<0.0001).

Experience with the differential diagnosis of lacrimal gland illnesses is limited in daily practice due to their rarity. It is therefore of particular importance to have guidelines for the practitioner by which he can decide on the application of conservative or surgical therapy, and whether it is necessary to take a biopsy to clarify the diagnosis. There is a wide spectrum of possible illnesses which include systemic diseases, inflammatory disorders, neoplastic, benign and malignant tumors. When a pleomorphic adenoma cannot be excluded, biopsy is contraindicated and complete tumor excision with its capsule is necessary to prevent the possibility of malignant transformation and a negative effect on long-term prognosis. In this overview, special interest is placed on the typical clinical aspects and imaging features of lesions of the lacrimal gland fossa, their differential diagnosis and management.

Objective: In an evaluation of our patients with parotid gland neoplasms, we noticed that patients with a Warthin's tumour were heavy smokers. The aim of this study was to confirm earlier findings in the literature concerning a possible association between smoking and the development of a Warthin's tumour., Methods: A case control study was performed using the clinical records and discharge letters of all consecutive patients with a Warthin's tumour in the pathology database of our hospital covering the last 15 years. Patients with a pleomorphic adenoma and a group of patients visiting our audiology department were used as controls., Results: A smoking history was found in 97.5% of the patients with a Warthin's tumour. Of the patients with a pleomorphic adenoma, 59% had a smoking history; 56.5% of the audiology group had a smoking history. Mean age at the time of the operation was 60.1 years of age in the Warthin's tumour group and 48.6 for the pleomorphic adenoma group., Conclusion: The mean age for the development of a Warthin's tumour is ten years older than for a pleomorphic adenoma. Furthermore, the development seems to be closely related to smoking habits.

Background: Pleomorphic adenomas and Warthin's tumors are the two most common benign parotid tumors. Previous studies investigating the role of viruses in tumorigenesis of these neoplasms have been conflicting. The aim of this study was to determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) might play a role in the pathogenesis of pleomorphic adenomas and Warthin's tumors., Methods: Paraffin-embedded surgical specimens of 24 pleomorphic adenomas, 10 Warthin's tumors, and 13 normal parotid tissues were obtained from the University of California-San Francisco Pathology Department. Genomic DNA was extracted from the specimens, and primers for connexin 26, a gap junction protein, were used to confirm the integrity of this DNA. The presence or absence of EBV and CMV DNA within the samples was determined with PCR-based assays, in which radiolabeled primers were used for maximal sensitivity of detection., Results: PCR analysis of serially diluted control DNA revealed that using radiolabeled primers, five copies of viral DNA could be detected. By use of this method, we showed that none of the 24 pleomorphic adenomas, 10 Warthin's tumors, or 13 normal parotid samples contained EBV DNA or CMV DNA., Conclusions: These results do not support CMV or EBV as etiologic factors in pleomorphic adenomas or Warthin's tumors. In addition, normal parotid seems not to harbor either of these viruses. Future studies with larger numbers of specimens are needed to confirm these findings., (Copyright 2002 Wiley Periodicals, Inc.)

Myotonic dystrophy (MD) is an autosomal dominant systemic disorder with an unstable expansion of the CTG triplet repeat in the 3'-untranslated region of the gene encoding myotonine protein kinase (DMPK) which maps to chromosome 19q13.3. Somatic mosaicism of CTG repeats in MD has been reported; and it has been observed that CTG repeats in tumor tissues associated with MD are more expanded than the other tissues. It is not rare that parotid tumors are found in patients with MD. We performed Southern blot analysis for tissues from the parotid tumor, the normal parotid gland, the skeletal muscles, and the leukocyte from a 60-year-old patient with MD. CTG repeat was most expanded in the parotid tumor, and the normal parotid gland had longer expansion of CTG repeat than the skeletal muscles. The leukocyte had the shortest expansion of CTG repeat. The expansion of CTG repeat in the parotid tumor may be related to active cell division and may underlie the occurrence of tumors in MD.

The smoking history was surveyed in 160 consecutive patients with Warthin's tumour of the parotid gland in order to investigate the relationship between smoking and the development of this tumour. Two hundred cases of middle-aged or elderly normal persons and 163 consecutive patients with pleomorphic adenoma in the parotid gland served as controls. The percentage of smoking in patients with Warthin's tumour (96.3%) was much higher than that of middle-aged or elderly normal persons (25.5%) and in patients with pleomorphic adenoma (26.4%). Moreover, the amount of smoking was greater and the smoking history was longer in patients with Warthin's tumour. When the male and female patients were analysed respectively, the same result was shown. This case-control study suggests that smoking may be one of the aetiologic factors associated with the development of Warthin's tumour.

Background: The rate of tumor recurrence after surgery for benign salivary gland pleomorphic adenoma varies considerably in different clinical settings and seems to depend to a great extent on the surgical technique used. The importance of tumor spillage for subsequent recurrence has recently been questioned. The current follow-up study was undertaken to ascertain whether intrasurgical rupture, tumor spillage, or any histopathologic feature might have had an impact on the rate of recurrence., Methods: The medical records of all 255 patients operated on for benign salivary gland pleomorphic adenoma between the years 1974 and 1993 at the Department of Otorhinolaryngology, Huddinge University Hospital, were reviewed. All patients alive in April 1995 (n = 230) were sent a simple questionnaire. Two hundred thirteen of these patients received follow-up. All cases of tumor recurrence after surgery or intrasurgical rupture of the tumor capsule were reviewed histopathologically., Results: Two (7.1%) of the 28 patients who had macroscopic capsule rupture during surgery experienced recurrence at a later stage. This was not a statistically higher rate than the 4.1% recurrence rate for the rest of the material. As many as 5 of the 9 primary tumors that subsequently recurred (56%) sent fingerlike tumor extensions or pseudopodia outside the pseudocapsule. The rate of occurrence of such structures was statistically higher than that of the tumors that ruptured during surgery (25%) and the examined uncomplicated cases (8%)., Conclusions: Occurrence of pseudopodia--microscopic fingerlike formations of tumor tissue that extend beyond the main lump of the tumor--is a significant risk factor for local recurrence.

The smoking history was surveyed in 128 cases with Warthin tumor of parotid gland in order to investigate the relationship between smoking and the development of the tumor. Two hundred cases of middle or old age normal persons and 136 cases with pleomorphic adenoma in parotid gland served as the controls. The percentage of smoker in patients with Warthin tumor (96.9%) was much higher than that of middle or old age normal persons (25.5%) and patients with pleomorphic adenoma (24.3%). Morever, the amount of smoking was greater and the smoking history was longer in patients with Warthin tumor. When the male and female patients were analysed respectively, the same results were shown. This case--control study suggests that smoking may be one of the etiologic factors associated with the development of Warthin tumor.

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly, in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.

We studied 11 cases of mixed tumor of the skin with a polyclonal antibody against human type II collagen. Two of the cases were of the eccrine type, six were apocine, and three were malignant. In all of the benign cases of mixed tumor and in some of the malignant type, "chondroid" and mucinous portions stained. The clearly epithelial portions of the tumor stained as well, and staining was most intense in the eccrine types and least intense in the malignant types. The positive staining in mixed tumors may help elucidate the histogenesis of these unusual tumors as well as help differentiate among the various subtypes.

In order to further examine a preliminary association between smoking and the subsequent development of Warthin's tumor, a case-control study was undertaken between the years 1980 and 1989. Consecutive patients with Warthin's tumor served as cases, and consecutive patients with pleomorphic adenomas served as controls. A positive history of smoking was defined as a patient with greater than a 10-pack year history. There were 28 cases and 69 controls (ratio: 1:2.5). The number of male to female patients with Warthin's tumor and pleomorphic adenoma was 22 to 6 (3.7:1) and 22 to 47 (1:2.1), respectively. The mean age at presentation with Warthin's tumor or pleomorphic adenoma was 60.7 years and 40.7 years, respectively. In those patients for whom a definite smoking history was known (93 patients), an odds ratio of 8.1 (p < 0.001) was calculated. In order to exclude sex as a possible confounder, the odds ratio in males only was 6.4 (p = 0.007). In order to exclude age as a possible confounder, the odds ratio in all patients over 45 years (48 patients) was 11.2 (p < 0.001). In summary, smokers have eight times the risk of developing a Warthin's tumor than nonsmokers. This case-control study suggests that smoking may be one of the etiologic factors associated with this benign salivary gland tumor.

Electron microscopic examinations of pleomorphic adenoma tissue showed epithelial and myoepithelial cell elements to take part in morphogenesis of both epithelial and "mesenchymal" zones. The epithelial component of pleomorphic adenoma is represented by cells showing signs of structural-functional differentiation of the squamous epithelium,, epithelium of terminal secretory parts of the salivary gland, and myoepithelial cells. The "mesenchymal" component is also represented by myoepithelial and epithelial cells. Differences in the structure of the epithelial and "mesenchymal" components are due to the pattern of arrangement and the functional status of the cells rather than to the set of the cell forms. A slow growth of the tumor and the marked functional activity of myoepithelial cells result in the accumulation of the substance of basal membranes released into the intercellular space, separation of the cells and degenerative changes in them. The results of ultrastructural examinations confirm the theory of the epithelial genesis of salivary gland pleomorphic adenoma. In this connection it sould be acknowledged that the term "mixed tumor" does not relate the essence of this neoplasia because the point at issue is a tumor of epithelial nature, whereas the term "pleomorphic adenoma" recommended by the WHO is more acceptable and emphasized the epithelial origin and heterogeneity of the cell composition and structures of the tumor.

An analysis was carried out on glycosaminoglycan produced in pleomorphic adenoma, adenoid cystic carcinoma, sialadenitis and normal tissue of the salivary gland. After incubation of the tissue segments in a medium containing 35SO4, a radioautograph of the tissue section was made to observe the localization of 35SO4 incorporation, and 35S-labelled materials were purified from the tissues, and analyzed. High 35S-radioactivity was observed in the ductal cells of the inflammatory gland tissue and in the acinar cells of normal palatinal gland, but little radioactivity was observed in the interstitial components in these tissues, and the amount of 35SO4 incorporated in the tumor cells was also significant. Eighty to 90% of the 35S-radioactivity incorporated could be detected as 35S-glycosaminoglycans in all tissues except for the normal palatinal gland, which contained a large amount of 35S-sulfated glycoprotein. No significant difference in the synthetic activity of 35S-glycosaminoglycans and in their components were observed between nonneoplastic and neoplastic cells. These results suggest that glycosaminoglycan-producing cells in pleomorphic adenoma as well as in adenoid cystic carcinoma are derived from the tubuloacinar cells of the salivary gland.

The lacrimals glands may be the focus of the pleomorphic tumours with the same property as the major and minor salivary glands. Their localisation causes different clinical and therapeutic consequences. The cylindromes or Adenoid Cystic Carcinoma are to be put on a parallel with the pleomorphic tumours, though the issue of the clinical evolution is very different for each of them.

Two malignant mixed tumours, in which both carcinomatous and sarcomatous features were present, are described. They arose in the palate in patients who had undergone surgery and irradiation for a pleomorphic adenoma at the same site 30 and 36 years previously. The histological differential diagnoses of recurrent benign pleomorphic adenoma, pleomorphic adenoma resembling mesenchymal tumour, and carcinoma in (ex) pleomorphic adenoma are discussed. On the basis of their positive reaction for keratin with specific monoclonal antibodies it is suggested that the myoepithelial cells are of epithelial origin. Immunohistochemical studies together with the histological appearance of the neoplasms indicate that the carcinomatous as well as the sarcomatous elements were derived from modified myoepithelial tumour cells. Irradiation may have been responsible for inducing a true malignant mixed tumour as distinct from the more common malignancy which may arise in pleomorphic adenoma, this being a simple carcinoma.

A pathological investigation was undertaken in Hiroshima on cases seen between 1945 and 1971 to determine the relationship between salivary gland tumors and exposure to atomic (A) bomb radiation. Of the 208 cases of histologically confirmed salivary gland tumors, 62 were A-bomb survivors and 146 were nonexposed. The relative risk based on the rate in the nonexposed for malignant tumors of salivary glands among the exposed in Hiroshima Prefecture was 11.0, while that of the submaxillary gland was 13.8 and that of the parotid gland was 9.8. They were all highly significant by X2 test (P less than 0.001). The latent period of malignant salivary gland tumors was shorter in the exposed than in the nonexposed. Four cases of benign salivary gland tumor, all being benign mixed tumors of the parotid gland, were observed in children whose parents had been exposed. The incidence of mixed tumors of the salivary gland among the exposed in Hiroshima City was 2.0 times higher than that among the nonexposed and showed a tendency to increase with proximity to the hypocenter (P less than 0.01).