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Mucoepidermoid carcinoma (MEC) is a common malignancy arising in the parotid gland. The diagnosis of MEC is typically based on its morphological features alone, characteristically containing mucocytes, intermediate cells and epidermoid cells. However, when cystic degeneration is diffuse, it is challenging to distinguish MEC from other benign cystic tumors. This is a case report of a 58-year-old Caucasian man who presented with a parotid mass. H&E sections of the mass reveal multiloculated cysts lined by bland-looking epithelium with only rare papillary architectures. The papillary proliferation contains mucocytes, and epidermoid cells highlighted by the p63 immunohistochemistry study. The diagnosis was confirmed by FISH result of positive MAML2 (11q21) rearrangement. Patient underwent parotidectomy and is disease-free 6 months post-surgery. MEC with cystic degeneration is a common diagnostic pitfall which can mimic many benign lesions in the salivary gland. We present a rare case with MEC with extensive cystic change, its molecular and pathologic findings and review the diagnostic features of MEC, its benign mimickers and useful tools for distinguishing these entities.

ABSTRACT Background Methods Results Conclusion Mucinous cells can be detected sporadically or may constitute the primary tumor component in salivary gland tumors, as observed in the intraductal papillary mucinous neoplasm (IPMN). This low‐grade tumor is composed of mucinous columnar cells organized into papillary cystic structures. The present study aimed to compare the mucous cells in IPMN with mucous cells present in mucoepidermoid carcinoma (MEC) and papillary cystadenoma (PC).Immunohistochemistry analysis was carried out to compare the mucous cells in IPMN with the sporadic mucous cells in MEC (n = 4) and PC (n = 3).The results indicated that IPMN cells were positive for CK7, CK18, DOG1, and NKX3.1 and negative for CK14, SMA, and p63. The mucous cells in both MEC and PC were positive for CK7 and negative for CK18, SMA, DOG1, and NKX3.1. The positive expression of CK14 and p63 revealed the presence of basal cells both in PC, cystic areas of MEC, and normal mucous salivary glands.The immunohistochemical profile of IPMN closely resembles that of the mucous cells of the minor salivary glands yet differs from the mucous cells observed in MEC and PCX. This suggests that IPMN is probably derived from the transformation of secretory cells of the minor mucous salivary gland and has no rimming/basal cells. For this reason, we propose that this tumor is designated as mucous acinic cell carcinoma. [ABSTRACT FROM AUTHOR]

Background: To investigate the clinicopathologic characteristics, therapeutic methods, and prognosis of secretory carcinoma of salivary gland (SCSG). Methods: The clinicopathologic data of 13 patients with SCSG admitted to Shanxi Cancer Hospital from January 2018 to June 2023 were retrospectively analyzed, and a literature review was performed. Results: A total of eight males and five females aged 22–78 years old were enrolled, and they commonly presented with painless masses in the parotid or submandibular gland. They all underwent surgical treatment, accompanied by typical pathological examinations postoperatively. Fluorescence in situ hybridization (FISH) was conducted in seven cases, the results were all positive, and no gene fusion other than ETV6-NTRK3 was found. Two patients developed local relapse during follow-up, both of which were in the surgical area. By the end of the follow-up, 12 patients survived and one patient died. Conclusions: SCSG is a rare low-grade malignancy with a good prognosis. Pathological and immunohistochemical characteristics are the key to secretory carcinoma (SC) diagnosis, and surgical excision is the major treatment means for SCSG. Whether to perform simultaneous cervical lymph node dissection and other adjuvant therapies should be determined based on the pathological stage and the presence or absence of high-risk factors. [ABSTRACT FROM AUTHOR]

Purpose: Salivary gland tumors include numerous subtypes that vary from benign to highly aggressive, with many showing overlapping histopathological features that can make diagnosis challenging. Most subtypes express driver fusion genes that are tumor specific, and detection of such fusions is useful for differentiating amongst specific diagnoses, determining appropriate tumor grading, and guiding effective treatment. Currently, fusions can be detected by FISH, RT-PCR or through next-generation sequencing approaches, all of which are highly effective methodologies but can be costly or time consuming. Methods: We developed a rapid NanoString nCounter platform-based assay to detect salivary gland tumor fusions using a combination of fusion junction-specific probes and an approach through differential exon expression analysis. The assay includes 68 junction-specific probes and analysis of exon expression across 9 fusion-associated genes in a single multiplex assay. Results: Out of 55 retrospective and 171 prospective cases assayed, we accurately detected the majority of cases of pleomorphic adenoma, adenoid cystic carcinoma, cribriform adenocarcinoma, clear cell carcinoma, secretory carcinoma and NUT-rearranged carcinoma, including cases of these tumor types arising in non-salivary gland sites, with the major drawback being an inability to detect MAML2-containing mucoepidermoid samples. With mucoepidermoid carcinoma excluded, the assay shows an overall sensitivity of 96.1% and specificity of 100%. Conclusion: We show that the majority of salivary gland tumor fusions can be effectively detected with a single rapid NanoString based assay, which can serve as a useful adjunctive tool for routine diagnostic head and neck pathology. The assay is low cost with a rapid turnaround time (30 h total assay time per sample batch, with minimal technician input required) compared to alternate detection methods. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the clinicopathologic characteristics, therapeutic methods, and prognosis of secretory carcinoma of salivary gland (SCSG). Methods The clinicopathologic data of 13 patients with SCSG admitted to Shanxi Cancer Hospital from January 2018 to June 2023 were retrospectively analyzed, and a literature review was performed. Results A total of eight males and five females aged 22–78 years old were enrolled, and they commonly presented with painless masses in the parotid or submandibular gland. They all underwent surgical treatment, accompanied by typical pathological examinations postoperatively. Fluorescence in situ hybridization (FISH) was conducted in seven cases, the results were all positive, and no gene fusion other than ETV6-NTRK3 was found. Two patients developed local relapse during follow-up, both of which were in the surgical area. By the end of the follow-up, 12 patients survived and one patient died. Conclusions SCSG is a rare low-grade malignancy with a good prognosis. Pathological and immunohistochemical characteristics are the key to secretory carcinoma (SC) diagnosis, and surgical excision is the major treatment means for SCSG. Whether to perform simultaneous cervical lymph node dissection and other adjuvant therapies should be determined based on the pathological stage and the presence or absence of high-risk factors.

Pleomorphic adenoma is a benign tumor that can occur in the salivary glands, most commonly in the parotid gland. While it primarily occurs in the major salivary glands, it can sometimes be found in the minor salivary glands. Within the minor salivary glands, it most often originates in the hard palate and soft palate, and less frequently in the upper lips. Due to its location in the minor salivary glands, most pleomorphic adenoma involve and protrude on the mucosa. A 61-year-old man presented with 1.5 cm exophytic mass on the skin of his upper lip. This mass was exophytic on the skin and did not involve or protrude into the inner lip mucosa. The mass was entirely excised, and a subsequent permanent biopsy diagnosed it as a pleomorphic adenoma. In such situations, it can be challenging to suspect pleomorphic adenoma during a physical examination, leading to potential diagnostic confusion. It might also be mistaken for an inclusion cyst or another type of mass, making it tempting to treat without verifying the pathological results. [ABSTRACT FROM AUTHOR]

Background: Treatment of salivary gland tumors (SGTs) remains challenging. Little is known about the immune landscape of SGTs. We aimed to characterize the tumor microenvironment in benign and malignant SGTs. Methods: Eleven benign and nine malignant tumors were collected from patients undergoing curative intent surgery. Specimens were analyzed using mass cytometry by time‐of‐flight. Immune cell populations were manually gated, and T cells were clustered using the FlowSOM algorithm. Population frequencies were compared between high‐grade and low‐grade malignancies, corrected for multiple hypothesis testing. Results: There were trends towards increased CD4+ and CD8+ T cells among malignant tumors. High‐grade malignancies exhibited trends towards higher frequencies of CD8+ PD‐1+ CD39+ CD103+ exhausted T cells, CD4+ FoxP3+ TCF‐1+ CD127− Tregs, and CD69+ CD25− CD4+ T cells compared to low‐grade malignancies. Conclusion: SGTs exhibit significant immunologic diversity. High‐grade malignancies tended to have greater infiltration of exhausted CD8+ T cells and Tregs, which may guide future studies for immunotherapy strategies. [ABSTRACT FROM AUTHOR]

Objective: There are numerous diagnostic, biological, and histological manifestations of salivary gland tumors, each of which offers concerns and difficulties in terms of diagnosis, grading, categorization, and therapy. The purpose of this study was to evaluate and compare the immunohistochemical expression of Bcl-2, caspase-3, and GSTP in benign and malignant salivary gland tumors, as well as how they are connected to a variety of clinicopathological variables. Methods: A total of 61 cases of buffered formalin-fixed, paraffin-embedded tissues from previously identified cases of benign and malignant salivary gland tumors were included in this study. The immunohistochemistry staining process was carried out according to the manufacturer's recommendations, employing polyclonal anti-Bcl-2, anti-caspase-3, and anti- GST antibodies. Results: The correlation between mean tumor diameter and Bcl-2 expression was shown to be statistically significant (rs=0.258, p<0.05). In pleomorphic adenoma tumor tissues, there were statistically significant correlations between the expression levels of Bcl-2 and caspase-3 (rs=0.66, p<0.01), Bcl-2 and GST (rs=0.61, p<0.01), and caspase-3 and GST (rs=0.73, p<0.01) when tumor types were compared. The tissues with pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma had the highest staining intensity of Bcl-2 expression, while the lowest staining intensity of GSTP expression was observed. Conclusion: It seems probable to draw the conclusion that salivary gland tumors that resist apoptosis have elevated levels of Bcl-2 expression. The prognosis for salivary gland tumors may be poor due to the positive correlation between tumor diameter and high Bcl-2 expression. [ABSTRACT FROM AUTHOR]

Calculus represents a mineralized form of bacterial plaque, commonly developing on natural tooth surfaces exposed to a continuous supply of saliva. The salivary composition significantly influences the degree of calculus formation in individuals, exerting a pivotal role in this aspect. Reduced salivary output elevates vulnerability to oral diseases. Numerous contributing elements might be associated with the development of significant calculus, potentially implicating the existence of a salivary gland tumor, notably related to the left parotid gland. This report stands as notable documentation of an extraordinary and infrequent occurrence of calculus formation associated with a salivary gland tumor, presenting an exceptional case within the scope of medical literature.

Of all the head and neck tumors, salivary gland tumors account to 3%. Pleomorphic adenomas are one of the most common benign tumors arising from major salivary glands, although it could also develop from minor salivary glands situated at accessory sites like nasal cavity, pharynx, parapharyngeal space, lacrimal glands etc. Tumors of infratemporal fossa are quite unusual, mainly because of its hidden location in retromaxillary region. We report an unusual case of 65 years old male presenting with complaint of progressive left cheek swelling for 4 years. FNAC revealed pleomorphic adenoma of minor salivary gland tumor. Intraoperatively a giant lobulated tumor was seen occupying almost whole space of infratemporal fossa, which was removed in-toto via open approach. Patient was kept on regular follow up with no evidence of recurrence reported till date. [ABSTRACT FROM AUTHOR]

Objectives: To analyze and summarize the clinicopathological features, risk factors for cervical nodal metastasis, and prognostic factors of malignant sublingual gland tumors (MSLGT). Methods: Patients diagnosed with MSLGT were retrospectively reviewed from January 2005 to December 2017 at Shanghai Ninth Hospital. The clinicopathological features were summarized, and the correlations between clinicopathological parameters, cervical nodal metastasis, and local–regional recurrence were evaluated using the Chi‐square test. Kaplan–Meier method and Cox regression analysis were performed to assess the survival and independent prognostic factors. Results: Seventy‐nine patients were included, and the 5‐year overall survival and disease‐free survival rates was 85.7% and 71.7%, respectively. Gender and clinical tumor stage were risk factors for cervical nodal metastasis. Tumor size and pathological lymph node (LN) stage were independent prognostic factors for adenoid cystic carcinoma (ACC) of the sublingual gland; while age, pathological LN stage, and distant metastasis were prognostic factors for patients with non‐ACC of the sublingual gland. Patients with higher clinical stage were more likely to undergo tumor recurrence. Conclusions: Malignant sublingual gland tumors are rare, and neck dissection should be performed in male MSLGT patients with higher clinical stage. Among patients with both ACC and non‐ACC MSLGT patients, pN+ indicate a poor prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Secretory Carcinoma is a malignant salivary gland tumor, initially described in 2010. This rare tumor is associated with the translocation t(12;15) (p13;q25), resulting in the fusion gene ETV6‐NTRK3. Since this tumor is quite rare, most publications describe only small cohorts of patients. We aimed to investigate the clinical, pathological, and prognostic features of this newly defined malignant entity. Data Sources: Pubmed, Google Scholar, and Web of Science databases. Review Methods: All published articles between 2010 and 2023 were reviewed. Search terms included the terms "Mammary Analogue Secretory Carcinoma" and "Secretory Carcinoma". All articles published in English reporting on Secretory Carcinoma of salivary glands were retrieved. Results: One‐hundred and 12 retrospective articles reporting a total of 674 patients were included, with 52% males and a mean age of 44.9 ± 18.9. The event rate for patients with advanced‐stage disease (Stage 3/4) at presentation was 24.1% (95% CI 17.6%–31.9%, I2 = 9.2%), 14.6% for regional metastases (95% CI 10.5%–20%, I2 = 12%), and the event rate of distant metastasis was 8.4% (95% CI 5.5%–12.7%, I2 = 4.2%). Adjuvant radiotherapy was administered for 30.3% of patients (95% CI 24.1%–37.2%, I2 = 21.5%). The recurrence rate was 19% (95% CI 15.1%–23.8%, I2 = 5%). Survival outcomes showed a 17.2% death of disease rate for Secretory Carcinoma patients (95% CI 13.5%–21.8%, I2 = 7.3%). Conclusions: Secretory Carcinoma is a rare and relatively newly defined entity arising in the parotid gland most commonly. Characterized as a low‐grade tumor, the majority of patients are diagnosed at an early stage, without regional or distant disease, and the prognosis is relatively good. Level of Evidence: NA Laryngoscope, 134:1716–1724, 2024 [ABSTRACT FROM AUTHOR]

Dysgenetic polycystic disease, also known just as polycystic disease, is a very rare developmental abnormality affecting the salivary gland duct system. This entity has been reported in only 21 patients previously, although a careful review suggests only 16 patients have histological evidence of the disease. In previously reported cases, this lesion most commonly presents as either an incidental finding or as a swelling affecting the parotid glands bilaterally, or rarely the submandibular glands bilaterally. This case report details the first time dysgenetic polycystic disease is found affecting the minor salivary glands of the tongue in a 55-year-old male. Histochemical and immunohistochemical stains are presented and include positivity for AE1/AE3 and p63, and negativity for progesterone receptor, androgen receptor, mammaglobin, S100 and BRAF V600E. PAS-D and Congo Red highlight special microamyloid spheroliths structures intraluminally. [ABSTRACT FROM AUTHOR]

Different surgical techniques have been proposed for parapharyngeal space tumors, including trans-cervical, trans-parotid, trans-mandibular, infratemporal, and trans-oral. The choice of the correct approach depends on size, localization, and nature of the tumor. We describe a case of a 32-year-old female presented with a large pre-styloid pleomorphic adenoma, originating from the right deep parotid lobe. A trans-oral approach was chosen and an en-bloc excision of the mass (46 × 42 × 30 mm) was performed. Our case showed that trans-oral approach to pre-styloid parotid tumors represents a safe procedure that may be used also for large benign masses in selected cases. [ABSTRACT FROM AUTHOR]

Salivary gland tumors (SGTs) are a relevant, highly diverse subgroup of head and neck tumors whose entity determination can be difficult. Confocal Raman imaging in combination with multivariate data analysis may possibly support their correct classification. For the analysis of the translational potential of Raman imaging in SGT determination, a multi-stage evaluation process is necessary. By measuring a sample set of Warthin tumor, pleomorphic adenoma and non-tumor salivary gland tissue, Raman data were obtained and a thorough Raman band analysis was performed. This evaluation revealed highly overlapping Raman patterns with only minor spectral differences. Consequently, a principal component analysis (PCA) was calculated and further combined with a discriminant analysis (DA) to enable the best possible distinction. The PCA-DA model was characterized by accuracy, sensitivity, selectivity and precision values above 90% and validated by predicting model-unknown Raman spectra, of which 93% were classified correctly. Thus, we state our PCA-DA to be suitable for parotid tumor and non-salivary salivary gland tissue discrimination and prediction. For evaluation of the translational potential, further validation steps are necessary. [ABSTRACT FROM AUTHOR]

To investigate the risk of developing salivary gland tumors associated with the use of mobile phones. There have been a number of epidemiological studies conducted to assess for a possible association between mobile phone usage and the development of intracranial tumours, however results have been conflicting. We conducted an extensive literature search across four different databases was conducted. After selecting the articles relevant to the area of study, a total of seven studies were included in this meta-analysis, with no restrictions set on publication date or language. Studies were qualitatively assessed using the Newcastle-Ottawa scale. No significant association between the use of mobile phones and salivary gland tumors was observed (OR=1.06, 95% CI=0.86–1.32). No evidence for publication bias was detected. Our findings indicate no significant association between mobile phone usage and salivary gland tumours. However, there were many limitations encountered in these studies, suggesting that the observed result may not be an accurate estimate of the true carcinogenic risk of mobile phones, especially for heavy long-term users. In fact, the studies included in this meta-analysis highlight the need to correctly define exposure assessment in order to ascertain the risk of a certain variable. [ABSTRACT FROM AUTHOR]

Primary adenoid cystic carcinoma (ACC) accounts for less than 0.2 % of all primary lung malignancies. Here we present two cases of lung ACC (ACCL), first is a 65-year-old female who was diagnosed with ACCL and surgically treated at another institution. She presented with recurrent tumor which was resected at our hospital. No adjuvant treatment was given, and she is without any signs of residual tumor or recurrence after 6 months. The second case is a 68-year-old female with a right upper lobe nodule noticed in 2017 but declined biopsy due to fear of possible complications. In 2022 she underwent biopsy at our institution which showed ACCL and was treated surgically without adjuvant therapy. Till date she is with no evidence of residual tumor or recurrence. Multiple disciplines need to work together to provide the best patient care from accurate diagnosis to surgical resection and additional therapy. More research is needed to generate guidelines for treatment of this rare malignancy, especially the indications for chemotherapy.

Abstract Objectives The present study aimed to characterize the ultrasonography (US) features of cystic components in salivary gland tumors (SGTs). Materials and methods A total of 207 patients (218 lesions) with pathologically confirmed primary SGTs were analyzed. Preoperative US revealed the presence of cystic components in lesions. Lesion size, shape, margin, and US findings of the cystic components, including number, distribution, margin, occupying rate, and internal characteristics, were evaluated. Results Similarities were observed between the US performance of benign SGTs (B-SGTs) and malignant SGTs (M-SGTs) with cystic components. Differences in sex and age of patients, number, distribution, and internal characteristics of cystic components were statistically significant. For SGTs with cystic components, the proportions of M-SGTs to ill-defined margins (P = 0.002), eccentric distribution (P = 0.019), and none of the internal characteristics (P = 0.019) were significantly higher than those of B-SGTs. Younger age (P = 0.001), eccentric distribution (P = 0.034) and ill-defined margin (P < 0.001) were risk factors for diagnosing M-SGTs. Cystic component features needed to be combined with lesion indicators (border and shape) to improve diagnostic sensitivity. Conclusions US features of the B-SGTs and M-SGTs were significantly different. Cystic component is of interest in the US-related differential diagnosis of B-SGT and M-SGT. Clinical relevance Cystic components are potentially valuable in the differential diagnosis of B-SGTs and M-SGTs on US.

Ultrasound is the primary tool for evaluating salivary gland tumors (SGTs); however, tumor diagnosis currently relies on subjective features. This study aimed to establish an objective ultrasound diagnostic method using deep learning. We collected 446 benign and 223 malignant SGT ultrasound images in the training/validation set and 119 benign and 44 malignant SGT ultrasound images in the testing set. We trained convolutional neural network (CNN) models from scratch and employed transfer learning (TL) with fine-tuning and gradual unfreezing to classify malignant and benign SGTs. The diagnostic performances of these models were compared. By utilizing the pretrained ResNet50V2 with fine-tuning and gradual unfreezing, we achieved a 5-fold average validation accuracy of 0.920. The diagnostic performance on the testing set demonstrated an accuracy of 89.0%, a sensitivity of 81.8%, a specificity of 91.6%, a positive predictive value of 78.3%, and a negative predictive value of 93.2%. This performance surpasses that of other models in our study. The corresponding Grad-CAM visualizations were also presented to provide explanations for the diagnosis. This study presents an effective and objective ultrasound method for distinguishing between malignant and benign SGTs, which could assist in preoperative evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mucoepidermoid carcinoma is a malignant tumor of the salivary glands. Clinically it appears as an asymptomatic mass that frequently ulcerates. The diagnosis is confirmed by histopathological study. Treatment is mainly surgical, although chemotherapy and radiotherapy can be used as adjuvant or neoadjuvant therapy in high-risk carcinomas. CLINICAL CASE: A 53-year-old female patient arrived at the dermatology department for an ulcerated mass in the oral cavity of three years of duration. A neoplastic process was suspected; therefore, an incisional biopsy was performed which reported a highgrade mucoepidermoid carcinoma. Staging was performed with intravenous contrastenhanced skull tomography, which revealed infiltration of the retromolar trigone and the skull base, T4N0M0 stage was determined. CONCLUSIONS: Mucoepidermoid carcinoma is the most common malignant tumor of the salivary glands. Its behavior varies according to the histological grade, it is imperative that the dermatologist is familiar with rapidly growing neoplasms of the oral cavity since an early diagnosis can be associated with better outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to characterize the ultrasonography (US) features of cystic components in salivary gland tumors (SGTs). Materials and methods: A total of 207 patients (218 lesions) with pathologically confirmed primary SGTs were analyzed. Preoperative US revealed the presence of cystic components in lesions. Lesion size, shape, margin, and US findings of the cystic components, including number, distribution, margin, occupying rate, and internal characteristics, were evaluated. Results: Similarities were observed between the US performance of benign SGTs (B-SGTs) and malignant SGTs (M-SGTs) with cystic components. Differences in sex and age of patients, number, distribution, and internal characteristics of cystic components were statistically significant. For SGTs with cystic components, the proportions of M-SGTs to ill-defined margins (P = 0.002), eccentric distribution (P = 0.019), and none of the internal characteristics (P = 0.019) were significantly higher than those of B-SGTs. Younger age (P = 0.001), eccentric distribution (P = 0.034) and ill-defined margin (P < 0.001) were risk factors for diagnosing M-SGTs. Cystic component features needed to be combined with lesion indicators (border and shape) to improve diagnostic sensitivity. Conclusions: US features of the B-SGTs and M-SGTs were significantly different. Cystic component is of interest in the US-related differential diagnosis of B-SGT and M-SGT. Clinical relevance: Cystic components are potentially valuable in the differential diagnosis of B-SGTs and M-SGTs on US. [ABSTRACT FROM AUTHOR]

Background: Myoepithelioma is a rare type of salivary gland tumor that mainly occurs in the parotid glands and palate. Case presentation: A 43‐year‐old woman presented with swelling and pain in the right maxillary molar. We performed enucleation and curettage under general anesthesia. The tumor was cyst‐like. Histopathological examination revealed nests of tumor cells diffusely interspersed within fibrotic connective tissues. A few cells were positive for cytokeratin AE1/AE3, α‐SMA, GFAP, and vimentin; S‐100 protein and calponin were also positive. Final diagnosis was myoepithelioma. Conclusion: Over 7 years after the surgery, the postoperative course was good, with no recurrence of the tumor. [ABSTRACT FROM AUTHOR]

Basal cell adenoma (BCA) is a benign salivary gland tumor that usually arises in the parotid gland. It was classified as an independent tumor for the first time by the World Health Organization in 1991. BCA appears as a hard, mobile, slow-growing mass. A BCA situated within the palatal minor salivary glands is rare. As far as we could wade through the literature, only 9 cases of BCA occurring in the palatal minor salivary glands have been reported. We present a case of BCA arising in the palatal minor salivary glands. A 70-year-old woman was referred to our department for evaluation of a painless swelling in the left palate region. Based on the clinical findings, an excisional biopsy was planned with the tentative diagnosis of a benign tumor of the palate. Under general anesthesia, the tumor was resected with healthy peripheral tissue. The tumor was well-differentiated and did not invade the surrounding tissues. Immunohistochemically, tumor cells reacted positively to cytokeratin (AE1/AE3), S-100 protein, p 63, and α-smooth muscle actin (α-SMA). The Ki-67 labeling index, a marker of cell proliferation, was low. Thus, the final diagnosis was a BCA. No recurrences or postoperative complications have been noted 42 months postoperatively. [ABSTRACT FROM AUTHOR]

Background: Lymphadenomas are rare benign tumors of the major salivary glands that are further classified as sebaceous and non-sebaceous. No association with viruses has been reported so far. Little is known about the mechanisms that allow lymphadenomas to undergo malignant transformation. Among these rare instances, there has never been a malignant transformation to Epstein–Barr virus (EBV)-associated lymphoepithelial carcinoma. Methods: Clinical data of the reported case were retrieved from the patient's electronic medical record. Hematoxylin & eosin-stained slides, immunohistochemical tests, and in situ hybridization performed for routine diagnostic purposes were reviewed. Results: We report a salivary gland sebaceous lymphadenoma in which the luminal components were mostly replaced by malignant epithelial cells with markedly atypical nuclear features. Presence of EBV was demonstrated in all components by EBER. The morphological and immunohistochemical findings were consistent with a lymphoepithelial carcinoma arising from a sebaceous lymphadenoma. Conclusion: We report the first case of an Epstein–Barr virus-associated lymphoepithelial carcinoma arising from a sebaceous lymphadenoma. [ABSTRACT FROM AUTHOR]

Salivary duct carcinoma (SDC) is an aggressive type of salivary gland carcinoma. Recently, immunotherapies targeting immune checkpoints, including PD1, PD-L1, CTLA4, and LAG3, have had a considerable prognostic impact on various malignant tumors. The implementation of such immune checkpoint inhibitor (ICI) therapies has also been attempted in cases of salivary gland carcinoma. The tumor immune microenvironment (TIME) is implicated in tumorigenesis and tumor progression and is closely associated with the response to ICI therapies. However, the TIME in SDC has not been fully explored. We examined the immunohistochemical expression of CD8, FOXP3, PD1, PD-L1, CTLA4, LAG3, and mismatch repair (MMR) proteins, tumor-infiltrating lymphocytes (TILs), and microsatellite instability (MSI) status in 175 cases of SDC. The associations between these TIME-related markers and the clinicopathological factors and prognosis were evaluated. An elevated expression of CD8, FOXP3, PD1, CTLA4, and LAG3 was associated with more aggressive histological features and an advanced N and/or M classification, elevated Ki-67 index, and poor prognosis. Furthermore, cases with a high PD-L1 expression exhibited more aggressive histological features and adverse clinical outcomes than those with a low expression. Alternatively, there was no significant correlation between TILs and clinicopathological factors. No SDC cases with an MSI-high status or MMR deficiency were found. The coexistence of both an immunostimulatory and immunosuppressive TIME in aggressive SDC might play a role in the presence of T-cell exhaustion. The contribution of multiple immune escape pathways, including regulatory T cells and immune checkpoints, may provide a rationale for ICI therapy, including combined PD1/CTLA4 blockade therapy. [ABSTRACT FROM AUTHOR]

Adenoid cystic carcinoma is a relatively rare epithelial tumor of the major and minor salivary glands that makes up less than 1% of head and neck neoplasms. The typical clinical and pathological findings of this neoplasm include slow growth, perineural invasion, multiple local recurrences, and distant metastasis. Herein, we report a patient with adenoid cystic carcinoma located to the lower lip which is quite uncommon.

Simple Summary: Carcinomas of the minor salivary glands of the oral cavity are a rare and heterogeneous group of malignant tumors. The small number of patients limits the available data on treatment and outcome. In this study, we compared clinical and pathological features and oncological outcomes in a cohort of patients suffering from different kinds of minor salivary gland cancer who received primary surgical therapy. Overall, we found different rates of cervical metastases and disease recurrence in dependence on the tumor entity. Therefore, we conclude that the surgical therapy of patients suffering from minor oral salivary gland cancer is feasible and brings good oncological results although the different tumor entities require different levels of therapeutic aggressiveness and adjuvant treatment. The aim of this study was to analyze the clinical outcomes of three types of minor salivary gland carcinomas (adenoid-cystic carcinomas (ACC), adeno carcinomas not otherwise specified (AC-NOS), and mucoepidermoid carcinomas (MEC)) after primary surgical therapy. A retrospective cohort study was designed and patients with cancer of the minor oral salivary glands treated in our department in the years 2011 to 2022 were included. Clinicopathological data were evaluated to compare overall survival and progression-free survival between the entities. Eighty-one patients were included. The rates of cervical metastases were 38.9% for ACC, 25% for MEC, and 9.1% for AC-NOS. ACC exhibited significantly higher rates of local and systemic disease recurrence (p = 0.02), and the presence of neck node metastases was confirmed as an independent prognostic factor for progression-free survival (p = 0.014). Treatment success in terms of oncological outcome varied significantly between the different entities and implies different treatment regimens for each tumor entity. [ABSTRACT FROM AUTHOR]

Basal cell adenocarcinoma (BCAC) is a rare malignant tumor of the salivary glands, representing 1–2% of salivary gland neoplasms. It is considered a low-grade tumor, often associated with a good prognosis. We report a case of a 60-year-old man with 3-month history of a growing, painless mass in the right ascending ramus of the mandible. Ultrasound and CT scan showed an asymmetry between parotid glands, depicting a nodular structure on the right side. A parotid fine needle aspiration cytology revealed neoplastic cells suggestive of adenoid cystic carcinoma. The patient underwent a total parotidectomy with lymph node dissection. Histopathology result was reported as BCAC. The patient concluded adjuvant radiotherapy and continued follow-up surveillance without evidence of relapse. The adjuvant approach in this case was decided by a multidisciplinary team given the absence of classically known risk factors. We highlight the importance of considering BCAC in the differential diagnosis in salivary gland tumors.

Statement of the Problem: Heat shock protein 27 (HSP27) plays important roles in many cellular processes and has been implicated in different types of diseases such as cancers.Purpose: This study aimed to evaluate the serum level of HSP27 in patients with salivary gland tumors and to determine its possible correlation with the prognosis of the disease.Materials and Method: This cross-sectional study was performed on 60 patients with salivary gland tumor including 16 pleomorphic adenoma, 33 adenoid cystic carcinoma, 6 mucoepidermoid carcinoma, 5 acinic cell carcinoma, and 28 healthy control subjects. The control cases were healthy blood donors who matched the study group in age and sex. Serum samples were obtained from the clotted blood and HSP27concentrations were measured with sandwich enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed by using one-way ANOVA, post Hoc test, independent sample t-test, and ROC analysis. A p value of less than 0.05 was considered as significant.Results: The mean serum level of HSP27 was 3956.1±3830.1 (pg/ml) in patients with malignant salivary gland tumor, which was significantly higher than that in benign salivary gland tumor (752.2±485.6) and healthy controls (602.3±575.8) (p< 0.001). However, there was no significant difference in the HSP27 serum levels between the patients with benign salivary gland tumors and healthy controls (p= 0.2). No association was detected between the mean serum levels of HSP27 and clinicopathologic factors such as age, sex, stage and nodal metastasis (p> 0.05), except for the tumor size (p= 0.04).Conclusion: The HSP27 concentration increased in patients with malignant salivary gland tumors. Moreover, the HSP27 level was correlated with tumor growth, invasiveness, and diagnosability. Yet, larger clinical studies are required to explore its prognostic value.

Objectives: To evaluate the prognostic and locoregional metastatic features of carcinoma ex pleomorphic adenoma of submandibular gland (SMG‐CXPA) and improve the understanding of this uncommon condition. Patients and methods: We retrospectively reviewed patients who were diagnosed with SMG‐CXPA. The survival data of SMG‐CXPA patients were statistically analyzed using Cox regression and Kaplan–Meier method. The associations between cervical metastasis and clinicopathological parameters were evaluated using chi‐squared test. Additionally, two different histological categories (histological grade and invasiveness) and their combination were evaluated with the Kaplan–Meier method and receiver operating characteristic curves. Results: In total, 86 patients were diagnosed: 38 clinically node‐negative, 31 pathologically node‐negative, and 17 node‐positive patients. Clinical tumor stage and histological grade were two independent prognostic factors for SMG‐CXPA. There were significant correlations between sex, tumor size, clinical tumor stage, clinical lymph node stage, histological grade, invasiveness, malignant components, perineural invasion, and no specific criteria exist for the clinical outcome. Conclusion: SMG‐CXPA is a high‐grade malignancy with an unfavorable prognosis. Elective neck dissection should be performed in SMG‐CXPA patients with a risk of locoregional metastasis. Histological grade seems to be a more valuable predictor of lymph node involvement than invasiveness. [ABSTRACT FROM AUTHOR]

Thyroid cancer ranks as the leading endocrine malignancy in adults. The foundation for primary diagnosis of thyroid cancer is a high-resolution ultrasound (US) of the thyroid gland including US-guided fine-needle biopsy (FNB) of suspected thyroid nodules. Advanced cross-sectional imaging, including computed tomography (CT), magnetic resonance imaging, and positron emission tomography, can be useful in selected patients. The mainstay of treatment of thyroid cancer is surgery. It may be supplemented by radioactive iodine ablation/therapy in high-risk differentiated thyroid cancer. Radiology plays a crucial role in both diagnostic and posttreatment follow-up imaging. Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder with single parathyroid adenoma being its most common cause. The radiologist's aim in parathyroid imaging is to provide the clinician with an illustrative picture of the neck, locating lesions with respect to landmarks. Imaging helps in the detection of solitary versus multiglandular disease, ectopic and supernumerary glands with precise localization. US, nuclear imaging, and four-dimensional CT are the most commonly used imaging modalities for the preoperative localization of the parathyroid disease. Salivary gland tumors account for approximately 0.5% of all neoplasms, the most common location being the parotid gland (70%). Imaging is crucial in salivary gland tumors by defining its location, detecting malignant features, assessing local extension and invasion, staging the tumors according to the tumor-node-metastasis classification, and assessing the feasibility of surgery. [ABSTRACT FROM AUTHOR]

Background: Mammary analogue secretory carcinoma (MASC) is characterized by similar histologic, immunohistochemical, and molecular features with breast secretory carcinoma. MASC usually occurs in adults. Case report: A 4-year-old boy presented with a right infra-auricular mass. Features of the tumor include solid, tubular, and papillary growth patterns, with homogenous eosinophilic secretions inside microcystic structures. Immunohistochemical stains showed strong, diffuse staining for CK7, S100, pan-TRK protein. P63 was positive in a peripheral pattern. Fluorescence in situ hybridization (FISH) analysis showed the characteristic ETV6-NTRK3 gene fusion. Conclusion: Typical histological, immunohistochemical, and molecular features are present in MASC occurring early in childhood. [ABSTRACT FROM AUTHOR]

Salivary gland-type intraductal carcinoma (IC) is a rare malignant salivary gland neoplasm. Primary salivary gland-type IC has never been described in the lung. Herein, we present a primary pulmonary IC in a 63-year-old woman. The tumor originated in the bronchus wall of the right middle lobe. The tumor consisted of two histological types, intercalated component and oncocytic component. The intercalated component showed tubular/cystic pattern composed of column to cube-shaped cells and scattered mucous cells. The oncocytic component showed solid nests composed of large cells with abundant eosinophilic granular cytoplasm. Immunohistochemically, both histological components were positive for cytokeratin 7 (CK7), S-100 protein, SOX10, and mammaglobin. The rimming myoepithelial cells were highlighted by p63 and smooth muscle actin (SMA). The tumor cells were negative for androgen receptor (AR), HER-2, Dog-1, TTF-1, napsin A, GCDFP-15, and GATA3. In the present case, we detected KIAA1217::RET fusion via DNA-based next-generation sequencing (NGS) and RT-PCR, which established the diagnosis of IC at a molecular level. The present case expands the categories of bronchopulmonary salivary gland-type tumors. [ABSTRACT FROM AUTHOR]

Sialoblastoma is an extremely rare embryonal tumor derived from salivary gland primordial cells. Treatment usually consists of surgery alone; however, in some cases, chemotherapy is required and is administered with good response. We present a case of a 5-week-old girl diagnosed with a parotid gland tumor and co-existing nevus sebaceous on the face. Initial tumorectomy was microscopically non-radical and histopathology revealed sialoblastoma. The patient received adjuvant chemotherapy consisting of vincristine, actinomycin, and cyclophosphamide. Due to imaging studies being inconclusive regarding response and possible residual disease, a second surgery (total parotidectomy) was performed. The histopathology results showed fields of necrosis in the parotid gland but no neoplastic cells in the material. The patient remains under watchful observation and there is no evidence of relapse 12 months after the second surgery. The adjuvant chemotherapy regimen with vincristine, actinomycin, and cyclophosphamide is a viable option of treatment in children with sialoblastoma. [ABSTRACT FROM AUTHOR]

Background: To investigate the differential expression of PD-1 and PD-L1 in salivary gland tumors (SGTs, malignant and benign subtypes) and determine their association with the clinicopathological characterization of the patients. Methods: The immunohistochemistry was used to examine PD-1 and PD-L1 expression in specimens from 83 patients with primary SGTs including salivary ductal carcinoma (SDC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (ACC), mucoepidermoid carcinoma (MEC), warthin's tumors (WT), poleomorphic adenoma (PA) and other subtypes. Results: The expression of PD-1 in peripheral and central immune cells (ICs) of MEC, and peripheral ICs of ACC was significantly higher than those with AdCC (P = 0.02, P = 0.02, P = 0.03, respectively). Interestingly, the expression of PD-1 was also observed in peripheral and central malignant tumor cells (TCs), particularly in SDC and ACC. Despite no significant difference in PD-L1 expression of TCs among malignant subtypes, the peripheral and central ICs of ACC and MEC were revealed to express PDL-1 significantly more than those with AdCC (P < 0.05). WTs were rich in PD-1/PD-L1 expressing ICs. However, the tumor microenvironment of PA generally had low levels of PD-1/PD-L1 expression. In general, the expression of PD-1 in peripheral and central TCs was found to be significantly higher in malignant tumors than in benign ones (P = 0.002 and P = 0.003, respectively). Conclusion: The simultaneous presentation of PD-1 and PD-L1 in TCs and ICs of SGTs, their significant association with disease severity as well as the positive correlation between these immune checkpoints may suggest the therapeutic potential of anti-PD-1 and anti-PDL-1 combinational immunotherapy for SGTs. [ABSTRACT FROM AUTHOR]

Salivary gland tumors (SGTs) are a relevant, highly diverse subgroup of head and neck tumors whose entity determination can be difficult. Confocal Raman imaging in combination with multivariate data analysis may possibly support their correct classification. For the analysis of the translational potential of Raman imaging in SGT determination, a multi-stage evaluation process is necessary. By measuring a sample set of Warthin tumor, pleomorphic adenoma and non-tumor salivary gland tissue, Raman data were obtained and a thorough Raman band analysis was performed. This evaluation revealed highly overlapping Raman patterns with only minor spectral differences. Consequently, a principal component analysis (PCA) was calculated and further combined with a discriminant analysis (DA) to enable the best possible distinction. The PCA-DA model was characterized by accuracy, sensitivity, selectivity and precision values above 90% and validated by predicting model-unknown Raman spectra, of which 93% were classified correctly. Thus, we state our PCA-DA to be suitable for parotid tumor and non-salivary salivary gland tissue discrimination and prediction. For evaluation of the translational potential, further validation steps are necessary.

Given the location of the lesion proximate to the angle of the jaw/salivary gland, the immunohistochemical profile, and histopathologic architecture, the findings were diagnostic of a salivary gland ACC. Acinic cell carcinoma, dermatology, dermatopathology, salivary gland tumor, head and neck cancer In cases where the skin lesion is in close proximity to the salivary glands, a salivary gland tumor should be considered in the differential diagnosis. [Extracted from the article]

Metastases of distant primary tumors on the parotid gland are very rare. Tumor‐to‐tumor metastasis to salivary gland tumors is extremely rare. A case of a 69‐year‐old woman with a large left parotid gland mass with no previous salivary gland problems or cancer. Fine‐needle aspiration (FNA) showed evidence of a Warthin tumor. A total left parotidectomy was performed. The final pathology report showed a Warthin tumor containing two metastases of adenocarcinoma. The immunohistochemistry of the metastases led to the diagnosis of primary breast cancer. A negative FNA does not rule out the possibility of a malignant parotid tumor or metastasis, and a parotid lump should be presumed to be a secondary tumor until proven otherwise if the patient has a history of any distant primary cancer. Our patient case serves as a reminder that a new distant primary cancer might be the cause of a parotid lump. [ABSTRACT FROM AUTHOR]

Objectives: Discussions regarding the specific management and outcomes for laryngeal MEC are limited to very small, single-institution case series. To look further into the diagnosis and management of these uncommon non-squamous cell carcinomas of the larynx, we present 3 recent cases of laryngeal MEC treated at our institution. Methods: Patients at a tertiary hospital treated for MEC between October 2019 and December 2020 were retrospectively identified. Chart review, imaging analysis, and histologic slide creation were completed for all patients. Results: We identified and treated 2 patients with high-grade supraglottic and 1 patient with intermediate-grade glottic MEC. These patients presented to our clinic with a primary complaint of either gradual, worsening dysphonia, dysphagia, or both. All patients underwent laryngovideostroboscopy as well as panendoscopy with directed submucosal biopsy, which was consistent with MEC. MRI was performed in 2 of the cases further elucidating the extent of submucosal spread. PET-CT was performed in all 3 cases, and none demonstrated evidence of regional or distal metastases. Surgically, high-grade MEC lesions were treated with a total laryngectomy. The intermediate MEC lesion was managed with a supracricoid partial laryngectomy (SCPL). Surgical margins were free of tumor in all cases with no nodal metastases by modified radical neck dissection. Radiation therapy was offered to both high-grade MEC patients and declined by one. Radiation was not recommended to the patient with intermediate-grade MEC as we believed that the risk of additional treatment outweighed the benefit. Conclusion: We believe that MEC of the larynx should be considered in patients with atypical submucosal laryngeal masses. Laryngovideostroboscopy, MRI, and PET imaging may be valuable in determining the extent of the lesions and planning appropriate surgery. Postoperative radiation therapy should be considered a per tumor grade in other more studied sites, as there is no data on efficacy in laryngeal MEC. [ABSTRACT FROM AUTHOR]

Background: Salivary gland intraductal papillary mucinous neoplasm (SG IPMN) is a recently proposed entity characterized by a papillary-cystic proliferation of mucin-producing cells. Because of overlapping histologic features and a clonal AKT1 p.E17K variant, SG IPMN has been presumed to be a precursor or a low-grade subtype of mucinous adenocarcinoma. NKX3.1 is a tumor suppressor gene located on chromosome 8p and is a known immunohistochemical marker of prostate epithelium and mucinous acinar cells of the intraoral salivary glands. Methods: We retrieved 12 SG IPMN cases, and performed histologic and genetic analysis. Given the association of SG IPMN with mucinous acinar cells, we also investigated the performance of NKX3.1 as a marker of this tumor entity. Results: Diffuse and strong NKX3.1 expression was observed in all SG IPMN cases (12/12, 100%) as well as in normal mucinous acinar cells. In contrast, mucoepidermoid carcinoma and pancreatic IPMN cases as well as normal serous acinar cells were negative for NKX3.1. Genetically, 11 of 12 cases (92%) harbored an AKT1 p.E17K variant. A novel PTEN frameshift deletion (p.G36Dfs*18) was detected in the other single case. At least one of the histologic features implying malignant tumors, such as severe cellular atypia, brisk mitotic activity, high Ki-67 proliferating index, lymphovascular invasion, and lymph node metastasis, was detected in 6 SG IPMN cases (50%). Conclusion: The findings suggest that SG IPMN is a low-grade subtype of mucinous adenocarcinoma which may be derived from mucinous acinar cells of the minor salivary gland. [ABSTRACT FROM AUTHOR]

Polymorphous adenocarcinoma (PAC) is a rare variant of minor salivary gland tumors. Because of its architectural diversity, histological diagnosis of PAC can be difficult especially for small biopsies, and immunohistochemistry is of great help in differentiating it from its histologic mimics. The aim of this study is to conduct a systematic literature review to identify reliable immunohistochemical markers for PAC. We conducted an electronic literature search of the MEDLINE, ScienceDirect, SpringerLink, and Wiley Online Library databases, covering the literature published in the period between 1988 and 2021. The eligibility criteria included case reports and retrospective studies of PAC cases with details of immunohistochemical markers. Following the search and selection process, 32 studies with 409 cases were included in this systematic review. Overall, > 90% positivity was observed for pan-cytokeratin (CK) (97.3%), CK7 (96.8%), CK7/8 (97.4%), E-cadherin (90.0%), Vimentin (92.5%), S100 (97.0%), p63 (91.7%), and SOX10 (100%), while little to no positivity was observed for CK20 (0.0%), p40 (0.0%), and GFAP (5.0%). The average MIB-1 labeling index was 3.78%. The results of this systematic review indicate that CK7+/CK20−, p63+/p40−, S100+, Vimentin+, and GFAP– immunophenotype have diagnostic value for PAC. In addition, the use of S100, MSA, p40, and c-Kit provide additional layers of information helpful to differentiate PAC from adenoid cystic carcinoma, one of challenging differential diagnoses. [ABSTRACT FROM AUTHOR]

Sialadenoma papilliferum (SP) is a rare salivary gland tumor mostly reported in the oral cavity. Here we describe a bronchial SP in the left upper lobe bronchus of a 10-year-old boy. At bronchoscopy, a well-circumscribed polypoid lesion protruding into the bronchial lumen was identified. The tumor was excised, but eventually, the patient had to undergo a sleeve resection after 2 recurrences. Pathology revealed a papillocystic lesion with exophytic and endophytic components. The cells lining the exophytic surface and papillary structures were columnar and squamous, and the cells lining endophytic cystic and papillary structures were cuboidal to columnar, all of which were diffusely reactive with antibodies to SOX10 protein. The presence of basal cells was demonstrated by p63 immunoreactivity. The cells failed to immunohistochemically express BRAF V600E. Fluorescence in situ hybridization analysis revealed no MAML2 or RET gene rearrangement. The patient is alive 24 years after resection with no additional recurrences. Bronchial SP needs to be recognized and distinguished from other benign and malignant salivary gland and pulmonary neoplasms so that patients can receive appropriate treatment and follow-up. [ABSTRACT FROM AUTHOR]

Ultrasound is the primary tool for evaluating salivary gland tumors (SGTs); however, tumor diagnosis currently relies on subjective features. This study aimed to establish an objective ultrasound diagnostic method using deep learning. We collected 446 benign and 223 malignant SGT ultrasound images in the training/validation set and 119 benign and 44 malignant SGT ultrasound images in the testing set. We trained convolutional neural network (CNN) models from scratch and employed transfer learning (TL) with fine-tuning and gradual unfreezing to classify malignant and benign SGTs. The diagnostic performances of these models were compared. By utilizing the pretrained ResNet50V2 with fine-tuning and gradual unfreezing, we achieved a 5-fold average validation accuracy of 0.920. The diagnostic performance on the testing set demonstrated an accuracy of 89.0%, a sensitivity of 81.8%, a specificity of 91.6%, a positive predictive value of 78.3%, and a negative predictive value of 93.2%. This performance surpasses that of other models in our study. The corresponding Grad-CAM visualizations were also presented to provide explanations for the diagnosis. This study presents an effective and objective ultrasound method for distinguishing between malignant and benign SGTs, which could assist in preoperative evaluation.

Abstract Background Currently, the clinicopathological characteristics and prognosis of myoepithelial carcinoma of salivary gland (MC‐SG) have not been defined well. The present study aimed to describe the clinicopathological characteristics and prognosis of MC‐SG patients. Methods The Surveillance, Epidemiology, and End Results database was searched for all patients diagnosed with MC‐SG between 1991 and 2016. The Kaplan–Meier method and log‐rank tests were used to evaluate the survival. Univariate and multivariate Cox regression analysis were used to identify prognostic biomarkers for overall survival (OS) and disease‐specific survival (DSS). Furthermore, a prognostic nomogram was established, and its predictive accuracy and discriminative ability were determined using the concordance index (C‐index). Results In total, 245 patients diagnosed with MC‐SG were identified. The median OS was 152.0 months, with 3‐, 5‐, and 10‐year survival rates of 79.8%, 69.2%, and 50.3%. The 3‐, 5‐, and 10‐year DSS rates were 82.5%, 77.1%, and 61.9%, respectively. Regarding the treatment regimen, most patients (92.2%) underwent surgery, and 103 patients (42.4%) received postoperative radiotherapy. Surgery could significantly prolong OS and DSS (p .05). Multivariate Cox analysis revealed that T category (T4), lymph node metastasis (N2), distant metastasis (M1), and poor differentiation were independent unfavorable prognostic factors for OS and DSS. Older age (>62 years) was also independently associated with OS. In addition, the C‐index for the established OS‐ and DSS‐specific nomogram was 0.80 (95% CI: 0.72–0.88) and 0.82 (95% CI: 0.73–0.90). Conclusion Age, tumor invasion, metastases, and pathological grade were independently associated with prognosis of MC‐SG patients, and the prognostic nomogram of this rare disease was established.

Background: Myoepithelial cells are involved in the development of salivary glands. Many studies propose that these cells can prevent cell proliferation. Aim: This study aimed to investigate the expression of Ki-67, P63, P40, and alpha-smooth muscle actin (α-SMA) in salivary gland carcinomas with or without myoepithelial differentiation. Methods: A panel of myoepithelial markers including P63, P40, α-SMA, and Ki-67 were used for immunohistochemical study in 67 salivary gland carcinomas (33 with and 34 without myoepithelial differentiation). The percentage of positive cells was calculated (in high-power field) from a minimum of 1000 neoplastic cells. SPSS software (version 21) was used. Results: There was no statistically significant difference between Ki-67 expression and the presence or absence of myoepithelial cells (P = 0.6), but Ki-67 expression was related to the age (P = 0.032) and location of carcinomas (P = 0.001). All carcinomas with myoepithelial differentiation exhibited consistent P63+/P40+ staining, whereas polymorphous adenocarcinomas showed P63+/P40− immunophenotype. The expression of Ki-67 in adenoid cystic carcinomas was higher than mucoepidermoid carcinomas (P = 0.020) and polymorphous adenocarcinomas (P = 0.002). Conclusion: In the present study, although the decrease in the number of myoepithelial cells was associated with increased proliferation in adenoid cystic carcinomas, no such relationship was found in the overall assessment between the two groups. This can be justified by the fact that the clinical behavior of salivary carcinomas and their cell proliferation may be affected by factors other than the presence of myoepithelial cells or lack thereof. Ki-67 and P63/P40 expressions may be useful to differentiate adenoid cystic carcinomas from polymorphous adenocarcinomas in small biopsies.

Abstract Metastases of distant primary tumors on the parotid gland are very rare. Tumor‐to‐tumor metastasis to salivary gland tumors is extremely rare. A case of a 69‐year‐old woman with a large left parotid gland mass with no previous salivary gland problems or cancer. Fine‐needle aspiration (FNA) showed evidence of a Warthin tumor. A total left parotidectomy was performed. The final pathology report showed a Warthin tumor containing two metastases of adenocarcinoma. The immunohistochemistry of the metastases led to the diagnosis of primary breast cancer. A negative FNA does not rule out the possibility of a malignant parotid tumor or metastasis, and a parotid lump should be presumed to be a secondary tumor until proven otherwise if the patient has a history of any distant primary cancer. Our patient case serves as a reminder that a new distant primary cancer might be the cause of a parotid lump.