Radiotherapy in Inoperable Mucoepidermoid Parotid Cancer: A Case Report

Introduction: Salivary gland cancer is an uncommon malignancy in the head and neck. The most common histopathologic type in salivary gland malignancies is mucoepidermoid carcinoma (MEC). Radiotherapy has a role in salivary gland malignancy, especially in inoperable cases and postoperative settings. Definitive or postoperative radiotherapy with or without chemotherapy can improve locoregional control (LRC) in patients with parotid mucoepidermoid carcinoma. Case Presentation: We report a case of a 77-year-old male with inoperable MEC of the right parotid, who received definitive radiotherapy. From the three-month evaluation after radiation therapy, we found a significant reduction in the tumor mass. Conclusions: Surgery remains the treatment of choice for patients with salivary gland malignancies. Definitive radiotherapy can be a treatment modality in inoperable cases or patients who refuse surgery. Although the result is not satisfactory, radiotherapy can still give clinical benefits to patients.

Management of Salivary Gland Malignancy: ASCO Guideline

PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies. Additional information is available at www.asco.org/head-neck-cancer-guidelines .

Carcinoma Ex-Pleomorphic Adenoma Diagnosis During Global Health Engagement Operations

ABSTRACT Introduction In global health engagement settings, performance of oncologic surgery is evaluated by understanding the host nation healthcare capacity to include inpatient care support and the available postoperative adjunctive therapy to include chemotherapy and radiation therapy. Materials and Methods We present a case during Pacific Partnership 2018 of a patientwith a malignant facial mass diagnosed postoperatively. A literature review was conducted, searching specifically for cases related to pleomorphic adenoma (PA), carcinoma ex-PA, cases of misdiagnosis, and global health engagement operations. Results The patient presented without constitutional symptoms, clinical lymphadenopathy, or cranial nerve VII weakness with a preoperative host nation diagnosis of a benign salivary neoplasm (PA). Postoperatively, a gross total resection of the mass was diagnosed as high-grade adenocarcinoma—a carcinoma ex-PA of the parotid gland. Oncologic staging was noted to be advanced at T3N0, and the patient was referred back to the host nation surgeons for radiation oncology consultation and clinical surveillance to follow. Discussion Diagnosis of carcinoma ex-PA—a rare form of salivary gland malignancy—is not always straightforward because of its high degree of cellular heterogeneity, leading to inconsistencies in preoperative sampling results. This case addresses the preoperative diagnostic challenges associated with this type of malignancy, different types of possible treatment modalities aimed at reducing postoperative morbidity, and the preoperative and postoperative challenges that are critical to address during health engagement operations.

Surgical anatomy of the lymphatic drainage of the salivary glands: a systematic review

BackgroundNodal metastasis in salivary gland malignancies has important clinical implications; a good understanding of their complex anatomy is paramount to the head and neck surgeon.MethodsA contemporary and comprehensive literature review was conducted of the lymphatic drainage of the salivary glands, with special emphasis on its surgical applications.ResultsThe parotid gland has extraglandular and intraglandular nodes acting as a single functional drainage unit. Intraglandular parotid notes are unique to the parotid gland, and consist of a larger superficial group and a smaller deep group. The presence of intraglandular submandibular nodes, as described by early anatomists, is much debated nowadays. The sublingual glands drain to the lingual lymph nodes, which are divided into median, intermediate and lateral groups.ConclusionThis review highlights the complex arrangements of lymph nodes draining the salivary glands. It may provide a valid anatomical explanation for the nodal metastasis patterns commonly seen in salivary gland malignancy.

Tuberculosis as a differential diagnosis of salivary gland malignancy

Mycobacterial infection of the salivary glands is extremely rare, even in endemic countries. Differential diagnosis with benign or malignant neoplasms is challenging, and treatment is often delayed. We describe the case of a 62-year-old female patient who presented with a 2-month-old complaint of a right preauricular painless swelling. An ultrasound-guided fine-needle aspiration biopsy was performed, with a resulting lymphocytic infiltrate, without clear atypia. MRI demonstrated a lesion with ill-defined contours, described as probably malignant. Because of this mismatch in results, a core biopsy of the main lesion was performed, demonstrating granulomas with central necrosis, with no mycobacteria detected in PCR or culture. As the lesion continued to enlarge, a new biopsy was ordered, and this time Mycobacterium tuberculosis was detected. Treatment with extrapulmonary tuberculosis therapy was initiated. The sensitivity of PCR and culture combined is only 73% in extrapulmonary tuberculosis. A systematic approach may prevent unnecessary surgical interventions.

Aquaporin 1, 3, and 5 Patterns in Salivary Gland Mucoepidermoid Carcinoma: Expression in Surgical Specimens and an In Vitro Pilot Study

Salivary gland aquaporins (AQPs) are essential for the control of saliva production and maintenance of glandular structure. However, little is known of their role in salivary gland neoplasia. Salivary gland tumors comprise a heterogeneous group of lesions, featuring variable histological characteristics and diverse clinical behaviors. Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. The aim of this study was to evaluate the expression of AQP1, AQP3, and AQP5 in 24 MEC samples by immunohistochemistry. AQP1 expression was observed in vascular endothelium throughout the tumor stroma. AQP3 was expressed in epidermoid and mucosal cells and AQP5 was expressed in mucosal cells of MEC. These proteins were expressed in the human MEC cell line UH-HMC-3A. Cellular ultrastructural aspects were analyzed by electron microscopy to certificate the tumor cell phenotype. In summary, our results show that, despite the fact that these molecules are important for salivary gland physiology, they may not play a distinct role in tumorigenesis in MEC. Additionally, the in vitro model may offer new possibilities to further investigate mechanisms of these molecules in tumor biology and their real significance in prognosis and possible target therapies.

Pattern of Major Salivary Gland Malignancy in B.P. Koirala Memorial Cancer Hospital

Background: Salivary gland tumors represent a different variety of histological types. The definite diagnosis of type of salivary gland tumor is required for proper treatment planning. The aim of this study was to evaluate the pattern of salivary gland malignancy in B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan. Methods: This cross-sectional study was carried out in patients of malignant salivary gland tumor registered in B.P. Koirala Memorial Cancer hospital retrospectively from September 2009 to August 2012. Results: Parotid gland was the most common sites for malignant salivary gland tumor (80%) followed by submandibular gland (20%). Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of parotid gland and Adenoid cystic carcinoma was the most common malignant tumor of submandibu-lar gland. Male: Female ratio was 1.5:1 with age range from 12 years to 71 years. Common age group for malignant salivary gland tumor was from 50 to 60 years. Conclusions: Parotid was the most common site whereas Mucoepidermoid carcinoma was the most common malignant tumor of major salivary gland.