Adenomatoid Hyperplasia: Case Report of a Rare Lesion in Uncommon Location

Adenomatoid hyperplasia is a rare lesion of the minor salivary glands recognized by localized swelling that mimics a neoplasm. This so-called pseudotumor usually occurring in adults 4th to 6th decade of life mostly, in 80%, occurs as a unilateral swelling without ulcer on the hard and soft palate. The pathogenesis of this condition is not well known but local trauma might have a role. In this case report three cases of adenomatoid hyperplasia have been reported to bring attention to this lesion as it is clinically similar to many soft tissue lesions of oral mucosa so should be considered while making a clinical diagnosis. Also, Pathologists should investigate a proper sample size under a microscope not to confuse a normal salivary gland adjacent to salivary gland tumours with Adenomatoid hyperplasia.

Expression of p16Ink4a protein in pleomorphic adenoma and carcinoma ex pleomorphic adenoma proves diversity of tumour biology and predicts clinical course

AimsThe aim of the study is to correlate p16Ink4a expression with the clinical courses of pleomorphic adenoma (PA), its malignant transformation (CaexPA) and treatment outcomes.MethodsRetrospective analysis (1998–2019) of 47 CaexPA, 148 PA and 22 normal salivary gland samples was performed. PAs were divided into two subsets: clinically ‘slow’ tumours characterised by stable size or slow growth; and ‘fast’ tumours with rapid growth rate.ResultsPositive p16Ink4a expression was found in 68 PA and 23 CaexPA, and borderline expression in 80 and 20, respectively. All 22 (100%) normal salivary gland samples presented with no p16Ink4a expression. Significant difference in p16Ink4a expression was observed between normal tissue, PA and CaexPA (χ2 (4)=172,19; p=0.0001). The PA clinical subgroups were also evaluated separately, revealing additional statistical relations: ‘fast’ PA and CaexPA differed significantly in p16Ink4a expression (χ2 (2)=8.06; p=0.01781) while ‘slow’ PA and CaexPA did not (χ2 (2)=3.09; p=0.2129). 3-year, 5-year and 10-year survival among p16Ink4a positive CaexPA patients was 100%, 90.56% and 60.37%, respectively, and in CaexPA patients with borderline p16Ink4a expression was 90.0%, 73.64% and 22.20%, respectively. Statistically significant difference between expression pattern and survival rate was observed (F Cox test – F (16, 24)=2.31; p=0.03075).ConclusionsOur study confirms no p16Ink4a expression in normal tissue, but reveals differences in expression between ‘fast’ and ‘slow’ PA. We suggest that p16Ink4a overexpression is connected to PA proliferation and subsequent malignant transformation to CaexPA. Borderline p16Ink4a staining correlates with worse prognosis of CaexPA.

Adenomatoid Hyperplasia: Case Report of a Rare Lesion in Uncommon Location

Adenomatoid hyperplasia is a rare lesion of the minor salivary glands recognized by localized swelling that mimics a neoplasm. This so called pseudotumor usually occurring in adults 4th to 6th decade of life mostly, in 80 percent, occurs as a unilateral swelling without ulcer on the hard and soft palate. The pathogenesis of this condition is not well known but local trauma might have a role. In this case report three cases of adenomatoid hyperplasia have been reported to bring attention to this lesion as it is clinically similar to many soft tissue lesions of oral mucosa so should be considered while making a clinical diagnosis. Also, Pathologists should investigate a proper sample size under a microscope not to confuse a normal salivary gland adjacent to salivary gland tumours with Adenomatoid hyperplasia.

Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren’s syndrome in anti-SSA-negative patients with sicca syndrome

ObjectiveTo evaluate the relevance of salivary gland ultrasound (SGUS) and its place in the diagnostic algorithm in patients referred with dry syndrome (DS) for a suspicion of Sjögren’s syndrome (SS).MethodsWe included all patients assessed at our dedicated DS clinic from June 2015 to September 2019 for which a SGUS has been carried out. Images were read blindly and the worst salivary gland was scored according to OMERACT classification. Clinical features, disease activity and treatments were collected.Results337 patients were seen from June 2015 to September 2019. 269 patients underwent SGUS. 77 patients were diagnosed with SS and 192 did not meet the ACR/EULAR criteria for SS: non-Sjögren’s DS (NSDS). Of these 192 patients, 60 had another possible cause of DS, and 132 patients were diagnosed with SAPS (sicca, asthenia, polyalgia syndrome).SGUS abnormalities were significantly higher in patients with SS versus NSDS: 51% vs 8% for a score ≥2 (p<0.0001), and 43% vs 3% for a score ≥3 (p<0.0001). SGUS score ≥2 had a specificity (Sp) of 91%, sensitivity (Se) of 57%, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 82% for SS diagnosis. SGUS’s characteristics in SSA-negative patients were similar to the whole population (Se=42%, Sp=91%, PPV=42%, NPV=92%). The high specificity and NPV in this population could avoid labial salivary gland biopsy (LSGB) in SSA-negative patients with normal SGUS (186 patients, 69%).ConclusionSGUS is useful for SS diagnosis. If anti-SSA antibodies are negative and SGUS score <2, the diagnosis of SS is very improbable and LSGB could be avoided.

A retrospective study of salivary gland diseases in 179 dogs (2010–2018)

Salivary gland diseases are well characterized in human medicine but are uncommonly reported in dogs. Herein we describe the clinical and pathologic features of 179 canine salivary gland biopsy submissions to the Athens Veterinary Diagnostic Laboratory from 2010 to 2018. The mean age of affected dogs was 8.5 y; no sex or breed predisposition was evident. The main reason for sample submission was regional swelling (107 cases; 59.7%). Extraoral (major) salivary glands were affected in 125 cases (69.8%), and oral (minor) salivary glands were affected in 43 cases (24% of cases). The location of the lesion (extraoral or oral) was not specified in 11 cases (6.1%). The diagnoses included nonspecific sialoadenitis (89 cases; 49.7%), normal salivary gland (42 cases; 23.4%), neoplasia (36 cases; 20.1%), salivary gland lipomatosis (7 cases; 3.9%), necrotizing sialometaplasia (4 cases; 2.2%), and traumatic hemorrhage (1 case; 0.5%). Most cases of sialoadenitis (63 cases), neoplasia (23 cases), and lipomatosis (5 cases), as well as all cases of necrotizing sialometaplasia and the only case of traumatic hemorrhage, affected extraoral glands. Most neoplasms (32 cases, 88.8% of the tumors) were epithelial and malignant, followed by round cell tumors (2 cases; 5.5%), a carcinosarcoma (1 case; 2.7%), and a tumor of undetermined histogenesis (1 case; 2.7%).

Expression of TdT in Myoepithelial Cells: Investigation in Breasts, Sweat Glands, and Salivary Lesions Emphasizing the Never-Documented Immunohistochemical Findings

Background. The expression of terminal deoxynucleotidyl transferase (TdT) in myoepithelial cells (MECs) within the breast was recently incidentally observed in our routine practice. This study aimed to elucidate the expression of TdT in MECs. Methods. TdT immunostaining was performed on 180 mammary, 89 cutaneous, and 94 salivary tissues or lesions. Other myoepithelial markers, including P63, calponin, and SMA as well as double staining for TdT and calponin, were also evaluated in some cases. Selected lesions with basal or myoid differentiation were also included in the investigation. Results. MECs were positive for TdT in mammary lesions that contained MECs (132/135) but negative when they did not contain MECs (45/45). MECs in sweat glands (24/30) and their neoplastic counterparts, including those in hidradenoma papilliferum (2/9), spiradenoma (6/6), and cutaneous mixed tumor (9/9), showed weak to moderate TdT positivity. MECs were variably immunolabeled for TdT in salivary or salivary gland–type tumors with myoepithelial differentiation (pleomorphic adenoma, 24/25; basal cell adenoma, 6/7; adenoid cystic carcinoma, 7/7; Warthin tumor, 0/6; mucoepidermoid carcinoma, 0/8; acinic cell carcinoma, 0/4), but MECs in normal salivary gland barely stained for TdT (30/32). Conclusions. Our findings indicate that TdT may be eligible as an additional auxiliary immunohistochemical marker as P63, but not a surrogate, to identify the MECs in the breast with limited cross-reactivity, particularly in lesions with a prominent proportion of MECs. Positivity for TdT, along with other relevant markers, in a subset of sweat gland lesions and salivary tumors may contribute to their diagnosis.

Approaches to preventive periodontal care for geriatric patients with somatic disorders

During the last two decades the acute interest in longevity has been kept by the world’s scientific community in relation to quality of health of older adults and prevention of emerging diseases including oral disorders in the old age. This article presents the study of oral conditions in 100 patients between the ages of 60 and 69 who were divided into three groups. This study aims to define approaches to preventive periodontal care for elderly patients with comorbidities. The primary group included patients with periodontal disease (PD) and salivary gland dysfunction: Sjogren’s disease and syndrome, non-insulin dependent diabetes mellitus, chronic pancreatitis. Two experimental groups included patients with normal salivary gland function and PD as well practically healthy persons without PD and normal salivary gland function. A comparative analysis of the results showed spread of dental caries (100%) and periodontal diseases (80%). The clear correlation between periodontium complex inflammation and poor oral hygiene is defined, mostly with men (p<0.05). Structural and optical properties of mixed saliva significantly change subject to periodontium inflammation and xerostomia: severity of xerostomia corresponding to profound hemodynamic and microcirculatory changes causes more intensive structural developmental abnormalities of mixed saliva. The important component of the Periodontal Treatment Protocol is to help older people develop skills and controls of effective thorough tooth brushing.

Sialolipoma of the Parotid Gland: An Uncommon Lipoma Variant of Salivary Gland

Sialolipoma affecting the salivary glands is an uncommon lipoma variant composed of mature adipose tissue mixed with acinar, ductal, basal and myoepithelial cells of normal salivary gland. It has a wide age range at presentation. Generally, the major gland has male predilection while the minor gland has a female preponderance. A diagnostic workup requires CT or MRI to define the exact location and texture of the lesion. Surgical excision is recommended when the tumor progressively increases in size. Prognosis is good whereby no malignant transformation or recurrences has been reported.