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The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Benign tumors, such as hemangiomas, lipomas, neurolemmomas, oxphylic adenoma (oncocytoma), and papillary cystadenoma lymphomatosum (Warthin’s tumor), are usually treated by excision of the gland or superficial parotidectomy (if encountered in the superficial lobe of the parotid gland).
Miscellaneous
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
The two essential microscopic components of Warthin’s tumor are the epithelium and the lymphoid stroma. The epithelium forms tubules and cystic spaces. Delicate, finger-like papillary processes project into the cystic spaces. The epithelium lining the cystic spaces and covering the papillary structures is double-layered. The external layer is composed of tall, columnar, deeply eosinophilic cells; the cells of the basal layer are cuboidal or round. The lymphoid stroma contains many germinal centers (Figures 133 and 134).
Keratin
Published in Masahiko Mori, Histochemistry of the Salivary Glands, 2019
Pleomorphic adenomas of salivary gland origin most frequently occur in the parotid glands and palatal mucous glands. Monomorphic adenomas are rather rare benign tumors of salivary glands with a frequency similar to pleomorphic adenomas. Warthin’s tumor (cystadenolymphoma) has a high predilection for development in parotid glands, and mucoepidermoid carcinomas usually occur in submandibular glands. Histogenesis of those salivary gland neoplasms (both benign and malignant) are postulated to develop from ICD and myoepithelial cells.62,63 Reserve cells, which are possibly located in ICD, SD, and/or ECD epithelium64,65 have also been suggested as progenitor cells. The concept of reserve cells in salivary gland ducts may correspond to ductal basal cells; however, such direct evidence has not been evaluated. Histochemical studies for keratins have focused on ductal basal cells using different kinds of monoclonal keratin antibodies. The correspondence of ductal basal cells to reserve cells as progenitor cells has been discussed. Normal salivary glands are composed of acinar cells and ductal segments (ICD, SD, and ECD cells), and they are characterized by the existence of specific immunohistochemical markers. The histochemical marker of acinar cells could be amylase, and ductal cells can be identified with stains for keratins, lactoferrin, and lysozyme.66 Immunohistochemical identification of keratin polypeptides in salivary gland tumors have routinely employed monoclonal antibodies. Monoclonal antibody AE1 identified nos. 10, 14, 15, 16, and 19 as acid keratins (40, 50, 54, and 56.6 kDa, respectively), and AE3 identified 52, 54, 56, 58, 59, 64, and 67 kDa as basic keratins. In addition, the two monoclonal antibodies could detect wide spectrum keratins, and not monospecific keratins. Immunohistochemical distribution of keratin proteins in stratified squamous epithelia of oral mucosa was characterized by the existence of regional patterns of different molecular weight keratins. Low molecular keratin as PKK1 was confined to the basal cells, whereas high molecular keratin as KL1 appeared in upper spinous cells (Figure 25 a, b).67 In contrast to keratin patterns of cylindrical epithelium of nasal mucosa, both PKK1 and KL1 were distributed in superficial layers, whereas K8.12 keratin was limited to basal cells of nasal epithelium. In the normal salivary glands, all the ductal epithelial cells in 10% formalin-fixed paraffin sections showed positive staining for PKK1 and KL1 (Figure 2 g, h). PKK1 staining was confined to ductal basal cells in Carnoy’s fixed sections (Figure 3 a), and K4.62, K8.12, and RPN 1165 also stained strongly or moderately in ductal basal cells in 10% formalin-fixed paraffin sections68 (Figure 3 c, d, j) (Tables 19 a, 19 b).
A modified V-shaped incision combined with superficial musculo-aponeurotic system flap for parotidectomy
Published in Acta Oto-Laryngologica, 2019
Min-Gyu Jo, Dong-Joo Lee, Wonjae Cha
Aesthetic approaches tend to employ smaller incisions, as long as surgical exposure and safety are not significantly compromised. Some researchers have reported the application of VSI in parotidectomy for cosmetic purpose[1,4]. In their researches, parotidectomies were performed using VSI with a skin flap raised under the periparotid fascia in benign parotid tumors, without the elevation of separate SMAS flap. Before this study, the operation using VSI elevating the skin flap under the periparotid fascia was exploratively performed similar to previous reports [1,4]. However, we found VSI alone approach to be difficult to facilitate exposure of the surgical field because thick subperiparotid fascial skin flaps were inflexible and the skin margin was liable to be damaged when retracted severely. Ahn et al. noticed the limitation of VSI with a single flap and suggested that excessive retraction or additional hairline incision of MFI would thus be inevitable to expose the inferior portion of parotid [4]. Among their 15 cases series, the incision had to be extended in one case of Warthin’s tumor to provide adequate exposure [4]. To overcome the limitation of exposure and avoid the further extension, we conceptualized the dual flaps of a subcutaneous flap and a separate SMAS flap for VSI, to release tissue resistance and expand the working space. The dual flap concept was adopted from the classical SMAS technique of rhytidectomy [10] and MBI combined with an SMAS flap [16].
Successful Treatment of Interdigitating Dendritic Cell Sarcoma Presenting as Multiple Parotid Tumors
Published in Acta Oto-Laryngologica Case Reports, 2019
Yasuyuki Kajimoto, Naoki Otsuki, Masanori Teshima, Yukiko Morinaga, Tomoo Itoh, Ken-Ichi Nibu
In the present case, a Warthin’s tumor was suspected initially. As the tumor progressed rapidly, it was suspected to be malignant, and the complete surgical resection was scheduled. Accordingly, despite the invasion of the facial nerve, we performed the partial resection of the tumor to preserve the facial nerve and selected radiotherapy instead of radical surgery for the macroscopic lesion remnants. Finally, she achieved complete remission and has been alive without disease for three years. These results suggest that radiotherapy is an effective alternative option for the treatment of localized IDCS, although the role of radiation therapy for IDCS is not clearly defined as mentioned previously.
Clinicopathologic analysis of 2736 salivary gland cases over a 11-year period in Southwest China
Published in Acta Oto-Laryngologica, 2018
S. Y. Shen, W. H. Wang, R. Liang, G. Q. Pan, Y. M. Qian
Benign SGTs in this study accounted for 77.6%, malignant tumors accounted for 22.4%, with a benign and malignant ratio of about 3.46:1. This is consistent with the previously reported salivary gland benign and malignant ratio of 3.37:1 in northeastern China [5] and the ratio of 3.5:1 in Brazil [8], which is lower than previous reports of benign and malignant salivary glands in northern Poland reported as 5.62:1 [2]. It was higher than those reported at 2.12:1 [6] and 2.92:1 [4] in eastern China, and also higher than those reported by UK at 1.85:1 [9] and Croatia at 1.79:1 [10], and higher than the 1.49:1 in western China [1] and India 1.61:1 [11]. This may be related to geographical factors, and conditions of the author’s hospital. The most common benign and malignant were pleomorphic adenoma and adenoid cystic carcinoma, accounting for 50.8 and 7.2%, respectively. This is similar to the reports of 51.3% (1776/3461) and 7.3% in western China [1] and 47.0% (3281/6982) and 9.8% in eastern China [6], and slightly different from the reports of 41.15% (1032/2508) and 4.78% in northeastern China [5] and the 44.4% (329/741) and 8.4% of UK [9]. In addition, Warthin tumors accounted for 16.5% of all SGTs in this study, with 431(95.6%) significantly more men than 20 (4.4%) women. The age of 1–87 years, mean 46.2 ± 15.9 years old is consistent with previous literature [12]. In terms of the Warthin tumor composition ratio, the results in this study are similar to those reported in 13.8% of the eastern China and 18.0% of northeast China [5,6]. However, this is obviously higher than the 4.4% in western China [1], 3.1% in India (21/684) [11] and 4.6% in UK [9]. Most scholars believe that the occurrence of the Warthin tumor is related to smoking, autoimmune diseases, and other factors, but the exact pathogenesis is still not clear [12–14].