John G. Batsakis

Polymorphous low‐grade adenocarcinoma of minor salivary glands a study of 14 cases of a distinctive neoplasm

M. D. Anderson Hospital cases diagnosed as adenocarcinoma of minor salivary glands before 1977 were reviewed. Within this heterogeneous group of neoplasms there was identified one clinicopathologic tumor entity, which we have designated “polymorphous low‐grade adenocarcinoma.” The 14 tumors in that category were characterized by cytologic uniformity and histologic diversity; growth patterns varied (both within and among cases) from solid to tubular to papillary to cribriform (pseudoadenoid cystic) to fascicular, while the cells were always small to medium‐sized, regular, and lacking in nuclear atypia. Mitotic figures were infrequent, and tumor necrosis was seen in only one instance (a recurrent neoplasm). Clear cytoplasm, oxyphilic and mucinous metaplasia, and intratubular calcification were sometimes present, and stromal mucinization and hyalinization were common. The tumors were always unencapsulated, and exhibited extension into surrounding tissues including bone. The 14 patients ranged in age from 27 to 76 years (median, 64 years). Eight were male and six were female; eight were white and six were black. The neoplasm was intraoral in all cases, involving the palate in 11, the buccal mucosa in two, and the posterior mandibular area in one. Local recurrence developed in one case, cervical lymph node metastasis in one, and both recurrence and cervical lymph node metastasis in two. The number of successive recurrences ranged up to three, and the interval to recurrence varied up to nine years (the interval to metastasis up to five years). Although radical surgical procedures were necessary for tumor control in some cases, no distant metastases occurred and all patients were clinically tumor‐free at latest follow‐up.

Adenocarcinomas of the oral cavity: a clinicopathologic study of terminal duct carcinomas.

A clinico-pathologic study of 12 patients, each harboring a hitherto not delineated adenocarcinoma of salivary origin is presented. The authors have designated this histologically unique carcinoma as terminal duct adenocarcinoma in deference not only to its light-optic appearance, but also to a putative origin from the reserve cells (epithelial and myoepithelial) of the intercalated duct. The tumors local invasive properties with extension into nerves and adjacent bone suggest their biologic behavior is like that of adenoid cystic carcinomas.

Small cell carcinomas of the parotid gland. A clinicopathologic study of three cases

Clinical, histological and ultrastructural features of three small cell carcinomas arising in the parotid gland are presented. The light microscopic appearance of two of the neoplasms suggested neuroendocrine cell derivation, confirmed by electron microscopy in both instances. The fine structure of the third neoplasm suggested intercalated duct cell differentiation. The possibility that both types of neoplasm may arise from the same primitive precursor cell is considered. The findings from this study confirm the occurrence of two different types of small cell carcinoma of salivary gland origin. A distinction between duct cell and neuroendocrine subtypes may be impossible by conventional light microscopic evaluation. Cancer 52:2115‐2121, 1983.

Risk factors for major salivary gland carcinoma. A case-comparison study

The authors conducted a case‐comparison chart‐review study on 498 patients with histologically confirmed salivary gland carcinoma and 487 randomly selected patients registered at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1960 through 1981. The study was undertaken to identify potential risk factors for salivary gland carcinoma. Univariate analysis of the data indicated a relationship with prior radiation therapy (odds ratio estimate of 6.17 with 95% confidence limits of 3.11–12.22) and with previous primary cancer (odds ratio estimate 4.81 with 95% confidence limits of 2.70–8.55). For agricultural occupations, the odds ratio was 1.62 with confidence limits of 1.05 to 2.49. The excess for previous primary cancer was largely due to previous skin cancer, especially in men, for whom the odds ratio was 13.7 (4.17–44.97). Multivariate analysis of these data, using the logit model, confirmed the association with both previous primary cancer and previous radiation. The rationale for a possible relationship between cutaneous neoplasms and salivary carcinoma is explained in embryologic and histogenetic terms.

Necrotizing sialometaplasia of major salivary glands

Major salivary glands have been rarely reported as sites of necrotizing sialometaplasia, a disease primarily affecting minor salivary tissue, particularly that of the palate. Eight cases of necrotizing sialometaplasia of the parotid and submandibular glands are presented and added to six reported earlier by Donath (1979). The clinical and pathologic findings in the 14 cases give strong support to the vascular-based-infarct genesis of necrotizing sialometaplasia.

Enteric‐type adenocarcinoma of the nasal cavity. An electron microscopic and immunocytochemical study

A primary adenocarcinoma of the nasal cavity with light microscopic, electron microscopic, and immunocytochemical features of an enteric‐type carcinoma is presented. The carcinoma contained a variety of dense‐core granules similar to those seen in enterochromaffin cells of different functional types. Some granules demonstrated an immunoreactivity with serotonin, cholecystokinin, gastrin, somatostatin and leu‐enkephalin antibodies. It is suggested that the endocrine cells in the neoplasm belong to the non‐neuroectodermal paraneurone system.

Hemangiopericytoma of the nasal cavity: Electron-optic study and clinical correlations

A case of a hemangiopericytoma of the nasal cavity in a 79-year-old woman is presented. Ultrastructural examination confirmed the pericytic origin of the tumor. Most of the reported hemangiopericytomas of the sinonasal tract are histologically low-grade and their biologic course is in concert with their appearance.

Leukoplakia: still a gallimaufry or is progress being made?--A review.

Summary Leukoplakia as a medical term has been encumbered by a hodgepodge of synonyms and interpretations. It also has been a term associated with strong emotions with respect to an implied malignant potential. It now is regarded as potentially malignant, with varying degrees of risk for transformation. Leukoplakia at its major anatomic site of occurrence, the oral cavity, recently has been redefined, classified, and staged as a preamble to a more rational approach to the clinicopathologic study of leukoplakia. These changes are presented, as are current assessments of proliferative verrucous leukoplakia, verrucous hyperplasia, palatal white lesions, effects of smokeless tobacco on the oral mucosa, hairy leukoplakia, and lichen planus

Perinatal salivary gland tumours (embryomas).

Epithelial salivary gland tumours presenting in the first month of life (perinatal tumours) are exclusively of major salivary gland origin and predominantly of the parotid gland. Approximately 25 per cent of these rare tumours have been histologically and/or biologically malignant. Except for an occasional pleomorphic and monomorphic adenoma, the majority of the tumours are proliferations suggesting a tumourous arrest of maturation of the salivary gland anlage, hence their designation as embryomas. A case report of an embryoma of the parotid is presented, accompanied by a review of the literature.

Osteoclast-type giant cell neoplasms of the parotid gland

The parotid gland is added to the list of parenchymal organs, notably the pancreas, in which osteoclast-like cells appear as constituent cells in their neoplasms. The cells role in the neoplasms is a reactive one or, more rarely, as an integral element in an osteoclast-type giant cell neoplasm or so-called osteoclastoma. Distinctive in histological appearance, the osteoclast-type giant cell neoplasm is a malignant lesion that, to date, has been described only in the pancreas and parotid glands. This report presents examples of each type of giant cell lesion in the parotid gland.