Mario A. Luna

Histologic grading of adenoid cystic carcinoma of the salivary glands

Seventy‐nine patients with adenoid cystic carcinoma arising in salivary glands were studied to determine whether a correlation existed between the morphologic features of the tumor and the prognosis. Three histologic grades were established: Grade I, tumors with tubular and cribriform areas but without solid components; Grade II, cribriform tumors that were either pure or mixed with less than 30% of solid areas; and Grade III, tumors with a predominantly solid pattern. Cumulative survival rates at 15 years were 39%, 26%, and 5%, for Grades I, II, and III, respectively. Grade III tumors were larger, recurred frequently, and killed the patients within 4 years. Grade I lesions were smaller, were amenable to complete surgical excision, and had a protracted clinical course. Grade II tumors lay between the other two forms both clinically and pathologically. Other important prognostic features of the adenoid cystic carcinoma were its primary site, its presence or absence at surgical margins, and the anatomic structures it involved.

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.

Metastatic tumors in the jaws

Abstract In thirty-two cases of histologically verified metastases to the jaws treated between 1944 and 1968, breast and lung carcinomas were the most common primary tumors, followed by thyroid carcinoma, carcinoma of the prostate, malignant melanoma, osteogenic sarcoma, retinoblastoma, hepatoma, renal-cell carcinoma, leiomyosarcoma, and an unknown adenocarcinoma. In nine cases, the jaw metastasis was the initial manifestation.

Causes of death in breast cancer a clinicopathologic study

Between January 1973 and October 1977, 166 patients who died of breast cancer were autopsied. The examination revealed consistently more tumor involvement than had been clinically suspected. Unsuspected areas of tumor involvement included the endocrine organs (40%), lungs (28%), cardiovascular system (21%), and the genitourinary system (21%). The error in diagnosis was smaller with metastasis to the bones (10%) and central nervous system (14%). The major causes of death included pulmonary insufficiency (26%), infection (24%), cardiac disease (15%), hepatic insufficiency (14%), hemorrhage (9%), central nervous system disease (9%), and hypercalcemia (3%). The most common cause of death was metastatic disease to various organs, accounting for 42% of all deaths. Infection was the second most common cause of death; however, only 27% of the patients with infection had significant neutropenia. In patients dying of hemorrhage, only 9% were thrombocytopenic. In conclusion, although many clinicians have expressed concern that chemotherapy would add to early mortality in cancer, our study shows that this is not the case for patients with breast cancer. Deaths due to chemotherapy were rare and the rise in the infection rate did not correlate with the advent of chemotherapy. Cancer 46:162–167, 1980.

Malignant gingival and skin “infiltrates” in adult leukemia

The clinicopathologic and histopathologic features of leukemic gingival and cutaneous infiltrates were studied in 1,076 adults hospitalized for cancer chemotherapy. Leukemic gingival hyperplasia was present in 3.6 percent and leukemia cutis in 3.1 percent of the patients. Only 7.6 percent of those with leukemic infiltrates had simultaneous gingival and skin involvement. Histologically, the lesions consisted of extravasated and proliferating monocytoid or myeloid cells. The infiltrative-proliferative tendency was most pronounced in patients with, in a sharply descending order, acute monocytic leukemia, acute myelomonocytic leukemia, and acute myelocytic leukemia. Formation of lesions in the skin and gingiva was unrelated to sex, age, and white blood cell count. Gingival lesions were particularly prone to infectious complications in patients with poor oral hygiene. Aside from the morphologic predisposition, the propensity for adults with leukemia to develop chemotherapeutically reversible malignant mucocutaneous lesions was highly individualistic and unpredictable.

Pulmonary dirofilariasis: the great imitator of primary or metastatic lung tumor. A clinicopathologic analysis of seven cases and a review of the literature.

The clinical, radiologic, and pathologic features of seven patients with pulmonary dirofilariasis were studied. The findings were analyzed in conjunction with those of 76 cases previously reported from the United States. We found that, in most instances, the disease was acquired in states along the Atlantic and Gulf coasts and occurred predominantly in whites (94.7%) in their fifth or sixth decades of life, with a male to female ratio of 2:1. Symptoms, commonly chest pain, cough, or hemoptysis, were present in 37.6% of patients. Most patients (62.4%) were asymptomatic, and the disease was discovered incidentally on routine radiography or during the investigation of another problem. Peripheral eosinophilia was present in 20% of patients. The radiologic findings consisted of single (89.8%) or multiple (10.2%) pulmonary nodules that simulated primary or metastatic lung tumor. Dirofilariasis was not included in the clinical differential diagnosis in any of the patients. In one case, the diagnosis was accurately obtained by fine needle aspiration biopsy. All other patients required thoracotomy with excisional lung biopsy for diagnosis. Pathologically, the dirofilaria nodule consisted of a spherical subpleural infarct with a central thrombosed artery containing Dirofilaria immitis in various stages of disintegration.

Malignant tumors of the submaxillary gland

Malignant submaxillary gland tumors are so rare that the clinician may see only a few in a lifetime of practice. No uniform approach to t rea tment of these tumors exists; in fact, surgeons today are in controversy concerning the relative value of radical versus conservative surgical procedures. Since the advent of megavoltage radiation therapy, radiotherapists are re-evaluating the time-honored theory tha t these lesions are resistant to radiation. This paper explores in depth the various facets in the diagnosis, t reatment, and prognosis of malignant submaxillary gland tumors, in an a t tempt to bring order to their proper management .

Salivary dermal analogue tumors arising in lymph nodes

Dermal analogue tumor, an unusual type of monomorphic salivary adenoma, occurs in the parotid gland and rarely in other salivary tissues. This report describes three patients with dermal analogue tumors arising from ectopic salivary tissue in lymph nodes. Two tumors appeared in the periparotid lymph nodes and one in the lateral upper cervical region. All of the patients were men, aged 50 to 60 years, who all had a painless neck mass for 1 year or longer. Currently, the patients are free of disease 14, 3, and 2 years, respectively, after surgical excision. Dermal analogue monomorphic adenomas join several other salivary tumors in possible intranodal origin and should not be confused with metastases. Cancer 59:1165‐1169, 1987.

Central hemangioma of the mandible and maxilla: Review of a vascular lesion

Abstract Central hemangiomas of the jawbones are rare lesions. However, even though the diagnosis of hemangioma may appear to be a very remote possibility, any questionable cystic lesion that has peculiar characteristics or for which a direct causal reason for its existence is not known should be suspect and a needle biopsy should be performed. Oozing bluish gingivae, with or without related cystic defects, seem to be the initial clinical finding. Aggressive examination without proper knowledge of the involved area may lead to exsanguination with possible death. This article presents two central hemangiomas—one located in the maxilla and the other in the mandible. This represents the total series of central hemangiomas of the jawbones presently on file since 1964 at the M. D. Anderson Hospital and Tumor Institute.

Palatal canalicular adenoma: Report of 12 cases and review of the literature

Canalicular adenoma is the second most common type of adenoma of the oral region and arises almost exclusively in the upper lip. Other locations include the buccal mucosa, the palate, and the parotid gland. We report 12 cases of canalicular adenoma that arose in the palates of nine women and three men between the ages of 42 and 76 years. The tumor presented as a nonulcerated (eight patients) or ulcerated (four patients) lesion, usually at the junction of the hard and soft palates. Two tumors were misdiagnosed: one as adenoid cystic carcinoma and the other as low-grade adenocarcinoma. Both patients had had partial maxillectomy; the patient diagnosed with adenoid cystic carcinoma also received radiotherapy. One patient reported having had an adenoma removed from the palate 10 years previous to presentation; thus, the tumor was classified as a recurrence. Evidence of tumor metastasis was absent in all cases during the follow-up period, which ranged from 1 to 25 years. Eleven patients are alive and disease free; one died of other causes. Canalicular adenoma does not commonly occur in the palate. This tumor has an excellent prognosis after conservative surgical treatment in all locations. Pathologists should be aware of the occurrence of this neoplasm in the palatal region and of its histopathology so they can distinguish it from malignant tumors of the salivary gland.