Spomenka Manojlović

Salivary gland tumours: 25 years of experience from a single institution in Croatia

INTRODUCTION The aim of this study was to determine the types, frequency, distribution, and demographic characteristics of salivary gland tumours in a large representative sample. PATIENTS AND METHODS We retrospectively analysed the medical records of 779 patients with tumours of the salivary glands surgically treated from 1985 to 2009 at a single institution. RESULTS There were 500 benign and 279 malignant tumours. The average age of patients with benign tumours was 50 years and of malignant salivary gland tumours 56 years. No differences in age and incidence of tumours existed between males and females. The majority of the tumours occurred in the parotid gland (509), followed by the minor salivary glands (212), the submandibular gland (51) and lastly, the sublingual gland (7). Minor salivary gland tumours occurred most frequently on the palate, the pleomorphic adenoma being the most frequent benign tumour type and the adenoid cystic carcinoma being the commonest malignant tumour. Tumours of the sublingual gland were rare, but all were malignant. Malignant tumours were more common in the minor salivary glands and the submandibular gland. CONCLUSION This large study of salivary gland tumours in Croatia could improve our understanding of the significant differences in the global distribution of salivary gland tumours which have been reported.

Glandular odontogenic cyst: a case report and clinicopathologic analysis of the relationship to central mucoepidermoid carcinoma.

Glandular odontogenic cyst (GOC), an unusual multilocular cystic lesion of jaws exhibiting the features of both botryoid odontogenic cyst and mucoepidermoid tumor has been reported recently as a new entity with uncertain histogenesis. The World Health Organization named GOC as an independent pathologic entity and classified it as a developmental odontogenic epithelial cyst. We report an additional case, describe its clinicopathologic features, and discuss the similarity to the central mucoepidermoid carcinoma.

Schwannoma of the tongue in a child

A schwannoma or neurilemmoma is a benign, slow growing, usually solitary and encapsulated tumour originating from Schwann cells of the nerve sheath. Approximately 25-40% of all schwannomas are seen in the soft tissues of the head and neck, often originate from the acoustic nerve. Intraoral schwannomas are rare and account for 1% of schwannomas of the head and neck region. We report the case of a 10-year-old boy diagnosed with a schwannoma of the tongue. The purpose of this report is to emphasize the possibility of diagnosing schwannoma among all other lingual lesions in children. The disease itself was diagnosed histologically after complete surgical excision. Five years after surgical treatment, the patient is without signs of recurrence. This paper highlights the importance of a multidisciplinary approach in the diagnosis and surgical treatment of this very rare entity.

Localized pigmented villonodular synovitis of the knee: diagnostic challenge and arthroscopic treatment: a report of three cases

Abstract. The localized form of pigmented villonodular synovitis (LPVS) is a lesion characterized by focal involvement of the synovial membrane. The knee is the most commonly affected joint. We report three cases of LPVS of the knee which were not diagnosed upon clinical evaluation. The aim is to bring the attention of clinicians to this pathological entity, which is often regarded as extremely rare and is therefore not considered in the early differential diagnosis of various knee derangements. Diagnostic and therapeutic arthroscopy was performed. The lesions were completely resected and patohistological findings confirmed the diagnosis of LPVS. All of our three patients have remained asymptomatic at 8, 10, and 12-month follow-ups.

Melanotic neuroectodermal tumour of infancy: Report of two cases and review of the literature

Melanotic neuroectodermal tumour of infancy (MNTI) is an uncommon tumour affecting predominantly the craniofacial bones of the newborn infants. The neural crest origin of the tumour has been confirmed. MNTI is generally accepted as a benign tumour despite of its rapid and locally infiltrative growth. Recurrence rate varies between 10% and 60%, and malignant behaviour has been reported in 6.5% of MNTIs. Systematic review of the literature revealed 445 MNTIs published between 1918 and 2010. We present additional two cases of MNTI from our Department, typical in all terms, which equals a total number of 447 reported cases. One of our cases revealed histological features consistent with malignant behaviour, but at present, 18 months after the surgical excision, there is no evidence of recurrence. Biological behaviour of MNTI cannot be predicted by gross or histologic characteristics, thus early diagnosis and careful follow-up after the complete surgical excision is required.

Mucoepidermoid carcinoma of the larynx: report of three cases.

Mucoepidermoid carcinoma of the larynx is very rare, with only a few individual cases or studies in small patient groups reported in the literature. Treatment modalities for this type of carcinoma are not uniform; in addition, errors in the recognition and pathologic diagnosis are not uncommon. During the period 1991-2000, 771 cases of malignant laryngeal tumours were recorded and histologically verified at the University Department of Otorhinolaryngology and Cervicofacial Surgery, Zagreb University Hospital Centre, three of them were mucoepidermoid supraglottic carcinomas. The experience acquired in the treatment of these tumours is presented along with a review of the literature.

Primary synovial sarcoma of the parotid gland in 15-year-old boy

Synovial sarcoma (SS) is a malignant mesenchymal tumour, predominantly found in the deep soft tissues of lower extremities, whereas only 3% occur in the head and neck region. Primary synovial sarcoma of the parotid gland is exceptionally uncommon. This is a report of a 15-year-old boy with a synovial sarcoma arising in the parotid gland, and, to the best of our knowledge, this is the youngest patient on record. The patient was treated primarily surgically, followed by chemotherapy and radiotherapy. Two years after this multimodal therapy, the patient is without signs of loco-regional recurrence or distant metastases. This paper highlights the importance of a multidisciplinary approach in the diagnosis and treatment of this very rare entity.

Oral inverted ductal papilloma

Anoralpapillomaisabenignsurfacetumourthatcan present anywhere in the oral cavity. Micro-scopically,itisanexophytic,finger-likegrowthofstratifiedsquamousepitheliumonathinfibrovas-cular core of loose connective tissue. Papillomaswithahistologicalendophyticorinvertedpatternof growth are rare. Benign papillary lesions thatseem to originate from the salivary ductal sys-temincludeintraductalpapilloma,invertedductalpapilloma, and sialadenoma papilliferum. Previ-ously,theyhavebeenincludedinthecategoriesofmonomorphicadenomaorductaladenoma.

Significance of myofibroblast appearance in squamous cell carcinoma of the oral cavity on the occurrence of occult regional metastases, distant metastases, and survival

The aim of the present study was to assess the frequency of appearance of stromal myofibroblasts in patients with oral squamous cell carcinoma (OSCC) and to further clarify whether myofibroblasts influence tumour suppression or progression. Surgical resection specimens from 152 patients with cT1-T3N0 OSCC were analysed. The frequency of myofibroblasts within the tumour stroma was assessed immunohistochemically and compared with other clinical and histopathological factors. The immunohistochemical reaction for alpha-smooth muscle actin showed positive cells in the stroma of 84.2% of OSCC (n=128). An increased presence of myofibroblasts in the tumour stroma was significantly correlated with T stage (P=0.019), the presence of occult neck metastasis (P<0.001), regional recurrence (P=0.037), and distant metastasis (P=0.008). There was also an association between the presence of myofibroblasts and patient survival (P=0.009). The presence of myofibroblasts was not associated with local recurrence, tumour cell differentiation, mode of invasion, or bone invasion. The results of this study suggest that myofibroblast proliferation facilitates tumour invasion, the occurrence of occult neck disease, and distant metastasis. The survival rate was poorer in patients with abundant myofibroblasts. Further investigations on tumour-associated stroma at the invasive front are needed in order to establish new diagnostic markers and therapeutic strategies.

Chondromyxoid fibroma of the mandible

Chondromyxoid fibroma is infrequent, slow-growing benign neoplasm and it is the rarest of the cartilaginous tumors. Approximately two thirds of the cases have occured in bones of the lower exmity but 2% of all reported chondromyxoid fibromas have involved mandible and skull bones. The most important lesion to distinguish from CMF is a well differentiated chondrosarcoma. Misdiagnosis of CMFs cal lead to inadequate treatment and can have direct consequences for patient health. A careful review of radiological and histological findings may be helpful to optain a correct diagnosis. A case of CMF of the mandible in a 24-year old man and review of the current literature on this benign skeletal tumor is presented.