Low-grade salivary duct carcinoma: description of 16 cases.
ABSTRACT Low-grade salivary duct carcinoma is a rare neoplasm. We report on 16 patients, with a median age of 64 years. All but one tumor arose from the parotid gland, including one tumor that arose in an intraparotid lymph node; one arose in the submandibular gland. Tumors consist of single to multiple dominant cysts, accompanied by adjacent intraductal proliferation. Cysts are lined by small, multilayered, proliferating, bland ductal cells with finely dispersed chromatin and small nucleoli. Separate, smaller ductal structures are variably filled by proliferating ductal epithelium with cribriform, micropapillary, and solid areas. The overall appearance is very similar to breast atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Foci of definitive stromal invasion were seen in four tumors. Two tumors demonstrated transition from low- to intermediate- or high-grade cytology, with scattered mitotic figures and focal necrosis. S-100 revealed diffuse strong expression in all 9 cases studied. Myoepithelial markers (calponin) highlighted supportive myoepithelial cells rimming the cystic spaces, confirming the intraductal nature of most, or all, of six tumors studied. Nine tumors studied for Her2-neu antigen were uniformly negative. Follow-up was obtained on 13 of our 16 patients. All patients were disease-free after surgery 6 to 132 months (median 30 months). Low-grade salivary duct carcinoma is a low-grade neoplasm with an excellent prognosis; it may be treated by conservative but complete resection. Its resemblance to atypical breast ductal hyperplasia, or micropapillary/cribriform intraductal carcinoma, distinguishes it from high-grade salivary duct carcinoma, papillocystic acinic cell carcinoma, and cystadenocarcinoma.
Article: Management of Salivary Gland Cancer[Show abstract] [Hide abstract]
ABSTRACT: Carcinomas of the salivary glands are uncommon representing only 2–6.5% of all head and neck cancer and less than 1% of all cancers. About 85% of salivary gland tumors arise in the parotid glands and approximately 75% of these are benign while about 75% of tumors arising from minor salivary glands are malignant. The latest WHO’s histological classification (2005) includes both benign and more than 20 different types of malignant tumors. The morphological diversity between different tumor types and sometimes within the same tumor mass along with the relative rarity of some tumors can make diagnosis difficult and needs a skilled pathologist.The American Joint Cancer Committee’s (AJCC) tumor, node, metastasis (TNM) has defined a staging system for major salivary gland malignancies. Cancer from minor salivary gland scattered throughout all the head and neck mucosa are staged according to the AJCC system for the more common squamocellular cancer arising in the same location.Surgery of primary tumor, whenever possible, is the treatment of choice both for major and minor salivary gland tumors. A clinically positive neck requires a neck dissection along with the resection of primary tumor. The treatment of N0 neck in patients with malignant salivary gland tumors is a matter of debate. High-grade tumors, high primary T stage, and the presence of facial paralysis are associated with high incidence of neck node metastasis.Adjuvant radiotherapy improves locoregional control following surgery. Despite the absence of randomized trials, postoperative radiotherapy is recommended in high-grade tumors, advanced stage tumor (T4), “close” (≤5 mm) or microscopically positive surgical margins, and neck node metastases.Radiotherapy can be the best treatment option in case of “technically” unresectable or “medically” inoperable tumor. The use of concomitant chemoradiotherapy in salivary gland cancer is still investigational.Chemotherapy is delivered in case of relapsed and/or metastatic disease with a palliative aim. There is neither standard chemotherapy regimen nor data on whether polychemotherapy is more active than monochemotherapy. Although, a cisplatinum-based chemotherapy for four to six courses is considered the best choice.Targeted therapies, as tyrosine-kinase inhibitor or monoclonal antibodies, are under evaluation. Phase II studies are ongoing.
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ABSTRACT: This chapter is designed as an easy reference for the practicing pathologist aiming to solve diagnostic problems in head and neck pathology by immunohistochemistry (IHC). It is a collection of 38 practical tables including tables for commonly used antibodies, IHC reactions in normal salivary gland, IHC reactions in common salivary gland and head and neck tumors, and IHC reactions to resolve differential diagnostic challenges. Also included are practical footnotes and photographic illustrations. KeywordsHead and neck pathology-Immunohistochemistry-Salivary gland tumors-Antibodies01/1970: pages 173-196;
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ABSTRACT: Basic results from a qualitative analysis of the exponential stability and equilibrium characterization of a class of dynamical neural networks intended to serve as associative memories are presented. A simple learning rule tailored to efficiently minimize the deviation between the stable equilibrium points of the network and the desired memory vectors to be stored is proposed and is established as a descent procedure for minimizing the deviation. The results are developed for asymmetric interconnection matrices and hence considerably enlarge the scope of the associative memory design compared to existing proceduresNeural Networks, 1990., 1990 IJCNN International Joint Conference on; 07/1990