Different histological subtypes of parotid gland tumors: CT findings and diagnostic strategy

AIM:To present computed tomography(CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy.METHODS:From January 2009 to November 2011,56 patients were collected through the histopathology and Picture Archiving and Communication Systems records,which revealed 5 basal cell adenoma(BCA),16 pleomorphic adenoma(PA),25 Warthin's tumor(War-T),3 Kimura's disease(KD) and 7 parotid carcinoma(PCa) cases.All the CT images were retrospectively analyzed by two radiologists in consensus,based on their description of morphology(location,number,size,margin and fibrous capsule) and enhancement patterns of masses.In addition,the diagnostic efficiency of diagnostic strategy is tested.RESULTS:War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years;the significant difference was seen in War-T vs PA and BCA vs PA.About 40% of War-Ts presented with bilateral multifocal lesions,a higher ratio than others.Seventy two percent of War-Ts were limited to the superficial lobe,followed by BCA 60% and PA 40%.Vessel facing sign and enlarged lymph nodes were both frequent in War-T,which respectively accounts for 84% and 76% of cases.Rapid contrast enhancement and decreases were unique for War-T.BCA and PA showed obvious delayed enhancement.The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency,with high accuracy,sensitivity and specificity.CONCLUSION:Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data.A diagnostic strategy with high diagnostic efficiency was established.

Oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor: A case report

Gastric adenocarcinoma is one of the most common malignancies worldwide.Histochemical and immunohistologic analyses classify the phenotypes of gastric adenocarcinoma into several groups based on the variable clinical and pathologic features.A new and rare variant of gastric adenocarcinoma with chief cell differentiation(GA-CCD)has recently been recognized.Studies reporting the distinct clinicopathologic characteristics proposed the term oxyntic gland polyp/adenoma because of the benign nature of the GACCD.Typically,GA-CCD is a solitary mucosal lesion that develops either in the gastric cardia or fundus.Histologically,this lesion is characterized by tightly clustered glands and anastomosing cords of chief cells.Immunohistochemically,GA-CCD is diffusely positive for mucin(MUC)6 and negative for MUC2and MUC5AC.However,other gastric tumors such as a gastric neuroendocrine tumor or fundic gland polyp have been difficult to exclude.Because GA-CCD tends to be endoscopically misdiagnosed as a neuroendocrine tumor or fundic gland polyp,comprehensive assessment and observation by an endoscopist are strongly recommended.Herein,we report a rare case of oxyntic gland adenoma endoscopically mimicking a gastric neuroendocrine tumor that was successfully removed by endoscopic mucosal resection.

Advanced magnetic resonance imaging findings in salivary gland tumors

Salivary gland tumors(SGTs)make up a small portion(approximately 5%)of all head and neck tumors.Most of them are located in the parotid glands,while they are less frequently located in the submandibular glands,minor salivary glands or sublingual gland.The incidence of malignant or benign tumors(BTs)in the salivary glands varies according to the salivary gland from which they originate.While most of those detected in the parotid gland tend to be benign,the incidence of malignancy increases in other glands.The use of magnetic resonance imaging(MRI)in the diagnosis of SGTs is increasing every day.While conventional sequences provide sufficient data on the presence,localization,extent and number of the tumor,they are insufficient for tumor specification.With the widespread use of advanced techniques such as diffusion-weighted imaging,semiquantitative and quantitative perfusion MRI,studies and data have been published on the differentiation of malignant or BTs and the specificity of their subtypes.With diffusion MRI,differentiation can be made by utilizing the cellularity and microstructural properties of tumors.For example,SGTs such as high cellular Warthin’s tumor(WT)or lymphoma on diffusion MRI have been reported to have significantly lower apparent diffusion values than other tumors.Contrast agent uptake and wash-out levels of tumors can be detected with semiquantitative perfusion MRI.For example,it is reported that almost all of the pleomorphic adenomas show an increasing enhancement time intensity curve and do not wash-out.On quantitative perfusion MRI studies using perfusion parameters such as Ktrans,Kep,and Ve,it is reported that WTs can show higher Kep and lower Ve values than other tumors.In this study,the contribution of advanced MRI to the diagnosis and differential diagnosis of SGTs will be reviewed.

Incidence of orbital,conjunctival and lacrimal gland malignant tumors in USA from Surveillance,Epidemiology and End Results,1973-2009

AIM： To determine the types and incidence of tumors affecting the orbit, conjunctiva and lacrimal glands and to study the trend line of these tumors in the United States from 1973 to 2009.METHODS： We used the publicly available Surveillance, Epidemiology and End Results （SEER） database registries to determine the incidence rates. Age was adjusted to the 2000 US Standard Population. Patients were stratified according to age group, gender, race and histological grouping of tumor lesions. Three age groups were defined： 0-19, 20-49 and ≥50y. Annual percentage changes were calculated to examine trends.RESULTS： The overall age adjusted incidence rate was 3.39 （95%CI： 3.27-3.52） per million person-years. The tumors were more prevalent in age group ≥50 counting 9.51 （95%CI： 9.11-9.92） per million person-years. Most of the soft tissue sarcomas occurred in the young age with incidence rate of 0.35 （95%CI： 0.28-0.42） per million person-years. Lymphomas were the dominant subtype in the adult population with incidence rate of 5.74 （95%CI： 5.43-6.06） per million person-years. Incidence rates were higher in males than females with an overall rate ratio of 1.31 （95%CI： 1.21-1.41） mainly caused by the increase in carcinoma subtypes. White race had a higher tumor incidence with a rate ratio of 1.47（95%CI： 1.25-1.73） driven by the higher incidence of most histological subtypes. Orbital tumors showed a higher incidence rate followed by conjunctival and lacrimal gland tumors with incidence rates of 1.59, 1.37 and 0.43 per million person-years respectively. The trend line of overall incidence of tumors showed a significant increase （APC=3.11, 95%CI： 2.61-3.61） mainly due to increase of lymphomas. This increase was higher than the increase of lymphomas at other sites.CONCLUSION： Orbital, conjunctival and lacrimal gland malignant tumors differ among children and adults. Over the years there has been a noticeable increase in incidence rates of orbital and lacrimal gland tumors mainly caused by an increase in lymphomas and an apparent increase due to advances in diagnostic techniques. ICD-O-3 topographical coding should be improved to consider the different orbital bones and ocular structures.

Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland-immunophenotypic and genetic features: A case report

BACKGROUND Warthin’s tumor(WT)is composed of several cysts that are lined with tall,bilayered oncocytic columnar cells and lymphoid stroma.Within WT,the two components rarely transform into carcinoma or lymphoma,and when it does,carcinoma is the most common type.Approximately 28 cases of lymphoma with WT have been reported,most of which were non-Hodgkin lymphomas,and only a few cases were Hodgkin lymphomas.In the present report,we studied a case of diffuse large B cell lymphoma(DLBCL)arising from follicular lymphoma(FL)with WT in the parotid gland and its immunophenotypic and genetic features.CASE SUMMARY A 67-year-old man presented with a slowly enlarging right cheek mass for 12 years,and the mass began to change in size over a 2-mo time period.Over time,the patient felt mild local pain and right cheek discomfort.His medical history included a hepatitis B virus infection for 20 years and 30 years of smoking.Gross examination of the excised specimen showed a gray-red and gray-white appearance and a soft texture lobulated external surface neoplasm that measured 9 cm×8 cm×7 cm and was well circumscribed by relative normal parotid gland tissue.In cross section,the cut surfaces of the neoplasm were multicystic and had a homogeneous scaly appearance.A small fluid was discovered in the cyst.Bilateral oxyphilic,cuboidal or polygonal epithelium cells and lymphoid intraparenchymal components were observed.Many medium-to large-sized lymphoid cells were observed diffusely in part of the neoplasm,and a few secondary lymphoid follicles were observed at the center or edge of the neoplasm.Immunohistochemical staining showed that the columnar oncocytic cells were positive for AE1/AE3;neoplastic cells located in coarctate follicular were positive for CD20,Pax-5,bcl-2 and bcl-6;and the adjacent diffusely medium-to large-sized lymphoid cells were positive for Pax-5,bcl-6,CD20,MUM-1,bcl-2 and CD79a.The bcl-6(3q27)break-apart rearrangement was observed,and an Epstein Barr virus test was negative in the tumor cells.The patient survived 6 months after being diagnosed without any treatment.CONCLUSION WT-associated lymphoma is a very rare neoplasm in the parotid gland.Most cases are B cell non-Hodgkin lymphomas and involve middle-age and older males.This case highlights the extremely rare association of DLBCL arising from FL with WT and the importance of deliberate evaluation of the WT intraparenchymal stroma.Molecular detection techniques have potential advantages in the diagnosis of lymphoma with WT.

Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature

BACKGROUND Solitary fibrous tumor(SFT)is an uncommon mesenchymal neoplasm that arises from the pleura.A few SFTs have also been described in extrapleural sites.However,SFT of the thyroid gland is rare.Here,we report a case of extrapleural SFT on the thyroid gland,in addition to a literature review.CASE SUMMARY A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck.His thyroid function test results,including antibody levels,were within the normal limits.Ultrasonography showed a 4.7 cm×4.0 cm×3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe.A fine-needle aspiration biopsy was subsequently performed.The pathologist reported a benign follicular lesion.However,the size of this nodule increased to 5.5 cm×5.0 cm×3.4 cm by April 2018.After a multidisciplinary discussion,a left lobectomy was performed in May 2018.The specimen showed a well-demarcated,partly encapsulated,soft nodule of whitish and tan/brown color on the cut surface.Light microscopy revealed high cellularity with moderate cytologic atypia.The mitotic count was 5/10 high-power fields.There was no tumor necrosis or lymphovascular invasion.The tumor was CD34-positive and signal transducer and activator of transcription 6-positive.Neither thyroid transcription factor-1 nor cytokeratin expression was detected.The Ki-67 showed intermediate proliferative activity.The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin.The patient was discharged without complication three days after the surgery.CONCLUSION In the literature,extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis,although surgical resection is the treatment of choice.Understanding this disease entity is important for accurate diagnosis and proper management.

Minor Salivary Gland Tumors: A Retrospective Study of 37 Cases

Salivary gland tumors represent 2% - 6.5% of all head and neck tumors. Since salivary gland tumors have various clinical features and histological types, it is often difficult to diagnose and treat them. The aim of this study was to conduct a retrospective clinical-statistical analysis of 37 minor salivary gland tumors (MSGTs) treated in the Department of Oral Surgery at Nihon University School of Dentistry at Matsudo over a 16-year period. The frequencies and distributions of sex, age, occurrence site, preoperative examination (fine needle cytology and/or biopsy), treatment, and prognosis of the tumors were analyzed and compared with previous reports. The average age at diagnosis was 58.1 years (range 22 - 91 years). The peak occurrence of tumors was in the sixties (10 cases, 27.0%), followed by the forties (8 cases, 21.6%) and the seventies (7 cases, 18.9%). The average age of patients with benign tumors was 56.8 years (range 22 - 91 years). For malignant tumors, the average age was 61.7 years (range 42 - 81 years). The male-female ratio was 1:2.1 for all minor salivary gland tumors, 1:2.4 for benign tumors, and 1.5:1 for malignant tumors. There were 27 (73.0%) benign and 10 (27.0%) malignant tumors. Pleomorphic adenoma (PA) was the most common tumor (24 (64.9%) cases). Most salivary gland tumors originated from the palate (21 cases, 56.8%);the second most common site was the buccal mucosa (14 cases, 37.8%). For most patients, an intraoral mass was the primary presentation, and the second most common symptom was swelling. Surgical treatment was performed for all cases, both benign and malignant tumors. There was one case of local recurrence of PA, as well as one of multiple lung metastases after surgery for adenoid cystic carcinoma. Diagnosis and treatment of MSGTs are often delayed because the patients have few symptoms, and it is difficult to distinguish benign from malignant tumors. More cases need to be examined in the future, and the diagnostic accuracy of imaging and histopathological diagnosis needs to be improved.

Salivary Gland Tumors: Randomized Study of Adjuvant Chemo-Radiotherapy versus Radiotherapy Alone

Objective: Concurrent chemoradiation value of the resected salivary tumor adjuvant context against regular radiation therapy alone. Design: Prospective randomized clinical trial. Patients: 48 patients were randomized to either adjuvant postoperative radiology alone versus concurrent chemoradiotherapy (weekly cisplatin 40 mg/m2 for 6 cycles) “with resected high-risk salivary tumors of the large and minor salivary gland”. Main Outcome Measures: Recurrent locoregional Free survival, distant free survival, and overall survival. Results: Out of the 48 participants in the study 31 patients had parotid gland tumors. 23 patients received solely adjuvant radiation while 25 patients received concurrent chemoradiotherapy. In the chemoradiation group, platinum-based regimens were employed in all. The mean age in both groups was 48 years. Adenoid cystic carcinoma was the primary pathogenic form of both arms 56% (28 cases). Stage II patients were 35% and 32%, stage III was 39% and 48% and stage VIa were 26% and 20% in the radiation arm and chemoradiotherapy arm respectively. 40 of 48 patients (83%) had close or positive surgical margins and 30 of 48 patients (62%) have a perineural invasion. Both risk variables are more or less well balanced in both arms with no statistical difference. The 2- and 4-year estimates of the locoregional recurrence-free survival rate in the chemoradiation group were 95% and 73%, compared to 77.4% and 43.6% in the radiation arm respectively (p = 007). In the two-and four-year-old chemoradiation arm distant free metastases were 100% and 59% compared to 68% and 39% respectively in the radiation arm (p = 0.08). The overall survival estimates for 2 and 4 years were 93% and 78% respectively in the Chemoradiation Group but in the radiation-alone group were 95% and 48% respectively. The statistically significant differences were p = 0.009 by log-rank testing. Treatment was generally tolerated, although, in the chemoradiation group adverse symptoms, mainly mucositis increased. Conclusions: Adding weekly cisplatin as a radiosensitizer for locally advanced stage or high-grade salivary gland cancer with adjuvant conventional radiation looks to be helpful and justifies further exploration in selected patients.

Secretory carcinoma——impact of translocation and gene fusions on salivary gland tumor

Secretory carcinoma（SC）, previously described as mammary analogue secretory carcinoma（MASC）, is a recently described salivary gland tumor which morphologically resembles mammary secretory carcinoma. The first description of SC/MASC, reported by Skálová et al. in 2010, was as a rare salivary carcinoma imitating secretory carcinoma of the breast. SC/MASC is a unique salivary gland tumor with morphological overlap with acinic cell carcinoma（Aci CC）, mucoepidermoid carcinoma（MEC）, and adenocarcinoma not otherwise specified（ADCNOS）. SC/MASC shares similar clinicopathological features with Aci CC. As a critical difference between SC/MASC and Aci CC, SC/MASC characteristically has the chromosomal translocation t（12;15）（p13;q25） which leads to a fusion gene between the ETV6 gene on chromosome 12 and the NTRK3 gene on chromosome 15. This genetic background is an important differential diagnostic finding for excluding other salivary gland tumors and may be a critical factor determining the prognosis for patients with SC/MASC. Research in recent years has provided a large body of new data on SC/MASC and suggests the possibility that the ETV6-NTRK3 translocation could be a therapeutic target. Here, we review the morphological and clinicopathological features of SC/MASC and discuss new directions for therapy.

Immunohistochemical demonstration of transforming growth factor－β and bone morphogenetic protein in salivary gland tumors

Transforming growth factor-β (TGF-β) and bone morphogenetic protein (BMP)were related to embryonic development and the differentiation of many types of cells. Recent studies showed that they might play an important role in regulating the differentiation o

A Case Report of Two Primary Cancers, Breast Cancer with Adrenal Gland Metastatic and Second Primary Neuroendocrine Tumor in Colon, a Rare Case in Al-Bashir Hospital

A 68 years old female, was diagnosed as a case of right breast cancer in 2013;grade II/III according to Bloom Richardson grading, Modify radical mastectomy (MRM) was done and the pathology report showed moderately differentiated invasive ductal carcinoma (IDC), stage T3N3M0. Immunohisrochemisty (IHC) findings revealed a tumor with Triple positive. Patient refused to treat by chemotherapy. Patient was given adjuvant trastuzumab (first dose 8 mg/kg, followed by 6 mg/kg every three weeks) for the period of one year (16) cycles after which she went on regular follow up. Exemestane tab for 5 years and radiotherapy (50 gray in 25 fractions) was applying on right breast. One year and half after diagnosed primary breast cancer, patient complained from severe diarrhea 8 times per day watery contents, vomiting and suffered from lower abdominal pain. PET scan for whole body in October 2014 was done;the results showed ascending colon is highly suspicious for malignancy and moderately hypermetabolic left adrenal mass. Subtotal colectomy surgery was done, the pathology report of biopsy revealed low grade malignant neuroendocrine neoplastic lesion stage of T3N1Mo. Physician prescribed octreotide acetate 20 mg I. M monthly due to neuroendocrine lesion. In January 2016, cancer recurrence in the same right breast, IHC revealed ER+, PR−, Her 2+, physician decided to change exemestane to fulvestrant 250 mg s. c for 6 cycles. Radiation therapy was applied 20 gray in 10 fractions on scar. In May 2016, CAP-CT scan result revealed two enlarged left axillary L.N and left soft tissue density adrenal mass (3.0 × 2.3). Excisional lymph node was done which revealed IDC, ER+, PR−, Her 2+. Physician decided to discontinue fulvestrant and switch to exemestane 20 mg monthly. CAP-CT was done in Feb 2017;single left axillary L.N 1 cm, small hypodense lesion (spleen 4 cm), left adrenal lesion (2.2 × 2.6 cm) and osteolytic lesion were noted in iliac areas, so the physician considered those results a metastatic area from breast and prescribed lapatinib 84 tablets. Patient now onoctreotide acetate 20 mg I. M, trastuzumab 440 m, exemestane and lapatinib tablets) monthly, zoledronic acid 4 mg q 3 months, patient now still on follow up with a good condition. Conclusion: Breast cancer metastatic to left adrenal gland which is extremely rare especially when they originate from IDCs. The present case is the seventh breast cancer metastatic to the adrenal gland in the literature up to our search. Neuroendocrine tumor was happened in colon after one year and half which was a rare second primary malignancy (SPM) among female breast cancer.

Changes of norepinephrine and tumor necrosis factor in submandibular gland of rats with sympathetic nerve injury and the protective effect of 17 beta-estradiol

BACKGROUND： Recent researches have indicated that estrogen has extensive neuroprotective effects. So some studies designed ovariectomized animal models and administrated with estrogen, so as to verify its neuroprotective effects. OBJECTIVE： To observe the effect of 17 beta-estradiol on the content of norepinephrine （NE） and level of tumor necrosis factor （TNF） in submandibular glands of rats with sympathetic nerve injury, and analyze the dose-dependence and pathway of action. DESIGN： A randomized control animal study SETTINGS： Department of Hand Surgery, the 252 Hospital of Chinese PLA; Department of Hand Surgery Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology. MATERIALS： Fifty healthy female Wistar rats were randomly divided into 5 groups with 10 rats in each group： sham-operated group, ovariectomy＋6-OHDA＋saline group, ovariectomy＋6-OHDA＋17β-estradiol 50, 200 and 500 μg/kg groups. METHODS： The experiments were carried out in Tongji Medical College, Huazhong University of Science and Technology between October 2005 and March 2006. Bilateral ovaries were only exposed but not resected for the rats in the sham-operated group, but bilateral ovaries were resected in all the other groups. In the ovariectomy＋6-OHDA＋176-estradiol 50, 200 and 500 μg/kg groups, the rats were administrated with intraperitoneal injection of 6-OHDA （8 mg/kg）, and then immediately given 176-estradiol of corresponding dosages respectively, once a day for 10 days continuously. Rats in the sham-operated group and ovariectomy＋6-OHDA＋saline group were administrated with saline of the same volume. After administration, 5 rats in each group were killed to determine the NE contents in bilateral submandibular glands with high performance liquid chromatography-electrochemical detector （HPLC-ECD）, and the other 5 rats were used to determine the TNF levels in submandibular glands with enzyme-linked immunosorbant assay. MAIN OUTCOME MEASURES： The NE contents and TNF levels in submandibular glands of rats in each group were observed. RESULTS： All the 50 rats were involved in the analysis of results. （1） The NE content was obviously lower in the ovariectomy＋6-OHDA＋saline group than in the sham-operated group [（1 035±196）, （1 823±314） ng/g, P 〈 0.05], there were no significant differences between the ovariectomy＋6-OHDA＋17β-estradiol 50 μg/kg group and ovariectomy＋6-OHDA＋saline group [（1 004±253）, （1 035±196） ng/g, P 〉 0.05], but obviously higher in the ovariectomy＋6-OHDA＋17β-estradiol 200 and 500 μg/kg groups than in the ovariectomy＋6-OHDA＋saline group [（1 487±268）, （1 939±274）, （1 035±196） ng/g, P 〈 0.05]. （2） The TNF level was obviously higher in the ovariectomy＋6-OHDA＋saline group than in the sham-operated group [（3.498±0.792）, （1.893±0.533） ng/g, P 〈 0.05], there were no significant differences between the ovariectomy＋ 6-OHDA＋17β-estradiol 50 μg/kg group and ovariectomy＋6-OHDA＋saline group [（3.328 ±0.712）, （3.498±0,792） ng/g, P 〉 0.05], but obviously lower in the ovariectomy＋6-OHDA＋17β-estradiol 200 and 500 μg/kg groups than in the ovariectomy＋6-OHDA＋saline group [（2.639±0.438）, （2.016±0.619）, （3.498＋0.792） ng/g, P 〈 0.05]. CONCLUSION： Estrogen has obvious protective effect dose-dependently on 6-OHDA induced chemical sympathetic nerve terminal injury in rats, and it may play its protective role by reducing TNF level and ameliorating inflammatory reaction.

Pleomorphic adenoma(mixed tumor)of the upper lip:A case report

BACKGROUND Salivary gland tumors are relatively rare.Most minor salivary gland tumors are malignant with benign tumors accounting for 18%of the tumors.Pleomorphic adenoma(PA)is the most common salivary gland tumor.Lip PA is uncommon with 9.8%occurring in the upper lip.We are adding on the knowledge of the rare upper lip PA(benign mixed tumor).CASE SUMMARY We report an upper lip PA(benign mixed tumor)in a 28-year-old man.His complaint was a painless swelling on the upper lip.A painless,non-tender,well-circumscribed,slightly mobile,sessile,nodular,and rubbery(in consistency)tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip.The overlying skin was not fixed and of normal color.There was no ulceration,and palpation did not elicit pain or bleeding.There was no history of trauma.Blunt dissection was used to completely excise the nodular,whitish,and encapsulated tumor.Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion,with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells,well-formed tubules containing eosinic secretion,and nests of myoepithelial cells.A diagnosis of PA(benign mixed tumor)was confirmed.CONCLUSION Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.

Long-term survival of a patient with a large adrenal primitive neuroectodermal tumor: A case report

BACKGROUND Adrenal primitive neuroectodermal tumor(PNET) is an extremely rare malignant tumor with poor prognosis and of neural crest origin. Herein, we report a case of adrenal PNET and summarized its clinical and pathological characteristics on the basis of 16 patients reported recently.CASE SUMMARY A female patient aged 25 years presented with right lumbago for 12 mo, and preoperative computed tomography showed a huge right adrenal mass. She received tumorectomy, and post-operative pathological examination showed adrenal PNET. After surgery, she underwent adjuvant chemotherapy and was followed up 31 mo after surgery. She received brachytherapy for right paracolic and hepatic metastases. She was alive and followed up for 60 mo. In available studies, only 57.14%(4/7) and 44.44%(4/9) were positive for the expression of neuron-specific enolase and synaptophysin, respectively, although CD99 expression was found in all the patients(100%; 10/10).CONCLUSION It is concluded that adrenal PNET is very rare and highly malignant, and histology is a golden standard in its diagnosis. Surgery and adjuvant therapy is the main treatment.

Metastatic apocrine sweat gland adenocarcinoma in a terrier dog

This report describes the clinical and pathological aspects of an apocrine sweat gland carcinoma with distant metastasis in an aged dog.A 7-year-old male terrier dog was referred to small animal hospital of Shuhid Bahonar University of Kerman with a 5.5×3.5 centimeter pedunculated mass on its head near left auricular region which had been progressively growing since tliree months ago.The radiography showed no local and distant metastasis.Surgical excision and histological evaluation was done.Histologically,the mass was composed of epithelial cells arranged in glandular and solid patterns.The morphologic findings suggested either a primary or metastatic apocrine-gland carcinoma.Immunohistochemically,the tumor cells were intensely positive for cytokeratin 7 and 20 and negative for S100 protein.On the basis of histopathological and clinical findings,the tumor was diagnosed as a malignant apocrine gland tumor,arising from apocrine sweat glands of the skin.Local tumor recurrence with anorexia and weight loss was reported by the owner nine month later.Severe submandibular and prescapular lymphadenomegaly was noted in clinical examination.Several large pulmonary nodules were noted in chest radiographs resembling mediastinal lymph node metastasis.Second surgery and chemotherapy was rejected by the owner due to grave prognosis of the patient.The animal was died 45 days later due to respiratory complications.Tumors of apocrine sweat glands are relatively uncommon in dogs whereas apocrine gland adenocarcinoma with distant metastasis is extremely rare.

Carcinosarcoma of the deep lobe of the parotid gland in the parapharyngeal region:A case report

BACKGROUND Salivary carcinosarcoma is an extremely rare tumor containing both malignant epithelial and mesenchymal constituents.This article reports a rare case of carcinosarcoma with salivary duct carcinoma and osteosarcoma as the tumor components.The clinicopathological characteristics,treatment,and prognosis are discussed in conjunction with the literature.CASE SUMMARY A 48-year-old man presented with a complaint of a mass in the right parotid region.Osteosarcoma was first considered for assessment by fine-needle aspiration cytology.Physical examination revealed a mass measuring approximately 4 cm×3.5 cm×3 cm.The mass,the whole lobe of the right parotid gland,and the right mandible were completely removed during surgery.Postoperative histopathology confirmed carcinosarcoma of the salivary gland.CONCLUSION A definite diagnosis of salivary gland carcinosarcoma can only be obtained after complete surgical resection.

A Rare Tumor in a Rare Location: Ganglioneuroma

Ganglioneuroma is a rare benign tumor Neuronagliomas of the adrenal gland are a rare pathology. Therefore, this case will be of interest to urologists, surgeons, oncologists, and pathologists. Located in the adrenal gland (20%), along the sympathetic chain, and particularly in the posterior mediastinum (40%) and the retroperitoneum (30%). Ganglioneuroma poses a positive diagnostic and therapeutic problem. We report the case of a patient aged 48 admitted for pain in the right hypochondrium. He had no significant past medical or surgical history. On a physical examination, there were no noticeable findings except for mild tenderness and a mass on palpation. He underwent abdominal CT, which showed a relatively homogenous right adrenal tumor measuring. Endocrine work-up including urine catecholamine and cortisol levels was normal. Due to the tumor size and with consideration of the differential diagnosis of a malignant lesion, we elected to operate on the patient. Right adrenalectomy was performed, with no related complications. The final histopathologic report revealed adrenal ganglioneuroma. Although benign, the ganglioneuroma can present malignant aspects, in particular, CT scans and biological that can mislead the clinician, so histology remains the examination of choice for making the diagnosis.

Effective chemotherapy for submandibular gland carcinoma ex pleomorphic adenoma with lung metastasis after radiotherapy: A case report

BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.

Pediatric intrahepatic bile duct adenoma-rare liver tumor: A case report

BACKGROUND Intrahepatic bile duct adenoma(BDA)is one of the rarest of the rare benign tumors of the liver in the pediatric age group.It arises from the epithelial lining of intrahepatic bile ducts.The overall incidence of BDA is 1.3%of all primary benign liver tumors.Few case reports of this rare tumor occurring in adult population are present in the literature and to date,only one pediatric case has been reported worldwide.CASE SUMMARY An 18-month-old male child presented with chief complaints of mass per abdomen for 8 mo.Computerized tomography abdomen revealed a well-defined exophytic solid tumor arising from the posteroinferior margin of the right lobe of the liver with heterogenous enhancement and cystic changes,suggesting a suspicion of hepatoblastoma.Non-anatomical liver resection was done and a tumor of 10 cm×9.5 cm was excised.Histopathology of the specimen was conclusive with the diagnosis of intrahepatic bile duct adenoma,which was further supported by immunohistochemistry panel testing.The post-operative period was uneventful.On follow-up,the child was doing well and had no postoperative complication.CONCLUSION Intrahepatic bile duct adenoma in children is very rare and to date only one case has been reported.This is the second pediatric case of intrahepatic bile duct adenoma in the world.Additionally this is the first ever case of such a large tumor presenting in a child.

Establishing a protein expression profile database for the normal human pituitary gland using two-dimensional high-performance liquid chromatography combined with LTQ-Orbitrap mass spectrometry

In this study, we selected adult normal pituitary gland tissues from six patients during operations for pituitary microadenomas via the transsphenoidal approach for extended normal pituitary tissue resection around the tumor, and analyzed the protein expression of human normal pituitary using two-dimensional high-performance liquid chromatography combined with LTQ-Orbitrap mass spectrometry proteomics technology. The ten most highly expressed proteins in normal human pituitary were： alpha 3 type VI collagen isoform 5 precursor （abundance among tall pituitary proteins 1.30%）, fibrinogen beta chain preproprotein （0.99%）, vimentin （0.73%）, prolactin （0.69%）, ATP synthase, H~ transporting and mitochondrial F1 complex beta subunit precursor （0.52%）, keratin I （0.49%）, growth hormone （0.45%）, carbonic anhydrase I （0.40%）, heat shock protein 90 kDa I （0.31%）, and annexin V （0.30%）. Based on the biological function classifications of these proteins, the top three categories by content were neuroendocrine proteins （abundance among all pituitary proteins, 40.1%）, catalytic and metabolic proteins （28.3%）, and cell signal transduction proteins （9.8%）. Based on cell positioning classification, the top three categories were cell organelle （24.5%） membrane （20.8%）, and cytoplasm （13.0%）. Based on biological process classification, the top three categories of proteins are involved in physiological processes （42.9%）, cellular processes （40.4%）, and regulation of biological processes （9.1%）. Our experimental findings indicate that a protein expression profile database of normal human pituitary can be precisely and efficiently established by proteomics technology.