1051/1223. Diagnostic difficulties in etiology of the lesion of peripheral neuron of the facial nerve during the growth of sialoma. There are varied causes of lesions of the facial nerve: 75% of them is idiopathic paralysis or Bell paralysis (1), then there are injuries, diseases of the ears (otitis media and externa, otic zoster) and carcinomas of neuron VII, cerebellopontine angle tumors, tumors of the pons, of the petrosal bone, the middle ear, leukemias, diabetes, tumors of the salivary gland (2, 3, 4). Especially careful diagnosing is required for the cases of the lesions of the peripheral neuron n. VII, where, despite conventional treatment, there is no distinct improvement or where it is necessary to determine the right etiopatogenic factor among several possible ones. The patient under observation merits particular attention because it is necessary to determine the underlying cause of the lesion of the peripheral neuron of the facial nerve. ( info) |
1052/1223. Spindle cell malignant lymphoepithelial lesion of the parotid gland: clinical, light microscopic, ultrastructural, and in situ hybridization findings in one case. Malignant lymphoepithelial lesions (MLEL) are rare tumors of the salivary glands that show high incidence in Inuit Canadians, Alaskans, and greenland Eskimos. The tumors are usually anaplastic or poorly differentiated squamous cell carcinomas. Focal spindle cell elements have been rarely reported. The tumors have been epidemiologically linked to Epstein-Barr virus infection. We present a case of malignant lymphoepithelial lesion showing exclusive spindle cell morphology. The patient is a 44-year-old male Inuit Canadian who presented with a long-standing history of a left parotid mass. The mass did not show evidence of rapid growth or facial nerve involvement. Parotidectomy was performed. The tumor was histologically composed of spindle cells nodules in a background of lymphocytes. The spindle cells showed no evidence of cytologic atypia but were mitotically active. Immunohistochemical staining for low-molecular-weight cytokeratin was only focally positive. The differential diagnosis included a mesenchymal neoplasm and malignant lymphoepithelial lesion. Electron microscopic examination confirmed the squamous nature of the neoplasm. Intracytoplasmic viral particles were also identified ultrastructurally. in situ hybridization for Epstein-Barr virus mRNA using a 30-base oligonucleotide probe specific for the EBER-1 gene showed very high level of expression in the tumor cells. No expression was noted in the adjacent parotid gland tissue. Our findings confirm the squamous nature of malignant lymphoepithelial lesions despite the spindle cell morphology occasionally seen in these neoplasms. They also confirm the strong role of Epstein-Barr virus infection in the pathogenesis of these tumors. This may have further diagnostic and therapeutic implications.(ABSTRACT TRUNCATED AT 250 WORDS) ( info) |
1053/1223. Undifferentiated carcinoma of the parotid gland in a white patient: detection of Epstein-Barr virus by in situ hybridization. paraffin sections of an undifferentiated salivary gland carcinoma of lymphoepithelioma type, arising in a white (Greek) patient and confirmed by immunohistochemistry, were examined for the presence of Epstein-Barr virus (EBV), using in situ hybridization to detect EBV-specific EBER1 message. Epstein-Barr virus was detected in malignant epithelial cells, but was not found in lymphoid stroma or in residual benign salivary epithelium. These results confirm the existence of an association between EBV and tumor cells of undifferentiated carcinoma of parotid gland. This is the first demonstration of EBV in a salivary gland lymphoepithelioma arising in a non-Eskimo, white patient. This finding suggests that the association of EBV with undifferentiated salivary gland carcinoma may exist in geographic regions remote from greenland. ( info) |
1054/1223. Acinic cell tumour of the maxillary sinus: an unusual case initially diagnosed as parotid cancer. An unusual case of acinic cell tumour of the maxillary sinus is presented. The patient, a 41-year-old male who had undergone incomplete excision of the tumour in the left parotid region previously, was referred to our department for further treatment. The initial pathological diagnosis was adenocarcinoma of the parotid gland. CT-scan not only revealed tumours in the left pre-auricular and upper neck region, but also an enhanced mass in the left maxillary sinus. Although there were neither nasal symptoms nor destruction of the maxillary bone, aspiration biopsy of the maxillary sinus revealed class V. Total maxillectomy, radiotherapy and systemic chemotherapy were performed just after total parotidectomy and radical neck dissection at the left side. The clinical and histopathological findings are discussed. ( info) |
1055/1223. Second primary malignancies of the head and neck in children. Second malignant neoplasms are not uncommon in children, especially following multimodality therapy. The incidence of second cancers may approach 12% at 20 years following the initial cancer. Diligent surveillance is mandatory over a patient's lifetime to minimize morbidity and mortality from second malignant neoplasms. ( info) |
1056/1223. Cutaneous metastasis from a parotid adenocarcinoma. Report of a case with immunohistochemical findings and review of the literature. We present a rare case of metastatic adenocarcinoma of the parotid gland to the skin. Reviewing the histologic features of the primary parotid gland and comparing the microscopic sections and immunohistochemical studies, we concluded the skin tumor to be metastases from the parotid adenocarcinoma. By histologic examination alone, it is difficult to distinguish an eccrine sweat gland carcinoma from a metastatic carcinoma of the salivary gland. Immunohistochemical analysis may not be conclusive. Therefore, clinical history and clinicopathologic correlation are essential in arriving at an accurate diagnosis in these cases. ( info) |
1057/1223. Well-differentiated malignant cylindroma with partially preserved hyaline sheaths. A locally invasive neoplasm? light microscopic and ultrastructural features of a well-differentiated malignant cylindroma are described. The tumor was locally invasive but it neither recurred nor metastasized during the 3 years after surgery. This fact, together with the similar biologic behavior of two previously described, well-differentiated malignant cylindromas, suggests that these tumors possess either low or no metastatic potential. ( info) |
1058/1223. melanoma arising within the parotid salivary gland--a case report and review of management. melanoma arising within the parotid salivary gland is an unusual, though well-recognized phenomenon. melanocytes are derived, embryologically, from neural crest tissue and are not a constituent of normal salivary tissue. It is, therefore, reasonable to assume that a melanoma within the parotid has arisen either as a metastasis to a parotid lymph node or as a metastasis to the gland itself. The primary lesion cannot always be identified--spontaneous regression of melanomas is an equally well-recognized phenomenon. This is a report of such a case, with a review of the management. ( info) |
1059/1223. Combined acinic cell mucoepidermoid carcinoma of the parotid gland. Report of a case with immunohistochemical study. A case where mucoepidermoid and acinic cell carcinoma occurred simultaneously in the left parotid gland of a 67-year-old man is presented. Histologically, the neoplasm contained diagnostic areas of these tumors close to each other within the same tumor mass. A complete immunohistochemical study was performed and confirmed the presence of both components. To the best of our knowledge no similar case has previously been reported. ( info) |
1060/1223. Metastatic pleomorphic adenoma. We report a case of pleomorphic adenoma of the parotid with metastasis to the liver, following resection for local recurrence, which has only been described once before. The diagnosis was made by fine needle aspiration and the lesion was resected without complications. The patient is free of disease 4 years later. Histological features of malignancy were not present in any specimens from the original resection, the local recurrence and the metastatic lesion. It is difficult to say which patients with pleomorphic adenoma should be observed for the development of treatable metastases, but metastases have been reported to occur mainly after repeated resections for local recurrences. ( info) |