Left total parotidectomy was performed on the 2nd hospital day. The mass was well encapsulated and attached to parotid tissue. The mass measured 3.5 ⫻ 3.0 ⫻ 2.0 cm in diameter. It showed a smooth and lobulated surface and homogeneously pale, yellowish appearance with minute foci of cystic areas. Gross resection showed a well-encapsulated tumor of the pa- rotid gland. The tumor was composed of small uniform basaloid cells arranged in solid or trabecular pattern. The stroma was scanty. There was characteristic palisading in the peripheral portion of the tumor nests and sharp demarcation between the neoplastic cells and stroma. The histologic fea- tures were consistent with basalcelladenoma, rather than pleomorphic, adenoma (Fig 3C and E).
This series included 16 women (72.8%) and 6 men (27.2%), aged between 32 and 73 years (mean 51.5 years, SD 10.2 years). In 4 patients, the tumor was found during an incidental healthy examination. Seventeen patients presented with a pal- pable mass without tenderness, while 1 patient had slight pain. The CT and sonography characteristics of the tumors are summarized in the On-line Table. All 22 cases were single lesions. Fifteen tumors were on the left parotidgland, while the remaining tumors were located on the right side. The tu- mors were located in the superficial lobe in 19 patients (type 1 ⫽ 11; type 2 ⫽ 8) and in the deep lobe (type 3) in 3 cases. On CT, 21 cases showed well-defined borders (Fig 1), while 1 case (case 14, a type 2 tumor) showed heterogeneous enhancement with ill-defined borders (Fig 2). On sonography, all 20 cases showed a round or oval nodule, and 19 cases displayed well- defined borders. The CT attenuation of the soft-tissue portion of the tumors on unenhanced CT was 38.6 ⫾ 9.5 HU (mean ⫾ SD). The soft-tissue components showed early intense en- hancement after contrast injection; the postcontrast CT atten- uation was 103 ⫾ 19.4 HU (mean ⫾ SD) and the CT attenu- ation increase was 64.5 ⫾ 19 HU (mean ⫾ SD).
SUMMARY: Mandibular actinomycosis is an uncommon disease. We retrospectively reviewed 6 patients with pathologically proven mandib- ular actinomycosis who underwent both CT and MR imaging to evaluate the characteristic imaging ﬁndings. CT results showed an irregularly marginated lesion with increased bone marrow attenuation, osteolysis, and involvement of the skin in all patients. Periosteal reaction and intralesional gas were seen in 4 patients. MR imaging results revealed low signal on T1-weighted and high signal on T2-weighted images of the mandible, and moderate heterogeneous enhancement was seen in all patients who received intravenous contrast. Cervical lymphadenopathy was not observed. Involvement of the masseter, lateral pterygoid, and medial pterygoid muscles was seen in 4 patients, whereas parotidgland and submandibular gland as well as parapharyngeal space involvement were seen in 3 patients. Familiarity with the imaging ﬁndings of mandibular actinomycosis may help to diagnosis this entity.
There is, therefore, overlap of radiologic features between oncocytomas and other benign parotid tumors such as Warthin tumors, basalcell adenomas, and, to a lesser degree, pleomorphic adenomas. However, when taken together, the diagnosis of a benign parotid oncocytoma is favored in a middle-aged or elderly woman who presents with CTfindings of well-defined, enhancing bilateral, and multifocal parotid tumors that demonstrate a nonenhancing curvilinear cleft. These imaging findings will be atypical for pleomorphic ade- nomas due to their lack of enhancement in the early post- contrast phase. Bilateral and multifocal parotid tumors on CT also render pleomorphic adenomas and basalcell adenomas less likely differential diagnoses because these tend to present as unilateral solitary tumors.
2.Ogawa I, Nikai H, Takata T, Miyauchi M, Ito H, Ijuhin N. The cellular composition of basalcelladenoma of parotidgland: An Immunohistochemical analysis. Oral Surg Oral Med Oral Pathol1990;70(5):619-26. 3.González-García R1, Nam-Cha SH, Muñoz-Guerra MF, Gamallo-Amat C. Basalcelladenoma of the pa- rotid gland. Case report and review of the literature. Med Oral Patol Oral Cir Bucal 2006;11(2):E206-9 4.Chakravarthi S, Rao V.T, Prasad L.K, Kalyan, Kat- timani V.S. BasalCellAdenoma – A Rare Presentation of Parotid Swelling – A Case Report and Review of The Literature. Jr.of Orofac. Scie. 2009;1(2):13-16. 5.Chawla AJ, Tan TY, Tan GJ. Basalcelladenoma of parotidgland: CT scan features Eur J Radiol 2006;58(2):260-5.
years (range, 43-83 years). The mean age in this group was slightly higher than that in the other two groups, but the difference was not statistically significant. Five tumors were locat- ed in the left parotidgland, and six were locat- ed in the right gland. The average disease dura- tion prior to surgery was 10.5 ± 11.0 months. One patient received treatment because of local pain. In these patients, ultrasonography revealed a hypoechoic mass located in the deep lobe of the parotidgland. CT examination showed that the maximum tumor diameter was 20.4 ± 5.2 mm. Cystic degeneration was pres- ent in 5 of the 11 tumors (45.5%), which was higher than the incidence in the other two groups (Table 1). The surgical treatment includ- ed dissection of the facial nerve and excision of the tumor, and the superficial and deep lobes of the parotidgland. FNAB was conducted in seven cases (63.6%), and four tumors were confirmed to be BCA on FNAB (4/11, 36.4%). Six tumors (6/11, 54.5%) were confirmed on intraoperative frozen-section biopsy, and the others were confirmed on the final pathological diagnosis. In four cases, the facial nerve func- tion deteriorated to HB grade II after the sur- gery. Two of them recovered within 6 months and in other two cases, this function failed to recover. Two patients died of other diseases during follow-up. The remaining patients had no local recurrence or malignant transformation during the follow-up (Table 2; Figure 2E, 2F). BCA is composed of basaloid cells, which can be divided into the following categories: solid tubular type (Figure 3A), solid trabecular type (Figure 3B), membranous type cells (Figure 3C), and solid type (Figure 3D). The histological subtype was evaluated by examination of par- affin sections and Hematoxylin and Eosin stain- ing. The histological subtypes found in this study were as follows: solid tubular lesions, 6 tumors; trabecular lesions, 4 tumors; membra- nous lesions, 2 tumors; and solid lesions, 17 tumors; (Table 2).
Various malignancies exhibit the nuclear expression of β- catenin. Several studies have also shown that ACC and other salivary gland tumors, such as epithelial-myoepithelial carcinoma, pleomorphic adenoma, BCA, and BCAC, ex- press β-catenin [17-20]. In particular, two studies showed that BCA has nuclear β-catenin expression [17,18]. One of these, by Kawahara et al., concluded that while nuclear β- catenin expression may be a helpful marker for diagnosing BCA, it is not useful in the differential diagnosis between BCA and BCAC. They also showed that 154 other salivary gland tumors, including ACC, do not have nuclear β- catenin expression . By contrast, two other studies suggest that some ACCs do express nuclear β-catenin [21,22]. Nevertheless, our results concur with the findings of Kawahara et al. : all ACCs were negative for nuclear β-catenin staining, and all BCACs and BCAs without capsular invasion, and most BCAs with capsular invasion (7/10), showed nuclear positivity for β-catenin immuno- staining. Interestingly, the three BCAs with capsular inva- sion that did not show nuclear β-catenin staining had higher mitotic activity (>10/10 HPFs) or apoptosis. Not- ably, most BCNs and ACCs also showed cytoplasmic/ membranous positivity for β-catenin. It is generally well known that activation of Wnt signaling increases the cyto- plasmic levels of β-catenin, resulting in increased nuclear β-catenin levels. A recent study of 45 salivary gland tu- mors revealed that various benign and malignant salivary gland tumors had cytoplasmic/membranous β-catenin expression . A mutation in CTNNB1 (the gene that encodes β-catenin) may explain why BCAs show nuclear β-catenin expression [18,22]. Thus, although the signifi- cance of the nuclear expression of β-catenin in BCNs is currently not clear, it may be useful for differentially diag- nosing between BCNs and ACCs.
in the tubular type, which is the least common type of BCA. The most characteristic feature of the membranous type is the pro- duction of a conspicuous amount of basal lamina that is recog- nized as an eosinophilic, Periodic acid-Schiff (PAS)-positive hy- aline material, which forms thick bands at the periphery of the basaloid cell islands. 2 In contrast to the other types of BCAs, the
Using a CT system (HighSpeed Advantage, General Electric Medical Systems, Milwaukee, WI) with or without contrast enhancement, imaging was performed on the submandibular glands of all 16 patients with sialolithiasis. After intravenous injection of 100 mL of contrast medium (iopamidol, Iopamiron 300, Schering, Germany), axial images of 4-mm thickness were obtained and used for assessment of the number, location, and size of sialoliths. The size of each sialolith was expressed as a maximal diameter determined on sequential 2–4 images (window level 5 500 HU, window width 5 3000 HU) ob- tained from each of the patients. All sialoliths were measured directly after surgical removal. In general, sialolith size was found to be underestimated on CT images, probably because of thin soft tissues covering the calcified core. The location of each sialolith was classified into one of the following catego- ries: distal one third, middle one third, or proximal one third of the duct.
uniform epithelial cells that were columnar or cuboidal in shape with scanty eosinophilic cytoplasm and round to ovoid nuclei. The stroma  surrounding the epithelial tumor nests was composed of thin fibrous tissue and was well demarcated from the solid nests (Figures 3(a) and 3(b)). Further analysis showed a glandular structure containing a mucinous substance that was positive in Periodic Acid-Schiff (PAS) staining (Figure 4(a)) and deposition of abundant PAS- positive basal lamina material within and around the tumor nests (Figure 4(b)).
The standard treatment of pleomorphic adenomas in the parotidgland is a surgical procedure. However, adverse outcomes of the surgical procedures are common. As noted in the Introduction, the recurrence rate of pleomorphic adenoma after surgery has been reported to be 1% - 45% . The wide range of the rate depends on the type of surgical procedures. The recurrence rate after tumor enucleation has been reported to be 20% to 45% . The high rate of recurrence is considered to be associated with positive margins consisting of in- complete tumor capsules. Other suggested causes of pleomorphic adenoma recurrence are the perforating pseu- dopodia of the tumor, capsule rupture by the surgical procedure, and the proximity of the tumor to facial nerves . In this case, although tumor was removed along with the surrounding tissue of the membrane in the primary surgical procedure, the size of tumor was not small, therefore capsule rupture might have occurred in this pro- cedure and have led the tumor recurrences. More comprehensive dissection methods, extracapsular dissection or superficial parotidectomy are considered more effective to prevent tumor recurrence compared to enucleation when a pleomorphic adenoma is limited to the superficial lobe of the parotidgland. After extracapsular dissec- tion or superficial parotidectomy, recurrence rates are reduced to less than 5% .
In April of 2013, the patient underwent a new CT scan showing a low-density nodular lesion measuring 1.7 cm in the apical segment of the upper lobe of the left lung that had increased in volume and a hypovascular lesion measuring 4.8 cm in the superior-medial portion of the spleen, which had also increased in volume (Figure 3). The patient was referred to the General Surgery Depart- ment and underwent a laparoscopic splenectomy. This operation became hard due to the presence of metastasis displacing the hilar vessels. Histologic examination re- vealed that three out of four of the removed lymph
The large, solid component of HAE shown by sonography and MR imaging distinguishes this le- sion from most vascular malformations, including cystic lymphatic malformations (cystic hygromas). Solid lymphatic malformations usually show exten- sion beyond the parotid (3, 14), and do not contain prominent blood vessels (1, 10). In general, vascular malformations grow at about the same rate as the child, which also helps distinguish them from HAE. Although rhabdomyosarcoma often arises in the head and neck region, it is unusual in infancy. Rhabdomyosarcoma is rarely confined to the pa- rotid gland (15), but often arises in the infratem- poral fossa and involves neighboring structures with an infiltrative growth pattern. It appears to be less vascular than HAE (16).
The histological features of MA are distinctive and are characterized by epithelial cells with different amounts of cytoplasm. The adenomatous components are com- posed of uniform small cells arranged in tubular or pap- illary architectural patterns . In the present patients, immunohistochemical staining showed that neoplastic cells were positive for vimentin, CK, and EMA. Previous findings demonstrate that CD57, AE1/AE3, and CAM5.2 are also positive in MA, while NSE, CEA, CgA, Syn, actin, desmin, and AMACR are negative [3, 20]. Patho- logical detection remains the most effective method for MA diagnosis.
Abstract: Pleomorphic adenoma (PA) is the most common type of all salivary gland tumors. Although PAs are benign in pathology, they are malignant in biological behavior sometimes. The tumor could transform to malignancy as malignant pleomorphic adenoma (MPA), if the preexisting remains for long time or after multiple recurrent. Cases of giant pleomorphic adenomas (GPA) are rare, according to previous medical literatures, the majority of which were involving in the parotidgland. We presented a 73-year old woman with a giant pleomorphic adenoma in left parotidgland who had kept the mass for more than forty years and was successfully treated with surgery without any facial nerve injury.
Lupus erythematosus (LE) is a complex autoim- mune disorder showing a variety of cutaneous lesions. LE profundus, also referred to as lupus panniculitis, is an uncommon variant of pan- niculitis that is characterized histopathologi- cally by lobular panniculitis with concomitant septal involvement and lymphoplasmacytic infiltration [1, 2]. In the dermis, superficial and deep perivascular lymphocytic infiltration was usually observed, and mucin deposition was also frequently noted . LE profundus usually develops in association with systemic or dis- coid LE in approximately 1-3% of patients with both conditions, although it may also occur in the absence of either . Sites of predilection include the face, head, arm, and trunk [1, 3], however, albeit extremely rare, salivary gland involvement has also been documented [4-7]. In this report, we describe the first documented case of prominent mucoid degeneration and
Myeloid means “pertaining to,” “derived from,” or “manifesting” certain features of the bone marrow. It has the appearance of myelocytes, but not derived from bone marrow. Myeloid leukemias can produce malignant cells that usually show features of granulocytes or monocytes and less frequently erythrocytes or megakaryocytes (Fig. 20). To identify and classify the myeloid leukemias, immunohistochemical confirmation of certain characteristic enzymes (such as myeloperoxidase and lysozyme) is necessary. The following myeloid features are observed in myeloid: Erythroid ratio, myeloid leukemia, myeloid metaplasia, myeloid sarcoma, myeloid epulis, osteoclastoma, giant cell epulis, and peripheral giant cell granuloma. 34
Neurologic involvement in Wegener granulo- matosis primarily involves the peripheral ner- vous system, usually in the form of multiple peripheral neuropathies (mononeuritis multi- plex) (1, 4). Cranial neuropathy is the most common CNS manifestation (1). Both the pe- ripheral and cranial neuropathies are thought to be the result of a small-vessel vasculitis (1). Although one early article on the neurologic complications of any type in patients with Wegener granulomatosis reported a prevalence of 50%, subsequent articles have reported rates between 22% and 33% (1, 2, 4). The lower fig- ures in more recent series are thought to reflect earlier treatment with immunosuppressive ther- apy. Involvement of the brain and meninges is uncommon. In one series of 85 patients with Wegener granulomatosis who were followed up prospectively for 21 years, CNS manifestations developed in 10, but symptoms and signs were related to cranial neuropathy in most of these cases. None of these patients had ischemic symptoms, infarcts, or symptoms clearly re- lated to intracranial masses or dural granuloma- tous disease (1). In another series of 324 pa- tients, clinical findings directly related to brain
Initial MR imaging was performed before treatment, and the postirradiation study was performed within a week after the last irra- diation. All MR imaging examinations were performed with a 1.5T superconductive MR imaging unit (Gyroscan ACS-NT; Philips Med- ical Systems, Best, the Netherlands) with bilateral 14-cm diameter surface coils for the temporomandibular joints. MR sialography was performed with 2D-thick sectioned heavy T2-weighted turbo spin- echo sequences with the following parameters: TR/TE, 10 000/1000 ms; number of averages, 6; turbo spin-echo factor, 6; spectral presatu- ration with inversion-recovery fat-suppression technique; FOV, 140 ⫻ 140 mm; matrix, 512 ⫻ 512; separate 27-mm section thickness of each side; and total imaging, 4 minutes 10 seconds. MR sialography was performed before and after salivary secretion stimulation with intraoral administration of a few drops of tartaric acid on the tongue (Fig 1.).