P1.06. Pleomorphic adenoma in the upper lip: Report of two cases

Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings

124

Poster session I / Oral Oncology Supplement 3 (2009) 123–161

and embedded in paraffin-wax. Ten cases of normal salivary glands were used as controls. Immunohistochemical staining of CK7, CK14, CK19, CK20 and smooth muscle actin (SMA) was performed on 4-lm thick paraffin sections using the streptavidin–biotin-complex technique. Results: At first, we examined the immunohistochemical staining of normal controls. CK7 was strong positive in luminal ductal cells and weak positive in acinar cells, but negative in basal ductal and myoepithelial cells. CK 19 was positive in luminal ductal cells, but negative in acinar, basal ductal and myoepithelial cells. Only basal ductal and myoepithelial cells were positive for CK14. CK 20 was negative. SMA showed strong positive only in myoepithelial cells. In ACCs, immunohistochemical staining for CKs varied according to the growth patterns. Tumor cells in microcystic, follicular and papillary-cystic subtypes were strongly and diffusely positive for CK7. But only scattered cells in solid subtype was positive for CK7. Positive expression for CK19 was observed in microcystic, follicular and papillary-cystic subtypes, but not in solid subtype. Scattered positive cells for CK14 could be observed in all subtypes of ACC. No positive cells for CK20 and SMA were found. Discussion: Our study proved that tumor cells in ACCs show differentiation towards acinar, luminal ductal and basal ductal cells. In microcystic, follicular cystic and papillary-cystic growth patterns of ACC, most of tumor cells showed differentiation towards ductal cells, but not acinar cells. No tumor cells showed immunohistochemical features of myoepithelium in ACCs. Granted by National Natural Science Foundation of China (30700955). doi:10.1016/j.oos.2009.06.289

P1.04. Hyalinizing clear cell carcinoma of salivary glands: Experience in the National Institute of Cancer of México J. Soriano a,*, A.M. Cano b a b

Universidad Quetzalcoatl en Irapuato, Mexico Instituto Nacional de Cancerología, Mexico

The Hyalinizing clear cell carcinoma (HCCC) of salivary glands is a rare low grade neoplasm described by Milchgrub et al. in 1994. This tumor arises in the minor salivary glands of adult women involving mainly the base of the tongue, palate and floor of the mouth. Histopathologically is characterized for nest or trabeculae of glycogen-rich clear cells lying in a prominent hyalinized stroma. These cells are reactive with antibodies against cytokeratins and epithelial membrane antigen, the myoepithelial differentiation is absent. Objective: The purpose of the study was to identify and analyze the features of the HCCC diagnosed or not, over a period of 20 years in a Mexican sample. Study design and results: We retrieved and analyzed the records of 650 cases of salivary glands tumors from a total of 179,008 cases from the archives of the pathology department of the Instituto Nacional de Cancerología of México from 1983 to 2003. Of these 650 tumors, 245 were benign and 405 were malignant. We found only two cases of histopathologically verified HCCC, the clinical features, behavior and prognostic factors were compared with the literature. Conclusion: We described two cases of HCCC in a period of 20 years, this result confirm the rare incidence of this neoplasm. The clinical and histopathological features were similar to the previous reported cases and provided good evidence of the indolence and tendency of repeated local recurrences of HCCC. doi:10.1016/j.oos.2009.06.290

P1.05. Salivary glands tumors: A role for epigenetics? M. Mascolo a,*, G. Ilardi a, L. Nugnes a, L. Califano b, G. De Rosa a, S. Staibano a a

Department of Biomorphological and Functional Sciences, Pathology Section, ‘‘Federico II” University of Naples, Italy b Department of Maxillofacial Surgery, Federico II University of Naples, Italy Introduction: Salivary glands tumors (SGT) are characterized by the extreme variability of morphological phenotype and behavior. This makes difficult the evaluation of prognosis and appropriate treatment. During the last years, the co-existence of genetic and epigenetic alterations in salivary glands cancerogenesis has been reported. However, conclusive data concerning the role of epigenetics in SGT are still lacking. The existing reports in literature signal a considerable heterogeneity of methylation and acetylation profiles of many genes regulating apoptosis and cell proliferation in SGT. Among epigenetic alterations correlated with cancerogenesis, a role for the molecules responsible of the chromatin assembly has been recently reported. A great attention has been delivered particularly to the Chromatin Assembly Factor-1 (CAF-1), a heterotrimeric protein complex formed of three subunits, p150, p60, and p48, involved in the epigenetic control of cell replication and DNA-repair, and p60/ CAF-1 has been proposed as a new prognostic marker for several human tumors. Methods: We evaluated by immunohistochemistry the expression of CAF-1/p60 on a selected series of SGT. Results were compared with the clinical and pathological features of tumors and with follow-up data, in order to verify the relationship between CAF-1/p60 expression and the biological behavior of each tumor. Results: We found a considerable heterogeneity of the CAF-1/p60 expression among the different histotypes of SGT. However, all the tumors with an adverse clinical behavior were characterized by the highest level of protein expression, and this finding resulted statistically significative (P < 0.05). Discussion: The strict association between hyper-expression of CAF-1/p60 and unfavourable outcome of tumors prompted us to suggest a role for this protein as new, sensible prognostic marker for SGT, independent from the traditional clinical and histopathological parameters. These data support the hypothesis that, the epigenetic alteration of the chromatin assembly process plays a relevant role in the determining the aggressive behavior of SGT. doi:10.1016/j.oos.2009.06.291

P1.06. Pleomorphic adenoma in the upper lip: Report of two cases F.L. Zanferrari a, L.M. Sassi a,*, J.L. Dissenha a, R.T. Stramandinoli a, J.L. Schussel a,b, L.F.C. Avila a a b

Erasto Gaertner Hospital, Brazil Universidade de São Paulo, Brazil

The Pleomorphic adenoma is the most common salivary gland tumor. The most common site is mainly the parotid gland, following by the submandibular and minor salivary glands. The tumor can occur at any age, the women are affected slightly more often than man and is most prevalent in fourth to sixth decades of life. This tumor presents as a slow painless mass and growth. The histological features appear with combinations of epithelial, myoepithelial cells and the stroma may be myxoid, chondroid or hyaline. We report

two cases of an upper lip painless mass that were referred to our department. A 31-year-old man presented in the right upper lip the painless mass. An excisional biopsy was then performed under local anesthesia and the lesion was carefully dissected and removed. Surgical specimen was flat, encapsulated, of hard-elastic thickness and was fixed in 10% formalin, routinely processed and embedded in paraffin wax. Sections were stained with hematoxylin and eosin. The histologic picture showed myxoid and chondroid areas with epithelial strings solid areas, blood vessels dilated with recent hemorrhage. There was no evidence of recurrence after 2-years follow-up and showed good healing without complaints or volume alteration. A 48-year-old woman presented a slowly painless swelling in the right upper lip. An excisional biopsy was then performed under general anesthesia and the lesion was removed. Surgical specimen was routinely processed and embedded in paraffin wax. Sections were stained with hematoxylin and eosin. The histologic pictures showed a tumor comprised of duct-like structures, sometimes forming micro cysts with double layer of epithelial cells with outbreaks of squamous metaplasia and presence of the chondromyxoid stroma. After 7-years follow-up there was no evidence of recurrence. The cases reported have clinical relevance for presenting themselves in upper lip and this is an unusual location for the pleomorphic adenoma. doi:10.1016/j.oos.2009.06.292

P1.07. Acinic cell carcinoma of the parotid gland J.W. Kim a, Y.C. Lim b, H.J. Hong c,*, E.C. Choi d a

Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Republic of Korea b Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Republic of Korea c Department of Otorhinolaryngology-Head and Neck Surgery, National Health Insurance Corporation Ilsan Hospital, Republic of Korea d Department of Otorhinolaryngology, Yonsei Head and Neck Cancer Clinic, Yonsei University Health System, Republic of Korea Objectives: The purpose of this study is to review the clinical and pathologic features of acinic cell carcinoma of the parotid gland and to determine predictive factors of the recurrence. Methods: From October 1991 to October 2007, we retrospectively reviewed the treatment outcomes of 33 patients with treated acinic cell carcinoma of the parotid gland at our institution. Complete follow-up information was available on 26 patients. All patients had curative surgery with or without neck dissection as their initial treatment, and 7 received postoperative radiotherapy due to positive margin and/or facial paralysis. The follow-up period ranged from 10 to 150 months (mean, 67 months). Results: Twenty-six patients consisted of 14 men and 12 women, with a mean age of 42 years (18–63 years). Fourteen patients (46.2%) had early T stage (T1, T2) tumors and twelve patients (43.8%) had advanced T stage (T3, T4). Four patients (15.4%) had preoperative facial paralysis. Radical parotidectomy was attempted in 5 patients. Occult metastasis node was not found in all 5 patients with elective neck dissection. Six patients (23.1%) presented with recurrences after initial treatment (3 with local recurrence, 2 with regional recurrence, and 1 with distant metastasis). All six patients underwent salvage surgery and five

125

of them were salvaged. One patient with distant metastasis died of residual disease after salvage surgery. The 5-year locoregional control, overall survival, and disease-specific survival rates were 74.2%, 91.6%, and 95.2%, respectively. Pathologic T stage and tumor grade were significant predictive factor for locoregional control rate (p < 0.05). Conclusions: Although we have considered that acinic cell carcinoma of the parotid gland was low grade tumor, the authors identified it has a higher incidence of locoregional recurrence in advanced T stage. Total parotidectomy or/and adjuvant radiotherapy may decrease locolegional recurrence in advanced T stage. Also long term follow-up will be necessary. doi:10.1016/j.oos.2009.06.293

P1.08. Paraganglioma of the hypoglossal nerve – A rare location of head and neck paraganglioma A. Ntomouchtsis a,*, M. Kinigou b, S. Tsova a, A. Megalopoulos b, K. Antoniades a,b a b

Aristoteles University of Thessaloniki, Greece Papanikolaou Hospital of Thessaloniki, Greece

Introduction: Paragangliomas of head and neck comprise a unique subset of lesions which derive from the extra-adrenal paraganglia of the autonomic nervous system, but most of them arise from the parasympathetic nervous system. Methods: We present a case of a 46-year-old woman presented with a 4-year-history of a swelling in the left side of the neck, slowly enlarging. The patient presented with palsy of the left hypoglossal nerve accompanied by fibrillations of the left side of the tongue, which was established as the ipsilateral neck mass was growing. No other cranial nerve palsies were observed. Results: On the basis of the histological and immunohistochemical findings, the clinical and intraoperative appearance, the diagnosis of a paraganglioma of the hypoglossus nerve was established. The excision was complete and uneventfully, performed by a multidisciplinary team including an ENT surgeon, a Vascular surgeon and two Oral and Maxillofacial Surgeons. The operation resulted in a motor deficit of the tongue and a permanent considerable difficulty in swallowing, treated with comprehensive techniques, with no postoperative aspiration, pneumonia or weight loss. Postoperative rehabilitation and swallowing therapy by speech therapists reduced these functional deficits. During the four years follow-up there are no signs of local recurrence or metastatic disease. Discussion: In conclusion, combined endovascular and surgical intervention is an effective treatment for cervical paragangliomas, although preoperative selective embolization of the tumor remains a matter of debate as major complications such as cerebrovascular accidents might occur. Early treatment with appropriate postoperative rehabilitation optimizes the outcome. This report illustrates the problems in diagnosing paragangliomas originating from the hypoglossal nerve that does not belong to the parasympathetic nervous system and does not have a glomus body. The diagnosis was made upon high clinical suspicion, which was confirmed by the intaoperative findings, the histology and the follow up. doi:10.1016/j.oos.2009.06.294

Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings

Poster session I / Oral Oncology Supplement 3 (2009) 123–161