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1/39. Synchronous pleomorphic adenomas of the major salivary glands: a case report.

    The presentation of multiple distinct tumors in major salivary glands is rare. Although the most common tumor with bilateral synchronous or metachronous development is the Warthin tumor, pleomorphic adenomas have been diagnosed simultaneously as well. We report the case of a female patient who was diagnosed with pleomorphic adenomas in the right parotid and submandibular glands, concomitant with sialolithiasis affecting the submandibular gland. This patient had been exposed to head and neck radiotherapy in childhood, which may have played a role in the development of her tumors. A review of the relevant literature is included.
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2/39. Gastric adenocarcinoma with tonsil and submaxillary gland metastases: case report.

    Local invasion, hematogenous and lymphatic metastases are the major modes of spreading gastric cancer. The most common sites of metastases in patients with gastric cancer are liver, peritoneum, omentum, lungs and mesentery. Of the two pathological types of gastric cancer, intestinal-type gastric cancer showed preferential metastasis to the liver, whereas the diffuse-type showed a preference for peritoneal involvement and lymph node metastasis. However, metastases of gastric cancer to the head and neck regions are not common. The hematogenous route appears to account for a great majority of metastases to the head and neck regions. Malignant neoplasm metastases to major salivary glands or tonsils are not common. Several patients with cancers from the infraclavicular area have been reported with parotid gland or tonsil metastases. However, metastasis of gastric adenocarcinoma to the tonsils or submandibular glands is rare. We present a patient with recurrent gastric adenocarcinoma with both tonsil and submandibular gland metastases which is even rarer.
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3/39. Squamous carcinoma in a major salivary gland: a review of the diagnostic considerations.

    CONTEXT: Squamous carcinoma in a major salivary gland has several possible sources: (1) high-grade mucoepidermoid carcinoma, (2) metastasis or direct invasion from a primary skin carcinoma, (3) metastasis from a distant primary carcinoma, or (4) a primary malignant neoplasm. The latter is conventionally regarded as a diagnosis of exclusion after a history of squamous carcinoma elsewhere has been obtained or there is a positive mucin stain. DESIGN: Eleven cases of squamous carcinoma in a major salivary gland are presented and the literature reviewed. RESULTS: Two cases, 1 metastatic from a histologically identical squamous carcinoma from the ipsilateral tonsil and 1 with in situ squamous carcinoma in a duct, demonstrated positive mucicarmine stains. Two cases were high-grade mucoepidermoid carcinomas, also with positive mucin stains. Five cases represented metastases from cutaneous squamous carcinomas. Only 2 cases were regarded as primary carcinomas. There were no histologic clues as to correct subclassification. Six patients died, 4 from their disease. Three of the 5 still alive had recurrence or metastasis. CONCLUSION: The occurrence of squamous carcinoma in a major salivary gland exhibits a histologic sameness that precludes accurate subclassification and assignation of origin. Also irrespective of tumor origin, the clinical approach to diagnosis and treatment is similar. Adjuvant therapy (eg, radical neck dissection, radiation, chemotherapy) is not uniformly applied. Most patients present with a sizable (>3-cm) mass for which total excision is attempted. The natural evolution of the tumor is aggressive, irrespective of clinical context. The traditional subclassification of squamous carcinoma in a major salivary gland may not be clinically relevant.
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4/39. A multifocal neurinoma of the hypoglossal nerve with motor paralysis confirmed by electromyography.

    A rare case of neurinoma in a 72 year-old Japanese woman derived from the hypoglossal nerve is reported. The tumour was composed of three interconnected nodules occurring simultaneously in the left submandibular and sublingual regions. The lesion, which presented as a neck mass, caused a slight left-sided hemiparesis of the tongue with tongue deviation to the affected side not noticed by the patient. An electromyographic (EMG) study revealed decreased muscle activity on the left side of the tongue muscle, indicating dysfunction of the hypoglossal nerve. EMG was useful for diagnosis.
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5/39. A case of submandibular malignant rhabdoid tumor transformed from papillary thyroid carcinoma.

    Malignant rhabdoid tumor (MRT) in the neck region is very rare. We report a case of MRT in a 60-year-old woman who had a history of papillary carcinoma of the thyroid gland 7 years previously. One year before admission, in 1995, thyroid carcinoma recurred, and the tumor contained a small undifferentiated region with rhabdoid features. The tumor in 1996 consisted of round to oval rhabdoid cells with abundant cytoplasm, and the growth pattern was diffuse and infiltrative, with no papillary structures. We therefore concluded that the lesion was MRT, transformed from papillary thyroid carcinoma.
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6/39. Kikuchi-Fujimoto disease. A case report.

    Histologically, Kikuchi-Fujimoto disease (KFD) is a necrotising, self-limiting lymphadenitis. It typically affects the lymph nodes of the neck and it is often accompanied by a high fever. The present paper documents the case of a 28-year old male carrier of KFD. From the x-ray images, the KFD clinically appeared to be a submandibular salivary gland tumor. An ultrasound study led us to believe that it was more likely a branchial cyst. Malignant lymphoma can be mistaken for KFD, thus the diagnosis must be precise and the differentiation is crucial.
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7/39. Implantation metastasis of head and neck cancer after fine needle aspiration biopsy.

    One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.
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8/39. carcinosarcoma of the submandibular and sublingual salivary glands. A case report and review of the literature.

    carcinosarcoma of the salivary gland is a rare lesion, estimated at 0.2% of malignant salivary gland tumors [1, 2]. The present article describes a case occurring in a 54-year-old man with a submandibular mass in the right neck. Histologically, this lesion was a carcinosarcoma which involves the submandibular and the sublingual glands. Its stromal component was a chondrosarcoma and the epithelial one was an undifferentiated carcinoma in the whole tumor, with areas of adenoid cystic carcinoma in the sublingual gland. To our knowledge, we have not found any previously reported carcinosarcoma involving the sublingual gland.
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9/39. Submandibular synovial sarcoma with t(X;18) and synovial sarcoma of the toe with additional cytogenetic abnormalities: presentation of two cases and review of the literature.

    We report cytogenetic findings from fine-needle aspiration samples of two synovial sarcoma patients. The cases are of interest because (1) one case is of a rare site (submandibular region) of the head and neck, and (2) the other is a patient with synovial sarcoma of the toe showing additional cytogenetic abnormalities along with t(X;18). The literature of this tumor is reviewed.
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10/39. Foreign body reaction to calcium alginate fibre mimicking recurrent tumour of the submandibular salivary gland.

    A 50-year-old woman was referred after the discovery of adenoid cystic carcinoma in an excised left submandibular gland. Treatment involved clearance of the left submandibular fossa, and bilateral levels II and III selective neck dissections. A left-sided submandibular haematoma developed during the immediate postoperative period. After removal of the clot, there was a persistent, low volume capillary ooze from the left submandibular fossa and a calcium alginate fibre pack (Kaltostat) was left in place to control the bleeding. After an extended period of time the pack excited a foreign body reaction which, on a computed tomogram, mimicked a recurrence of the tumour. We review the role of Kaltostat in this setting and its potential for foreign body reaction, which may mimic serious disease.
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