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Background: The diagnosis and management of salivary gland tumors in pediatric patients can be challenging. The utility of fine-needle aspiration (FNA) cytopathology and the performance of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in this age group have not been systematically assessed. The paucity of data has contributed to the controversial role of FNA cytopathology in the presurgical management of these patients., Methods: The authors retrospectively analyzed 104 pediatric salivary gland FNAs (2000-2020). A correlation with the available histopathologic follow-up (n = 54) was performed. The distribution percentages, the risk of neoplasm (RON), and the risk of malignancy (ROM) were assessed for each category of the MSRSGC., Results: The overall sensitivity, specificity, negative predictive value, and positive predictive value of pediatric salivary gland FNAs were 80%, 97%, and 92%, respectively. The RON values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories were 60%, 11%, 100%, 100%, 100%, 100%, and 100%, respectively, whereas the ROM values were 0%, 11%, 100%, 6%, 67%, 100%, and 100%, respectively. The percentage of nonneoplastic FNAs was greater in comparison with the adult population (52% vs 8%). All neoplasms in patients aged 0 to 10 years were malignant, whereas benign neoplasms occurred only in patients aged ≥11 years; this supported an inverse correlation between age and malignancy rate in salivary gland neoplasms., Conclusions: FNA cytopathology demonstrates excellent diagnostic performance in differentiating malignant and benign pediatric salivary gland lesions. The MSRSGC is a valuable tool for standardization of the reporting and preoperative risk stratification of these lesions., (© 2021 American Cancer Society.)

Abstract: A variety of tumors can develop in the salivary glands. The aim of this retrospective study was to describe the demographic characteristics of salivary gland tumors (SGT) in the population of a large area of the city of Rome, ASL RM1, over a 4-year period and compare these data with other epidemiological studies. Forty-nine cases were diagnosed as SGT; 63.2% were males and 32.6% were females. The mean age range was 62.13 years. Forty SGT (81.6%) were benign and 9 (18.4%) were malignant. Among benign tumors, Warthin' s tumor was the most common tumor, comprising 55.1% all SGTs followed by Pleomorphic Adenoma and other less common types. Among malignant tumors, Non-Hodgkin lymphoma was the most frequent type. The results of this study suggest that benign tumors are most common in parotid gland and are mainly represented by Warthin's Tumor. Males are the most affected, especially for benign lesions. Regarding malignant tumors, the incidence by gender is variable, as the incidence of several types worldwide. The findings of this study contribute to the knowledge regarding the incidence of SGT.

Background: Distant metastases in adenoid cystic carcinoma (ACC) are common. There is no consensus on the management of metastatic disease because no therapeutic approach has demonstrated improvement in overall survival (OS) and because of prolonged life expectancy. The aim of this study is to build and validate a prognostic nomogram for metastatic ACC patients., Methods: The study end-point was OS, measured from the date of first metastatic presentation to death/last follow-up. A retrospective analysis including metastatic ACC patients was performed to build the prognostic nomogram at the INT (Milan, Italy). The model was validated on an independent cohort of patients with similar characteristics treated at Leuven (Belgium). Outcome data and covariates were modelled by resorting to a random forest method. This machine-learning approach was used to guide and benchmark the subsequent use of more conventional modelling methods. Cox model performance was assessed in terms of discrimination (Harrell's c-index)., Results: Two hundred ninety-eight patients with metastatic ACC (testing set 259 INT, validation set 39 Leuven) were studied. Akaike Information Criterion-based backward selection yielded a 5-factor model showing a bias-corrected c-index of 0.730. Five independent prognostic factors were found: gender, disease-free interval and presence of lung, liver or bone metastases. Nomogram discrimination in the validation series was c = 0.701., Conclusion: This retrospective analysis allowed the building of an externally validated prognostic nomogram. This tool might help clinicians to discriminate patients requiring prompt management from who can benefit from a 'watchful waiting'. In addition, the nomogram might be useful to stratify patients in clinical trials., Competing Interests: Conflict of interest statement L.D.L. declares grant and other financial relationship with Biogen, Eisai, Ipsen, Lilly, Merck Serono, MSD and BMS. P.B. is on advisory board of Merck, Sanofi, Merck Sharp & Dohme, Sun Pharma, Angelini, AstraZeneca, Bristol-Myers Squibb, Helsinn and received conference honoraria from Bristol-Myers Squibb, Kyowa Hakko Kirin, Angelini, Sanofi, Roche, GSK. L.L. has received funding (for her Institution) for clinical studies and research from AstraZeneca, Boehringer Ingelheim, Eisai, Merck Serono, MSD, Novartis and Roche; has received compensation for service as a consultant/advisor and/or for lectures from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Debiopharm, Eisai, Merck Serono, MSD, Novartis, Roche and Sobi and she has received travel coverage for medical meetings from Bayer, Bristol-Myers Squibb, Debiopharm, Merck Serono, MSD and Sobi. The remaining authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Necrotizing sialometaplasia (NS) is an uncommon benign process which affects minor and, more rarely, major salivary glands. While self-limiting, the condition might be clinically and histologically mistaken for malignancy. Furthermore, NS may accompany neoplasms. The aim of this paper was to report a series of Italian patients affected by NS associated with an unusual high presence of neoplasms of minor and major salivary glands., Study Design: Clinical and histological features of twelve patients with NS were retrospectively evaluated., Results: Eight patients presented NS of the minor salivary glands of the palate, and two of them had associated neoplasms (pleomorphic adenoma and adenoid cystic carcinoma) at the same site. Four patients had NS of the parotid gland associated with a history of fine-needle aspiration biopsy performed to diagnose parotid neoplasms. These were epithelial-myoepithelial carcinoma, adenoid cystic carcinoma, Warthin's tumor, and oncocytoma, respectively., Conclusion: Tumors of minor and major salivary glands might be associated with NS more frequently than previously reported. While NS of the parotid is generally the result of invasive diagnostic procedure and is detected after the excision of the tumor, NS of the minor salivary glands may obscure an underlying neoplasm, resulting in delays in referral or treatment., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Objective: Basal cell adenoma (BCA) is an uncommon benign epithelial neoplasm of salivary glands, which was first described by Kleinsasser and Klein in 1967 and which derives its name from the monomorphic basaloid appearance of tumor cells. This tumor represents 1-2% of all salivary gland epithelial tumors; the most common site of occurrence is the parotid gland. It usually arises in adults over 50 years of age with slight female prevalence., Study Design: We analyzed 5 cases of parotid lesions investigated by fine needle aspiration cytology at a single institution between 2002 and 2018., Results: Our series was composed by 3 women and 2 men with a mean age of 62 years. The most important cytological criteria we observed were cohesive sharp-angled clusters of regular basaloid cells, palisaded by p63-positive myoepi-thelial cells, and bordered by basement membrane-like hyaline membrane in the absence of a myxochondroid stroma. Overall features were consistent with the diagnosis of BCA., Conclusions: Our aim is to highlight the cytological features of these rare lesions improving the awareness of cytological pitfalls of salivary gland basaloid neoplasms. Moreover, the goal of this paper is to add to the literature 5 additional cases of these unusual tumors., (© 2018 S. Karger AG, Basel.)

We present a retrospective multicentric study of 67 patients with adenoid cystic carcinomas of the intraoral minor salivary glands, who were diagnosed and treated between 1986 and 2004 in the Operative Units of Maxillofacial Surgery of the University of Parma and of the Bellaria Hospital in Bologna. There were 28 males and 39 females with a mean age of 54.5 years (range 28-84 years). The palate was the most common site of involvement, with 71.6% of cases. All the patients were treated with surgery as the primary modality. Neck dissection was performed in 9% of the patients, and more than half (59.7%) were treated with adjuvant radiation therapy. All surviving patients had a minimum of 2 years follow-up, with a range of 2-20 years (median: 12 years). Of the 67 patients examined in this study, 19 were dead at the end of the follow-up, 16 of them due to tumor disease. Distant or loco-regional recurrence was documented in 29 of the 67 patients (43.3%). Disease-free intervals ranged from 1 month to 12 years. Twenty-two percent of patients had loco-regional failure, whereas 29.8% had distant metastases. The disease specific survival rates were 76.1% at 5 years and 74% at 10 and 15 years.The actuarial loco-regional control rates at 5-, 10- and 15-years were 79.7%, 74.8% and 70%, respectively. The actuarial freedom from distant relapse was 76.5% at 5 years, 64.9% at 10 years and 61.1% at 15 years. Stage T, cervical lymph node metastasis and surgical margin status proved to make a statistically significant contribution when describing the outcome.

Background: Epithelial salivary gland tumors are very uncommon in pediatric age. We report a series of 52 cases treated at the Istituto Nazionale Tumori of Milan, Italy, over a 30-year period. These results are presented in conjunction with a literature review of salivary tumors with a view to providing an up-to-date overview of the clinical course, prognosis, and treatment options for this rare tumor., Procedure: Fifty-two cases of epithelial salivary tumors were reviewed and the clinical-pathological information concerning tumor characteristics, therapy, and follow-up were collected. Patients' age ranged between 4 and 18 years., Results: The major salivary glands were the main site of tumor occurrence (79% of cases arose in parotid glands); 37 patients had benign tumors (pleomorphic adenoma), 15 had malignant tumors (12 mucoepidermoid carcinoma, 9 low grade). All the patients were treated by surgery; local relapses after parotidectomy were 4% and 25%, in benign and malignant tumors, respectively. When tumor enucleation was performed, recurrences occurred in 50% of benign neoplasms. At the time of the report, all patients with benign tumors were alive, 35(95%) without evidence of disease; only one patient with malignant tumor died of disease., Conclusions: Epithelial salivary glands tumor in children had different characteristics compared with their adult counterpart with respect to the frequency of histotypes and site of occurrence, but their prognosis seems to be similar. Parotidectomy (total or superficial) is the best choice for achieving good cure rates in both benign and malignant tumors., ((c) 2006 Wiley-Liss, Inc.)

Background: Mucoepidermoid carcinoma (MEC) can have a variety of clinical outcomes, but prognosis seems to be related to the tumor grade. The system proposed by Auclair and Goode is useful, and our data lend further support to its application and validity in clinical practice., Methods: We have clinicopathologically reviewed 108 cases of MEC originating in major (MASG) and minor (MISG) salivary glands that were treated at the National Cancer Institute of Milan between 1975 and 1995. Following the methods of Auclair and Goode, a quantitative grading system was used. The relationships between clinical and pathologic characteristics and survival rate were investigated., Results: Twenty-six (44%) cases located in MASG and 19 (39%) cases in MISG were categorized as high-grade tumors. In patients with MASG tumors, the 5-year disease-free survival rate was 22.5% when the tumor was high grade and 97.0% if the tumor was low grade (P <.0001). For patients with a tumor of the MISG, the percentages were 35.3% for high-grade and 80.0% for low-grade tumors (P =.0066)., Conclusions: Our study confirms that in MEC, tumor grade, subdividing cases into low and high grade by using the criteria delineated by Auclair and Goode, correlates well with prognosis.

Purpose: Fine-needle aspiration biopsy (FNAB) is frequently used in the diagnosis of lesions occurring in the head and neck region. This study evaluated the correlation between the findings on FNAB and the histological findings observed after surgery., Materials and Methods: A review of 218 patients who underwent FNAB of a head or neck tumor was performed. Cytological reports were classified into the following diagnostic categories: negative or positive for malignant cells and unsatisfactory. False-positive, false-negative, true-positive (sensitivity), and true-negative (specificity) rates were calculated., Results: Twelve specimens did not allow an adequate diagnosis (5.5%). Among benign tumors, 96.2% of the cases were correctly diagnosed, and 3.8% were nondiagnostic specimens. Among malignant tumors, 86.4% of cases were correctly identified. There were two (3.4%) false-negatives and six (10.2%) nondiagnostic specimens, with a total false-negative rate of 13.6%., Conclusions: Sampling errors present a minor problem with FNAB. Most nondiagnostic or incorrect specimens were caused by nonhomogenous lesions, with poor placement of the needle and an insufficient amount of aspirated material. FNAB is a useful modality for the diagnosis of head and neck masses.

A series of 76 cases of adenolymphoma (Warthin's tumor) of the salivary glands is presented with emphasis on its epidemiological, clinico-pathological and therapeutic features; together with the analysis of the clinical records and of the epidemiological data, this study has reevaluated the histopathological features of the 76 cases of Warthin's tumor on hematoxylin-eosin stained slides. On these bases, the authors underline the frequent multifocality and/or bilaterality of Warthin's tumor (11.3% of cases), its frequent association with tumors of other sites (11.3% of cases), the prevalence in males (M:F ratio = 24:1) and in adults (mean age: 57 years) of this type of tumor. Furthermore, this study confirms the parotid gland as the elective site for Warthin's tumor and the possibility to categorize this entity into four different histological types. The latter finding should be kept in mind especially when fine needle aspiration (FNA) is used as a preoperative diagnostic procedure for Warthin's tumor to avoid misleading diagnosis and overtreatment. From the analysis of the results the authors underline the need for a complex and multidisciplinary approach to the diagnosis of Warthin's tumor in order to allow conservative surgery with preservation of the facial nerve.

Mucoepidermoid carcinomas (MEC) make up 32% of the heterogeneous cases of malignant epithelial neoplasm of salivary glands observed in our Department. From 1980 to 1990, 270 patients with salivary gland tumefaction, which had previously been treated surgically, were studies. Thirty-four proved to be cases of malignant epithelial neoplasms while 12 oh these 34 were MEC. The biological behaviour of MEC appears to be closely linked to histological grading: a tumor with a low grading has good prognosis while in the case of tumors with a high grading there is a rapid development of local as well as distant metastases. At appears that, with regard to malignancy, localization is an important factors as well submandibular neoplasms are more aggressive the other cancers, probably because they attack periglandular tissue so promptly.

292 cases of salivary gland diseases have been observed and treated at the Oral and Maxillo-Facial Surgery Department of the Faculty of Medicine II Naples University. The statistical results concerning age, sex, localization, histological characteristics and therapy are analysed and compared with other references.

Three-hundred-ninety-two cases of salivary gland cancer observed at Turin University Dental and Ear, Nose and Throat Clinics have been examined. Statistical analysis of the age and sex of patients shows the importance of selecting the statistical population and of its origin for the purpose of reliable statistical study, examining the whole set and its structural breakdown in the two Clinics.

The authors carried out a histopathological and epidemiological study on 151 cases of primary and secondary neoplasms of the salivary glands. The parotid gland was involved in 117 cases (78.5%). The tumours were malignant in 20% (30 cases) of the lesions. The most common neoplasms were pleomorphic adenoma (74 cases) and adenolymphoma (35 cases). The occurrence of the latter were, for both sexes, directly correlated to the age of the subjects. The malignant neoplasms were also in direct relation to age. In 7 patients pleomorphic adenoma recurred (11.3%) and in 3 of these the tumour showed a carcinomatous change. The world standardized incidence of malignant forms in the province of Trieste was slightly lower than that for other countries with a similar socio-economic and demographic situation.

479 cases of tumors of salivary glands were examined at the Institute of Surgical Pathology of the University of Padua during the years 1973-1986; all these were reviewed. The diagnosis of individual tumors was based on the World Health Organization classification. Tumors were analyzed considering the histological type, sex, age and site. Primary tumors of epithelial origin were 91.8%. The principal site was the parotid (78.1%) while the submandibular gland forms the second largest group (14.57%). The malignant forms increase with age and were more common in submandibular and sublingual glands than the parotid. Connective tissue tumors were rare; 50% were hemangiomas that occur in children and young people; the only malignant neoplasias of soft tissue were 2 cases of rhabdomyosarcoma.