A histopathologic study of benign and malignant lymphoepithelial lesions of the parotid gland

Nagao, Kōichi; Matsuzaki, Osamu; Saiga, Hajime; Akikusa, Bunshiro; Sugano, Isamu; Shigematsu, Hidekazu; Kaneko, Toshio; Katoh, Takayuki; Kitamura, Τakeshi; Asano, Yoshinori; Okamoto, Makoto

doi:10.1002/1097-0142(19830915)52:6<1044::aid-cncr2820520620>3.0.co;2-r

Cited by 37 publications

(4 citation statements)

References 14 publications

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“…A stromal desmoplastic reaction may be focally noted, but is not usually a prominent finding. Tumor cell spindling may be prominent, and when present brings to mind basal cell adenoma/adenocarcinoma and myoepithelial carcinoma [5,8,31,47,48]. However, none of these other tumors are reactive with nuclear EBER by ISH [8,9,25,28,47].…”

Section: Discussionmentioning

confidence: 99%

Lymphoepithelial Carcinoma of Salivary Gland EBV-association in Endemic versus Non-Endemic Patients: A Report of 16 Cases

Whaley

Carlos²,

Bishop

et al. 2020

Head and Neck Pathol

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Lymphoepithelial carcinoma of salivary glands (LECSG) are rare neoplasms, reported in endemic populations (southeastern Chinese) with a strong Epstein-Barr virus (EBV) association. A retrospective series comparing EBV status within an ethnically diverse population (endemic vs. non-endemic patients) has not been reported. Sixteen LECSG were equally distributed between males (n = 8) and females (n = 8) with a median age of 54 years (range 18 to 85 years) at initial diagnosis. Ten patients were white, 4 Asian, and 2 black. The patients typically presented with swelling or mass for an average of 11.6 months. Tumors affected only major salivary glands: parotid (n = 13); submandibular (n = 3). Tumors were an average of 2.9 cm (range 1.5 to 5.8 cm). Nine of 16 (56%) patients had cervical lymph node metastases at presentation. No patients had nasopharyngeal or oropharyngeal tumors. Microscopically, the tumors were widely infiltrative, characterized by large polygonal to spindled cells arranged in a syncytial, lattice-like network in a background of lymphoplasmacytic cells. The neoplastic cells showed an open-vesicular nuclear chromatin to a more basaloid-morphology, the latter showing hyperchromatic nuclei and less cytoplasm, while nearly all of the cases had associated lymphoepithelial lesions/sialadenitis. By in situ hybridization, 8 of 16 cases had a strong, diffuse EBER expression (4 of 4 Asians; 4 of 12 non-Asians), while with immunohistochemistry all cases tested were pan-cytokeratin, CK5/6 and p63 reactive; none of the cases tested were p16 reactive. All patients were managed with wide or radical excision, 4 with concurrent chemoradiation, and 6 with radiation alone. Distant metastasis (lung, brain, and bone) developed in 2 patients. Overall follow-up (mean 3.8 years) revealed 12 patients alive and 2 dead, none with evidence of disease (mean 4.3 years); one white male alive with disease at 1.9 years, and one Asian female dead of disease at 4.2 years; both of these latter patients had Group IV stage disease. High stage (Group IV) patients had a shorter mean survival than lower stage patients: 3.1 versus 4.8 years, respectively. In conclusion, LECSG are uncommon primary neoplasms. Concurrent lymphoepithelial lesions may help suggest a primary tumor. The tumors, irrespective of race or ethnicity, may express EBER. There is an overall good survival, perhaps better for EBV-negative patients and for those with lower stage disease.

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Section: Discussionmentioning

confidence: 99%

Lymphoepithelial Carcinoma of Salivary Gland EBV-association in Endemic versus Non-Endemic Patients: A Report of 16 Cases

Whaley

Carlos²,

Bishop

et al. 2020

Head and Neck Pathol

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“…Several reports have demonstrated the occurrence of myoepithelial islands in biopsy specimens of the parotid glands that also contained lymphoma; therefore, the occurrence of myoepithelial islands can no longer be taken as definitive evidence for the "benign" condition of a biopsy sample (57)(58)(59). Persistent major salivary gland swelling also may result from adenoma or carcinomas (Table 2).…”

Section: Differential Diagnosis Of Enlarged Major Salivary Glandsmentioning

confidence: 99%

“…Although the histologic appearance of these lesions is similar to that found in SS patients, these individuals lack clinical features of oral and/or ocular dryness. Batsakis (12) and Nagao et a1 (57) have suggested that these lesions be termed "benign lymphoepithelial lesions," to contrast these patients with SS patients, in whom KCS and other systemic autoimmune characteristics are present. Finally, metabolic disorders, including alcoholism, malnutrition, pancreatitis, and ingestion of particular foods (12,3 I), might also lead to chronic major salivary gland swelling due to hypertrophy of ductal/acinar elements (31).…”

Section: Differential Diagnosis Of Enlarged Major Salivary Glandsmentioning

confidence: 99%

Sjögren's syndrome. Proposed criteria for classification

Fox¹,

Robinson²,

Curd³

et al. 1986

Arthritis & Rheumatism

617

230

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The term “Sjögren's syndrome” (SS) is frequently used to describe the occurrence of keratocon‐junctivis sicca and xerostomia in association with an autoimmune disorder. However, well‐defined criteria for the classification of SS have not been established, and this diagnosis is being applied to a wide spectrum of conditions, ranging from clear “autoimmune” disease in some patients, to sicca complaints without evidence of a systemic immune process in elderly patients. Here, we review the clinical and laboratory features of patients referred for evaluation of sicca symptoms. In particular, we emphasize the need for care in choosing the site for minor salivary gland biopsy, and we describe the histologic features that aid in the evaluation of these biopsy specimens. In an attempt to identify a population of patients whose conditions might have a common etiopathogenesis and, thus, a common treatment program, we propose the following criteria for a diagnosis of SS: 1) objective evidence of keratoconjunctivis sicca, as documented by rose bengal or fluorescein dye staining; 2) objective evidence of diminished salivary gland flow; 3) minor salivary gland biopsy, obtained through normal mucosa, with the specimen containing at least 4 evaluable salivary gland lobules, and having an average of at least 2 foci/4 mm2; 4) evidence of a systemic autoimmune process, as manifested by the presence of autoantibodies, such as rheumatoid factor and/or anti‐nuclear antibody. The diagnosis of “definite SS” would be made when all 4 criteria are met; the diagnosis of “possible SS” would be made when 3 criteria are present. Specific exclusions for this diagnosis are preexisting lymphoma, graft‐versus‐host disease, sarcoidosis, and acquired immunodeficiency disease. These proposed criteria are more restrictive than are those currently used for diagnosing SS. Future multicenter trials will be required to determine whether these criteria are generally useful. Finally, we emphasize the rheumatologist's role in selecting safe, inexpensive methods of objectively monitoring sicca complaints (i.e., kerato‐conjunctivitis sicca and parotid salivary flow) and in evaluating the results of minor salivary gland biopsy.

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“…The benign lymphoepithelial lesion (BLL) coined by GODWIN (1) is a histopathologic entity characterized by atrophy of salivary gland parenchyma and lymphocytic infiltration with islands of epithelial and myoepithelial cells (epimyoepithelial islands) replacing the intralobular ducts (2). This lesion is found mostly in association with Sjogren's syndrome (SS), however, occasionally seen as a localized salivary gland lesion in patients who do not have an autoimmune disease (3,4),…”

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confidence: 99%

Benign lymphoepithelial lesion with large cysts: case report

Hong

Ogawa

Yagi

et al. 1990

J Oral Pathology Medicine

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A case of benign lymphoepithelial lesion with two large cysts and many foci of duct dilatation is reported. Clinical features, except for absence of dry eyes, indicated the case was Sjögren's syndrome. The cysts were found in the left parotid gland of a 60-yr-old woman and were surgically removed. The size of each cyst was 20 mm in diameter and one of them was located in the lymph node. Because of the HLA-DR expression by the epithelium, the cysts are considered to have formed as a result of duct dilatation due to autoimmune response. As for one cyst, it is also possible that the pre-existing lymphoepithelial cyst might be involved in the autoimmune phenomenon because of its relation to the lymph node.

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A histopathologic study of benign and malignant lymphoepithelial lesions of the parotid gland

Cited by 37 publications

References 14 publications

Lymphoepithelial Carcinoma of Salivary Gland EBV-association in Endemic versus Non-Endemic Patients: A Report of 16 Cases

Lymphoepithelial Carcinoma of Salivary Gland EBV-association in Endemic versus Non-Endemic Patients: A Report of 16 Cases

Sjögren's syndrome. Proposed criteria for classification

Benign lymphoepithelial lesion with large cysts: case report

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