Clinical records Malignant oncocytic tumour of the parotid salivary gland By GEORGE LEVENTON, DAVID R. KATZ, and C. DAVID BELL

(Tel-Hashomer, Israel) tumours of the major salivary glands aie unusual (Blanck et al., 1970; Eneroth, 1965 and 1971; Foote and Frazell, 1954). Most of the reported cases have been tumours excised from the minor salivary glands of the nasopharynx (Cohen and Batsakis, 1968) and hard palate (Briggs and Evans, 1967). Proven malignant oncocytic tumours are even more exceptional. Recently Fayemi and Toker (1974) collected four cases of malignant oncocytoma and added one of their own. Our case is an example of this rare tumour which developed in a patient nine years after a benign pleomorphic adenoma had been removed from the same parotid gland. ONCOCYTIC

Report of a case A 49-year-old man presented with swelling in the right parotid region which had gradually increased in size over a period of 9 months. Significant past history was that a benign pleomorphic adenoma had been removed from the parotid salivary gland on the same side 9 years earlier in another country. This tumour had been present for 5 years prior to excision. On examination, a firm, localized, fixed mass approximately 3 X 5 cm. in diameter was palpated in the upper central portion of the parotid gland on the right side. Many smaller masses were palpable in the area of the submaxillary gland and in the neck, both along the length of the jugular vein and in the posterior triangle. Radical neck dissection was performed and the parotid gland, including the deep and superficial portions, the submaxillary gland, the sternocleidomastoid muscle, the jugular vein, and adjacent lymph nodes and tissues were removed. The post operative course was uneventful and the patient well and free of tumour two and one-half years after surgery. He then (October, 1974) presented with a tumour mass just below the mastoid, 3 centimeters in diameter, which was completely excised. Pathologic finding 1. Partial right parotidectomy (1963). (Provided by Professor Nordmann, Hanover, West Germany). Histology (Fig. 1) showed tumour tissue composed of round or spindleshaped cells with lightly eosinophilic cytoplasm. The cells were arranged in acini, groups and strands, separated by a stroma which is fibrous, hyaline and in places, myxoid. No mitotic figures or cellular atypia was seen and there were no oncocytic cells. The diagnosis was that of pleomorphic adenoma (benign mixed tumour). 289

George Leventon, David R. Katz and C. David Bell 2. Parotidectomy and block dissection of right side of neck (July, 1972). (a) Mass in the right parotid gland.—The specimen consisted of a tumour and a thin layer of surrounding adipose tissue. Cells were large, round or polygonal with abundant granular eosinophilic cytoplasm. Few of these cells were vacuolated (the vacuoles were PAS negative.) Some nuclei were vesicular with large nucleoli varying in size and shape, while other nuclei were small and dense with a 'pyknotic' appearance. Acinar structures of double-layered epithelium were occasionally found in the midst of the tumour tissue and may represent surviving intralobular ducts (Fig. 2). The diagnosis is that of an oncocytoma.

FIG. 1. Benign pleomorphic adenoma of right parotid salivary gland excised in 1963. (H-E Xno).

(b) Residual parotid gland with radical neck dissection of superficial muscles, veins, and lymph nodes.—Histology (Fig. 3) showed parotid gland acini with foci of invading tumour cells, similar in appearance to those described in the preceding specimen. Variation in size and shape of nuclei was more obvious and mitotic figures were frequent. Most of the lymph nodes found in the neck dissection were replaced by tumour (Fig. 4). These metastatic deposits were also characterized by cellular atypia with frequent mitoses. The submaxillary salivary gland, muscles and soft tissues showed no tumour invasion. No tumour with features of pleomorphic adenoma was found in the salivary glands. 2. Mass excised mastoid region (Novembei, 1974).—Lymph node metastases were again confirmed and there was infiltration of surrounding tissue. 290

Clinical records

FIG. 2. Biopsy of right parotid, 1972. Oncocytic tumour cells with acinar structure. (H-E X450).

FIG. 3. Right parotidectomy, 1972. Infiltration of tumour cells surrounding interlobular duct. (H-E

XIIO).

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George Leventon, David R. Katz and C. David Bell

FIG. 4. Lymphnode metastasis, neck dissection, 1972. (H-E X160).

Discussion Benign oncocytic tumours of major salivary glands and of other secretory organs are an unusual group of neoplasms. Malignant oncocytic tumours of major and minor salivary glands are even more uncommon and possibly represent malignant transformation of oncocytic cells sometimes seen in secretory organs (Hamperl, 1950, 1962; Bauer and Bauer, 1953). Benign hyperplasia of oncocytic cells in salivary glands and other organs is more frequent with increasing age (Meza-Chavez, 1949). A possible theory of their origin is that these oncocytic cells represent a 'degenerate clone' of secretory cells (Hamperl, 1962, Tandler, 1966). Biochemical studies have shown a defect in function of these 'giant mitochondria' in the form of loose coupling of oxidative phosphorylation (Askew et al., 1971; Hiibner et al., 1967. It is difficult to support this theory here because the patient is younger than expected and no foci of hyperplastic oncocytic cells were seen in his parotid gland. A few reports have been published of pleomorphic adenoma (benign mixed tumour) eithei coexisting with benign oncocytic tumours in the same salivary gland, or being followed by the development of an oncocytic tumour in the same salivary gland a number of years after the first tumour had been excised (Greenberg and Haley, 1957; Eneroth, 1965). Our patient differs in that the oncocytic tumour was malignant following the excision of the benign tumour. 292

Clinical records Summary A 49-year-old man developed a tumour mass in his right parotid salivary gland nine years after a histologically proven benign mixed tumour of the same salivary gland had been surgically removed. Radical resection of the right parotid salivary gland and associated lymph nodes and soft tissues of the neck was performed. The parotid tumour was composed of oncocytic cells which infiltrated the surviving salivary gland tissue. Most of the excised lymph nodes contained metastatic deposits of oncocytic cells identical to the tumour seen in the pai otid. There are no previous reports of the occurrence of both pleomorphic adenoma and malignant oncocytoma in the same salivary gland. Acknowledgement The authors express their gratitude to Professor Doctor Nordmann of Hanover, Germany, foi kindly providing us with the histology of the first tumour. ASKEW,

J. B.,

JR., FECHNER,

BIBLIOGRAPHY R. E., BENTINCK, D. D., and

JENSON,

A. B. (1971)

Archives of Otolaryngology, 93, 46. BAUER, W. H., and BAUER, J. D. (1953) Archives of Pathology, 55, 328. BLANCK, C , ENEROTH, C. M., JAKOBSSON, P. A. (1970) Cancer, 25, 919. BRIGGS, J., and EVANS, J. N. G. (1967) OralSurgery, 23, 796. COHEN, M. A., and BATSAKIS, J. G. (1968) Archives of Otolaryngology, 88, 71.

ENEROTH, C. M. (1965) Journal of Laryngology and Otology, 79,1064. ENEROTH, C. M. (1971) Cancer, 27, 1415. FAYEMI, A. O., and TOKER, C. (1974) Archives of Otolaryngology, 99, 375. FOOTE, F. W. J R . , and FRAZELL, E. L. (1954) Section IV, Fascicle 11, Atlas of

Tumour Pathology; Armed Forces Institute of Pathology, Washington, D.C., pp. 131. GREENBERG, S. D., and HALEY, M. D. (1957) American Journal of Clinical Pathology, 27, 321. HAMPERL, H. (1950) Archives of Pathology, 49, 563. HAMPERL, H. (1962) Virchow Archives of Pathology and Anatomy, 335,452. HAMPERL, H. (1962) Cancer, 15, 1019. HUBNER, G., PAULUSSEN, F., and KLEINSASSER, O. (1967) Virchow Archives of

Pathology and Anatomy, 343, 34. MEZA-CHAVEZ, L. (1949) American Journal of Pathology, 25,532. TANDLER, B. (1966) Virchow Archives of Pathology and Anatomy, 341, 317. Department of Otolaryngology, The Chaim Sheba Medical Centre, Tel-Hashomer, Israel.

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Malignant oncocytic tumour of the parotid salivary gland.

Clinical records Malignant oncocytic tumour of the parotid salivary gland By GEORGE LEVENTON, DAVID R. KATZ, and C. DAVID BELL (Tel-Hashomer, Israel)...
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