臺灣博碩士論文加值系統

背景: 腭是口內小唾液腺腫瘤最好發的位置。本研究的主要目的探討一系列 133
個良性及惡性腭小唾液腺腫瘤的臨床及病理特徵。 <br>
方法: 本研究的 133 個良性及惡性腭小唾液腺腫瘤，收集自國立台灣大學附屬醫院病理部門，從 1993 年 1 月到 2009 年 12 月期間的病例。此 133 個腭小唾液腺腫瘤的臨床病理特徵與相互關係被分析且報告。<br>
結果: 本研究共包涵 78 個良性 (58.6%) 與 55 個惡性 (41.4%) 腭小唾液腺腫瘤。其中多形性腺瘤 (pleomorphic adenoma) 佔 74 例，黏液表皮樣癌 (mucoepidermoid carcinoma) 佔 26 例，腺樣囊狀癌 (adenoid cystic carcinoma) 佔18 例 ，此三者包括所有腫瘤的 89%。多形性腺瘤明顯好發於女性患者 (女男比為 2: 1) 且平均年齡為 47 歲。74 例多形性腺瘤中，古典型有 47 例，細胞型有27 例；12 例有完整被膜 (capsule)，40 例有部分被膜，22 例無被膜。漿細胞樣肌上皮細胞、亮細胞、鱗狀上皮細胞巢、角質珠、透明基質、骨基質樣區域、軟骨樣區域各可發現於 50, 19, 29, 19, 49, 8 及 6 個病例。黏液表皮樣癌患者同樣明顯好發於女性患者 (女男比為 2.7: 1) 且其平均年齡為 43 歲。大多數的黏液表皮
樣癌患者 (69%)其腫瘤大小是 T1 或 T2 且分級上屬 stage 1 或 stage 2。於 26 個黏液表皮樣癌患者中，只有一個病例有局部淋巴結轉移，一個病例出現遠處轉移，及一個病例在治療後發生局部復發。更甚者，其中一個黏液表皮樣癌患者在治療一年後死亡。因此，黏液表皮樣癌患者的 2 年、5 年與 10 年的存活率都是 96%。組織學上，13 個黏液表皮樣癌為低惡性度 (low-grade)，4 黏液表皮樣癌是中惡性度 (intermediate-grade)，而 9 個黏液表皮樣癌是高惡性度 (high-grade) 腫瘤。神經周侵犯在 2 個黏液表皮樣癌中發現。高惡性度黏液表皮樣癌通常發生在
較年長的病人 (> 50 歲)，而低惡性度黏液表皮樣癌通常發生在較年輕的患者 (≦
50 歲, P = 0.046)。反之，腺樣囊狀癌稍微好發於男性患者 (男女比為 1:0.8)， 且
平均年齡為 54 歲。三分之二的腺樣囊狀癌患者於最初發現時已為 T4 和 stage 4。再者，7 個腺樣囊狀癌患者有遠處轉移，但只有 2 個腺樣囊狀癌患者有局部淋巴結轉移。經過治療後，有 6 個病例發現局部復發。對於腺樣囊狀癌患者，其 2
年、5 年與 10 年的存活率分別為 100%，72%和 56%。於 18 個腺樣囊狀癌病例中，11 個被診斷為篩狀 (cribriform)，3 個為管狀 (tubular) 而 4 個為實心狀 (solid)腫瘤。13 個腺樣囊狀癌有神經周侵犯。統計分析顯示，當腫瘤為管狀或實心狀時，其腫瘤大小常為 T3 或 T4 (P = 0.057)，分級上常為 stage 3 或 stage 4 (P = 0.057)，其腫瘤較易局部復發 (P = 0.023)，且整體存活率較差 (P = 0.013)。而腺樣囊狀癌一旦伴隨神經周侵犯，其腫瘤大小常為 T3 或 T4 (P = 0.022)，且分類為stage 3 或 stage 4 的腫瘤 (P = 0.022)。而對於大小為 T3 或 T4 (P = 0.038) 且分級
上常為 stage 3 或 stage 4 (P = 0.038)。且 T3 或 T4 及 stage 3 或 stage 4 腺樣囊狀癌較常有遠處轉移。較大的腺樣囊狀癌 (T3 和 T4, P = 0.054) 和後期的腺樣囊狀癌(stage 3 和 stage 4, P = 0.054)，在治療後，較常有局部復發。除此之外，較年長
的腺樣囊狀癌患者 (> 50 歲, P = 0.025) 通常也有較差的整體存活率。<br>
結論：本研究發現，多形性腺瘤為最常見的良性腭小唾液腺腫瘤，而黏液表皮樣
癌和腺樣囊狀癌則是兩個最常見之惡性腭小唾液腺腫瘤。多形性腺瘤和黏液表皮
樣癌都有明顯好發於女性的傾向；相反的，腺樣囊狀癌則稍微好發於男性患者。
腺樣囊狀癌的患者平均年齡，相較於多形性腺瘤和黏液表皮樣癌的患者較為年
長。對腭黏液表皮樣癌的患者，其預後較腭腺樣囊狀癌的患者為佳。三分之二的
腺樣囊狀癌病例，在一開始就顯示出大小為 T4 和分級為 stage 4 的腫瘤。本研究
中，腺樣囊狀癌有較多遠處轉移，較少局部淋巴結轉移。腺樣囊狀癌常表現神經
周侵犯。除此之外，當患者的腺樣囊狀癌為管狀或實心狀，常更有機會發展成較
大的腫瘤，較高的分級，較多的局部復發，及較差的整體存活率。

Abstract
Background: The palate is the most common site for intraoral minor salivary gland
tumors. This study was aimed to present the clinicopathological features of a series of
133 benign and malignant palatal minor salivary gland tumors.

Methods: In this study, 133 benign and malignant palatal minor salivary gland tumors
were retrieved from the files of Department of Pathology, National Taiwan University
Hospital from January, 1993 to December, 2009. The clinicopathological features and
their correlations of these 133 palatal minor salivary gland tumors were analyzed and
reported.

Results: There were 78 (58.6%) benign and 55 (41.4%) malignant minor salivary
gland tumors in the palate. Pleomorphic adenoma (PA, 74 cases), mucoepidermoid
carcinoma (MEC, 26 cases), and adenoid cystic carcinoma (ACC, 18 cases)
constituted 89% of all tumors. PA patients showed a marked female predominance
(2:1) and a mean age of 47 years. Histopathologically, there were 47 classic and 27
cellular PAs. Of the 74 PAs, 12 were completely-encapsulated, 40
partially-encapsulated, and 22 non-encapsulated. Plasmacytoid myoepithelial cell,
clear cell, squamous epithelial nest, keratin pearl, hyalinized stroma, osteoid area, and
chondroid area were found in 50, 19, 29, 19, 49, 8, and 6 PAs, respectively. MEC
patients also demonstrated a significant female predilection (2.7:1) and a mean age of
43 years. The majority of MEC patients had T1 or T2 (69%) and stage 1 or stage 2
tumors (69%) at the initial presentation. Of the 26 MEC patients, only one had
regional lymph node metastasis, one distant metastasis, and one recurrence of the
tumor after treatment. Moreover, only one MEC patient died 1 year after treatment.
Thus, the 2-year, 5-year and 10-year survival rates were all 96% for MEC patients.
Histologically, 13 MECs were classified as low-grade, 4 intermediate-grade, and 9
high-grade tumors. Perineural invasion was noted in 2 MECs. High-grade MECs
occurred commonly in older patients (> 50 years old) and low-grade MECs frequently
affected younger patients (≦ 50 years old, P = 0.046). The ACC patients, however,
revealed a slight male predominance (1:0.8) and a mean age of 54 years. Two-thirds
of ACC patients showed T4 and stage 4 tumors. Moreover, 7 ACC patients had distant
metastases, but only 2 had regional lymph node metastases. Local recurrence was
noted in 6 ACCs after treatment. The 2-year, 5-year and 10-year survival rates were
100%, 72% and 56% for ACC patients, respectively. Of the 18 ACCs, 11 were
classified as cribriform type, 3 tubular type, and 4 solid type. Perineural invasion was
present in 13 ACCs. Statistical analyses showed that patients with tubular or solid
ACCs were more likely to have T3 or T4 tumors (P = 0.057), stage 3 or stage 4
disease (P = 0.057), local recurrence of the tumor (P = 0.023), and poorer overall
survival (P = 0.013). ACCs with perineural invasion were prone to present as T3 or
T4 (P = 0.022) and stage 3 or stage 4 tumors (P = 0.022). Moreover, T3 or T4 (P =
0.038) and stage 3 or stage 4 (P = 0.038) ACCs more frequently showed distant
metastases. Larger ACCs (T3 and T4, P = 0.054) and advanced stage ACCs (stage 3
and stage 4, P = 0.054) were prone to have local recurrence after treatment. In
addition, older ACC patients (> 50 years, P = 0.025) were more frequent to have
poorer overall survival.

Conclusion: We conclude that PA is the most common benign and MEC and ACC are
the two most frequent malignant palatal minor salivary gland tumors. Both PA and
MEC patients have a prominent female predilection, but ACC patients have a slight
male preponderance. The mean age of ACC patients is much older than that of PA or
MEC patients. The prognosis of palatal MEC patients is better than that of palatal
ACC patients. Two-thirds of ACC patients show T4 and stage 4 tumors at the initial
presentation. ACCs are prone to have distant metastases rather than regional lymph
node metastasis. Perineural invasion is frequently present in ACCs. In addition,
patients with tubular or solid ACCs are more likely to have larger tumors, advanced
stages, local recurrence, and poorer overall survival.

中文摘要
8
Abstract
10
Introduction
12
Background
15
Purposes of this study
17
Literature Review
18
Major and minor salivary glands
18
All salivary gland tumors
19
Minor salivary gland tumors
26
Palatal minor salivary gland tumors
38
Pleomorphic adenoma
40
Mucoepidermoid carcinoma
45
Adenoid cystic carcinoma
51
Materials and methods
58
Results
61
Discussion
65
Conclusions
74
References
75
Tables
86
Figures
96

75
References
Adebiyi EK, Ndukwe KC, Ugboko VI, Omoniyi-Esan GO, Oluwafemi OO.
Histopathological study of salivary gland tumours in Ile-Ife, Nigeria. Niger
Postgrad Med J 2011;18:257-61.
Adeyemi BF, Ogun GO, Akang EE. Retrospective analysis of intra-oral salivary gland
tumours in Ibadan, Nigeria. West Afr J Med 2010;29:98-103.
Arotiba GT. Salivary gland neoplasms in Lagos, Nigeria. West Afr J Med
1996;15:11-7.
Auclair PL, Goode RK, Ellis GL. Mucoepidermoid carcinoma of intraoral salivary
glands. Cancer 1992;69:2021-30.
Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization
Classification of Tumors. Pathology & Genetics of Head and Neck Tumors. Lyon:
IARC Press, 2005, p 210.
Batsakis JG, Luna MA. Histopathologic grading of salivary gland neoplasms. I.
Mucoepidermoid carcinomas. Ann Otol Rhinol Laryngol 1990;99:835-8.
Becelli R, Frati R, Cerulli G, Perugini M, Frati A, Lannetti G. Pleomorphic adenoma
of the minor salivary glands of the palate. J Exp Clin Cancer Res 2001;20:25-8.
Beckhardt RN, Weber RS, Zane R, Garden AS, Wolf P, Carrillo R, Luna MA. Minor
salivary gland tumors of the palate: clinical and pathologic correlates of outcome.
Laryngoscope 1995;105:1155-60.
Beltran D, Faquin WC, Gallagher G, August M. Selective immunohistochemical
comparison of polymorphous low-grade adenocarcinoma and adenoid cystic
carcinoma. J Oral Maxillofac Surg 2006;64:415-23.
Bianchi B, Copelli C, Cocchi R, Ferrari S, Pederneschi N, Sesenna E. Adenoid cystic
carcinoma of intraoral minor salivary glands. Oral Oncol 2008;44:1026-31.
Bouquot JE, Kurland LT, Weiland LH. Primary salivary epithelial neoplasms in
Rochester, Minnesota population. J Dent Res 1979;58:419.
Bradley PJ. Adenoid cystic carcinoma of the head and neck: a review. Curr Opin
Otolaryngol Head Neck Surg 2004;12:127-32.
Brandwein MS, Ivanov K, Wallace DI, Hille JJ, Wang B, Fahmy A, Bodian C, Urken
ML, Gnepp DR, Huvos A, Lumerman H, Mills SE. Mucoepidermoid carcinoma:
a clinicopathologic study of 80 patients with special reference to histological
grading. Am J Surg Pathol 2001;25:835-45.

76
Caccamese JF Jr, Ord RA. Paediatric mucoepidermoid carcinoma of the palate. Int J
Oral Maxillofac Surg 2002;31:136-9.
Castro EB, Huvos AG, Strong EW, Foote FW Jr. Tumors of the major salivary glands
in children. Cancer 1972;29:312-7.
Cawson RA, Gleeson MJ, Eveson JW. The pathology and surgery of the salivary
glands. Oxford: ISIS Medical Media. 1997
Chapnik JS. The controversy of Warthin’s tumor. Laryngoscope 1983;93:695-716.
Chau MN, Radden BG. A clinical-pathological study of 53 intra-oral pleomorphic
adenomas. Int J Oral Maxillofac Surg 1989;18:158-62.
Chen JC, Gnepp DR, Bedrossian CWM. Adenoid cystic carcinoma of the salivary
glands: An immunohistiochemical analysis. Oral Surg Oral Med Oral Pathol
1988;65:316-26.
Clode AL, Fonseca I, Santos JR, Soares J. Mucoepidermoid carcinoma of the salivary
glands: a reappraisal of the influence of tumor differentiation on prognosis. J
Surg Oncol 1991;46:100-6.
Coates HL, Devine KD, DeSanto LW, Weiland LH. Glandular tumors of the palate.
Surg Gynecol Obstet 1975;140:589-93.
Conley J, Casler JD. Adenoid Cystic Cancer of the Head and Neck. New York:
Thieme Medical Publishers. 1991.
Conley J, Tinsley PP Jr. Treatment and prognosis of mucoepidermoid carcinoma in
the pediatric age group. Arch Otolaryngol 1985;111:322-4.
Copelli C, Bianchi B, Ferrari S, Ferri A, Sesenna E. Malignant tumors of intraoral
minor salivary glands. Oral Oncol 2008;44:658-63.
Cwalina P, Skorek A, Narozny W, Stankiewicz C. Pleomorphic adenoma of minor
salivary glands. Otolaryngol Pol 2002;56:737-40.
da Cruz Perez DE, de Abreu Alves F, Nobuko Nishimoto I, de Almeida OP, Kowalski
LP. Prognostic factors in head and neck adenoid cystic carcinoma. Oral Oncol
2002;42:139-46.
Daley TD, Gardner DG, Smout MS. Canalicular adenoma: Not a basal cell adenoma.
Oral Surg Oral Med Oral Pathol 1984;57:181-88.
Da-Quan M, Guang-Yan Y. Tumors of the minor salivary glands: a clinicopathologic
study of 243 cases. Acta Otolaryngol 1987;103:325-31.
Darling MR, Schneider JW, Phillips VM. Polymorphous low-grade adenocarcinoma
and adenoid cystic carcinoma: a review and comparison of

77
immunohistiochemical markers. Oral Oncol 2002;38:641-45.
de Oliveira FA, Duarte EC, Taveira CT, Maximo AA, de Aquino EC, Alencar Rde C,
Vencio EF. Salivary gland tumor: a review of 599 cases in a Brazilian population.
Head Neck Pathol 2009;3:271-5.
Dhanuthai K, Boonadulyarat M, Jaengjongdee T, Jiruedee K. A clinico-pathologic
study of 311 intra-oral salivary gland tumors in Thais. J Oral Pathol Med
2009;38:495-500.
Ellis AL, Auclair PL. Benign epithelial neoplasms. In Atlas of Tumor Pathology:
Tumors of the Salivary Glands. Washington, DC: Armed Force Institute of
Pathology, 1996.
Ellis AL, Auclair PL. Malignant epithelial neoplasms. In Atlas of Tumor Pathology:
Tumors of the Salivary Glands. Washington, DC: Armed Force Institute of
Pathology, 1996.
Ellis GL, Auclair PL, Gnepp DR. Surgical pathology of the salivary glands.
Philadelphia: WB Saunders, 1991.
Eneroth CM. Salivary gland tumors in the parotid gland, submandibular gland, and
the palate region. Cancer 1971;27:1415-8.
Evans HL. Mucoepidermoid carcinoma of salivary glands: a study of 69 cases with
special attention to histologic grading. Am J Clin Pathol 1984;81:696-701.
Eveson JW, Cawson RA. Salivary gland tumours. A review of 2410 cases with
particular reference to histiological type, site, age and sex distribution. J Pathol
1985;146:51-58.
Eveson JW, Cawson RA. Tumours of the minor (oropharyngeal) salivary glands: a
demographic study of 336 cases. J Oral Pathol 1985;14:500-9.
Foote FW, Frazell EL. Tumor of the major salivary glands. Cancer 1953;6:1065-113.
Friedrich RE, Li L, Knop J, Giese M, Schmelzle R. Pleomorphic adenoma of the
salivary glands: analysis of 94 patients. Anticancer Res 2005;25:1703-5.
Garden AS, Weber RS, Morrison WH, et al. The influence of positive margins and
nerve invasion in adenoid cystic carcinoma of the head and neck treated with
surgery and radiation. Int J Radiat Oncol Bio Phys 1995;32:619-26.
Gbotolorun OM, Arotiba GT, Effiom OA, Omitola OG. Minor salivary gland tumours
in a Nigerian hospital: a retrospective review of 146 cases. Odonto-Stomatologie
Tropicale 2008;31:17-23.
Goode RK, Auclair PL, Ellis GL. Mucoepidermoid carcinoma of the major salivary

78
glands: clinical and histopathologic analysis of 234 cases with evaluation of
grading criteria. Cancer 1998;82:1217-24.
Guzzo M, Andreola S, Sirizzotti G, Cantu G. .Mucoepidermoid carcinoma of the
salivary glands: clinicopathologic review of 108 patients treated at the National
Cancer Institute of Milan. Ann Surg Oncol 2002;9:688-95.
Hamper K, Lazar F, Dietel M, Caselitz J, Berqer J, Arps H, Falkmer U, Auer G,
Seifert G. Prognostic factors for adenoid cystic carcinoma of the head and neck:
a retrospective evaluation of 96 cases. J Oral Pathol Med 1990;19:101-7.
Hand AR. Salivary gland. In: Nanci A. Ten Cate’s Oral Histology. Development,
structure, and function. 7th Edn. St. Louis: Mosby Elsevier; 2008; 290-318.
Hassmann-Poznańska E, Skotnicka B, Musiatowicz B, Hubert E. Adenoid cystic
carcinoma in the head and neck: clinical and pathologic review. Otolaryngol Pol
1993;47:399-405.
Horiuchi J, Shibuya H, Suzuki S, Takeda M, Takagi M. The role of radiotherapy in the
management of adenoid cystic carcinoma of the head and neck. Int J Radiat
Oncol Biol Phys 1987;13:1135-41.
Hickman RE, Cawson RA, Duffy SW. The prognosis of specific types of salivary
gland tumors. Cancer 1984;54:1620-24.
Hicks J, Flaitz C. Mucoepidermoid carcinoma of salivary glands in children and
adolescents: assessment of proliferation markers. Oral Oncol 2000;36:454-60.
Holst VA, Marshall CE, Moskaluk CA, Frierson HF Jr. Kit protein expression and
analysis of c-kit gene mutation in adenoid cystic carcinoma. Mod Pathol
1999;12:596-60.
Hyam DM, Veness MJ, Morgan GJ. Minor salivary gland carcinoma involving the
oral cavity or oropharynx. Aust Dent J 2004;49:16-9.
Ito FA, Ito K, Vargas PA, de Almeida OP, Lopes MA. Salivary gland tumors in a
Brazilian population: a retrospective study of 496 cases. Int J Oral Maxillofac
Surg 2005;34:533-6.
Jaafari-Ashkavandi Z, Ashraf MJ, Afandak N. A clinico-pathologic study of 82
intraoral minor salivary gland tumors. Iran Red Crescent Med J 2011;13:674-7.
Jaber MA. Intraoral minor salivary gland tumors: a review of 75 cases in a Libyan
population. Int J Oral MaxillofacSurg 2006;35:150-4.
Jones AS, Hamilton JW, Rowley H, Husband D, Helliwell TR. Adenoid cystic
carcinoma of the head and neck. Clin Otolaryngol 1997;22:434-43.

79
Jorge J, Pires FR, Alves FA, Perez DE, Kowalski LP, Lopes MA, Almeila OP.
Juvenile intraoral pleomorphic adenoma: report of five cases and review of the
literature. Int J Oral Maxillofac Surg 2002;31:273-5.
Kakarala K, Bhattacharyya N. Survival in oral cavity minor salivary gland carcinoma.
Otolaryngol Head Neck Surg 2010;143:122-6.
Kessler A, Handler SD. Salivary gland neoplasms in children: a 10-years survey at the
Children’s Hospital of Philadelphia. Int J Pediatr Otorhinolaryngol
1994;29:195-202.
Koivunen P, Suutala L, Schorsch I, Jokinen K, Alho OP. Malignant epithelial salivary
gland tumors in northern Finland: incidence and clinical characteristics. Eur Arch
Otorhinolaryngol 2002;259:146-9.
Kuo YL, Tu TY, Chang CF, Li WY, Chang SY, Shiao AS, Chu PY, Chan KT, Tai SK,
Wang YF, Kao SC, Kao SY, Lo WL, Wu CH, Shu WH, Ma S, Wang TH.
Extra-major salivary gland pleomorphic adenoma of the head and neck: a
10-year experience and review of the literature. Eur Arch Otorhinolaryngol
2011;268:1035-40.
Kusama K, Iwanari S, Aisaki K, Wada M, Ohtani J, Itoi K, Hanai K, Shimizu K,
Komiyama K, Kudo I, Moro I. Intraoral minor salivary gland tumors: a
retrospective study of 129 cases. J Nihon Univ Sch Dent 1997;39:128-32.
Laikui L, Hongwei L, Hongbing J, Zhixiu H. Epithelial salivary gland tumors of
children and adolescents in west China population: a clinicopathologic study of
79 cases. J Oral Pathol Med 2008;37:201-5.
Lack EE, Upton MP. Histiopathologic review of salivary gland tumors in childhood.
Arch Otolaryngol Head Neck Surg 1988;114:898-906.
Ledesma-Montes C, Garces-Ortiz M. Salivary gland tumours in a Mexican sample. A
retrospective study. Medicina Oral 2002;7:324-30.
Lee PS, Sabbath-Solitare M, Redondo TC, Ongcapin EH. Molecular evidence that
stromal and epithelial cells in pleomorphic adenomas of salivary glands arise
from the same origin: clonal analysis using human androgen receptor gene
(HUMARA) assay. Hum Pathol 2000;31:498-503.
Li LJ, Li Y, Wen YM, Liu H, Zhao HW. Clinical analysis of salivary gland tumor
cases in West China in past 50 years. Oral Oncol 2008;44:187-92.
Li Q, Zhang XR, Liu XK, Liu ZM, Liu WW, Li H, Guo ZM. Long-term treatment
outcome of minor salivary gland carcinoma of the hard palate. Oral Oncol

80
2012;48:456-62.
Li YN, He ZX, Liu LK, He HW. A retrospective study on 615 cases of minor salivary
gland tumors. Hua Xi Kou Qiang Yi Xue Za Zhi 2004;22:204-6.
Lopes MA, da Cruz Perez DE, de Abreu Alves F, de Almeida OP, Kowalski LP.
Clinicopathologic and immunohistochemical study of intraoral mucoepidermoid
carcinoma. Otolaryngol Head Neck Surg 2006;134:622-6.
Lopes MA, Kowalski LP, da Cunha Santos G, Paes de Almeida O. A
clinicopathologic study of 196 intraoral minor salivary gland tumours. J Oral
Pathol Med 1999;28:264-7.
Lopes MA, Santos GC, Kowalski LP. Multivariate survival analysis of 128 cases of
oral cavity minor salivary gland carcinomas. Head Neck 1998;20:699-706.
Loyola AM, de Araujo VC, de Sousa SO, de Araujo NS. Minor salivary gland
tumours. A retrospective study of 164 cases in a Brazilian population. Eur J
Cancer Part B Oral Oncol 1995;31B:197-201.
Lukšić I, Virag M, Manojlović S, Macan D. Salivary gland tumours: 25 years of
experience from a single institution in Croatia. J Craniomaxillofac Surg
2012;40:e75-81.
Luna MA. Salivary mucoepidermoid carcinoma: revisited. Adv Anat Pathol
2006;13:293-307.
Ma DQ, Yu GY. Tumours of the minor salivary glands. A clinicopathologic study of
243 cases. Acta Otolaryngol 1987;103:325-31.
Mărgăritescu C, Raica M, Simionescu C, Mogoantă L, Surpăţeanu M, Jaubert F,
Bogdan F. Tumoral stroma of salivary pleomorphic adenoma -- histopathological,
histochemical and immunohistochemical study. Rom J Morphol Embryol
2005;46:211-23.
Martinez-Rodriguez N, Leco-Berrocal I, Rubio-Alonso L, Arias-Irimia O,
Martinez-Gonzalez JM. Epidemiology and treatment of adenoid cystic
carcinoma of the minor salivary glands: a meta-analytic study. Med Oral Patol
Oral Cir Bucal 2011;16:e884-9.
Masanja MI, Kalyanyama BM, Simon EN. Salivary gland tumours in Tanzania. East
Afr Med J 2003;80:429-34.
Matsuba HM, Mauney M, Simpson JR, Thawley SE, Pikul FJ. Adenoid cystic
carcinoma of major and minor salivary gland origin. Laryngoscope
1984;94:1316-8.

81
Miguens SA Jr, Uchoa Vasconcelos AC, Figueiredo MA, Soares Yurgel L, Salum F,
Cherubini K. Mucoepidermoid carcinoma: a retrospective study. Minerva
Stomatologica 2010;59:325-32.
Nascimento AG, Amaral AL, Prado LA, Kligerman J, Silveira TR. Adenoid cystic
carcinoma of salivary glands. A study of 61 cases with clinicopathologic
correlation. Cancer 1986;57:312-9.
Neely MM, Rohrer MD, Young SK. Tumors of minor salivary glands and the analysis
of 106 cases. J Okla Dent Assoc 1996;86:50-2.
Neville BW, Damm DD, Weir JC, Fantasia JE. Labial salivary gland tumors: an
analysis of 103 cases. Cancer 1988;61:2113-6.
Noguchi S, Aihara T, Yoshino K et al. Demonstration of monoclonal origin of human
parotid gland pleomorphic adenoma. Cancer 1996;77:431-5.
Olsen KD, Devine KD, Weiland LH. Mucoepidermoid carcinoma of the oral cavity.
Otolaryngol Head Neck Surg 1981;89:783-91.
Ostman J, Anneroth G, Gustafsson H, Tavelin B. Malignant salivary gland tumours in
Sweden 1960-1989 – an epidemiological study. Oral oncol 1997;33:169-76.
Otoh EC, Johnson NW, Olasoji H, Danfillo IS, Adeleke OA. Salivary gland
neoplasms in Maiduguri, north-eastern Nigeria. Oral Dis 2005;11:386-91.
Pandey M, Thomas S, Mathew A, Nair MK. Malignant tumours of the minor salivary
glands: a survival analysis of 17 years from a tertiary referral cancer centre. J
Postgrad Med 2003;49:25-8.
Penner CR, Folpe AL, Budnick SD. C-kit expression distinguishes salivary gland
adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma. Mod
Pathol 2002;15:687-91.
Perez DE, Pires FR, Alves Fde A, Lopes MA, de Almeida OP, Kowalski LP. Juvenile
intraoral mucoepidermoid carcinoma. J Oral Maxillofac Surg 2008;66:308-11.
Perzin KH, Gullane P, Clairmont AC. Adenoid cystic carcinoma arising in salivary
glands: a correlation of histologic features and clinical course. Cancer
1978;42:265-82.
Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a
population-based study. Otolaryngol Head Neck Surg 1999;120:834-40.
Pires FR, de Almeida OP, de Araujo VC, Kowalski LP. Prognostic factors in head and
neck mucoepidermoid carcinoma. Arch Otolaryngol Head Neck Surg
2004;130:174-80.

82
Pires FR, Pringle GA, de Almeida OP, Chen SY. Intra-oral minor salivary gland
tumors: a clinicopathological study of 546 cases. Oral Oncol 2007;43:463-70.
Poomsawat S, Punyasingh J, Weerapradist W. A retrospective study of 60 cases of
salivary gland tumors in a Thai population. Quintessence Int 2004;35:577-81.
Rahman B, Mamoon N, Jamal S, Zaib N, Luqman M, Mushtaq S, Anwar M.
Malignant tumors of the minor salivary glands in northern Pakistan: a
clinicopathological study. Hematol Oncol Stem Cell Ther 2008;1:90-3.
Renehan A, Gleave EN, Hancock BD, Smith P, McGurk M. Long term fallow up of
over 1000 patients with salivary gland tumours treated in a single center. Br J
Surg 1996;83:1750-4.
Ries LAG, Hankey BF, Miller BA, Hartman AM, Edwards BK. Cancer Statistics
Review, 1973-88. National Cancer Institute: Bethesda 1991.
Seethala RR. An update on grading of salivary gland carcinoma. Head Neck Pathol
2009;3:69-77
Seethala RR. Histologic grading and prognostic biomarkers in salivary gland
carcinomas. Adv Anat Pathol 2011;18:29-45.
Seifert G. Orapathologie I: Pathologie der Speicheldrusen. Berlin: Springer-Verlag,
1996.
Seifert G, Sobin LH. Histological Typing of Salivary Gland Tumours. World Health
Oraganization International Histological Classification of Tumours, 2nd ed. New
York: Springer-Verlag. 1991.
Seifert G, Miehlke A, Haubrich J, et al. Diseases of the salivary glands.
Pathology-diagnosis-treatment-facial nerve surgery. New York: George Thieme
Verlag, 1986.
Seifert G, Okabe H, Caselitz J. Epithelial salivary gland tumors in children and
adolescents. Analysis of 80 cases (Salivary Gland Register 1965-1984). ORL J
Otorhinolaryngol Relat Spec 1986;48:137-49.
Shikhani AH, Johns ME. Tumors of the major salivary glands in children. Head Neck
Surg 1988;10:257-63.
Sobin LH, Wittekind C, eds. TNM classification of malignant tumours. 6th edn. New
York: Wiley-Liss, 2002. p. 19-35.
Speight PM, Barrett AW. Salivary gland tumours. Oral Dis 2002;8:229-40.
Spiro RH. Distant metastasis in adenoid cystic carcinoma of salivary origin. Am J
Surg 1997;174:495-8.

83
Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients.
Head Neck Surg 1986;8:177-84.
Spiro RH, Huvos AG. Stage means more than grade in adenoid cystic carcinoma. Am
J Surg 1992;164:623-8.
Spiro RH, Huvos AG, Berk R, Strong EW. Mucoepidemoid carcinoma of salivary
gland origin: a clinicopathologic study of 367 cases. Am J Surg 1978;136:461-8.
Spiro RH, Huvos AG, Strong EW. Adenoid cystic carcinoma of salivary origin. A
clinicopathologic study of 242 cases. Am J Surg 1974;128:512-20.
Stennert E, Guntinas-Lichius O, Klussmann JP, Arnold G. Histopathology of
pleomorphic adenoma in the parotid gland: a prospective unselected series of
100 cases. Laryngoscope 2001;111:2195-200.
Stewart FW, Foote FW, Becker WF. Mucoepidermoid tumors of salivary glands. Ann
Surg 1945;122:820-44.
Subhashraj K. Salivary gland tumors: a single institution experience in India. Brit J
Oral Maxillofac Surg 2008;46:635-8.
Sun EC, Curtis R, Melbye M, Goedert JJ. Salivary gland cancer in the United States.
Cancer Epidemiol Biomarkers Prev 8. 1999;1095-1100.
Szmeja Z, Kulczyński B, Kopeć T, Karlik M. Treatment results of patients with
adenoid cystic carcinoma in the Otolaryngology Department at the University
School of Medical Sciences in Poznań between 1958-1999. Otolaryngol Pol
2001;55:75-8.
Szanto PA, Luna MA, Tortoledo ME, White RA. Histologic grading of adenoid cystic
carcinoma of the salivary glands. Cancer 1984;54:1062-9.
Tarpley TM Jr, Giansanti JS. Adenoid cystic carcinoma. Analysis of fifty oral cases.
Oral Surg Oral Med Oral Pathol 1976;41:484-97.
Thackray AC, Lucas RB. Tumors of the major salivary glands: atlas of tumor
pathology. Series 2, fascicle 10, Washington, DC: Armed Forces Institute of
Pathology. 1974
Tilakaratne WM, Jayasooriya PR, Tennakoon TM, Saku T. Epithelial salivary tumors
in Sri Lanka: a retrospective study of 713 cases. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2009;108:90-8.
Tincani AJ, Del Negro A, Araujo PP, Akashi HK, Martins AS, Altemani AM, Barreto
G. Management of salivary gland adenoid cystic carcinoma: institutional
experience of a case series. Sao Paulo Med J 2006;124:26-30.

84
Toida M, Shimokawa K, Makita H, Kato K, Kobayashi A, Kusunoki Y, Hatakeyama
D, Fujitsuka H, Yamashita T, Shibata T. Intraoral minor salivary gland tumors: a
clinicopathological study of 82 cases. Int J Oral Maxillofac Surg
2005;34:528-32.
Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Koufogiannis D. Management of
adenoid cystic carcinoma of minor salivary glands. J Oral Maxillofac Surg
2006;64:1114-20.
Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Koufogiannis D. Mucoepidermoid
carcinoma of minor salivary glands: a clinical study of 16 cases and review of
the literature. Oral Dis 2006;12:364-70.
Ussmuller J, Donath K, Hartwein J. Site and epidemiology of mucoepidermoid
carcinoma. Analysis of 327 cases. Laryngo-Rhino-Otologie 1994;73:478-81.
Vaidya AD, Pantvaidya GH, Metgudmath R, Kane SV, D''Cruz AK. Minor salivary
gland tumors of the oral cavity: a case series with review of literature. J Cancer
Res Ther 2012;8 (Suppl 1):S111-5.
van der Wal JE, Snow GB, van der Waal I. Intraoral adenoid cystic carcinoma: the
presence of perineural spread in relation to site, size, local extension, and
metastatic spread in 22 cases. Cancer 1990,66:2031-3.
Vedrine PO, Coffinet L, Temam S, Montagne K, Lapeyre M, Oberlin O, Orbach
D, Simon C, Sommelet D. Mucoepidermoid carcinoma of salivary glands in the
pediatric age group: 18 clinical cases, including 11 second malignant neoplasms.
Head Neck 2006;28:827-33.
Venkata V, Irulandy P. The frequency and distribution pattern of minor salivary gland
tumors in a government dental teaching hospital, Chennai, India. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2011;111:e32-9.
Waldron CA, el-Mofty SK, Gnepp DR. Tumors of the intraoral minor salivary glands:
a demographic and histologic study of 426 cases. Oral Surg Oral Med Oral
Pathol 1988;66:323-33.
Wang D, Li Y, He H, Liu L, Wu L, He Z. Intraoral minor salivary gland tumors in a
Chinese population: a retrospective study on 737 cases. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2007;104:94-100.
Whatley WS, Thompson JW, Rao B. Salivary gland tumors in survivors of childhood
cancer. Otolaryngol Head Neck Surg 2006;134:385-8.
Woo VL, Bhuiya T, Kelsch R. Assessment of CD43 expression in adenoid cystic
carcinomas, polymorphous low-grade adenocarcinomas, and monomorphic
adenomas. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2006;102:485-500.
Wyszyńska-Pawelec G, Gontarz M, Zapała J, Szuta M. Minor salivary gland tumours
of upper aerodigestive tract: a clinicopathological study. Gastroenterol Res Pract
2012;2012:780453.
Yih WY, Kratochvil FJ, Stewart JC. Intraoral minor salivary gland neoplasms: review
of 213 cases. Int J Oral Maxillofac Surg 2005;63:805-10.
Yoo GH, Eisele DW, Askin FB, Driben JS, Johns ME. Warthin’s tumor: A 40-year
experience at the Johns Hopkins Hospital. Laryngoscope 1994;104:799-803.