\s=b\Two patients had small cell carcinomas of the salivary glands, with pathological features indicating squamous differentiation, heretofore not described. One is free of disease at seven years, and the second is alive, with regional metastases at four years. Sections from one tumor were studied by electron microscopy and revealed tonofilaments and desmosomes. Most cases of small cell carcinomas of the salivary glands have been considered akin to bronchogenic oat cell carcinoma. Their less aggressive behavior, however, suggests that at least some of these tumors were not true oat cell carcinomas.Our findings, and those of others, indicate that small cell carcinomas of the salivary glands (or head and neck) represent a heterogeneous group. Electron microscopy should be used to determine the exact nature of these neoplasms. If an oat cell nature is ruled out, local and regional treatment should be aggressive, since small cell carcinomas other than oat cell appear not to have a dismal prognosis. (Arch Otolaryngol 1982;108:511-514) oss et al,1 in 1972, reported 14 cases of small cell carcinoma of the minor salivary glands, which they described as "histologically akin to oat-cell carcinoma of the bronchus," even though one case showed a spindle and giant cell component and a second exhibited foci of keratinization. The biologic behavior of some of those tumors1 was much less aggressive than that of oat cell carcinoma of bronchial origin. Later, Wirman and Battifora2 described the ultrastruc¬ tural features of another small cell carcinoma of the salivary gland-sim¬ ilar to those described by Koss et al-from their observations on light microscopy. These observations did not support an identification as an oat cell type. Instead, they established that this tumor was a distinct neo¬ plasm originating in salivary duct epi¬ thelium. A review of the literature showed that oat cell carcinomas of the head and neck, documented by the ultrastructural demonstration of neurosecretory granules in the tumor cells, have invariably had a fatal out¬ come.3"5 In this article, we describe another distinct parotid small cell neoplasm. The clinical, light microscopic, and ultrastructural features of two cases of small cell carcinoma demonstrated squamous or epidermoid differentia¬ tion. REPORT OF CASES Case 1.-A 47-year-old man was admit¬ ted to the Hospitals of the University of Texas Medical Branch at Galvestonbecause of an enlargement of the left par¬ otid gland and pain in the left jaw of about six months' duration. The parotid gland had enlarged gradually over this period of time, but the pain had been the same. The patient underwent a total parotidectomy with sacrifice of the left facial nerve. A tumor of the deep lobe of the gland was found (see "Pathological Findings").Following surgery, the patient received radiation treatment, 6,000 rad to the surgi¬ cal area and the left cervical lymph nodes. Two years later, a peripheral nodule of the lower lobe of the left lung was resected, and pathological examination revealed a metasta...
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