Large-cell undifferentiated carcinoma

Fig. 3. Keratinization is notseen (hematoxylin and eosin).
Bar = 200 µm.

Fig. 4. Tumor cells, arrangedin palisades and sheets, show
large, atypical nuclei (hematoxylin and eosin). Bar = 50µm.

ferentiated carcinoma includes other primary salivary gland neoplasms: adenoid cystic carcinoma,
epidermoid carcinoma, malignant melanoma,
adenocarcinoma, poorly differentiated squamouscell carcinoma, lymphoma and sarcoma. In ourpatient, fine-needle aspiration cytologic examination resulted in a provisional diagnosis of adenocarcinoma versus pleomorphic adenocarcinoma.
It was reported that high grade mucoepidermoid
carcinoma or poorly differentiated adenocarcinoma or squamous cell carcinoma or melanoma
could not be ruled out because of cytomorphological overlap (Moore and Bocklage, 1998).

Undifferentiated carcinomas of the submandibular gland occur in adults. Patients haveranged in age from 40 to 96 years, with the peak
incidence in the 7th and 8th decades (Ellis andAuclair, 1996). However, 4 of 6 patients in 1 series were under 50 years old (Nagao et al., 1982).
Rapid growth of a recently discovered mass is acommon clinical presentation. Tumors typicallyare firm and fixed. Many patients already havecervical lymph-adenopathy at the time of diagnosis of the primary salivary gland carcinoma (Ellisand Auclair, 1996). Patients generally are treatedwith surgical excision, ipsilateral neck dissection75

K. Fujiwara et al.

and postoperative radiotherapy, with 50 to 60 Gy
delivered over 5 to 6 weeks (Hui et al., 1990).
The prognosis of large-cell undifferentiatedcarcinoma of salivary glands is poor, with a 10year survival rate of 0% to 35% reflecting distantmetastasis and recurrence. Various subtypes andother histopathologic features of undifferentiatedcarcinomas have had little prognostic importance(Hui et al., 1990), with tumor size being the mostimportant prognostic factor. Neoplasms 40 mm
or larger had a particularly poor outcome (Hui etal., 1990). Wang et al. reported 3 factors predicting a poor outcome for these patients: age over 50years, cervical lymph node metastasis and tumor
size over 60 mm. Locoregional control was obtained much more often in patients with smaller
primary neoplasms (Wang et al., 2004).
It has not yet been confirmed whether chemotherapy is effectively inhibits loco regional
recurrence or distant metastasis. Hatta et al reported that chemotherapy should be administeredwhen tumor diameter exceeds 4 cm is agreeable,
because prognosis becomes very poor (Hatta et al.,2003). Chemotherapy has not been administered
to our patient, considering that the tumor size did
not exceed 4 cm. Aggressive chemotherapy may
worsen the patient’s performance status. Continuously further investigation is necessary to clarify
the effectiveness of adjuvant chemotherapy.

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2 Eneroth CM. Histological and clinical aspects ofReceived October 22, 2008; accepted January 6, 2009
Corresponding author: Kazunori Fujiwara, MD76