title: Recurrent salivary pleomorphic adenoma shows increased immunohistologic expression of bcl-2 oncoprotein.
abstract: BACKGROUND
  Internal cell biology, including apoptotic regulation, is presumed to play a key role in the development of recurrent pleomorphic adenoma (PA).
  
  
  OBJECTIVE
  The aim of our study was to determine the relevance of B-cell lymphoma 2 (bcl-2) oncoprotein immunoexpression and distribution in primary PA, and its recurrence.
  
  
  METHODS
  Ten primary-non-recurrent, 14 primary-to-recur, and 28 recurrences of parotid PA patients aged 19-73 (mean 40.7±16.7) years were enrolled. The bcl-2 expression was compared between groups using a semi-quantitative histoscore, defined as the multiple of the percentage of cells by the intensity of immunostaining.
  
  
  RESULTS
  Widely varying bcl-2 immunoreaction was found in the epithelial areas of 91.7% of primary and 85.2% of recurrent PA. Similarly varying but much less, immunopositivity was found in the myxoid areas of 62.5% of primary and 71.4% of recurrent tumours. No obvious differences in the bcl-2 staining intensity or pattern of specific epithelial morphologic structures in either the primary-non-recurrent, primary-to-recur or recurrent tumours were found. In both the mesenchymal and epithelial areas of PA, the differences in bcl-2 immunohistoscore between the primary-non-recurrent and primary-to-recur groups were not statistically significant (P=0.62, respectively 0.51). In the mesenchymal areas, the study revealed a significantly increased histoscore in recurrent tumours compared to their corresponding primaries (P=0.01). Increased bcl-2 expression in recurrent PA suggests an exaggerated aggressiveness of that tumor.
  
  
  CONCLUSIONS
  The fact that a significant difference in the histoscore was found exclusively in the myxoid component seems to accord with the reported prevalence of the latter in recurrent and metastatic PA.
authors.affiliation: Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital and Faculty Hospital, Ruzomberok, Slovak Republic.
authors.forename: Katarina
authors.initials: K
authors.lastname: Obtulovicova
authors.affiliation: Clinic of Otorhinolaryngology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Ivo
authors.initials: I
authors.lastname: Starek
authors.affiliation: Clinic of Otorhinolaryngology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Richard
authors.initials: R
authors.lastname: Salzman
authors.affiliation: Institute of Pathology, Central Military Hospital and Faculty Hospital, Ruzomberok, Slovak Republic.
authors.forename: Adrian
authors.initials: A
authors.lastname: Kalis
authors.affiliation: Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc.
authors.forename: Jiri
authors.initials: J
authors.lastname: Ehrmann
authors.affiliation: Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital and Faculty Hospital, Ruzomberok, Slovak Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Sicak
authors.affiliation: Department of Pathology, University Hospital Ostrava.
authors.forename: Jana
authors.initials: J
authors.lastname: Dvorackova
mesh_terms: D008949:Adenoma, Pleomorphic / Q000378:metabolism* / Q000473:pathology; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000096:biosynthesis / Q000276:immunology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism* / Q000473:pathology; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000096:biosynthesis* / Q000276:immunology; D012468:Salivary Gland Neoplasms / Q000378:metabolism* / Q000473:pathology; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019253:Proto-Oncogene Proteins c-bcl-2
keywords: apoptosis; bcl-2 gene; mesenchymal stromal cells; pleomorphic adenoma; recurrence