Original Article
Histology of Submandibular Gland Tumours, 10 Years’ Experience
Histología de tumores de glándulas submandibulares. Experiencia de 10 años
Perla Bernice Becerril-Ramírez, Gerardo Arturo Bravo-Escobar
, Héctor Manuel Prado-Calleros, Bertha Beatriz Castillo-Ventura, Alejandro Pombo-Nava
Corresponding author
División de Otorrinolaringología, Hospital General Dr. Manuel Gea González, Distrito Federal, Mexico
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Experiencia de 10 años" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Salivary gland tumours comprise 3% of head and neck tumours. The overall incidence of these neoplasms is 4/100<span class="elsevierStyleHsp" style=""></span>000 per year, with the gender ratio being 1:1. The average age of onset is 45 years, with a peak between the fifth and sixth decades of life. The mean age is higher for carcinomas than for adenomas.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most frequently affected gland is the parotid, representing between 64% and 80% of cases, followed by the submandibular gland with 7%–15%, and finally the minor and sublingual salivary glands with 1%–5%. According to the classical studies by Simons and Spiro carried out in 1964 and 1976 with a total of 345 patients, benign neoplasms constitute 75%–80% in the parotid, 50%–60% in the submandibular gland and 35% in the minor and sublingual salivary glands; the smaller the affected salivary gland, the greater the likelihood of malignancy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most frequent neoplasms in the submandibular glands are: pleomorphic adenoma (which represents 36% of cases), adenoid cystic carcinoma (25%), mucoepidermoid carcinoma (12%) and malignant mixed tumour (10%).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinical reports indicate that benign neoplasms are characterised by a painless enlargement of the submandibular triangle. Malignant neoplasms are clinically manifested by a more rapid increase in volume, coupled with the presence of pain and neurological involvement due to involvement of the marginal branch of the facial nerve.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Tumours originating in the major salivary glands are accessible to biopsy by fine needle aspiration (FNA). An experienced cytopathologist can reliably distinguish malignant salivary pathologies from benign, but a histological classification based on only aspiration is an unrealistic goal. Computerized tomography and magnetic resonance imaging enable accurate assessment of tumour extension, compression or infiltration of adjacent structures, presence of nodal metastases and better planning of the therapeutic approach. The definitive diagnosis is done through a histopathological study.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are currently few reports focused on submandibular gland neoplasms. This is because they are rare and are usually grouped with other salivary glands. Most studies relating to frequency and prognosis of these neoplasms are from centres specialising in cancer or pathology departments. Little is known about the frequency of submandibular tumours treated at non-specialised centres.The proportion of malignant tumours of the submandibular gland varies from 10% to 78.2% in different reports; this in turn depends on several factors, among which are race and location where the information is collected, since tertiary referral centres find a higher proportion of malignant tumours. Most classical studies report malignancy rates greater than 50% in submandibular gland tumours. However, more recent studies in different populations (Asian, Brazilian) have reported smaller incidences, with a malignancy rate of 10%–30%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study, we report the prevalence of different submandibular gland neoplasms treated at our hospital during the period from 2000 to 2010.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We reviewed the records of cases registered in the database of the Otolaryngology Division at Dr. Manuel Gea González General Hospital from January 2000 to June 2010, who had undergone surgery due to submandibular gland neoplasm and in which there was a histopathology report. The variables analysed were age, gender, family history, consumption of tobacco and alcohol, type of neoplasm and histological diagnosis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">In the period from 2000 to 2010, there were a total of 22 records of patients with submandibular gland neoplasms. Neoplasms of benign type were predominant, representing 86% of the total. The age range was 13–66 years. The mean age of cases with benign pathology was 40 years, whilst the mean age of malignant cases was 55 years. The majority appeared in female patients (76%), although 2 of the 3 cases of malignancy occurred in males.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of all patients with benign neoplasms, 47% had a history of smoking and 26% of alcohol consumption. Of all benign neoplasms, the most frequent was pleomorphic adenoma, which represented 89% of the total.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Pleomorphic adenoma appeared more frequently in female patients (76%). Of these patients, 47% had a history of smoking; 23% referred alcohol intake and 11% (2 cases) reported a family history of salivary gland neoplasm, but were unable to clarify the histology.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Malignant neoplasms encountered were adenocarcinoma, well-differentiated squamous cell carcinoma and follicular lymphoma, with 1 case each.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In total, 2/3 of patients with malignant tumours were smokers and all of them consumed alcohol.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Warthin's tumour appeared in one male patient with a history of smoking and drinking (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">We found that 86% of submandibular gland neoplasms were benign and 14% were malignant. This data differs from that in classical studies of submandibular gland tumours; nevertheless, it agrees with recent studies performed with a smaller number of cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In our literature review, we found that the global distribution of these neoplasms varies.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–16</span></a> In a 10-year retrospective study on an Asian population of 101 patients in 2010, Denis et al. reported a low incidence of malignant tumours in submandibular glands (21.1%).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In a 5-year retrospective study in Singapore on 93 patients from a tertiary centre, Goh et al. found that 13.5% of submandibular tumours were malignant,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> which is consistent with the trend in Asian populations with a low prevalence of malignant tumours in the submandibular gland.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The most common benign neoplasm in our series was pleomorphic adenoma, whilst malignant neoplasms found were adenocarcinoma, well-differentiated squamous cell carcinoma and follicular lymphoma. It is noteworthy that we did not find any cases of adenoid cystic carcinoma, the most common malignancy in this location in other series. However, having only 3 cases to study represents a constraint in drawing conclusions in this regard. In a 10-year retrospective study carried out in a UK general hospital, Ethunandan et al. identified 25 patients with primary submandibular gland neoplasm, of which 68% were benign and all cases were of pleomorphic adenoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Malignant tumours represented 32% and adenoid cystic carcinoma was the most common histological subtype, followed by carcinoma ex pleomorphic adenoma, mucoepidermoid carcinoma and salivary duct carcinoma. The frequency of histological subtypes in this series was similar to that in previous reports in the literature.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In a Brazilian population study carried out in 2009, De Oliveira found that malignant tumours accounted for 19% of submandibular gland neoplasms and that adenoid cystic carcinoma was the most frequent. However, there are reports that mucoepidermoid carcinoma is the most frequent. Adenocarcinoma was the second most common, but it is reported as the third in frequency in other series. The age distribution in this study ranged from 1 to 88 years, with a mean age of 45 years and a peak incidence around 30–39 years. The mean age for malignant tumours (55 years) was significantly higher than for benign tumours (43 years).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In our series, the mean age at the time of diagnosis of benign tumours (40.7 years) was lower than the mean age at diagnosis of malignant neoplasms (55.3 years). The age range in our patients with pleomorphic adenoma was 13–65 years, with a predominance of females over males.</p><p id="par0085" class="elsevierStylePara elsevierViewall">De Oliveira reports that salivary gland tumours affect females more often, with a male:female ratio of 1:1.5. This ratio is reported as 1:1.6 in benign tumours and 1:1.5 in malignant tumours.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Similarly, other studies describe a range that varies from 1:1.2 to 1.3; however, there are studies describing a male predominance in a ratio of 1.4:1.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In our cases, benign neoplasms occurred in a male:female ratio of 1:2.8, whilst malignant cases presented a ratio of 2:1.The case of Warthin's tumour is particularly striking, as it is a benign neoplasm that appears almost exclusively in the parotid gland.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The subjects who underwent surgical excision of the tumour commonly described an asymptomatic growth that remained stable for years and sought medical attention when there was a greater increase in volume or accompanying symptoms appeared.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Population studies conducted in different geographical areas can provide more information as to the most common types of neoplasm and their clinical behaviour. Such studies can also generate new lines of research for this diverse group of tumours.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">In agreement with findings from other recent series, benign tumours in our study represented a major proportion of submandibular gland neoplasms. Pleomorphic adenoma was the most common neoplasm in the submandibular gland.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our series, submandibular neoplasms occurred more frequently in females. Submandibular gland neoplasms generally appeared around 40 years of age when they were benign and around 55 years when they were malignant.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres94866" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction and objectives" 2 => "Objectives" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec82016" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres94867" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción y objetivos" 2 => "Objetivos" 3 => "Métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec82017" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-01-13" "fechaAceptado" => "2011-04-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82016" "palabras" => array:5 [ 0 => "Neoplasm" 1 => "Submandibular gland" 2 => "Benign" 3 => "Malignant" 4 => "Pleomorphic adenoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82017" "palabras" => array:5 [ 0 => "Neoplasia" 1 => "Glándula submandibular" 2 => "Benigna" 3 => "Maligna" 4 => "Adenoma pleomorfo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There are few reports focused on neoplasms in the submandibular gland because they are uncommon and are frequently grouped with the other salivary glands tumours. In the classical studies, the proportion of malignancy reported in these cases is around 50%.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determining the proportion of malignancy, the most frequent histological types, the gender distribution and average age at diagnosis in patients with submandibular gland neoplasms who were treated in our hospital from 2000 year to 2010.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective review of our department database of the patients who underwent surgery for submandibular gland neoplasm in a ten-year period was performed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Twenty-two patient records were included, in which 19 (86%) patients presented benign disease and 3 were of a malignant type (adenocarcinoma, well-differentiated epidermoid carcinoma, follicular lymphoma). Two of the 3 cases of malignant neoplasms were in men.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A greater proportion of benign neoplasm was found in submandibular tumours. The most frequent benign tumour is the pleomorphic adenoma. Women are more commonly affected (76%). Benign tumours appear in younger patients than do malignant ones.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hay pocos trabajos enfocados a neoplasias de glándulas submandibulares porque son poco comunes y se les agrupa con otras glándulas salivales. En los estudios clásicos se reporta que los tumores malignos en esta localización representan alrededor del 50%.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Reportar la proporción de malignidad en pacientes con neoplasia de glándulas submandibulares y tipos histológicos más comunes que se trataron en nuestro hospital del año 2000 al 2010, así como la proporción por sexo y edad de presentación.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realizó una revisión retrospectiva de la base de datos de nuestro servicio de los pacientes que fueron atendidos en 10 años por neoplasia de glándula submandibular.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se atendieron 22 pacientes con neoplasias de glándula submandibular, 19 (86%) de tipo benigno y tres malignos (adenocarcinoma, carcinoma epidermoide bien diferenciado y linfoma folicular), edad promedio en patología benigna: 40 años y 55 años en malignos. Hubo predominio del sexo femenino (76%), sin embargo dos de tres casos de neoplasia maligna se presentaron en el sexo masculino.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La mayoría de las neoplasias de glándula submandibular son benignas. El tumor benigno más frecuente es el adenoma pleomorfo. Las mujeres son afectadas con mayor frecuencia. Los tumores benignos se presentan en pacientes más jóvenes que los malignos.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Becerril-Ramírez PB, et al. Histología de tumores de glándulas submandibulares. Experiencia de 10 años. Acta Otorrinolaringol Esp. 2011;62:432–5.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Number of Cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Female:Male Ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Family History \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tobacco \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Alcohol \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleomorphic adenoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13–66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Warthin's tumour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Well-differentiated epidermoid carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1:0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follicular lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total benign neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13–66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1:2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total malignant neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45–61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1:2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab179676.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Different Tumour Types, Age of Onset, Gender and History.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Salivary neoplasms: overview of a 35-year experience with 2807 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2021 January | 0 | 1 | 1 |
| 2020 October | 0 | 1 | 1 |
| 2020 May | 0 | 1 | 1 |
| 2020 March | 42 | 4 | 46 |
| 2020 February | 71 | 13 | 84 |
| 2020 January | 44 | 14 | 58 |
| 2019 December | 69 | 15 | 84 |
| 2019 November | 40 | 12 | 52 |
| 2019 October | 60 | 9 | 69 |
| 2019 September | 41 | 6 | 47 |
| 2019 August | 32 | 2 | 34 |
| 2019 July | 33 | 7 | 40 |
| 2019 June | 49 | 19 | 68 |
| 2019 May | 139 | 19 | 158 |
| 2019 April | 75 | 12 | 87 |
| 2019 March | 18 | 8 | 26 |
| 2019 February | 13 | 8 | 21 |
| 2019 January | 12 | 0 | 12 |
| 2018 December | 13 | 4 | 17 |
| 2018 November | 18 | 6 | 24 |
| 2018 October | 17 | 3 | 20 |
| 2018 April | 8 | 3 | 11 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 9 | 3 | 12 |
| 2018 January | 7 | 3 | 10 |
| 2017 December | 13 | 2 | 15 |
| 2017 November | 10 | 2 | 12 |
| 2017 October | 7 | 2 | 9 |
| 2017 September | 7 | 6 | 13 |
| 2017 August | 12 | 6 | 18 |
| 2017 July | 15 | 1 | 16 |
| 2017 June | 16 | 9 | 25 |
| 2017 May | 18 | 5 | 23 |
| 2017 April | 11 | 5 | 16 |
| 2017 March | 4 | 26 | 30 |
| 2017 February | 4 | 6 | 10 |
| 2017 January | 5 | 1 | 6 |
| 2016 December | 22 | 2 | 24 |
| 2016 November | 24 | 11 | 35 |
| 2016 October | 24 | 6 | 30 |
| 2016 September | 15 | 9 | 24 |
| 2016 August | 10 | 5 | 15 |
| 2016 July | 11 | 3 | 14 |
| 2016 June | 23 | 8 | 31 |
| 2016 May | 27 | 14 | 41 |
| 2016 April | 18 | 16 | 34 |
| 2016 March | 17 | 18 | 35 |
| 2016 February | 23 | 17 | 40 |
| 2016 January | 18 | 17 | 35 |
| 2015 December | 22 | 12 | 34 |
| 2015 November | 16 | 6 | 22 |
| 2015 October | 16 | 11 | 27 |
| 2015 September | 17 | 5 | 22 |
| 2015 August | 14 | 6 | 20 |
| 2015 July | 15 | 5 | 20 |
| 2015 June | 10 | 5 | 15 |
| 2015 May | 17 | 3 | 20 |
| 2015 April | 16 | 7 | 23 |
| 2015 March | 30 | 13 | 43 |
| 2015 February | 18 | 2 | 20 |
| 2015 January | 56 | 5 | 61 |
| 2014 December | 50 | 10 | 60 |
| 2014 November | 29 | 3 | 32 |
| 2014 October | 51 | 8 | 59 |
| 2014 September | 39 | 6 | 45 |
| 2014 August | 27 | 10 | 37 |
| 2014 July | 33 | 3 | 36 |
| 2014 June | 27 | 5 | 32 |
| 2014 May | 15 | 1 | 16 |
| 2014 April | 20 | 4 | 24 |
| 2014 March | 18 | 6 | 24 |
| 2014 February | 14 | 3 | 17 |
| 2014 January | 19 | 3 | 22 |
| 2013 December | 14 | 3 | 17 |
| 2013 November | 22 | 3 | 25 |
| 2013 October | 14 | 5 | 19 |
| 2013 September | 12 | 6 | 18 |
| 2013 August | 8 | 2 | 10 |
Show all