HEAD AND NECK New diagnostic markers in salivary gland tumors Sven Schneider • Philipp Kloimstein • Johannes Pammer • Werner Brannath • Matthaeus Ch. Grasl • Boban M. Erovic Received: 18 July 2013 / Accepted: 24 September 2013 / Published online: 4 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Parotid gland tumors are a rare and heteroge- neous entity. Molecular markers are sparse. The aim of the study was to identify new diagnostic markers in benign and malignant salivary tumors. A tissue microarray was con- structed with 158 tumor samples. Expression of 21 tumor antigens involved in tumor cell survival and known for prognostic potential was assessed immunohistochemically in all parotid gland samples. CEA, Cox-1, Cox-2, Sigma, beta-Catenin, WISP-1 and PDGF-beta were differently regulated in benign and malignant parotid tumors. Subse- quently, these seven proteins entered the step-wise logistic regression analysis. As a second step, we defined a score for differentiating benign versus malignant parotid lesions: 4*CEA?15*Cox-1?4*Cox-2?4*Sigma?3*PDGF-beta? 10*beta-Catenin?14*Wisp1. Sensitivity and specificity of 94 and 83 % were reached. Besides routine hematoxylin and eosin staining, definition of new diagnostic markers and subsequently a new diagnostic score are an attempt to create an additional tool for the diagnosis of parotid gland tumors. Keywords Molecular markers Á Parotid gland tumors Á Parotid gland cancer Á Diagnostic markers Introduction Parotid gland tumors represent a histological and clinical heterogeneous group of neoplasias comprising of about 40 different morphological types [1, 2], whereas malignant salivary gland tumors show an incidence of \ 1.3 cases per 100,000 per year [3]. The complexity to classify and the rarity of many of the entities are a considerable diagnostic and management challenge to the pathologist and the surgeon alike [1, 2]. Tumors with basaloid morphology like basal cell ade- noma, basal cell adenocarcinoma and adenoid cystic car- cinoma are difficult to distinguish because of overlapping morphology. More than 30 % of basal cell adenomas are diagnosed wrongly, and about 17 % are interpreted as suspicious or malignant-like adenoid cystic carcinoma [4– 6]. In particular, basal cell adenoma show a variable amount of metachromatic basement membrane-like mate- rial as seen in pleomorphic adenoma and in rare cases hyaline globules that are similar to those found in adenoid cystic carcinoma. Furthermore, it is important to distin- guish between adenoid cystic carcinoma and basal cell adenocarcinoma because of a higher metastasis rate and, therefore, worse prognosis than basal cell adenocarcinoma. The differential diagnosis for mucoepidermoid carci- noma includes necrotizing sialometaplasia, inverted papil- loma, squamous cell carcinoma, adenosquamous carcinoma, cystadenoma and carcinoma, sebaceous carcinoma, and other clear cell tumors. Especially distinguishing low-grade mucoepidermoid carcinoma from cystadenoma may be difficult and even it may not be possible in small biopsies. S. Schneider (&) Á P. Kloimstein Á M. Ch. Grasl Á B. M. Erovic Departments of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Wa ¨hringer Gu ¨rtel 18-20, 1090 Vienna, Austria e-mail: sven.schneider@meduniwien.ac.at B. M. Erovic e-mail: boban.erovic@meduniwien.ac.at J. Pammer Clinical Pathology, Medical University of Vienna, Vienna, Austria W. Brannath Medical Statistics, Medical University of Vienna, Vienna, Austria 123 Eur Arch Otorhinolaryngol (2014) 271:1999–2007 DOI 10.1007/s00405-013-2740-5