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During the years 1980-1994 159 patients with parotid tumors were treated in ENT Clinic in Bydgoszcz. 26.4% (42 patients) of tumors were malignant. The main surgical procedures were the removal of tumor, partial parotidectomy, total conservative parotidectomy and total radical parotidectomy. In malignant tumor cases the radiotherapy followed the surgery.
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Prostate-specific antigen (PSA) is secreted by both normal and neoplastic acinar cells of the prostate gland, and the immunohistochemical detection of PSA is widely accepted as an excellent method for confirming the prostatic origin of metastatic tumor implants in men with prostate cancer. Less recognized is the observation that certain nonprostatic tissues and their neoplastic counterparts also secrete PSA. As one example, salivary gland ducts and certain salivary gland neoplasms have been reported to be immunoreactive for PSA. Potentially, this nonspecificity could be a diagnostic pitfall when using immunoperoxidase on fine-needle aspiration (FNA) biopsy specimens to differentiate metastatic prostate cancer from primary salivary gland tumors. We report on a case where strong PSA immunoreactivity of a parotid oncocytoma led to its confusion with metastatic prostate cancer.
The occurrence of multiple tumours in the salivary glands is an unusual phenomenon and the simultaneous development of tumours different types is extremely rare. Two cases are presented with synchronous tumours of the parotid gland of different histological types. The first was a Warthin tumour in combination with a metastatic lung carcinoma and the second was a pleomorphic adenoma in combination with non-Hodgkin's malignant lymphoma.
In this case, the experts come out of the starting blocks disagreeing. One expert (Dr. Myers) does not routinely use FNA, relying instead on clinical signs to suspect a malignancy. the other physicians (Drs. Robbins and Suen) obtain an FNA for each parotid mass and use the information in counseling patients. MRI is an important preoperative tool for one physician (Dr. Suen). When faced with bilateral tumors, one approach is to stage the operations to avoid possible bilateral facial nerve injury (Dr. Myers). Other approaches include operating on the larger tumor first if both are benign, the malignant tumor first if one is benign and one malignant, and on both sides under the same anesthetic if both are malignant (Dr. Robbins). The other consultant agrees with this latter approach, with the exception being that in the case of bilateral benign tumors, he would operate on the smaller side first (Dr. Suen). Regarding the role for further surgery, one expert would reoperate if there were a suspicion for residual gross tumor on the facial nerve (Dr. Robbins). The others (Drs. Myers and Suen) agree that the positive margin likely reflects microscopic disease and further surgery is not warranted. Radiotherapy is recommended by all the experts. There is no proven role for chemotherapy. There is disagreement regarding whether the facial nerve should have been removed on the left side. Two experts (Drs. Myers and Suen) agree on peeling tumor off the nerve and following with radiotherapy. However, one physician (Dr. Robbins) believes that the facial nerve should have been removed.(ABSTRACT TRUNCATED AT 250 WORDS)
Differentially expressed genes in various benign and malignant salivary gland tumours were identified by use of cDNA microarrays containing 19,000 human expressed sequence tags. Samples were derived from 5 patients with pleomorphic adenoma, 4 with Warthin's tumour, one with clear cell carcinoma, and 2 with mucoepidermoid carcinoma. Tumours were classified by using a subset of 486 genes. Benign Warthin's tumour and pleomorphic adenoma showed very distinctive gene expression patterns. A total of 133 genes differentiated the single malignant clear cell carcinoma from non-tumour salivary glands (p < 0.01), whereas only 16 genes separated it from the highly related benign pleomorphic adenoma (p < 0.01). A total of 57 cDNAs were associated with mucoepidermoid carcinoma (p < 0.01). The results show gene expression alterations common to all tumours and unique to each benign and malignant tumour. The numerous Expressed Sequence Tags of unknown function we identified could also become useful as tumour markers and represent a set of novel tumour-associated genes.
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Parotid neoplasms are usually solitary and multiple tumours occurring in an individual are uncommon. The incidence and implications of multiple synchronous and metachronous tumours remains relatively unknown. We reviewed the case notes of 606 patients who had parotidectomies for neoplastic lesions over a 30 year period and identified 30 patients (5%) with multiple primary tumours. There were 24 patients with synchronous tumours and 6 with metachronous tumours. Sixteen of the synchronous tumours (67%) were ipsilateral, whereas all six metachronous tumours were contralateral. Preoperative examination was effective at detecting bilateral tumours but poor at detecting multiple ipsilateral tumours. Multiple tumours were likely to be of the same histology (n=24, 80%) and Warthin's was by far the most common multiple tumour. Ipsilateral tumours of differing histological types and identical tumours other than Wartin's were uncommon. All but one patient had superficial parotidectomies and there were no recurrences.
This clinical review presents a survey of the different types of epithelial neoplasms in the parotid gland. The incidence, histopathological classification, grade of malignancy, and staging system are discussed. Diagnostic procedures are reviewed and a scheme for treatment is proposed for the different types of epithelial parotid neoplasms.
Ten patients who presented with residual or recurrent parotid gland neoplasm after elective curative surgical excision between January 1992 to December 1999 were studied. It aimed at finding the contributory factors responsible for the persistence or recurrence of the tumour after surgical excision. The 10 patients comprised of four males and six females. Their ages ranged from 33 to 73 years with a mean of 52 years. Seven were of malignant histologic cell types while three were benign. Eight patients were treated with secondary parotidectomy while two received combination chemotherapy. In five patients, both the superficial and deep lobes of the parotid gland were found during secondary parotidectomy. This confirms that the extent of the initial surgery was less than superficial parotidectomy. This confirms that the extent of the initial surgery was less than superficial parotidectomy. Four patients were later referred to radiotherapy centers for further treatment It is concluded that most recurrent parotid neoplasm is a result of inadequate primary surgical excision, and best results are obtained by doing a minimum of superficial parotidectomy in the surgical treatment of parotid gland neoplasms.
Primary multiple malignant neoplasms and multifocal neoplasms are a very complex problem and therefore have been a topic of many articles. The mechanism of origin, frequency of occurrence, co-existence of neoplasms in functionally similar organs (uterus, mammary gland), heredity, a possibility of diagnostic and therapy are the most interesting aspects. Frequency of multiple primary malignant neoplasms occurrence is about 2-8% and still increases. Pathogenesis of multifocal and multiple neoplasms has rarely been a subject of articles. A simultaneous exposure of a tissue to damaging factors and special tissue sensitivity are the main reasons for neoplasms origin in this group. The authors present a rare case of parotid gland multiple neoplasm: fibrosarcoma and squamous cell carcinoma, as well as discuss the diagnostics, therapy, and prognosis of multiple neoplasms.