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PubMedDate not supplied

Salivary duct carcinoma--a clinicopathologic study of 12 cases.

Salivary duct carcinoma (SDC), a recently defined malignant tumor usually of major salivary glands, has probably been included in the group of adenocarcinomas, NOS. As yet, only a few descriptions of its clinical behavior have appeared. We have found 12 cases of SDC treated at our institution since 1970 and have reviewed their presentation and course. Despite total parotidectomy in most cases and radiotherapy in all, most patients have succumbed to their tumors, six with distant metastases. SDC appears to be a highly malignant tumor requiring aggressive combined therapy for locoregional control. The high incidence of systemic spread indicates a need for effective chemotherapy on an adjuvant basis.

Adenocarcinoma↗

PubMedDate not supplied

Tumors of the major salivary glands in children.

During the 30-year period 1955-1985, 21 children with neoplasms of the major salivary glands were treated at the Johns Hopkins Hospital. A thorough review of the English literature revealed an additional 472 cases. The cases were studied as to age, sex, site, histopathologic characteristics, mode of treatment, and results. The majority of the patients were between 8 and 20 years of age. There was a female preponderance of 1.42:1. The parotid gland was the site of origin in 85.1%, the submandibular in 11.7%, and the sublingual in 3.2%. An equal incidence of benign (50.1%) and malignant (49.9%) lesions is noted. Pleomorphic adenoma was the most common benign neoplasm and mucoepidermoid carcinoma the most common malignant neoplasm. The final prognosis seems to be similar with superficial or total parotidectomy, provided the tumor has been completely removed at the initial surgery. Re-excision is recommended for tumor recurrence, and the use of radiation therapy should be individually determined in cases of aggressive malignancies.

Adolescent↗

PubMedDate not supplied

Sonographic appearance of a congenital parotid gland hemangiolymphangioma simulating malignancy in an infant.

Congenital hemangiolymphangioma, also called mixed angioma, is a benign tumor that very rarely occurs in the parotid gland. We present a rare case of hemangiolymphangioma of the parotid gland in a 4-month-old boy whose clinical and radiologic presentation simulated malignancy. Gray-scale and color Doppler sonography revealed an enlarged left parotid gland and inhomogeneous hypoechoic and hyperechoic areas scattered throughout the gland. Mild internal vascularity was noted on color Doppler sonographic examination. CT revealed a predominantly fatty mass involving the superficial lobe of the parotid gland. The results of fine-needle aspiration cytology were inconclusive, and total parotidectomy was performed. Histopathologic examination of surgical specimens confirmed a diagnosis of hemangio lymphangioma. The patient recovered well and was free of recurrence at the 6-month follow-up visit. To our knowledge, this case report is the first to describe the findings of congenital hemangiolymphangioma of the parotid gland on sonography and CT. This rare diagnosis should be considered in neonates and infants presenting with a rapidly growing parotid gland tumor suggesting malignancy. Histopathologic examination is necessary to confirm the diagnosis.

Biopsy, Needle↗

PubMed2001

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi.

PURPOSE: The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. METHODS: From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. RESULTS: In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). CONCLUSIONS: ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.

Adult↗

PubMed1975

Unusual lesions of the parotid gland.

Ten unusual cases of parotid tumors are added to the literature from a series of 318 consecutive parotidectomies. These 10 cases are: 3 branchial cleft cysts; a lipoma; a lymphangioma; a hemangiopericytoma; a Boeck sarcoid; a metastasizing basal cell carcinoma; a lymphoma of the parotid; and a metastatic adenocarcinoma from the left breast to the right parotid. The lymphoma, Case 1, is also an example of some other cranial nerve taking over the function of the facial nerve when it is destroyed in early childhood. Though most tumors of the parotid gland are of the mixed type, many suprising findings are possible. The pathology report may be the first clue to a hidden systemic disease.

Adenocarcinoma↗

PubMed1984

Benign cysts of the parotid gland.

Benign cysts of the parotid gland are rare. They present with equal distribution between males and females as unilateral painless swelling in the area of the parotid gland without fixation to the overlying skin or involvement of the facial nerve. These cysts can be congenital, acquired, or occasionally may arise from surrounding structures. The preoperative diagnosis is very difficult and the treatment of choice consists of superficial parotidectomy. Our 10-year experience with benign cyst of the parotid gland at Roswell Park Memorial Institute is presented in this paper.

Adult↗

PubMed1989

Management of nodal metastases from head and neck melanoma.

Ninety-three patients with nodal metastases from melanoma (stage II) located in the head and neck underwent surgery at the National Cancer Institute of Milan. Different surgical techniques were employed, ranging from radical to conservative treatment. Analysis of the data shows no significant difference from an oncological standpoint between radical and conservative surgery when a radical dissection is performed. Elective nodal dissections for malignant melanoma of the head and neck region, like those at other sites of lymphatic drainage such as the groin and axilla, did not prove beneficial. We do recommend parotidectomy in cases where the primary tumor arises in the superior area of the head. The number of nodes involved and the type of disease spread constitute the major prognostic factors, as in the case of melanomas located in other sites. Our data further indicate that the incidence of distant and local recurrence is not influenced by the type of dissection performed.

Adult↗

PubMed1991

Parotid manifestations of HIV infection.

A lump in the parotid region is generally a salivary tumor unless proved otherwise. Recently with an epidemic of acquired immune deficiency syndrome (AIDS) and AIDS-related complex (ARC), a large number of pathologies are noticed in the parotid region. These conditions generally involve the intraparotid and periparotid lymph nodes. Hyperplastic lymphadenopathy and the benign lymphoepithelial lesions are the most common variants. Our knowledge regarding these new conditions is just evolving. There remains a therapeutic dilemma starting from observation only to local excision and superficial or total parotidectomy. These lesions must be kept in mind when we evaluate a patient with risk factors for human immunodeficiency virus (HIV) infection.

AIDS-Related Complex↗

PubMed1993

Wound bleeding after head and neck surgery.

Using our head and neck service database, we reviewed 3,200 surgical procedures performed at our institution over a 7-year period. We identified 54 patients whose surgery was complicated postoperatively by wound bleeding. The procedure most often complicated by wound bleeding was parotidectomy, 1.7% (14 of 510 patients), followed by thyroidectomy, 1.6% (8 of 504 patients), neck dissection combined with other procedures, 1.3% (12 of 885 patients), and neck dissection alone, 1.1% (6 of 534 patients). Bleeding developed in flap donor sites in 2 of 227 patients and followed miscellaneous procedures in 12 others. Thirty-one patients were treated by reexploration in the operating room, 13 had limited exploration on the ward and 10 were observed with no intervention. There was no difference in wound healing between the three treatment groups. However, mean hospital stay was shortest for patients who had wound exploration in the operating room, 6.2 days, for exploration on the ward, 10.8 days, and 18.9 for those that were observed. Drains had no effect on wound healing or mean hospital stay.

Hematoma↗

PubMed1993

Surgical management of accessory parotid tumors.

Accessory parotid gland tumors are defined as masses within salivary gland tissue located adjacent to Stensen's duct, but separate from the main body of the parotid gland. These tumors usually present as asymptomatic cheek masses. There is a temptation to excise these masses locally; however, the likelihood of injury to branches of the facial nerve is high. The best surgical approach to tumors in the accessory parotid region is via a standard parotid incision and concomitant superficial parotidectomy. Eight patients have been surgically treated with accessory parotid gland masses. Six patients had mixed tumors, one had a low grade mucoepidermoid carcinoma, and one had a localized parotitis. Our approach included a standard parotid incision, raising an anterior flap beyond the mass, and exposing the main trunk of the facial nerve, with careful tracing of all its branches. This approach to accessory parotid gland tumors is superior in that it provides a better margin of resection and minimizes functional and cosmetic deformities. Most importantly, there is less danger of injury to branches of the facial nerve.

Adult↗

PubMed1983

Cervicofacial mycobacterial infections presenting as major salivary gland disease.

Mycobacterium tuberculosis and atypical mycobacterium are well-known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally--if not more--difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands. Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid-fast stains, culture, and response to surgery and antituberculous chemotherapy.

Adult↗

PubMed1993

Recurrent neuroendocrine (Merkel cell) carcinoma of the skin presenting as marrow failure in a man with systemic lupus erythematosus.

Neuroendocrine carcinoma of the skin, Merkel cell carcinoma, is an aggressive malignancy with a high incidence of local recurrence and metastasis. We describe a case of neuroendocrine carcinoma of the skin with unusual metastatic spread to the bone marrow in a 55-year-old man with systemic lupus erythematosus. Following resection of a left temporal subcutaneous nodule and complete left parotidectomy and radical lymph node dissection, the patient presented with pancytopenia. Although focal bony metastatic disease was not identified, his bone marrow was diffusely replaced by metastatic carcinoma. High-dose chemotherapy allowed a brief remission; however, the patient subsequently died with central nervous system metastases.

Bone Marrow Diseases↗

PubMed2005

Mucoepidermoid carcinoma of the parotid gland as a second malignant neoplasm.

We report two second malignant neoplasms (SMNs) of the parotid gland. Patient 1 was initially diagnosed with precursor B-cell lymphoblastic lymphoma of the scalp. Eight years after her initial diagnosis she presented with a small, painless mass in the region of her parotid gland. Patient 2 was diagnosed with pre-B-cell acute lymphoblastic leukemia (ALL). Thirteen years after her initial diagnosis she presented with a painless mass in her right cheek. Both patients underwent superficial parotidectomies following excisional biopsies. Pathology revealed low-grade mucoepidermoid carcinoma (MEC) in both cases. Both patients are currently tumor free.

Adolescent↗

PubMed1995

Recurrent amyloid tumor of the parotid gland.

A case of an organ-limited amyloid tumor of the left parotid gland is described with a history of recurrence. A slowly growing parotid mass was the only symptom. After 5.5 years following local excision, the patient was readmitted with a slowly growing recurrence in the superficial lobe of the previously treated gland. Lateral parotidectomy was performed with wide excision of the infiltrated tissue and preservation of the facial nerve. Primary amyloidosis of the AL type was confirmed with immunohistochemical studies revealing staining for lambda but not kappa light chains of immunoglobulins. There has been no clinical or laboratory evidence of systemic amyloidosis or recurrence after 2 years. To the best of our knowledge, this is the first report of a recurrent amyloid tumor of the parotid gland.

Amyloid↗

PubMed1997

Choroidal metastasis of mixed carcinoma of the parotid gland.

BACKGROUND: A case of mixed carcinoma of the parotid gland (an epidermoid carcinoma located in a pleomorphic adenoma) metastatic to the choroid is presented. The histopathology of the tumor is discussed. METHODS: A 65-year-old man was admitted complaining of blurred vision in his right eye for 1 day. He underwent parotidectomy for mixed carcinoma of the parotid gland (an epidermoid carcinoma located in a pleomorphic adenoma that was completely excised) 6 months before. Funduscopic examination showed a nasal retinal detachment, with gray-whitish, minimally elevated nodular choroidal lesions. Fluorescein angiography and contact B-scan ultrasonography confirmed the presence of an underlying mass. RESULTS: The right eye was enucleated and an epidermoid infiltrating carcinoma was identified. CONCLUSIONS: Metastatic tumors are the most common intraocular malignancies, and the choroid is by far the most common location for intraocular metastases. There are few cases reported of parotid tumors metastatic to the orbit. To the best of our knowledge, no histological examination of an ocular metastatic mixed carcinoma of the parotid gland has yet been reported.

Aged↗

PubMed1982

Amylase released from the parotid gland by pilocarpine elevates the enzyme activity in the submandibular and sublingual glands of rats.

Stimulation by pilocarpine led to a marked increase in amylase activity in the submandibular and sublingual glands and serum, and resulted in a considerable depletion of the enzyme in the parotid gland and pancreas of rats. Parotidectomy reduced these pilocarpine effects. It is concluded that amylase released by pilocarpine from the parotid gland but not from the pancreas elevated the enzyme activity in the submandibular and sublingual glands.

Amylases↗

PubMed1994

Radiotherapy for parotid cancer.

BACKGROUND: Parotid malignancies represent a heterogeneous group of tumors primarily managed by surgical extirpation. Moderately high recurrence rates are seen after surgery alone, and postoperative radiotherapy has been used for patients with higher risks for local failure. METHODS: To assess the role of radiotherapy in the management of patients with malignant tumors of the parotid gland, the records of 68 patients receiving megavoltage therapy at our institution from 1966 to 1989 were reviewed. Patients were placed into three groups for analyses. Group I was composed of 41 patients receiving radiotherapy following total gross removal of parotid cancer by surgical procedures, varying from excisional biopsy through total parotidectomy. Radiation dose for this group ranged from 4,995 to 6,500 cGy. Group II was composed of 10 patients treated with radiotherapy after incisional biopsy or excision with positive margins. These patients received radiation doses of 4,000-9,470 cGy. Group III was composed of 17 patients receiving radiotherapy for a postsurgical local recurrence. Their radiation dose ranged from 4,300 to 8,400 cGy. RESULTS: Two of the 41 patients from group I developed a local recurrence. Two of these patients also developed distant metastases, one concurrent. Two of 10 group II patients failed locally, whereas three developed distant metastases. Only nine of the 17 patients in group III were controlled locally, and four patients developed distant dissemination. CONCLUSION: Total gross excision of parotid cancer, sparing facial nerve if possible and followed by regional radiotherapy, provides excellent rates of local control and survival with modest toxicity. Patients presenting postoperatively with gross residual tumor or recurrence after surgery should be considered for trials of more aggressive treatment with combined chemotherapy or altered fractionation schemes of irradiation.

Actuarial Analysis↗

PubMedDate not supplied

Recurrent pleomorphic adenoma: uninodular versus multinodular disease.

BACKGROUND: While treatment of previously untreated pleomorphic adenoma is relatively straightforward, recurrent pleomorphic adenoma presents a management problem with increased risk of injury to the facial nerve and an increased risk of malignant transformation in recurrent disease. AIMS: The objectives of this study were to review the management of recurrent pleomorphic adenoma in our unit to identify factors that might help treatment of future cases. METHODS: We reviewed the management of pleomorphic adenoma at our department over an eight-year period from 1990-1998 and present our experience of recurrent pleomorphic adenoma of the parotid gland and parapharyngeal space. RESULTS: Twelve patients were treated with recurrent pleomorphic adenoma. In 10 of these, the site of recurrence was in the parotid gland with the remainder occurring in the parapharyngeal space. Type of recurrence was uninodular or multinodular, the former being easier to treat. Three patients required adjuvant radiotherapy. None of our patients had permanent facial nerve damage. CONCLUSIONS: In order to prevent recurrence of pleomorphic adenoma of the parotid gland, we recommend formal superficial parotidectomy for first time surgery.

Adenoma, Pleomorphic↗