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PubMed1999

Primary squamous cell carcinoma of the parotid gland: the importance of correct histological diagnosis.

BACKGROUND: Primary squamous cell carcinoma of the parotid is an uncommon, aggressive malignancy with a poor prognosis. The diagnosis is made after excluding metastasis from other sites in the head and neck or other primary malignancies of the parotid. METHODS: Tumor registry data from 1974 to 1994 were reviewed at three University of Louisville-affiliated hospitals. Of 370 parotid tumors, 40 (11%) were initially classified as squamous cell carcinoma of the parotid. Chart review and histological specimen re-examination were conducted to confirm diagnosis. RESULTS: Only 8 (2%) of the 370 cases, were considered true primary squamous cell carcinoma of the parotid. Patients with metastases to the parotid from primary sites within the upper aerodigestive tract or skin of the head and neck region and high-grade mucoepidermoid carcinoma of the parotid were excluded. Facial nerve dysfunction was a presenting complaint in three patients. Two patients presented with American Joint Committee on Cancer (AJC) clinical stage III disease and six with AJC stage IV disease. All patients were treated with total parotidectomy and radiotherapy. One patient (12%) is alive and free of disease. Median survival was 13 months (range, 11 months-7 years). CONCLUSIONS: Primary squamous cell carcinoma of the parotid is uncommon, occurring in 2% of parotid neoplasms at our institution. This is an aggressive malignancy, usually presenting in advanced stage and with facial nerve involvement or cervical metastases. Prognosis is poor even with radical surgery and adjunctive radiotherapy. Careful clinical and histological review is necessary to differentiate primary squamous cancer of the parotid from metastases or other primary parotid malignancy.

Aged↗

PubMed2004

Salivary gland neoplasms.

Treatment and cure of salivary gland neoplasms requires surgical intervention in most cases. For parotid neoplasms, the most common surgical procedure performed is the superficial parotidectomy with facial nerve preservation. Postoperative radiation therapy is indicated in high-grade salivary gland malignancies and malignancies with increased risk of locoregional recurrence. Primary radiation, including neutron beam techniques, may play a role in certain histologic types or nonoperative candidates. Chemotherapy has yet to result in improvements in survival or quality of life in the treatment of salivary gland malignancy. Advances in radiation therapy techniques, including intensity-modulated radiation therapy, provide opportunities for reduced morbidity.

Chemotherapy, Adjuvant↗

PubMed2005

Melanoma of the head and neck.

Staging of cutaneous melanoma has changed in recent years with an increased emphasis upon thickness and ulceration on prognosis of early stage disease. Cutaneous melanoma of the head and neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size, depth, and presence of satellite lesions. Evaluation for regional and distant metastatic disease is necessary in all cases of advanced stage disease. Sentinel lymph node biopsy and possible parotidectomy and neck dissection should be considered in head and neck cutaneous melanomas greater than 1 mm in thickness or with ulceration. Adjuvant therapy may be indicated in advanced primary, nodal, and metastatic disease. Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis despite aggressive therapy.

Cancer Vaccines↗

PubMed1975

Experience with 1,360 primary parotid tumors.

Experience with 1,360 primary parotid tumors seen at the Mayo Clinic during two fifteen year periods, 1940 through 1954 and 1955 through 1969, is reviewed. A comparison of histopathologic classification, type of treatment indicated, recurrence rates, and survival in the two periods reveals considerably greater understanding of all factors in the later fifteen year period. The relatively high mortality still encountered among patients with high grade malignant tumors of the parotid glands indicate the nature of the challenge still to be met. Based on the data in this study, it is our opinion that superficial or total conservative parotidectomy is best employed primarily for benign tumors and that the shift to more radical operative procedures should continue in the management of malignant tumors, especially those that are less well differentiated. For experienced surgeons, exceptions might be the small superficially located tumors or the tumors in the lower pole of the gland such as Warthin's tumors. Local excision with removal of a margin of parotid parenchyma might be justifiable in such cases.

Humans↗

PubMed1976

Frey's syndrome.

Frey's syndrome occurs after parotid gland surgery or injury to the parotid gland and is characterized by gustatory sweating and erythema of the face upon mastication. The syndrome occurs in 50 to 60 per cent of all patients undergoing parotid surgery but the symptoms are only distressing to about 10 per cent of patients undergoing parotidectomy. A case of Frey's syndrome is reported The patient obtained good relief of symptoms with scopolamine cream and atropine cream. Other methods of therapy are discussed along with their limitations. Noninvasive therapy with topical anticholinergic creams is effective and seems appropriate in the control of gustatory sweating.

Administration, Topical↗

PubMed1976

Frey's syndrome after parotid surgery.

The operative records of seventy-one patients who had parotid surgery carried out in the ten year period from 1964 to 1973 were reviewed. Forty-one (67%) of the operations were suprafacial parotidectomies. Of the fifty patients who agreed to reassessment in a special clinic, seventeen had a noticeable degree of Frey's syndrome, and of these fourteen were submitted to further investigations. Minor's test in these fourteen patients showed the greater auricular nerve to be involved in six patients, the ariculotemporal nerve in four, and both nerves in two. The results in two patients were inconclusive. Because the starch test reveals only the distribution of the gustatory sweating, a useful adjunct is described for investigating Frey's syndrome. By blocking of the contralateral greater auricular nerve in the neck and mapping out of the anesthetized area, its sensory distribution is demonstrated. We conclude that it is manifestly unwise to avulse the auriculotemporal nerve if the sweating occurs in the distribution of the greater auricular nerve.

Adolescent↗

PubMed1976

Parotid tumors in children.

Most salivary gland tumors, both benign and malignant, develop within the parotid glands. Although an overwhelming majority of tumors are reported in the adult population, the parotid glands are also the most frequently involved salivary glands in the pediatric age group. This study represents a combination of case material from the Armed Forces Institute of Pathology and our personal experiences. Of approximately 10,000 salivary gland lesions accessioned in all ages, only 124 tumors occurred in the parotid gland in children less than fifteen years old. There were ninety benign and thirty-four malignant lesions. The two most common benign masses were mixed tumors and vascular lesions. The most common malignancies were the mucoepidermoid and acinic cell carcinomas. We recommended that all solid tumors be removed by parotidectomy.

Adenocarcinoma↗

PubMed1977

Carcinoma of the parotid gland.

Sixty-nine patients with parotid gland cancer were studied at the Cancer Control Agency of British Columbia; half were treated successfully. Localized cancers should be treated by total parotidectomy with facial nerve preservation. Facial nerve sacrifice and radical neck dissection for metastatic lymph nodes may be required. If adequate surgery has been done, the histologic type of the tumor significantly determines the outcome. Postoperative radiation to the parotid bed in the more malignant types of tumor is advocated and appears to improve the results of treatment.

Adenocarcinoma↗

PubMed1979

Tumors arising in accessory parotid tissue.

A summary is presented of our experience with 23 patients who had accessory parotid tumors, comprising 1% of all primary parotid neoplasms seen during a 40 year period. Although more than half of the tumors proved malignant, adequate excision was usually curative. We prefer to approach these tumors through an extended cheek-flap incision. Once the lesion is exposed, either local excision or resection in conjunction with subtotal parotidectomy can be performed, depending on the clinical findings.

Adult↗

PubMed1981

Is aggressive surgical treatment indicated for recurrent benign mixed tumors of the parotid gland?

The surgical treatment for recurrent or incompletely excised benign mixed tumors of the parotid gland is analyzed. In this series no operative procedure proved superior to another. For each patient the type of surgical procedure used must be individually selected. For patients with tumors recently excised or biopsied, superficial parotidectomy with excision of the skin scar is the minimal recommended procedure. Radiation therapy is not used as a primary method of treatment. It is however, recommended postoperatively for patients with very advanced recurrent tumor or inadequate surgical margins.

Adenoma↗

PubMed1989

Biological and chemical evidence for the existence of a porcine hypothalamic parotid hormone-releasing factor.

Methodology has been developed to achieve partial purification of a parotid hormone-releasing peptide from porcine hypothalamus-thalamus tissue using an in vivo parotid hormone stimulation test in pigs and a dentinal fluid transport stimulation test in rats. The purification steps include: acetone-water extraction of the tissue at pH 5.2, ultrafiltration through Amicon PM10 membrane, size exclusion chromatography on Bio-Gel P2, and open-column reversed-phase chromatography on Lichroprep RP8. A 100-fold increase in specific activity was attained. Intravenous infusion of porcine hypothalamus-thalamus extract stimulates a dentinal fluid transport mechanism in teeth of intact anesthetized rats, and the release of plasma immunoreactive parotid hormone in conscious catheterized pigs. Parotidectomy in both species suppresses the response, suggesting that the expression of parotid hormone-releasing activity requires the integrity of a putative hypothalamus-parotid gland endocrine axis.

Animals↗

PubMed1987

The posterior auricular flap: anatomical studies.

The aim of this study was to investigate the blood supply of the auriculomastoid skin and to prove the reliability of the posterior auricular vessels for supply of a skin flap in this region. This was done by means of studies of arteriograms, cadaver dissections, India ink perfusion, lead oxide injection and contact radiographs. Information from operative dissections performed in the course of superficial parotidectomies and neck dissections was included, as was information from 11 clinical flap transfers. The conclusion was drawn that the auriculomastoid skin could safely be transferred on the posterior auricular vessels, either as an island flap or as a free flap.

Angiography↗

PubMed1990

Atypical mycobacterial infection of the parotid gland.

A localized atypical mycobacterial infection of the major salivary gland is a rare disease. In this report the cases of three patients with this lesion are presented. The diagnosis was based on the clinical picture, skin testing with specific antigens, bacteriologic culture, and histopathologic findings. The patients were successfully treated by total parotidectomy with facial nerve preservation, which in our opinion is the therapy of choice in localized atypical mycobacterial infections.

Child, Preschool↗

PubMed1977

The human accessory parotid gland: its incidence, nature, and significance.

Observations on ninety-six dissections of human parotid glands have been presented, with the incidence, size, location, and histologic features of accessory parotid glands noted. Twenty-one per cent of the dissections revealed clearly detached accessory glands at variable distances from the main gland. There were no appreciable histopathologic differences between the accessory gland and the main gland in the same facial half. Aging changes, such as decreased glandular elements, increased fat, and increased fibrous connective tissue, were not more extensive in the accessory gland than in the main gland. Because of the histologic similarity, pathoses of the main gland could also involve the accessory parotid gland. Failure to remove a distantly separated accessory gland during parotidectomy could be a cause of tumor recurrence. X-ray films and sialograms were examined for visualization of accessory parotid glands and their ducts. Whereas routine diagnostic x-ray films were limited in their usefulness, sialograms provided visualization of accessory glands for diagnostic purposes.

Adult↗

PubMed1978

Persistent sialadenitis in an accessory parotid gland.

The patient who was followed had a persistent painful condition of the side of her face. Following a total parotidectomy, the symptoms presevered and this was ultimately diagnosed as being due to sialadenitis in the accessory parotide gland as well.

Adult↗

PubMed1982

Monomorphic adenomas of the major and minor salivary glands. Report of twenty-one cases and review of the literature.

Monomorphic adenomas are benign salivary gland tumors that have a predilection for development in the upper lip and parotid gland. Typically, patients are older persons (mean age, 61 years), but a broad age range (32 to 87 years) has been reported in the literature. Adequate treatment consists of superficial or total parotidectomy (depending on extent and location of the tumor) for parotid lesions and excision with a limited border of normal tissue for minor gland tumors. Uniform cellularity, lack of myxoid or chondroid features, and a tendency for multicentric origin are features which separate these tumors from pleomorphic adenomas. Monomorphic adenomas have been mistakenly diagnosed and treated as adenoid cystic carcinomas. Close attention to cytologic detail, histomorphology, and growth pattern at the periphery are important in separating these tumors.

Adenoma↗

PubMed1983

An immunohistochemical study of a carcinoma of the parotid gland exhibiting both ductal and acinic cell differentiation.

A 76-year-old man underwent a subtotal parotidectomy for removal of a 3 cm. multicystic mass. The tumor was a salivary gland carcinoma, with both infiltrating and intraductal/intra-acinar components, exhibiting three histologic patterns: cribriform, papillary, and comedo-like. Immunohistochemical stain for keratin by the immunoperoxidase technique was strongly reactive in the vast majority of the tumor cells, indicating ductal differentiation of the tumor. Ultrastructural studies indicated primarily ductal differentiation of the tumor cells, with additional areas of acinous and myoepithelial differentiation.

Animals↗

PubMed1986

Synovial chondromatosis of the temporomandibular joint presenting as a parotid mass: possibility of confusion with benign mixed tumor.

Synovial chondromatosis is a rare metaplastic disorder of synovium in which cartilaginous nodules are produced within joint spaces. An unusual case involving the temporomandibular joint, with extension of the lesion beyond the joint capsule into the parotid gland, is described. The patient had a history of previous superficial parotidectomy for a "benign mixed tumor." Review of the histologic features revealed both lesions to be identical. The reason for confusion between the two diagnoses is discussed.

Adenoma, Pleomorphic↗