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PubMed2003

Recurrent malignant schwannoma of the parapharyngeal space in neurofibromatosis type 1.

Malignant schwannoma is an aggressive tumor that carries a poor prognosis despite wide excision, chemotherapy, and radiotherapy. Malignant schwannoma of the parapharyngeal space is an uncommon finding; to our knowledge, only four cases have been described in the literature during the past 30 years, and only one of them involved a patient who had clinical evidence of neurofibromatosis type 1. In this article, we describe a new case of malignant schwannoma of the parapharyngeal space in a patient who had clinical evidence of neurofibromatosis type 1. Following resection of the tumor and a total parotidectomy, the diagnosis was made on the basis of histology and immunohistochemistry. The patient underwent postoperative chemotherapy with carboplatin and UP16. However, 5 months following surgery, the tumor recurred and metastasized. The patient was then placed on a different polychemotherapeutic regimen, which was made up of 3 g/m2 of ifosfamide, 1.5 mg/m2 of vincristine, and 1.5 mg/m2 of doxorubicin (IVA2 protocol). The IVA2 regimen slowed tumor growth, but 13 months after the initiation of therapy, the patient died of neoplastic cachexia. Although chemotherapy is generally ineffective in most cases of malignant schwannoma, we did experience some positive results with the IVA2 protocol. Therefore, we recommend that this combination be considered as a first-line adjuvant therapy following surgery or as a first-line therapy for patients with inoperable tumors.

Adult↗

PubMed2003

[Primary Hodgkin's lymphoma of the parotid gland: a case report].

Primary Hodgkin's lymphoma of the parotid gland is rare. A twenty-one-year-old man presented with a lesion that recurred two years after an excisional biopsy for a parotid gland mass. He underwent superficial parotidectomy. Frozen section examination suggested a diagnosis of Hodgkin's lymphoma. The patient was treated by radiotherapy. A complete recovery was obtained after a 27-month follow-up.

Adult↗

PubMed2003

[A case of parotid carcinoma with hepatic metastasis that responded remarkably to combination chemotherapy of docetaxel, cisplatin and 5-fluorouracil].

A patient who had parotid gland carcinoma with hepatic metastasis (T4N2bM1) underwent 3 cycles of neoadjuvant chemotherapy with docetaxel, cisplatin and fluorouracil (TPF). After this treatment, the patient showed a PR in the primary site and a CR in the hepatic metastasis. Left total parotidectomy and modified radical neck dissection were then performed followed by postoperative irradiation of 40 Gy. No recurrence in the primary site or the neck was seen, but in the metastatic site a recurrence was observed at 8 weeks after the first chemotherapy. The same chemotherapy is now applied in an outpatient setting. Toxicities with neutropenia, nausea and vomiting of CTC Grade 3 were observed, but these toxicities were mild and manageable. TPF is considered to show clinical activity for advanced parotid gland carcinoma, and we consider further investigation necessary.

Adenocarcinoma↗

PubMed2002

[Analysis for therapy and prognosis of undifferentiated carcinoma with lymphoid stroma in salivary gland].

OBJECTIVE: To analyse the clinical characteristic, evolution and prognosis of undifferentiated carcinoma with lymphoid stroma(malignant lymphoepithelial lesions, MLEL) in salivary gland. METHODS: During 1989 and 1997, 21 cases of MLEL in salivary gland were treated. The primary site was parotid in 18 cases, palate minor salivary gland in 2 cases and submandibular gland in 1 case. There were 5 men and 16 women with an age range of 31 to 74 years (median, 41 years). For stage II, III, mass dissection and superficial or total parotidectomy were adopted. The facial nerve was preserved when it had not been invaded. 3 to 25 lymph nodes were subjected to exam in pathology for every neck dissection specimen. For stage IV, neck dissection may be included, when necessary. All patients were irradiated on primary site or including ipsilateral neck 2 to 9 weeks after operation, except 2 cases irradiated after recurrence. Tumor doses were 52.03Gy in average. RESULTS: There were 3/21 patients with recurrent benign lymphoepithelial lesion history (BLEL). The shortest duration from the recurrence to specific diagnosis was 6 months, and the longest was 2 years. The II, III, IV stage cases were 8(42.9%), 3 (14.3%), 10 (47.6%), respectively. All of II, III stage cases were N0. The cases with positive lymph nodes were 10/21(47.61%). The 5-year survival rate was 70.66%, for II, III, IV stage was 86.68%, 66.67%, 33.3%, respectively, analyzed by Life Table. And test with Wilcoxon (Gehan) statistic, P=0.2789, means there was no specific difference among each group. In the group, 5 patients dead and 2 lost follow up (counted in dead); mortality was 33.31%, all of them were IV stage. Superior and middle deep cervical metastasis were found in 4 of those patients with parotid MLEL, and neck dissection and ipsilateral neck irradiation were adopted. Recurrence was found in 7/21(33.3%), 5 of 7 cases were IV with N2 or N3, 2 of 7 were palate MELE in early or middle stage. There were 6/7 recurrence occurred on neck. The duration from first treatment to recurrence was 20.7m in median, the shortest was 5 months and the longest was 65 months, among them the recurrence occurred shorter than 20 months in 5 cases. After comprehensive treatment, 3 patients were alive and 3 cases dead. Metastasis occurred in 4 patients in IV stage (T4N2M0), with positive middle cervical lymph nodes in 3 cases treated by neck dissection before. CONCLUSION: Recurrent BLEL intends to develop to malignant lesion. Superior and middle deep cervical lymph nodes metastasis were not unusual in IV stage patients. Neck, dissection and irradiation should be carried out on these patients, especially for those with N2. The peak time of recurrence was 2 years after the first treatment, and during the time, the tumor proliferated rapidly. Active comprehensive treatment should be carried out on recurrent patients. For patients with positive middle deep cervical lymph nodes, chemotherapy or other methods should be adopted to prevent distant metastasis.

English Abstract↗

PubMed2003

[Stenon's or Stensen's duct carcinoma].

Carcinomas arising from the Stensen's duct are extremely rare, and only 28 cases have been reported since 1927. Only two cases of the whole were adenoid cystic carcinoma like our case. A 83-year-old man with painless tumour of the left cheek is reported. The tumour was removed without facial nerve injury via extended parotidectomy incision and after superficial lobectomy.

Aged↗

PubMed2003

[Giant pleomorphic adenomas of the parotid gland].

The authors describe four cases of giant pleomorphic adenomas of the parotid gland with the diameter greater then 15 cm in patients treated in the ENT Department, Medical University of Gdańsk in years 1989-2002. Three of the patients were treated surgically--parotidectomy was performed, in first case removing tumor of 28 cm in diameter and 3.2 kg, in second case 15 cm and 0.7 kg and in third case 18 cm and 1.3 kg. The forth patient was disqualified from the surgical treatment because of the metastases to the lungs from the giant malignant pleomorphic adenoma involving half of the head. The authors presented opinions on the diagnostic and therapeutic methods in that disease and also present case reports from Poland and other countries.

Adenoma, Pleomorphic↗

PubMed2004

Cutaneous mucormycosis of the head and neck with parotid gland involvement: first report of a case.

Cutaneous mucormycosis is an uncommon, life-threatening, opportunistic fungal infection that is a distinctly different entity from the more frequent although still uncommon rhinocerebral form that is better known to otolaryngologists. We describe what to our knowledge is the only reported case of cutaneous mucormycosis of the face with parotid gland involvement, which occurred in a 56-year-old man. The diagnosis was established by tissue biopsy. The patient was treated with antifungal medications and wide local debridement, including a total parotidectomy with sacrifice of the inferior division of the facial nerve. At the 2-year follow-up, he remained free of disease. Familiarity with the risk factors associated with the development of cutaneous mucormycosis is critical to determining the need for early tissue biopsy to confirm the diagnosis. Generally favorable clinical outcomes are associated with prompt and aggressive medical and surgical therapy.

Biopsy↗

PubMed2004

[Diagnosis management of Warthin tumour: clinical presentation, fine needle cytology and MRI].

OBJECTIVES: Warthin tumour is the second most frequent benign tumour of the parotid gland after pleomorphic adenoma. The aim of this retrospective study was to define clinical, cytological and MRI characteristics in order to work out a therapeutic strategy. MATERIAL AND METHOD: During the period May 1991-January 2003, 53 patients with Warthin tumors were treated in our institution. Clinical data were reported from medical records reviewing. Histological diagnoses were compared with FNAB and MRI results. RESULTS: Warthin tumours represented 13% of all parotid lesions of our series. Mean age of patients was 58 year-old. Sex ratio was 3.8 men and 1 woman. Sensitivity of FNAB for Warthin tumour diagnosis was 75% while positive predictive value was 71%. Six cases of false positive patients were reported: 2 acinic cells carcinomas, 2 pleomorphic adenomas, 1 dermoid cyst, 1 branchial cyst. CONCLUSIONS: Surgical management is based on partial parotidectomy that may be adapted to the tumour location. Because of elderly patients, benign nature and low risk of malignant transformation of Warthin tumours, one might prompt to adopt a conservative strategy, avoiding surgery in some cases. Despite diagnosis of Whartin tumour on FNAB and MRI, one must be cautious in recommending conservative treatment in order to avoid ignoring a surgical tumour.

Adenolymphoma↗

PubMedDate not supplied

Brooke-Spiegler syndrome with parotid gland involvement.

Salivary gland involvement in Brooke-Spiegler syndrome (BSS), an autosomal dominantly inherited disease, is known though not frequent. A case of familial cylindromatosis with parotid gland adenoma is herein reported. A 67-year-old lady presented with multiple scalp nodules and papular coalescent lesions over the nasolabial folds and the forehead. The clinical examination also revealed a left preauricular lump. Multiple biopsies of the scalp lesions and the nasolabial papules revealed cylindromas and trichoepitheliomas respectively. CT scan and FNA of the preauricular lump were suggestive of parotid gland adenoma. The patient underwent excision of the scalp cylindromas and total left parotidectomy. There is no evidence of recurrence after 4 years. The association of BSS with salivary gland tumours, emphasizes the necessity of thorough salivary gland examination in all patients with skin lesions. Knowledge of the genetic background of BSS allows for genetic counseling of patients.

Aged↗

PubMedDate not supplied

Epithelioid haemangioendothelioma of the parotid salivary gland: a case report.

Haemangioendothelioma is a vascular tumour characterised by the proliferation of endothelial cells with an epithelioid appearance. The behaviour of this neoplasm is intermediate between haemangioma and angiosarcoma. It may be localised in a wide range of sites, with a preference for soft and bone tissue. It is only rarely localised in the head and neck and even more rarely in the salivary glands. We describe a case of haemangioendothelioma in a 28-year-old man that originated in the retroneural region of the parotid gland, compressing the gland tissue and posteriorly infiltrating the muscular plane. A total parotidectomy surgical operation including the removal of lymph nodes in the region was performed followed by radiotherapy. An immunohistochemical investigation, carried out using the oxidase-antiperoxidase method, indicated that the neoplastic elements of the marker of the endothelial cells CD34 were positive for vimentine and for muscle-specific actin, showing a moderate proliferative action of the cellular elements with MIB-1 positivity estimated at around 6%. The peculiarity of the case we describe resides in the rarity of the haemangioendothelioma localisation in the parotid gland.

Adult↗

PubMed2004

[Warthin's tumor of the parotid gland. Epidemiological and clinical analysis of 127 cases].

The aim of this study was a review of 127 patients treated for Warthin's tumor of parotid gland during 15-years period 1988-2003 in Pomeranian Voivodeship of Poland. The age-standardised incidence rate of this tumor was 0.32/100,000. There were 73.2% males and 26.8% females. Age ranged at presentation from 18 to 88 years (average 59.8+/-11.6). Workers from cities over 100,000 inhabitants, with technical education constituted the largest group. Almost 70% of the patients were smokers. Most frequently patients reported slow enlargement of tumor (55.9%), presence of tumor (24.4%) and rapid tumor enlargement (7.1%). Average duration of symptoms was 27 months. The average size of the tumor was 36+/-19 mm. More than half of tumors had less than 30 mm in diameter. After histopathological assessment the average size of tumor was 21+/-17 mm and the tumors less than 30 mm in diameter were 73.1%. There were 2.4% of bilateral neoplasms. Pre-operative cytological examination was not correlated with histopathological examination in less than half of cases (39.5%). All patients were treated surgically and in 81.9% the parotidectomy was performed. The most common localization of the tumor (52.4%) was lower pole of parotid gland. There were also stated 12.4% multifocal neoplasms and 3.8% tumors arising extraglandularly. The main complication after surgical treatment was temporary or permanent facial nerve palsy (10.8%). In 1 case the residual tumor was observed which required reoperation. In time of postoperative observation up to 15 years 1 case (0.9%) of recurrence which required surgical intervention. We noted an increase in number of Warthin's tumor in the analysed period of time.

Adenolymphoma↗

PubMed2004

[Study of the relative factors of the biological behavior of pleomorphic adenoma in parotid].

OBJECTIVE: To study the growth way of parotid pleomorphic adenoma and the relative factors. METHODS: The histological slides of 97 cases of the primary parotid pleomorphic adenoma were examined for the state of intra-capsule infiltration and extra-infiltration. The relative relationships between the infiltration state and the histological type, relative amount of various components, size and course of the tumor were analysed to investigate the growth way and relative factors. RESULTS: 1. There were more chances to develop infiltration of tumor in which the major content was epithelium. The tumor was severer with the increasing of epithelium, and decreasing of mucous content and elongation of course of the disease. 2. The limitation of the extra-envelop infiltration and budding was 0.085 - 0.210 mm, so, the boundary of partial parotidectomy should be away from the 1 cm envelop. CONCLUSION: The growth way of parotid pleomorphic adenoma is related to the histological types and characters, relative amount of various components and the course of the tumor.

Adaptation, Physiological↗

PubMedDate not supplied

Salivary gland tumors: a 10-year retrospective study of survival in relation to size, histopathological examination of the tumor, and nodal status.

Salivary gland neoplasms represent the most complex and diverse group of tumors encountered by the head and neck oncologist. Their diagnosis and management is complicated by their relative infrequency. The significance of the study was to analyze the different types of salivary gland tumors, the modalities of treatment given, and their varied outcomes in relation with morbidity, prognosis, and survival rate. A total of 436 patients were treated for salivary gland neoplasm at Madras Medical College and Research Institute between 1991 and 2001, and the results were analyzed retrospectively. The patients were between 11 and 72 years of age (mean, 41.5 years), and 334 were male and 102 were female. They were from different socioeconomic groups. Fine-needle aspiration cytology was done for all patients that presented with salivary gland swelling. Univariate analysis was done, the confidence interval and odds ratio were calculated, and the significance was noted. Kaplan-Meier survival analysis was estimated, and the results were analyzed. Pleomorphic adenoma was the most common benign tumor affecting the salivary glands. In our series, 155 patients had malignant parotid gland neoplasms, and 20 patients had cervical lymph node metastasis at the time of presentation. Facial nerve paralysis was noted in 21 cases. The recurrence after total parotidectomy for malignant salivary gland tumors was effectively managed with external beam irradiation in 19 patients. The survival, prognosis, and the mortality rate of the malignant parotid neoplasms and their relation to the sex of the patient, histopathological type of tumor, nodal status, and size of the tumor were analyzed.

Adenoma, Pleomorphic↗

PubMed2004

[Sialolithiasis of the parotid gland].

Sialolithiasis of the parotid gland is a rare diagnostic and therapeutic problem in otorhinolaryngology. The authors describe opinions concerned with symptomatology, localization, diagnostics and methods of treatment in parotid sialolithiasis in support of clinical material of three patients treated in the ENT Department, Medical University of Gdańsk in years 1993-2002. One patient was treated with antibiotics while the other two patients were treated surgically--partial parotidectomy was performed, removing in one case intraparenchymal calculus 15 mm in diameter and in second case--from proximal part of parotid duct with 5 mm of diameter. After treatment there were not observed any symptoms of the disease.

Adult↗

PubMed2004

[Bilateral Warthin's tumor of the parotid gland].

Three cases of bilateral Warthin's tumor (adenolymphoma) of the parotid gland in patients treated in the ENT Department, Medical University of Gdańsk were presented. They were stated 3.3% of all Whartin's tumors in our institution. In two cases the contralateral tumor developed after 2.5 and 15 years and in one case arised synchronically. Our three patients were males, 50-65 years old, cigarette smokers more than 25 years. All of the patients were treated surgically--conservative parotidectomy was performed. We did not observe the complications and reccurence of the disease. Opinions on the diagnostic and therapeutic methods in that disease reported in Polish and foreign references are discussed.

Adenolymphoma↗

PubMed2004

[Cat-scratch disease of the parotid gland].

Cat-scratch disease is a mild disease associated with regional lymph node enlargement. We present a case of cat-scratch disease of the parotid gland in 10-year-old girl. She presented with painful parotid mass, after unsuccessful treatment with antibiotics. Computed tomography showed tumour like lesions in parotid gland. Subtotal parotidectomy with facial nerve preservation was performed as neoplastic disease was suspected. Histopathology examination of the sample revealed typical changes for cat-scratch disease. History of continuous contacts with cats was confirmed by the parents. Cat-scratch disease should be taken into account in differential diagnosis of parotid masses, especially in children.

Cat-Scratch Disease↗

PubMedDate not supplied

DNA quantification as prognostic factor in a case of acinar cell carcinoma of the parotid gland, diagnosed by FNA.

Hereby we present a case of a 43-years-old male who complained of a three years history preauricular painful mass. Fine needle aspiration cytology was performed, diagnosing of compatible with acinar cell carcinoma, thus DNA quantification by image cytometry was carried out. Biological parameters studied (ploidy, S-phase, 5-c exceeding rate) showed that it is a low grade of malignancy lesion. Total parotidectomy conservative of facial nerve was recommended, without regional lymphadenectomy. Patient remains, one year later, asymptomatic and free of disease.

Adult↗

PubMed2005

Xanthogranulomatous sialadenitis: a case report and literature review.

Xanthogranulomatous tissue reaction is an uncommon but well-documented process that occurs at many sites in the body. It is most often recognized in the kidney and gallbladder, where its etiology is believed to involve an outflow obstruction. We report the case of a man with a parotid mass that exhibited features consistent with an inflammatory process on fine-needle aspiration biopsy. The mass persisted despite medical management, and the patient subsequently underwent a superficial parotidectomy. Histologic examination of the resected specimen identified a xanthogranulomatous tissue reaction adjacent to a Warthin's tumor. We compare the features of this case with those of the 2 previously reported cases of xanthogranulomatous sialadenitis, and we discuss its possible etiologies.

Biopsy, Fine-Needle↗