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[Parapharyngeal oncocytoma of the parotid gland].

Oncocytic tumors rarely occur in major salivary glands and generally account for less than 1% of all salivary tumors. Oncocytomas are infrequent tumors that most commonly arise in the salivary, thyroid, parathyroid and pituitary glands, kidneys and pancreas. They are rarely malignant. Oncocytic differentiation may also occur focally in a benign or a malignant epithelial tumor, such as a thyroid adenoma, papillary cystadenoma lymphomatosum and mixed tumors of salivary glands, malignant carcinoids of the bronchus, adrenal cortical carcinoma, and renal cell carcinoma. The term oncocytoma refers to a single neoplasm contrast to nodular oncocytic hyperplasia, which refers to two or more distinct tumor nodules, and to oncocytic mucoepidermoid carcinomas, where there is evidence of infiltrative growth and malignant of clinical behavior. We here report surgical treatment and light and electron microscopical findings obtained in the case of an oncocytoma of the parapharyngeal prestyloid space in a 62-year-old man who was admitted to our Department because of a slowly enlarging, painless mass in the pharyngeal extension of the right parotid gland. The mass has distorted the isthmus of the fauces, compressing the contra lateral pharyngeal-palatal plica. A total right parotidectomy which spared the branches of the facial nerve was performed. During the operative procedure, tissue was removed for frozen-section examination. The patient had an uneventful post-operative course. For all that has previously been written about oncocytic tumors, relatively very little is known of their etiology. In the past a correlation was made between the etiology and the history of direct or indirect radiation exposure. As oncocytic metaplasia and oncocytomas are often seen most in older individuals, the oncocyte was previously regarded as a "functional exhaustion" of a normal cell. As far as we concerned, the preferred method of surgically exposing the parapharyngeal-prestyloid space is that of removing the parotid gland through a cervical approach. Because of the proximity of certain anatomical structures, the transoral approach is not the most suitable.

Adenoma, Oxyphilic↗

[Hodgkin's disease in a patient with sarcoidosis].

We present the case of a 37 years old woman with mediastinal lymphadenopathy since the age of 13. At de age of 14, the patient presented a left cervical lymphadenopathy and the onset of episodic nodose erythema. One year later, histological examinations of an enlarged lymph node revealed sarcoidal granulomata. Corticotherapy was prescribed and the patient became asymptomatic. At the age of 31, the patient complained of asthenia and fever with left parotid tumefaction. Corticotherapy was therefore resumed with good response. Three years later, the patient presented left parotid tumefaction, left cervical lymphadenopathy and painful eye congestion. The patient was submitted to parotidectomy and lymphadenectomy. One month later, an ulceration with progressive enlargement developed in the surgical scar, and the patient suffered from asthenia, anorexia, weight loss, fever, nocturnal sweating and cervical and axillary lymphadenopathy. At Santa Maria Hospital, the patient's condition was diagnosed as Hodgkin's disease, mixed cellularity subtype, stage II Bb with local cutaneous involvement. The prescribed treatment was MOPP/ABV-8 cycles- and complete remission was achieved. The patient is still asymptomatic after a follow-up of 6 years. Cutaneous involvement in Hodgkin's disease is rare and generally associated with advanced disease and poor prognosis, facts that did not occur in this case. The differential diagnosis between sarcoidosis and sarcoid reaction in Hodgkin's disease, the accidental coexistence of both entities and the evolution of sarcoidosis into lymphoma are also discussed. The sarcoidosis immune defect may be the result of the same immune disorder. No relationships between sarcoidosis and cutaneous involvement in Hodgkin's disease were found in the literature.

Adrenal Cortex Hormones↗

[The role of SMAS in the prevention of Frey's syndrome].

Frey's syndrome is the most common postoperative complication in the parotid gland surgery. The authors report their own experience with 80 patients who underwent surgical operation of superficial or total parotidectomy. In 45 of them was performed the SMAS flap, no SMAS flap performed in the remaining 35 patients. The follow-up was performed by interviewing the patients about their symptoms. The purpose of this work is to show the role of SMAS flap, that minimize the frequency and the intensity of symptoms of the Frey's syndrome.

Adolescent↗

[A case of gigantic pleomorphic adenoma of the parotid gland].

The case of big size pleomorphic adenoma of the partoid gland was presented. Attention was paid on the necessity of the surgical treatment of pleomorphic adenomas by superficial or total parotidectomies. Possibility of the post operative complications avoidance, even in such big cases was emphasized.

Adenoma, Pleomorphic↗

[First branchial cleft cyst in the parotid gland].

The authors have described genesis, localization and diagnosis of the first branchial cleft anomaly and the case of the branchial cyst in the deep parotid lobe. Surgical treatment (superficial parotidectomy and cyst extirpation from the superior part of the deep parotid lobe) was effective; one-year follow-up revealed no recurrence of the anomaly.

Branchioma↗

[Malignant tumors of the parotid gland. Apropos of 60 cases].

Among a series of 520 parotidectomies performed between 1975 and 1995, we observed 88 cases of malignancy (17%). For this study, we excluded skin cancers which had invaded the parotid and glandular metastases of squamous cell carcinoma, malignant melanoma or kidney cancers, retaining only tumors with a glandular origin and lymphomas. Thus defined, our series comprised 60 patients, i.e. 12% of the operated parodids (31 confirmed cancers, 18 tumors with intermediary malignancy, including several in which the pathology report confirmed malignancy, and 11 lymphomas). We examined therapeutic management by histology and compared the outcomes. Relation with the facial nerve are discussed. Prognosis depends on histology, tumor stage and treatment.

Adolescent↗

Non-tuberculous mycobacterial infection of the parotid gland.

The case of a non-tuberculous mycobacterial infection of the parotid gland, presenting in a 15 year old female, is described. The patient presented with a six week history of a rapidly expanding, discrete parotid mass. Definitive management involved surgical removal of the mass by superficial parotidectomy. Current investigation and management of nontuberculous mycobacterial infections of the parotid gland is reviewed.

Adolescent↗

[Métastases of carcinoma of the kidney to the salivary glands. A case of intraparotid metastasis (author's transl)].

The authors first report the histopathological distribution of 111 parotidectomies carried out between 1965 and 1975. They then describe a case of a malignant tumour of the parotid which was shown by histological examination to be a metastasis of a carcinoma of the kidney, this being the first manifestation of the primary tumour. Finally, the authors review the literature concerning metastases of carcinoma of the kidney to the ENT area. They feel that the great rarity of parotid localisations is due to the fact that they may be confused with an acinous carcinoma of the parotid if histochemical stains are not used.

Adenocarcinoma↗

[Parotid gland tumor histopathologic picture and treatment].

The records of 41 patients with tumours of the parotid gland treated in ORL Clinic in Białystok from 1990-1995. Were retrospectively reviewed. Malignant tumours constituted 11.5% of all tumours. The most common benign tumour was pleomorphic adenoma. Superficial or total parotidectomy was used as the method of treatment. The incidence of facial nerve dysfunction was 4.87%. Only 4.87% of patients developed Frey's syndrome.

Adult↗

[Surgical treatment of pleomorphic adenoma of the parotid gland. Apropos of 192 cases].

Tumors of the salivary glands are exceptional, representing approximately 2% of head and neck tumors. The parotid gland is most often involved, at a frequency reaching 80%. Histology examination generally shows a pleomorphous adenoma. The choice of a surgical technique best adapted to curative treatment depends on the type of tumor and is widely debated. Our management strategy is based on simultaneous histology examination and superficial parotidectomy. Several pre and intra-operative factors determine the need for resection. We verified our strategy with a retrospective study.

Actuarial Analysis↗

[The application of regional excision of parotid gland in the treatment of Warthin tumors].

The regional excision of parotid gland (resection of the tumor with its surrounding glands) was applied in 54 cases with Warthin tumor. Its role was evaluated by follow-up study, iodine-starch test (Minor test), radionuclide scintigraphy, and comparison with superficial parotidectomy. The results showed that regional excision had the following advantages: shortening the time of operation, decreasing the injury of facial nerve, avoiding the facial deformity and Frey syndrome, and reserving the function of parotid glands. The theoretical basis, indications, and some considerable questions during the operation were discussed.

Adenolymphoma↗

A 25 year review of parotid surgery.

At a single institution over 25 years, 110 patients were operated upon for a mixture of parotid disease. The mean duration of symptoms for benign disease was 40.8 months compared with 15.6 months for malignant disease. Pain was a significant feature of malignant parotid disorders (46.1% compared with 17.8% for benign conditions). The pathology of these masses was diverse, with pleomorphic adenoma being the commonest (44%). Superficial parotidectomy was the commonest procedure employed (69/110) with local excision being performed only prior to 1984 (15/110). There were five cases of permanent facial palsy, all following radical resection for malignancy. One patient developed Frey's syndrome. Recurrence rate for pleomorphic adenomas was 7/48 (15%), three following enucleations prior to 1984. In primary malignancy of the parotid, 3/21 (14%) developed recurrences. Parotid tumours have a low incidence. Surgery for these tumours can be safely performed by those with a special interest in parotid surgery.

Female↗

[Treatment of Frey's syndrome with botulinum A toxin].

A 74-year-old woman suffered from severe gustatory sweating and flushing of the preauricular skin following parotidectomy (Frey's syndrome). She was treated with intracutaneous botulinum A toxin injections in the affected skin area. Minor's test was used to determine the extent of the affected area. Within one week, the symptoms disappeared. After three weeks, Minor's test was repeated and showed minimal residual hyperhidrosis. These small areas were treated again. No side effects were noted. At follow-up one year later, the patient was free of symptoms.

Aged↗

[The facial nerve and the parotid gland (author's transl)].

The modern histological classification of epithelial salivary gland tumours is described. An exact knowledge of the behaviour of each type of tumour permits correct surgical planning. Contrary to the teaching that the superficial parotidectomy is the minimal safe resection, the author feels that in many cases dependent on tumour site, size and histological type, a simple excision is sufficient. The application of microsurgical techniques permits careful and safe surgery.

Facial Nerve↗

Tuberculosis of the parotid gland.

The presentation of tuberculosis as an isolated parotid lump is rare. In this paper, six cases with tuberculous parotitis are reported which were evaluated as a benign parotid neoplasm in 216 specimens pre-operatively. All but one of them had no previous history of tuberculosis and all had a parotid lump as a sole symptom for at least one year. The diagnosis of tuberculosis was made, after superficial parotidectomy, by histopathology. Parenchymal involvement and intraparotid lymph node involvement with tuberculosis were seen in five and three patients, respectively. Two of the patients had lymph node involvement outside the parotid area. One of six patients had a coincidental Warthin tumour. A surgical approach is not only therapeutic but also diagnostic when other diagnostic tools fail.

Adult↗

[Lipoma of the superficial lobe of the parotid gland. A case report].

We report the case of a patient with a lipoma of the superficial lobe of the right parotid gland. Lipomas of the parotid gland are very rare. They are said to constitute one to two percent of all parotid tumours. Only six cases were found in the recent literature. Preoperative diagnosis is difficult when the physical examination reveals a renitent, well-localized and painless mass. However, magnetic resonance imaging is now the imaging modality of choice to facilitate the diagnosis, but the diagnosis can only be confirmed by histological examination of the tumour. We discuss the value of superficial parotidectomy, while some authors suggest an enucleation of lipomas of the superficial lobe of parotid.

Humans↗

[Parotid tumors: a report of 120 cases].

The treatment of the parotid tumors was clarified for a majority of the tumors, in spite of her histology diversity. The authors report in a retrospective study 120 cases of a parotid gland tumors during ten years over. They insist on the difficult of therapeutics, the histological diversity and the complications and sequelles of the surgery. The diagnosis was especially clinical and completed by scan and or a sialography. The superficial or total parotidectomy with preservation of facial nerve was realized in eighty-nine percent. The functional courage and the radiotherapy were associated respectively in eleven and seventeen patients. The histology was dominated by the benign tumors. The complications and sequelles were a facial paralysis definitive and a Frey's syndrome respectively in three percent cases. The ninety-seven percent patients were controlled with a mean follow up of three years. After results we must know every histologic type for to adapt his treatment. And the same complications and the sequelles were noted in all surgery type.

Adenocarcinoma↗

[Analysis of causes of the parotid pleomorphic adenoma recurrence].

Out of the total number of 173 patients who had undergone surgery for pleomorphic adenoma of the parotid gland, 19 had to be treated owing to the recurrence of the tumor, following earlier surgery 12 patients were reoperated on by means of the enucleation technique; 5 underwent superficial parotidectomy; in 2 cases the recurrence took on the form of tumor of the parapharyngeal space, which was removed through the cervical-parotid approach. The causes of the recurrences were analyzed taking into consideration the operation technique applied in the first surgery. A serious consequence of pleomorphic adenoma recurrence is the possibility of its becoming malignant, which took place in 2 cases (10.5%), as well as a permanent paralysis of facial nerve during the reoperation, which occurred in 4 cases (21%).

Adenoma, Pleomorphic↗