Management of Positive Cervical Lymph Nodes in Parotid Cancer

Zedan Ali,Mustafa Osama,Hussien Marwa,Aboeleuien Ebrahim,Morsy Aieat

doi:10.19080/ctoij.2021.18.555977

Zedan Ali, Mustafa Osama + Show 3 more

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https://doi.org/10.19080/ctoij.2021.18.555977

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Abstract

Objective: Assessment the management of positive cervical lymph nodes in parotid cancer. Associated clinical symptoms, histological types, regional lymph node stage (n stage), occult metastasis, neck dissection by level, recurrence, neck irradiation. Methods. We carried out a retrospective analysis of 43 patient’s pathological positive lymph nodes metastatic from parodied cancer, who underwent neck dissection. treated in years 2010-2020, we analyzed the following parameters: age, sex, pT-Status, tumour size, skin invasion, facial nerve palsy, tumour fixation, extraparotid extension, localization, grade, histology, Distribution of T classification was: T3 (60%), and T4 (40%). Results: Mean patient age was 52 years, the most common location of cervical Nodes Met. was level II (72%), then III (49%) then I (42%), then IV (40%) and V (19%). The incidence was highest among patients with (27.9%) mucoepidermoid carcinoma was most common, followed by (14.6%) carcinoma ex-pleomorphic adenoma (9.3%) with acinic cell carcinoma (7%) with squamous cell carcinoma, (11.6%) with adenoid cystic carcinoma, (7.0%) with adenocarcinoma, (7.4%) salivary duct carcinoma, When classified by histological grade, 35% of patients with low/intermediate-grade versus 65.0% high-grade ., Pre-operative fine needle aspiration (83.7%) patients, Post-surgical irradiation was performed in all 43 patients (100%). The resection status (R) was Negative margins R0. (93%), lymphovascular space invasion (44.2%) and (25.6%) had perineural invasion. Skin invasion in (14%) patients, and (4.7%) had regional nodal recurrence (7%) patients with pN1, vs (93%) patients with pN2. Pathologically positive lymph node 4 (range: 1–8 Nodes) lymph nodes harvest 29(range, 23–41 lymph nodes)., Conclusion: modified Radical Neck Dissection with additional radiotherapy should be carried out in patients. Nodes positive parotied cancer especially High histological stage, advanced stage, perineural invasion, positive operative edge, a fixed mass with extra parotid extension facial-nerve paralysis and tumor pain in partied cancer.

Highlights

Primary parotid carcinoma (PPC) is a comparatively rare (0.3% of all malignancy), [1] and histologically diverse disease [2]
The incidence was highest among patients with (27.9%) mucoepidermoid carcinoma was most common, followed by (14.6%) carcinoma ex-pleomorphic adenoma (9.3%) with acinic cell carcinoma (7%) with squamous cell carcinoma, (11.6%) with adenoid cystic carcinoma, (7.0%) with adenocarcinoma, (7.4%) salivary duct carcinoma, When classified by histological grade, 35% of patients with low/ intermediate-grade versus 65.0% high-grade ., Pre-operative fine needle aspiration (83.7%) patients, Post-surgical irradiation was performed in all 43 patients (100%)
Whole gland was infiltrate in 17(39.5%) cases; superficial lobe was infiltrate in 26 (60.5%) cases, 12 (27.9%) patients with pain, tumor was mobile in 29 (67.4%) patients, Preoperative facial nerve palsy 4 (9.3%) patients, 34 (79.1) patients had clinical nodal disease while 9 (20.9%) patients Occult metastasis

Summary

Introduction

Primary parotid carcinoma (PPC) is a comparatively rare (0.3% of all malignancy), [1] and histologically diverse disease [2]. Data on this neoplasm are usually based on reports pertaining to groups of patients from single institutions, amounting to approximately 100 cases over many years [3]. This is associated with the problem of metastases to cervical lymph nodes, whose presence significantly increases the risk of locoregional relapse and death, worsening 5- and 10-year. The Cancer Ther Oncol Int J 18(1): CTOIJ.MS.ID.555977 (2021)

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