Rupture of the Pleomorphic Adenoma of the Parotid Gland: What to Know before, during and after Surgery.

Michele Grasso,Marco De Vincentiis,Fabrizio Cialente,Griselda Agolli,Antonio Minni,Domenico Di Maria,Massimo Ralli,Vito D’Andrea,Paolo Petrone,Giulia De Soccio,Marc Remacle,Antonio Greco,Massimo Fusconi

doi:10.3390/jcm10225368

Michele Grasso, Marco De Vincentiis + Show 11 more

Open Access

https://doi.org/10.3390/jcm10225368

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Abstract

Background: We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. We aim to explain how the surgeon should manage a spillage during surgery (i.e., how to avoid spreading the contents that are coming out of the tumor). We also aim to investigate whether or not spillage is linked to a higher rate of PPA recurrence. Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors. Results: Intraoperative tumor spillage and tumor rupture occurred in 34/202 cases. There were three recurrences after a mean of 3.7 years (mean follow-up duration: 10.3 years). One recurrence happened to a patient who had an intraoperative tumor spillage, and two more recurrences happened to patients who did not have spillage. Conclusion: We believe that the real number of the events of spillage is underestimated and underreported by surgeons. Capsular rupture must always be avoided, and secure resection margins must always be pursued, independent of the type of parotidectomy being performed. Features that increase the risk of recurrence are an intraoperative rupture and the presence of satellite nodules (as recorded in the pathologist’s report). In these cases, patients need a longer follow-up period.

Highlights

All of the patients underwent preoperative FNAC, which returned a reading that was positive for pleomorphic adenomas (PPAs) in 197 cases and a reading that was suspicious of PPA in 5 cases
The surgeon should always report a rupture of the capsule of a PPA and the pathologist must always describe this event in their report
The rate of recurrence of PPAs rises when microscopic fingerlike formations of neoplasmic tissue run into the gland

Summary

Introduction

The most common way to treat a PPA that is less than 4 cm in diameter and located in the lateral lobe is superficial parotidectomy (SP), as this method has the greatest chance of preserving the facial nerve. Tumor recurrence is closely associated with incomplete surgical excision, accidental rupture of the pseudotumor capsule during surgery, incomplete tumor capsule removal, and multicentricity, all of which allow the spillage of tumor cells into the wound. Due to its complex branching form and its connections within the parotid gland, a small tumor of the superficial lobe of the gland could meet a branch of the nerve. We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors.

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