Benign Parotid Gland Tumors Research Articles

Paediatric parotid neoplasms: a 10 year retrospective imaging and pathology review of these rare tumours

To determine the relative incidence of benign and malignant paediatric parotid gland tumours and whether particular presenting symptoms or imaging characteristics were more likely to predict malignancy. Hospital records were reviewed for all patients <18 years with histopathology-proven parotid neoplasms over the 10 year period from 2003-2013. Infantile haemangiomas and patients with neurofibromatosis type I were excluded. The presenting clinical symptoms for each patient were recorded. All available CT and MRI examinations for these patients were evaluated for tumour imaging characteristics. Seventeen patients (nine boys, eight girls; age range 2-17 years) were identified with neoplastic parotid masses; 11 tumours were malignant (65%) and six were benign (35%). The malignant tumours consisted of three acinic cell carcinomas, two mucoepidermoid carcinomas, one alveolar rhabdomyosarcoma, one poorly differentiated carcinoma, one low-grade adenocarcinoma, and three metastases (two melanoma, one orbital medulloepithelioma). The benign tumours consisted of five pleomorphic adenomas and one schwannoma. Presenting clinical symptoms were similar between benign and malignant tumours. Twelve MRI and six CT examinations were available for review with five patients undergoing both techniques. MRI features commonly identified with malignant tumours included: hypointense T2 signal, restricted diffusion, ill-defined borders, and focal necrosis. Only four of the six tumours imaged at CT were visualized, and of those, the margins were indeterminate in three patients. Paediatric parotid masses are more likely to be malignant than benign. Presenting clinical symptoms and CT are not helpful for distinguishing benign and malignant disease. MRI features such as T2 hypointensity, restricted diffusion, ill-defined borders, and focal necrosis, although not specific, should raise concern for malignancy.

Facial nerve morbidity following surgery for benign parotid tumours.

To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. A case series. ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. RESULTS were described as frequency percentages. Out of 235 patients, 159 (67.65%) were female and 76 (32.35%) were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour (n=194, 82.6%), followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 (72%) patients and nerve dysfunction was observed in 66 (28%) patients. Complete paresis involving all the branches of facial nerve was seen in 25 (10.6%) patients and 41 (17.4%) patients were having incomplete dysfunction. Of these, 62 (26.3%) recovered and 04 (1.7%) had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 (86.3%) cases. The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours.

Temporary facial nerve dysfunction after parotidectomy correlates with tumor location.

To investigate the clinical factors associated with temporary facial nerve dysfunction (TFND) following surgery for benign parotid gland tumors. We reviewed the records of 175 patients with benign parotid gland tumors who underwent partial parotidectomy at Yokohama City University Medical Center in Japan. TFND was found in 33 patients (18.9%). We used two hypothetical lines in magnetic resonance imaging (MRI) images to define the tumor location (upper/lower or anterior/posterior) in the parotid gland. We then studied the associations of TFND with the following clinical factors: patient age, tumor size, histopathological diagnosis, and the location of the tumor within the parotid gland (superficial lobe/deep lobe; upper part/lower part; and anterior part/posterior part). Tumors located in the upper parts, anterior parts or the deep lobes of the parotid gland had statistically higher incidences of TFND compared with tumors located in the lower parts, posterior parts or the superficial lobe (P<0.001, <0.001, <0.01, respectively). The odds ratio for the risk of TFND was significantly high if tumors were located in the upper parts, the anterior parts or the deep lobes with stepwise multivariate regression analysis. The other factors, including patient's age, tumor size, histopathology of the tumor, and inadequate surgeon's experience, were not apparent risks for TFND. Parotid gland tumors located in the upper parts, the anterior parts or the deep lobes had a higher risk of TFND. The two hypothetical lines we used were shown to be useful to define the tumor location, eventually the risk of TFND.

Oncocytic lipoadenoma of the parotid gland: Cytological findings and differential diagnosis on fine‐needle aspiration

Oncocytic lipoadenoma is a rare benign neoplastic lesion of salivary gland. To the best of our knowledge, the detailed cytomorphological findings were described only in two cases. We are reporting a 56-year-old woman who presented with 1-year history of right parotid gland mass. Cytologic examination revealed tight clusters of bland looking oncocytic ductal cells with few aggregates of mature adipose tissue in a lipoid background and a benign oncocytic tumor of parotid gland was rendered. Histologically, a tumor with islands of oncocytic epithelial cells admixed with abundant mature adipose tissue was identified. Oncocytic lipoadenoma despite its rarity should be considered in the differential diagnosis of salivary gland fine-needle aspirations containing oncocytes especially those which are accompanied by mature adipose tissue and lipoid background.

Monitoring parotid gland tumors with a new perfusion software for contrast-enhanced ultrasound.

Contrast enhanced ultrasound (CE-US) is a promising imaging modality for non-invasive analysis of functional vascularisation. Lesions of the parotid gland are associated with a vascularisation that differs from normal gland tissue. The aim of this clinical study was to further analyse the perfusion in parotid gland lesions with CE-US. The new quantification software VueBox (Bracco, Italy) was used to assess the perfusion, based on DICOM datasets of CE-US examination. CE-US measurements were performed by intravenous application of a contrast agent (SonoVue, Bracco, Italy) before surgical tumor resection. From the analysis of a time sequence of 2D DICOM contrast images, area under time intensity curve (AUC), peak enhancement (PE), wash-in-rate (WiR) and wash-in-perfusion-index (WiPI) were calculated using VueBox. These were correlated with the histological analyses of the tumor tissue. Significant difference of area below intensity time curve (AUC), peak enhancement (PE), wash-in-rate (WiR) and wash-in perfusion index (WiPI) were observed in the malign lesions compared to benign tumors (p < 0,05) and in pleomorphic adenoma compared to cystadenolymphoma (p < 0,05). CE-US seems to be a quantitative and independent method for discriminating between malign and benign parotid gland tumors.

A Case of Facial Nerve Paralysis Following Parotid Abscess Treated by Catheter Drainage

Facial nerve paralysis is one of the complications of parotid abscess. Although a few cases of benign tumor and inflammatory condition of parotid gland with the facial nerve paralysis have been reported, the occurrence of facial nerve palsy following parotid abscess without coexisting tumor is very rare. The mechanism of facial nerve paralysis is not clear, but facial nerve paralysis is usually improved after the treatment of parotid abscess. The treatment of parotid abscess is composed of antibiotics based on proper culture study and drainages. Most of parotid abscess is drained by surgical approach, but catheter drainage is also recommended for selected patients. Here, we report a case of parotid abscess treated by pig-tail catheter drainage. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(6):415-9

A Case of Pleomorphic Adenoma of the Parotid Gland with Multiple Local Recurrences through Facial to Cervical Regions

Pleomorphic adenoma is the most common benign parotid gland tumor. Although its local recurrence rate is known to be high, the recurrence extending to the cervical region is rare. Here we report a case of a young female (25 years old) with pleomorphic adenoma of the parotid gland which showed multiple recurrences through facial to cervical regions over a span of eight years. We also discuss how this benign tumor with a high recurrence rate has been treated in other cases, and how it should be treated.

1例腮腺良性肿瘤合并完全性房室传导阻滞患者的护理

目的：总结腮腺良性肿瘤合并完全性房室传导阻滞患者的护理经验，提高护理经验。方法：对收治的1例腮腺良性肿瘤合并完全性房室传导阻滞患者的临床资料进行整理和回顾性分析。结果：患者顺利度过围收缩期，顺利出院。结论：对于此类腮腺良性肿瘤合并完全性房室传导阻滞患者在使用临时心脏起搏器期间，加强心理护理和起搏器护理，密切观察生命体征，能够有效帮助患者度过围手术期。 Objective: By summing up the experience of nursing care for patient with benign parotid gland tumor accompanied with complete atrioventricular block, to improve the nursing care. Methods: Clinical data of a patient with benign parotid gland tumor accompanied with complete atrioven-tricular block were collected, and retrospective analysis of the case was performed. Results: The patient was stable during perioperative period and discharged uneventfully. Conclusion: For this group of patients, the key points of nursing during the temporary cardiac pacemaker therapy in-cluded psycho-nursing, vital signs and cardiac pacemaker-nursing; all of these measures contribute to the clinical outcome.

ダイナミックMRIによる耳下腺良性腫瘍の診断

ダイナミックMRIによる耳下腺良性腫瘍の診断

Distribution of 37 human papillomavirus types in parotid gland tumor tissues

Human papillomavirus (HPV) infection has been shown to be associated with human tumorigenesis. The aim of the present study was to demonstrate the association between HPV infection and parotid gland tumors. Paraffin-embedded tissue sections from 59 cases of parotid gland tumors and 20 normal oral mucosa were subjected to DNA extraction and flow-through hybridization and gene chip technology to detect infection of 37 HPV types. The HPV-positive rate was 57.6% in parotid gland tumor paraffin-embedded tissue specimens, whereas, the normal control group was negative for HPV. The HPV-positive rate was 59.6% in parotid gland benign tumor tissues and 42.9% in parotid malignant tissues. HPV infection in parotid gland tumors was dominated by the high-risk subtypes (80.7%), which mainly consisted of HPV 16, 18 and 52 (61.4%). In addition, parotid gland tumor tissues were found to be infected by multiple or single types of HPV, but were predominantly infected by mixed HPV types. In this study, we found that the occurrence of parotid gland tumor is correlated with HPV infection.

Perfusion characteristics of parotid gland tumors evaluated by contrast-enhanced ultrasound

PurposeContrast enhanced ultrasound (CE-US) is a promising imaging modality for non-invasive analysis of parotid gland lesions because their vascularisation differs from normal gland tissue. This clinical study should further investigate CE-US as a diagnostic tool for parotid gland tumors. Materials and methods39 patients underwent CE-US measurements after intravenous application of a contrast agent (SonoVue, Bracco, Italy) before surgical tumor resection. Time–intensity curves gradients were calculated and parameters of intratumoral microcirculation were analysed. The vascularisation parameters were compared among the different tumor entities as defined per definitive histological diagnosis. ResultsHistological analyses revealed 17 pleomorphic adenoma, 15 cystadenolymphoma and 7 malignoma. A significant difference of area below intensity time curve (AUC) and mean transit time (MTT) was measured in the malignant lesions compared to benign tumors (p<0.05). A significant difference of AUC and maximum of signal increase (ΔSImax) for pleomorphic adenoma versus cystadenolymphoma was found (p<0.05). ConclusionCE-US seems to be a quantitative and independent method for the assessment of malign and benign parotid gland tumors. Further studies and clinical experience will have to validate this method as a reliable diagnostic tool that facilitates preoperative planning.

The Role of Intraoperative Facial Nerve Monitoring during Parotidectomy for Benign Parotid Gland Tumors

Objectives: 1) Compare outcomes of parotidectomy with and without electrophysiologist-assisted intraoperative nerve monitoring (IOM) for the treatment of benign parotid gland tumors. 2) Recognize potential benefits of IOM in parotidectomy. Methods: Retrospective case control of 151 consecutive patients undergoing parotidectomy for treatment of benign tumors between March 2006 and December 2011 at Weill Cornell Medical College. Interventions included parotidectomy and IOM. Outcome measures included complications from intervention(s). Results: Sixty-four percent of patients were female, and the median age at surgery was 57 years (range 17 - 86 years). The majority of patients (70%) had pleomorphic adenomas. One surgeon performed all 81 parotidectomies with IOM (54%), while another surgeon performed the remainder without IOM (46%). IOM use depended on the attending surgeon and was not due to any other factor. Superficial parotidectomies comprised 81% and 70% of surgeries performed with and without IOM, respectively. Temporary facial nerve dysfunction occurred in 10.6% of patients. No statistically significant difference was seen in temporary facial nerve paralysis rates post-operatively between groups with IOM (9.9%) and those without (11.4%) ( P = 0.76). In cases with IOM, electrical mapping and presence of transient nerve irritation did not influence the rate of complications ( P = 0.19). Conclusions: Use of IOM does not appear to impact the rate of facial paralysis post-parotidectomy for benign parotid gland tumors. However, IOM may be beneficial in aiding the surgeon in difficult cases, to preserve smaller branches, or when the tumor lies particularly close to the facial nerve.

Clinical analysis of 150 cases with parotid gland tumor

Objective To explore the ideal method of parotid tumors by clinical surgical treatment.Methods 150 patients with parotid gland tumor were divided into parotid gland tumors and total resection of the tumor,partial parotidectomy and parotid gland tumors and shallow lobectomy three groups,fifty cases in each group.After the operation,operation time,cure recurrence and other related projects were observed.Results In 150 patients with parotid gland tumor,benign parotid gland tumors accounted for 84.66％,malignant tumor accounted for 15.34％.The operation time of tumor resection group and partial parotidectomy group was (74.00 ± 12.54) min,which was less than that of the total resection group (112.00 ± 20.37) min and shallow leaf group (98.00 ± 17.35) min.The number of patients satisfied with facial in partial resection group was 48 cases,and 45 cases with parotid gland function reserved,which were significantly better than the other two groups,incidence rate of postoperative complications (3.3％) was obviously less than the other two groups (10.7％,8.7％),the difference was statistically significant (P ＜ 0.05).Conclusion The operation time of patients with parotid gland tumor underwent partial resection is short,the cure condition is ideal,can effectively control the tumor relapse,metastasis and postoperative complications,can keep part of the parotid gland function,has obvious advantages. Key words: Parotid neoplasms; Oral surgical procedures

Discovery and Prevalidation of Salivary Extracellular microRNA Biomarkers Panel for the Noninvasive Detection of Benign and Malignant Parotid Gland Tumors

This study was conducted to explore the differences in salivary microRNA (miRNA) profiles between patients with malignant or benign parotid gland tumors as a potential preoperative diagnostic tool of tumors in the salivary glands. Whole saliva samples from patients with malignant (n = 38) or benign (n = 29) parotid gland tumors were obtained from the Salivary Gland Tumor Biorepository (SGTB). After total RNA isolation, human miRNA cards were used for miRNA profiling. The differential miRNA expression was analyzed using two-sided Wilcoxon test. Quantitative real-time PCR (qRT-PCR) was used to validate selected miRNAs in an independent sample set. Receiver-operating characteristics curve and probability of malignancy was exploited to evaluate the diagnostic power of the validated miRNAs. With miRNA profiling, 57 of 750 investigated miRNAs were differently expressed, of which 54 showed higher miRNA expression in samples from patients with malignant tumors than those from patients with benign tumors. Validating the expression in an independent sample set of 9 miRNAs revealed indeed higher expression of miRNAs in malignant samples compared with benign samples. The expression of 6 validated miRNAs was statistically significantly different between the two groups (P < 0.05). A four miRNA combination was able to discriminate between saliva samples from patients with malignant tumors from those of patients with benign parotid gland tumors (sensitivity 69%, specificity 95%). Salivary miRNA profiles differ in saliva from patients with malignant from saliva from patients with a benign parotid gland tumor. These preliminary results are promising to develop a noninvasive diagnostic tool for diagnosing tumors in the salivary glands.

Highlights of This Issue

Vrignaud and colleagues present a comprehensive overview of preclinical studies with cabazitaxel, a semisynthetic taxane that has been shown to overcome docetaxel resistance, with proof-of-concept achieved in clinical studies. These findings support the current use of this agent in patients with metastatic hormone-refractory prostate cancer experiencing disease progression following docetaxel therapy and offer an insight into a successful development process for a new anticancer agent, highlighting the importance of conducting relevant, rationally designed studies to accelerate progress in drug discovery.Clinical studies estimate that 40% to 70% of survivors given chemotherapy-only treatment experience neurocognitive impairment. Cancer chemotherapeutics have been examined in preclinical models of learning in adult rodents; however, these models are not adequate for studying emergent effects of childhood treatment. To examine these effects using young rodents, Bisen-Hersh and colleagues treated mouse pups on postnatal days 14 to 16 with methotrexate and cytarabine. Nineteen days after treatment, impairment on one-trial learning tasks was found, but only mild deficits occurred on an extensive training task, suggesting that practice may ameliorate deficits. These findings have implications for the development of cognitive remediation programs for childhood cancer survivors.Salivary gland tumors constitute 0.3% of all human tumors and ∼4% of head and neck cancer, with 37 subtypes, many having overlapping histopathology, presenting clinical and diagnostic challenges. Extracellular RNA is an emerging target for biomarker development. Matse and colleagues explore the utility of salivary extracellular microRNA to discriminate malignant from benign parotid gland tumors, where 80% of salivary gland tumors occur. Six salivary extracellular microRNAs were statistically different between the 2 groups. The best combination of 4 biomarkers yielded a receiver-operating characteristics curve with an area under the curve of 90%, a sensitivity of 69%, and a specificity of 95% in discriminating saliva samples from patients with malignant tumors from those in patients with benign tumors in the parotid gland. These results are promising for the development of noninvasive tools for early detection of tumors in salivary glands.Vismodegib is an orally bioavailable small-molecule Smoothened inhibitor that is currently available for the treatment of advanced basal cell carcinoma. To explore the effects of food on plasma exposure of this drug, Sharma and colleagues designed and conducted a pharmacokinetic study in patients with advanced solid tumors. They found no significant differences in exposure at steady state after daily dosing between patients who took the drug fasting versus fed. Vismodegib can be safely taken with or without food, and the study design used here can serve as a template for studies of other oral anticancer drugs.

Diagnostic value of gadolinium-enhanced dynamic MR imaging for parotid gland tumors

ObjectiveThis study aimed to evaluate the value of gadolinium-enhanced dynamic MR imaging for differentiating benign and malignant parotid gland tumors, and for characterizing the various histological types. Patients and methodsNon-enhanced T1-weighted (T1-W), fat-suppressed T2-weighted (T2-W), and gadolinium-enhanced fat-suppressed dynamic T1-weighted images were obtained preoperatively in 27 patients (28 parotid gland tumors), by using a 1.5 or 3 T MR imaging unit (GE, Signa Exite). The tumor margins and the enhancement curve patterns on dynamic MR imaging were analyzed. All patients underwent a parotidectomy with histopathologic analysis. ResultsPleomorphic adenomas depict a gradual enhancement pattern. Warthin’s tumors depict an early peak of enhancement and a high washout pattern. Malignant tumors depict an early peak of enhancement and a low washout pattern. ConclusionGadolinium-enhanced dynamic MR imaging improved the performance of MR imaging in differentiating benign from malignant parotid gland tumors and characterizing the different histological types of benign tumors.

Parotid gland tumors: Correlation between routine cytology and cytomorphometry by digital image analysis using conventional and newly introduced cytomorphometric parameters

The objective of this study was to compare qualitative cytomorphology and morphometric characteristics of parotid gland tumor cells, with the aid of a computer-assisted system of image analysis. Routine qualitative cytologic and quantitative morphometric results from 64 parotid gland tumors were compared. Ultrasound (US)-guided fine-needle aspiration (FNA) specimens were taken from 54 patients. Eleven conventionally used morphometric parameters were studied: area, perimeter, convex area, convexity, maximal and minimal radius, length, breadth, form factor (FF), elongation factor, and nuclear- cytoplasmatic (N/C) ratio. Two newly introduced nuclear form factors were also measured: area symmetry factor and perimeter symmetry factor. The following nuclear morphometric parameters were significantly different between malignant and benign tumors: area, perimeter, convex area, convexity, maximal and minimal radius, length, breadth, FF, elongation factor, area symmetry factor, and perimeter symmetry factor. Comparing the cutoff values and receiver operating characteristic (ROC) curves the following nuclear morphometric parameters were found most useful in separating benign from malignant tumors: area, perimeter, convex area, maximal radius, length, and FF. The following whole cell morphometric parameters were significantly different between malignant and benign tumors: minimal and maximal radius, convexity, breadth, FF, and elongation factor. N/C ratio was significantly higher in malignant tumors. The quantitative morphometric analysis is a useful tool in the cytological differentiation between benign and malignant parotid gland tumors. Computerized image analysis may add to morphological evaluation by turning qualitative data into quantitative values.

副耳下腺腫瘍の臨床的検討

Accessory parotid gland tumors are relatively rare; hence, adequately detailed clinical analyses of these tumors are difficult to perform at a single institution. In this report, we describe the findings for 65 patients [29 men, 36 women; median age, 51 (9-81) years] with accessory parotid gland tumors, consisting of 4 cases documented by us and 61 cases previously reported by other Japanese authors. Approximately 50% of the patients were treated in an otolaryngology department, while the remaining patients were treated in plastic surgery, oral surgery, or dermatology departments. In 4 patients, the results of preoperative fine-needle aspiration cytology indicated that the tumor was benign; however, the postoperative histopathology results revealed malignant tumors. The frequencies of malignant and benign tumors were 44.6% (n = 29) and 55.4% (n = 36), respectively. Mucoepidermoid carcinoma and pleomorphic adenoma were the most frequent types of malignant and benign accessory parotid gland tumors, respectively. Among the various surgical methods that were used, such as direct cheek and intraoral incisions, a standard parotidectomy incision was the most preferred treatment approach for these tumors. Recently, an endoscopic approach has also been found to yield satisfactory results. An optimal approach should be selected after evaluating the advantages and disadvantages of these methods. No definite guidelines are available regarding the choice of elective neck dissection and postoperative radiation therapy for malignant accessory parotid gland tumors. Although tumor resection (plus elective neck dissection) and postoperative radiation therapy have been frequently performed for various kinds of malignant accessory parotid gland tumors to date, additional studies are needed regarding the criteria for selecting elective neck dissection and postoperative radiation therapy. Since the malignancy rate for accessory parotid gland tumors is higher than that for parotid gland tumors, the possibility of malignancy (especially mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma) should be considered when resecting accessory parotid gland tumors, even if the results of preoperative fine-needle aspiration cytology indicate that the tumor is benign.

Unusual Metastases from a Pleomorphic Adenoma of the Parotid Gland: A Case and Literature’s Review

Background: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgery has been described in 1%-5% of cases, and malignant evolution in 2%-9% of cases. Metastasizing pleomorphic adenomas has rarely been reported. No histologic or molecular parameters exist at the present time that could predict the development of metastasis in these neoplasms. Methods and Results: A 54-year-old woman had a superficial left parotidectomy with facial nerve preservation for pleomorphic adenoma. She developed two recurrences in 2000 and 2001, but 25 years later the first operation she presented a metastasis in her right gluteal region with evidence of local recurrence. Conclusion: Metastatizing pleomorphic adenoma is a rare pathologic situation but, in case of swelling or lump appearance in patients with pleomorphic adenoma history, it should be taken in mind.

Warthin's tumor associated with IgG4-related disease

Immunoglobulin G4-related disease (IgG4-RD) is an inflammatory condition associated with elevated serum IgG4 levels and tissue infiltration by IgG4-expressing plasma cells. Several inflammatory conditions associated with IgG4-RD have been reported. Warthin's tumor is a benign parotid gland tumor consisting of oncocytic epithelial cells and lymphoid stroma containing lymphoid follicles with reactive germinal centers. This is the first report describing a case of Warthin's tumor with possible involvement of IgG4-RD. The patient was a 71-year-old man presenting with swollen right parotid and bilateral submandibular glands. He had a history of a Warthin's tumor of the left parotid gland, autoimmune pancreatitis, and an inflammatory abdominal aortic aneurysm. Laboratory tests revealed a high serum IgG4 level. Histological examination of the resected parotid gland showed a Warthin's tumor and a nodule showing severe lymphocytic infiltration containing many IgG4-positive plasma cells. This case shows the possible involvement of Warthin's tumor with IgG4-RD.