Malignant Entities Research Articles

Common Pediatric Neck Lesions: A Pictorial Review

Pediatric neck lesions cover an expansive list including both benign and malignant entities. The ability to differentiate among these lesions is imperative to appropriately navigate management. Using a multimodality approach, this article clearly illustrates and describes the most common pediatric neck lesions to help make the task of differentiating these lesions more attainable.

ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions.

Subepithelial lesions (SEL) of the GI tract represent a mix of benign and potentially malignant entities including tumors, cysts, or extraluminal structures causing extrinsic compression of the gastrointestinal wall. SEL can occur anywhere along the GI tract and are frequently incidental findings encountered during endoscopy or cross-sectional imaging. This clinical guideline of the American College of Gastroenterology was developed using the Grading of Recommendations Assessment, Development, and Evaluation process and is intended to suggest preferable approaches to a typical patient with a SEL based on the currently available published literature. Among the recommendations, we suggest endoscopic ultrasound (EUS) with tissue acquisition to improve diagnostic accuracy in the identification of solid nonlipomatous SEL and EUS fine-needle biopsy alone or EUS fine-needle aspiration with rapid on-site evaluation sampling of solid SEL. There is insufficient evidence to recommend surveillance vs resection of gastric gastrointestinal stromal tumors (GIST) <2 cm in size. Owing to their malignant potential, we suggest resection of gastric GIST >2 cm and all nongastric GIST. When exercising clinical judgment, particularly when statements are conditional suggestions and/or treatments pose significant risks, health-care providers should incorporate this guideline with patient-specific preferences, medical comorbidities, and overall health status to arrive at a patient-centered approach.

From Self-supervised Learning to Transfer Learning with Musculoskeletal Radiographs

Abstract Ewing sarcomas are malignant neoplasm entities typically found in children and adolescents. Early detection is crucial for therapy and prognosis. Due to the low incidence the general experience as well as according data is limited. Novel support tools for diagnosis, such as deep learning models for image interpretation, are required. While acquiring sufficient data is a common obstacle in medicine, several techniques to tackle small data sets have emerged. The general necessity of large data sets in addition to a rare disease lead to the question whether transfer learning can solve the issue of limited data and subsequently support tasks such as distinguishing Ewing sarcoma from its main differential diagnosis (acute osteomyelitis) in paediatric radiographs. 42,608 unstructured radiographs from our musculoskeletal tumour centre were retrieved from the PACS. The images were clustered with a DeepCluster, a self-supervised algorithm. 1000 clusters were used for the upstream task (pretraining). Following, the pretrained classification network was applied for the downstream task of differentiating Ewing sarcoma and acute osteomyelitis. An untrained network achieved an accuracy of 81.5%/54.2%, while an ImageNet-pretrained network resulted in 89.6%/70.8% for validation and testing, respectively. Our transfer learning approach surpassed the best result by 4.4%/17.3% percentage points. Transfer learning demonstrated to be a powerful technique to support image interpretation tasks. Even for small data sets, the impact can be significant. However, transfer learning is not a final solution to small data sets. To achieve clinically relevant results, a structured and systematic data acquisition is of paramount importance.

Detection and Segmentation of Heterogeneous Bone Tumours in Limited Radiographs

Abstract Bone tumours are a rare and often highly malignant entity. Early clinical diagnosis is the most important step, but the difficulty of detecting and assessing bone malignancies is in its radiological peculiarity and limited experience of non-experts. Since X-ray imaging is the first imaging method of bone tumour diagnostics, the purpose of this study is to develop an artificial intelligence (AI) model to detect and segment the tumorous tissue in a radiograph. We investigated which methods are necessary to cope with limited and heterogeneous data. We collected 531 anonymised radiographs from our musculoskeletal tumour centre. In order to adapt to the complexity of recognizing the malignant tissue and cope with limited data, transfer learning, data augmentation as well as several architectures, some of which were initially designed for medical images, were implemented. Furthermore, dataset size was varied by adding another bone tumour entity. We applied a data split of 72%, 18%, 10% for training, validation and testing, respectively. To provide statistical significance and robustness, we applied a cross-validation and image stratification with respect to tumour pixels present. We achieved an accuracy of 99.72% and an intersection over union of 87.43% for hold-out test data by applying several methods to tackle limited data. Transfer learning and additional data brought the greatest performance increase. In conclusion, our model was able to detect and segment tumorous tissue in radiographs with good performance, although it was trained on a very limited amount of data. Transfer Learning and data augmentation proved to significantly mitigate the issue of limited data samples. However, to accomplish clinical significance, more data has to be acquired in the future. Through minor adjustments, the model could be adapted to other musculoskeletal tumour entities and become a general support tool for orthopaedic surgeons and radiologists.

Fine Needle Aspiration Cytology of Lymphnodes: A Hospital Based study in a Tertiary Health Care Center in Southern Odisha

Introduction: FNAC is widely accepted the most accurate sensitive, specific, cost-effective minimally invasive OPD technique to establish the basic diagnostic information not only to relieve the anxiety of the patients but also to provide materials for microbial culture, and decrease unnecessary surgery from the visibly accessible superficial masses. It also distinguishes a benign from a malignant entity that can obtain tissue for immuno-phenotyping &amp; molecular studies and obtain cellular &amp; genetic material for storage also useful for staging and follow up including response to treatment in patients with known malignancies. Material &amp; methods: FNAC was performed under aseptic precaution using a 22 to 24Gauge needle attached to a 20CC disposable syringe. The aspirated material after smearing was treated with 95% ethyl alcohol for fixation &amp; stained with H&amp; E and Papanicolaou stain &amp; air-dried smears are stained with Leishman stain. Modified Z-N stain was done wherever necessary followed by diagnosis based on clinic cytomorphological features. Result: Out of 796 cases the most common cause of lymphadenopathy in our study was found to be Tubercular lymphadenitis with 360 (45.22%) cases, the second most frequent entity was reactive lymphadenitis in 277(34.79%) cases followed by metastatic lesions in 47 (5.90%) cases and lymphoma 17 (2.13%) cases. Conclusion: FNAC is a simple, safe, reliable, and inexpensive method for early detection of various non-neoplastic (lymphadenitis) &amp; neoplastic lesions (lymphoma &amp; metastatic carcinoma) of enlarged lymph nodes which helped diagnose approximately 99% of cases.

Ultrasound-based “CEUS-Bosniak”classification for cystic renal lesions: an 8-year clinical experience

PurposeRenal cysts comprise benign and malignant entities. Risk assessment profits from CT/MRI imaging using the Bosniak classification. While Bosniak-IIF, -III, and -IV cover complex cyst variants, Bosniak-IIF and -III stand out due to notorious overestimation. Contrast-enhanced ultrasound (CEUS) is promising to overcome this deficit but warrants standardization. This study addresses the benefits of a combined CEUS and CT/MRI evaluation of renal cysts. The study provides a realistic account of kidney tumor boards' intricacies in trying to validate renal cysts.Methods247 patients were examined over 8 years. CEUS lesions were graded according to CEUS-Bosniak (IIF, III, IV). 55 lesions were resected, CEUS-Bosniak- and CT/MRI-Bosniak-classification were correlated with histopathological diagnosis. Interobserver agreement between the classifications was evaluated statistically. 105 lesions were followed by ultrasound, and change in CEUS-Bosniak-types and lesion size were documented.Results146 patients (156 lesions) were included. CEUS classified 67 lesions as CEUS-Bosniak-IIF, 44 as CEUS-Bosniak-III, and 45 as CEUS-Bosniak-IV. Histopathology of 55 resected lesions revealed benign cysts in all CEUS-Bosniak-IIF lesions (2/2), 40% of CEUS-Bosniak-III and 8% of CEUS-Bosniak-IV, whereas malignancy was uncovered in 60% of CEUS-Bosniak-III and 92% of CEUS-Bosniak-IV. Overall, CEUS-Bosniak-types matched CT/MRI-Bosniak types in 58% (fair agreement, κ = 0.28). CEUS-Bosniak resulted in higher stages than CT/MRI-Bosniak (40%). Ultrasound follow-up of 105 lesions detected no relevant differences between CEUS-Bosniak-types concerning cysts size. 99% of lesions showed the same CEUS-Bosniak-type.ConclusionThe CEUS-Bosniak classification is an essential tool in clinical practice to differentiate and monitor renal cystic lesions and empowers diagnostic work-up and patient care.

Frailty Assessed with FRAIL Scale and G8 Questionnaire Predicts Severe Postoperative Complications in Patients Receiving Major Head and Neck Surgery.

Introduction: Frailty represents a complex geriatric syndrome associated with elevated rates of postoperative complications as shown for several malignant entities, including head and neck cancer. A specific screening instrument to assess frailty in head and neck patients does not exist. Both the FRAIL Scale and the G8 questionnaire are well-established and easy to use as screening tools. The present study’s aim was to assess the potential of frailty screening to predict postoperative complications in head and neck patients prior to surgery. Patients and methods: We recorded demographic data, pre-existing medical conditions and clinical characteristics in a prospective cohort of 104 head and neck cancer patients undergoing major head and neck surgery and assessed frailty prospectively on the day of admission utilizing the G8 questionnaire and the FRAIL Scale. We analyzed the link between occurrence of postoperative complications up to the twenty-first postoperative day and age, frailty and other covariates using χ2 tests and receiver operating characteristic (ROC) curves. Results: There was no significant correlation between patients’ pre-existing medical conditions and postoperative complications. Whereas chronological age alone did not predict the occurrence of postoperative complications, frailty posed the highest risk for complications. Frailty according to either the G8 questionnaire or the FRAIL Scale predicted occurrence of complications with an area under the curve (AUC) of 0.64 (p = 0.018) and 0.62 (p = 0.039) and severe complications with an AUC of 0.72 (p = 0.014) and 0.69 (p=0.031), respectively. Neither frailty score correlated with age or with each other. Conclusion: Prospective screening using the FRAIL Scale or the G8 questionnaire reliably detected frailty in our sample group. Frailty is linked to increased risk of postoperative complications. The correct prediction of severe postoperative complications as shown identifies vulnerable cases and triggers awareness of potential complications. Anticipating risk allows for a more comprehensive view of the patient and triggers decision making towards risk adjustment, and therefore a selective view of alternative treatment modalities.

Follicular Growth Pattern Disease on Thyroid Fine-needle Aspiration Biopsy

Thyroid nodules are a common worldwide health problem and a diagnostic challenge for clinicians and cytopathologists. Follicular growth pattern constitutes the majority of thyroid lesions. Thyroid nodules can be neoplastic or non-neoplastic, and neoplastic nodules can be classified as benign, malignant, or gray zone. Gray zone lesions include different benign and malignant entities that might be resulted in unnecessary thyroidectomies with risk of morbidity and higher health care costs. Depending on the cellularity, most cases might fall into the follicular neoplasia (FN)/ suspicious for FN (SFN) category or follicular lesion of undetermined significance (FLUS) in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Pathologists must be aware of the relationship between this diagnostic category and follow-up patient management and avoid over-diagnosing by mastering the diagnostic criteria.

Anti-histone H3.3K36M Antibody is a Highly Sensitive and Specific Immunohistochemistry Marker for the Diagnosis of Chondroblastoma. A Validation Based on Study 136 Cases Comprising Chondroblastoma and its Mimics from Single a Centre in India.

Introduction. Chondroblastoma has a wide range of differential diagnosis encompassing various benign and malignant entities. The closest differential diagnosis is giant cell tumor of the bone due to overlapping radiological and histomorphological features. Extensive aneurysmal bone cyst like changes and lack of adequately sampled chondroid matrix often masquerades the primary bone lesion and amplifies the diagnostic difficulty in small biopsies with limited tissue. Immunohistochemistry is helpful in such instances to resolve the diagnostic dilemma. Objectives. To analyze the immunohistochemical expression of anti-histone H3F3K36M antibody inchondroblastoma and validate its utility in differentiating chondroblastoma from its histological mimics. Material and methods. Immunohistochemistry was performed using anti-histone antibody H3.3K36M in 44 histologically diagnosed chondroblastoma and 92 other histological mimickers. All chondroblastoma and giant cell tumor of the bone included in the study were also tested for anti-histone H3.3 G34W antibody. Of the 33 giant cell tumors of bone with classic morphology and imaging findings, 24 H3.3 G34W positive and 9 negative tumors were included intentionally to rule out the possibility of chondroblastoma. The sensitivity, specificity, positive and negative predictive value of marker with regard to chondroblastoma was calculated. Results. Immunohistochemistry revealed unequivocal nuclear positivity for H3.3K36M in the mononuclear cells in all the 44 chondroblastoma tested, denoting a sensitivity of 100% cases. Allthesetumors tested simultaneously for anti-histone H3.3G34W were negative. None of the histological mimickers were positive H3.3K36M indicating a specificity of 100%. The positive and negative predictive value was 100%. Conclusion. H3.3K36M mutant antibody is highly sensitive and specific IHC marker and can be used as a valuable adjunct to distinguish chondroblastoma from its histological mimics especially on small biopsies.

Non-urothelial lesions of the urinary bladder A 14.5-year, single-institution review

ContextIn contrast to urothelial cancers, non‐urothelial neoplasms involving the bladder are uncommon and often diagnostically challenging. These lesions include a variety of benign and malignant tumors often presenting with a combination of hematuria and the presence of a polypoid lesion at cystoscopy that may lead to an erroneous diagnosis of urothelial cancer. ObjectiveWe set out to quantify and classify the spectrum of non-urothelial lesions diagnosed in our institution, and briefly review the relevant literature on each lesion, with a focus on differential diagnosis and potential pitfalls. DesignWe performed a retrospective review (Jan 2008 – Jun 2022) of the cases diagnosed on TURB material at our institution. ResultsOut of 4071 TURB specimens, a total of 66 (1.62 %) non-urothelial lesions were identified. Most of these lesions were malignant (n = 51, 77 %), with metastases being the most common (n = 40, 60.6 %), followed by non-Hodgkin lymphoma (n = 8, 12 %). The remaining cases were benign lesions (n = 15, 22.7 %), with the most common being inflammatory myofibroblastic tumor (n = 4, 6.1 %) and endometriosis (n = 3, 4.5 %). ConclusionsIn this retrospective case series, we identified various malignant and benign entities, some of which have been rarely reported in the bladder, such as paragangliomas, inflammatory myofibroblastic tumor, and leiomyosarcoma. These lesions may macroscopically and histologically mimic urothelial carcinoma. Because of their relative rarity and diagnostic overlap with conventional urothelial tumors, the pathologist should always keep in the mind the possibility of non-urothelial lesions.

Imaging strategy for focal nodular hyperplasia in children: long-term experience from two specialist European centres.

Focal nodular hyperplasia (FNH) in children is a rare but benign tumour, which must be differentiated from malignant entities to avoid unnecessary treatment, leading to potential morbidity. To provide data on imaging findings of these lesions with a suggested algorithm for diagnosis, sampling and follow-up. This retrospective review evaluated imaging of all patients diagnosed with FNH in two tertiary referral centres in Europe between 1975 and 2018. One hundred and four patients with 137 tumours were reviewed. The mean age at presentation was 8.2 years. The median tumour size was 5cm (range: 0.3-29cm). Multiple lesions were seen in 16.3% of patients. The male-to-female ratio was 1:2. FNH with typical features on imaging can be safely followed up once the diagnosis has been established. The use of contrast-enhanced ultrasound and magnetic resonance imaging allows accurate characterisation in most cases. Histological sampling is only advised when there is diagnostic doubt. Atypical arterial enhancement of FNH should prompt the search for a congenital portosystemic shunt.

Fibrocartilaginous dysplasia (fibrous dysplasia and massive cartilaginous differentiation): Case report and literature review

Fibrocartilaginous dysplasia (fibrous dysplasia and massive cartilaginous differentiation or fibrochondroplasia, FCD) is a rare variant of fibrous dysplasia and a term used for cases of fibrous dysplasia with prominent cartilage tissue. A limited number of FCD cases have been reported in the literature, which can be seen in both clinical forms.&#x0D; A 16-year-old male patient, who had been followed for ten years with a diagnosis of polyostotic fibrous dysplasia in the left hip and cranium, presented with pain in the left leg after a fall. A subtrochanteric pathological fracture in the left femur was detected on exam, the lesion area was curetted, and osteotomy and fixation were applied. Microscopic assessment revealed a fibro-osseous lesion of benign spindle cell fibrous connective tissue with woven bone trabeculae, without osteoblastic rim or large areas of benign cartilage nodules. The final diagnosis was fibrocartilaginous dysplasia. In our literature review, 26 cases of FCD were reported so far. Age distribution of patients ranged from 4 to 53 years (mean 15.9) and the male / female ratio was 15/11 = 1.36. Eighteen cases were monostotic, and 8 were polyostotic. In cases with noted clinical and follow-up data, symptom duration ranged from 8 weeks to 18 years (mean 62.2 months), with no recurrence or malignant transformation in a mean follow-up of 21.71 (2-60) months post-treatment. In the cartilage component, there was increased cellularity, some nuclear atypia, binucleation, and myxoid degeneration. This situation simulates benign and malignant entities such as enchondroma, fibrocartilaginous mesenchymoma, well-differentiated intramedullary osteosarcoma, and chondrosarcoma with a differential diagnosis. FCD is a benign and very rare lesion with a prominent chondroid component, but may cause difficulty with differential diagnosis. Awareness of the histopathological and radiological features of FCD cases, their age range, and involvement areas provides an approach to distinguish them from lesions that may be confusing in a differential diagnosis.

A Rare Case of Synchronous Gastric Signet Ring Cell Adenocarcinoma Metastasis at the Right Colon Angle

Although it can affect any part of the gastrointestinal system, signet ring cell carcinoma (SRC) is a common malignant entity of stomach cancers. We discuss the case of a patient who had a prior history of gastric adenocarcinoma with signet ring cells, for which he underwent a partial gastrectomy with a gastro-jejunal anastomosis. Four months after surgery, he presented an acute postoperative blockage. Operative findings and pathology exams concluded the presence of SRC at the right angle of the colon. In patients with obstructive symptoms after surgery for SRC neoplasms of the stomach, the possibility of a second lesion should be considered among the differential diagnoses.

The Utility of Immunohistochemistry in Diagnosing Tubulocystic Renal Cell Carcinoma with Papillary Morphology

Tubulocystic renal cell carcinoma (TC-RCC) is a recently recognized, rare but distinct malignant entity. Pathologists have endeavored to completely define its histomorphologic, immunohistochemical and molecular features. Recounted is a case where the diagnosis of TC-RCC was confounded by presence of papillary morphology. Immunohistochemical expression of alpha-methyl acyl-CoA-racemase and vimentin with corresponding negativity for CK7 and CD10, following distinctive gross and microscopic findings, confirmed a diagnosis of TC-RCC. This report demonstrates the strategic value of performing immunohistochemistry studies to establish a diagnosis of TC-RCC especially when unusual histologic features are encountered. Immunohistochemistry continues to be the most practical approach to diagnosis as molecular testing methods, such as next generation sequencing, remain unfeasible in the local setting. Cautious prognostication is required as accounts of recurrence and metastasis continue to emerge.

P1574: ANTINEOPLASTIC THERAPY FOR HEMATOLOGIC MALIGNANCIES DURING COVID-19

Background: During the COVID-19 pandemic patients with hematologic malignancies frequently have to interrupt specific antineoplastic therapy as a result of a positive SARS-COV-2 RNA PCR result and for evidence of viral pneumonia on chest CT. However, delaying or withholding specific therapy for significant time may cause progression of a hematologic malignancy and increase the risks of tumor resistance. Aims: Analyze in-hospital overall survival and causes of death in COVID-19 patients during specific therapy for hematologic malignancies. Methods: During the period of March 2020 – November 2021, 192 patients with hematologic malignancies having coronavirus infection underwent specific antineoplastic therapy at the hematology unit of Moscow clinical hospital #52. We analyzed in-hospital overall survival and the causes of death, depending on the disease entity of a hematologic malignancy, disease status, patients’ age, Charlson comorbidity index and the intensity of specific antineoplastic therapy. The study included 93 patients with acute leukemias, 51 patients with non-Hodgkin’s lymphoma, 30 patients with chronic lymphocytic leukemia and 18 patients with multiple myeloma. Median age was 55 years (19-92 years). Results: In the acute leukemias group mortality was 25-82%, depending on the disease entity, disease status, age and intensity of the antineoplastic treatment. The most significant unfavorable prognostic factors were as follows: lack of acute leukemia remission (p=0.003), age above 65 years (p=0.002), Charlson comorbidity index > 6 (p<0,001). Infectious complications (24%) and severe coronavirus disease (60%) were the main causes of death in the acute leukemias group. In the group of patients who received chemotherapy for acute leukemia according to standard treatment protocols the rate of remission was higher, mortality was the lowest, and the risk of severe coronavirus disease was lower compared to patients who received specific antineoplastic therapy of lower intensity. In the non-Hodgkin’s lymphoma group mortality was 30%. In 90% cases of death patients had no remission of their underlying disease. Among the causes of death, the most common were lymphoma progression (46%) and severe COVID-19 (47%). In the chronic lymphocytic leukemia and multiple myeloma group in-hospital mortality was 27% and 17% respectively, and in 100% cases deaths were caused by severe coronavirus disease. Summary/Conclusion: The main risk factor for severe COVID-19 and death in patients with hematologic malignancies was lack of remission of the underlying disease. Therefore, specific antineoplastic therapy results in control over the neoplastic process, eventually reducing the risk of severe COVID-19. However, individual approach must be applied in the selection of antineoplastic treatment and its timing, and in evaluating the risks of coronavirus infection reactivation during immunosuppressive therapy.

Cytomorphology of lymphadenopathy on fine needle aspiration cytology

Introduction: FNAC is widely accepted the most accurate sensitive, specific, cost-effective minimally invasive OPD technique to establish the basic diagnostic information not only to relieve the anxiety of the patients but also to provide materials for microbial culture, and decrease unnecessary surgery from the visibly accessible superficial masses. It also distinguishes a benign from a malignant entity that can obtain tissue for immuno-phenotyping &amp; molecular studies and obtain cellular &amp; genetic material for storage also useful for staging and follow up including response to treatment in patients with known malignancies. Our study was conducted on 796 Outpatients including all age groups &amp; sexes presenting with palpable enlarged lymph nodes not only for early diagnosis &amp; treatment but also to reveal the burden of various categories of diseases in tribal areas where our institution is situated. Material &amp; methods: FNAC was performed under aseptic precaution using a 22 to 24Gauge needle attached to a 20 CC syringe (disposable). The aspirated material after smearing was treated with 95% ethyl alcohol for fixation &amp; stained with H&amp; E and Papanicolaou stain &amp; air-dried smears are stained with Leishman stain.

Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes.

While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.

Imaging and Management of Unusual Breast Neoplasms

Unusual breast neoplasms encompass a host of heterogeneous benign, borderline, and malignant entities, which often pose a management challenge when encountered on pathologic analysis after image-guided biopsy. Entities to be discussed in this article include select lesions of fibroepithelial, mesenchymal, and myoepithelial origin and nonneoplastic inflammatory lesions. Our objective is to discuss the imaging characteristics of these uncommon lesions and review management guidelines to facilitate radiologic-pathologic correlation and postbiopsy recommendations.

Pancreaticoduodenal Groove: Spectrum of Disease and Imaging Features.

The pancreaticoduodenal groove (PDG) is a small space between the pancreatic head and duodenum where vital interactions between multiple organs and physiologic processes take place. Muscles, nerves, and hormones perform a coordinated dance, allowing bile and pancreatic enzymes to aid in digestion and absorption of critical nutrition. Given the multitude of organs and cells working together, a variety of benign and malignant entities can arise in or adjacent to this space. Management of lesions in this region is also complex and can involve observation, endoscopic resection, or challenging surgeries such as the Whipple procedure. The radiologist plays an important role in evaluation of abnormalities involving the PDG. While CT is usually the first-line examination for evaluation of this complex region, MRI offers complementary information. Although features of abnormalities involving the PDG can often overlap, understanding the characteristic imaging and pathologic features generally allows categorization of disease entities based on the suspected organ of origin and the presence of ancillary features. The goal of the authors is to provide radiologists with a conceptual approach to entities implicating the PDG to increase the accuracy of diagnosis and assist in appropriate management or presurgical planning. They briefly discuss the anatomy of the PDG, followed by a more in-depth presentation of the features of disease categories. A table summarizing the entities that occur in this region by underlying cause and anatomic location is provided. ©RSNA, 2022.

Diagnostics and treatment of secondary malignancies of the parotid gland-An overview

Secondary malignancies of the parotid gland frequently have a cutaneous origin and the incidence in central Europe is increasing. The aim of this review article was to present the epidemiology, (differential) diagnostics and treatment of secondary malignancies of the parotid gland. A literature search of the current guidelines and evidence was carried out in the web-based databank PubMed. The incidence of secondary malignancies of the parotid gland seems to be increasing in Europe, mainly due to a rising incidence of metastases of cutaneous squamous cell carcinomas. Except for malignant lymphomas, parotidectomy is the treatment of choice in the curative situation. In the absence of clear evidence, in the case of an intact facial nerve lateral or total parotidectomy with ipsilateral neck dissection seems to be indicated, depending on the entity of the secondary malignancy. The differential diagnostics of squamous cell carcinoma (in) of the parotid gland can be complicated. When a squamous cell carcinoma of the parotid gland is diagnosed for the first time, a dermatological full body examination and a detailed medical history should be taken with respect to skin tumors of the head and neck region. In addition to surgical treatment of the parotid gland and neck, adjuvant radiotherapy is usually indicated.