Parotid Gland Tumors Research Articles

POSTOPERATIVE RADIOTHERAPY IN SALIVARY DUCTCARCINOMA: A CASE REPORT AND REVIEW OF THE LITERATURE

Salivary duct carcinoma(SDC) is a rare and aggressive tumor of the salivary glands that often occurs in men between the fifth and sixth decades of life. standard treatment is based on wide surgical resection of the primary tumor with lymph node dissection, followed by postoperative radiotherapy. The place of chemotherapy in the treatment of SDC remains unknown. In this publication, authors report a case of SDC of the left parotid gland. A 28-year-old male suffered from a painful neck mass associated with hearing loss that had been evolving for 6 months. The patient initially had a cervical CT scan and a parotid MRI, which showed a tumor of the left parotid gland. He initially had a total parotidectomy preserving the facial nerve with an ipsilateral neck dissection, as the intraoperative histological examination was in favor of malignancy. The final analysis of the surgical specimen concluded to a ductal carcinoma of the parotid with lymph node metastasis. Adjuvant radiation therapy has been indicated. The evolution was unfavorable due to the appearance of multisite metastases after one year.

Different techniques for identification of facial nerve during superficial parotidectomy

Background Parotidectomy is a common surgical procedure for the treatment of benign and malignant lesions of the parotid gland. Identification of the facial nerve trunk is essential during surgery of the parotid gland to avoid facial nerve injury. A comprehensive knowledge of its anatomy and meticulous dissection are the keys for the identification of the facial nerve trunk and its branches. Aim To compare between the traditional antegrade parotidectomy and retrograde in identification of facial nerve during superficial parotidectomy, determination the best anatomical landmark, the time of exploration of facial nerve, outcomes, facial nerve complication, duration of surgery, patient satisfaction as well as other complications. Methods Twelve patients who were diagnosed with having parotid gland neoplasms, and had undergone superficial Parotidectomy were recruited and assessed for eligibility at General Surgery Department, Beni-Suef University Hospital. Patients were divided according to the surgical technique into two equal groups, group A (the antegrade dissection group), and group B (the retrograde dissection group), follow-up was 6 months. Results There was no statistically significant differences between both groups regarding pain, paresthesia and pathology postoperation (P value>0.05). Longer mean operation time was observed in the antegrade dissection group in comparison with the retrograde dissection group (2.06±0.75 and 1.61±0.31 h, respectively), which was statistically insignificant (P value>0.05). There was a statistically significant increase in facial nerve injury among patients in the antegrade dissection group in comparison with the retrograde dissection group (P value=0.046). There was no statistically significant difference between techniques regarding hospital stay duration and complications three months postoperation (P value>0.05). Conclusion Retrograde facial nerve dissection technique is better than the classical antegrade technique in the superficial parotidectomy within this study.

Characterization of parotid gland tumors using diffusion–relaxation correlation spectrum imaging: a preliminary study

To assess the performance of diffusion-relaxation correlation spectrum imaging (DR-CSI) in the characterization of parotid gland tumors. Twenty-five pleomorphic adenomas (PA) patients, 9 Warthin's tumors (WT) patients and 7 malignant tumors (MT) patients were prospectively recruited. DR-CSI (7 b-values combined with 5 TEs, totally 35 diffusion-weighted images) was scanned for pre-treatment assessment. Diffusion (D)-T2 signal spectrum summating all voxels were built for each patient, characterized by D-axis with range 0∼5×10-3 mm2/s, and T2-axis with range 0∼300ms. With boundaries of 0.5 and 2.5×10-3 mm2/s for D, all spectra were divided into three compartments labeled A (low D), B (mediate D) and C (high D). Volume fractions acquired from each compartment (VA, VB, VC) were compared among PA, WT and MT. Diagnostic performance was assessed using receiver operating characteristic analysis and area under the curve (AUC). Each subtype of parotid tumors had their specific D-T2 spectrum. PA showed significantly lower VA (8.85±4.77% vs 20.68±10.85%), higher VB (63.40±8.18% vs 43.05±7.16%), and lower VC (27.75±8.51% vs 36.27±11.09) than WT (all p<0.05). VB showed optimal diagnostic performance (AUC 0.969, sensitivity 92.00%, specificity 100.00%). MT showed significantly higher VA (21.23±12.36%), lower VB (37.09±6.43%), and higher VC (41.68±13.72%) than PA (all p<0.05). Similarly, VB showed optimal diagnostic performance (AUC 0.994, sensitivity 96.00%, specificity 100.00%). No significant difference of VA, VB and VC was found between WT and MT. DR-CSI might be a promising and non-invasive way for characterizing parotid gland tumors.

PACULIARITIES OF CLINICAL PRESENTATION, DIAGNOSIS, AND TREATMENT FOR INJURIES OF THE LARGE SALIVARY GLANDS

Background. Salivary gland lesions of various genesis are quite widespread among patients, tumorous processes involving these organs make up 2.2-3.7% of the total number of head and neck tumors, 78-82% of salivary gland tumor cases, and sialoadenitis, which makes 3.8-6.7% of the total number of inflammatory diseases of maxillofacial organs. The initial diagnostic imaging for parotid gland tumors typically involves an ultrasound examination; however, it does not definitively indicate the need for surgical intervention. While computed tomography or magnetic resonance imaging are not obligatory elements of patient assessment, they may be recommended in specific instances to facilitate accurate treatment planning.&#x0D; Fine-needle aspiration biopsy can serve as an obligatory diagnostic test, irrespective of whether an ultrasound examination has been conducted, particularly when there are suspicions of atypical presentations of polymorphic adenoma. Incisional biopsy is contraindicated, as it frequently leads to neoplastic implantation, thereby increasing the risk of recurrence of polymorphic adenomas and malignant neoplasms.&#x0D; The purpose of the study is to conduct a comparative analysis of the data of clinical examinations, laboratory tests, surgical treatment, complications and postoperative results, taking into account the prevalence of tumor and inflammatory processes of the parotid salivary glands.&#x0D; Material and methods. We have conducted a retrospective study of the medical histories of 174 patients operated on at the Department of Maxillofacial Surgery of the “Poltava Regional Clinical Hospital named after M.V. Sklifosovsky”.&#x0D; Results. According to our data, pleomorphic adenoma was the most common benign tumor, and mucoepidermoid carcinoma was the most frequently detected malignant tumor. Regarding initial presentations, the primary observation was a tumor mass in 96.1% of all cases. Additional findings included incidental lesions detected during imaging studies and localized pain or inflammation. Isolated occurrences of inadvertent lesions during imaging of neoplasms have also been documented. Palpation was recognized as an excellent clinical parameter for topographic localization and classification of lesions for malignancy, with proven value in the specimen due to its high sensitivity for demonstrating nodules in the superficial lobe (97.1%) and high specificity for nodules in the deep lobe. We established that the average evolution time of benign tumors was approximately three times longer than that of malignant tumors. These data are consistent with literature data that malignant tumors are more aggressive and have a rapid evolution, while benign, in turn, have an insidious onset and slow growth. During intraoperative examination, high specificity is desirable because it can reliably exclude malignancy, preventing unnecessary radical interventions. Another intervention that we have analyzed in the treatment of benign tumors is dermal parotidectomy, which showed a recurrence rate similar to superficial parotidectomy, although with a lower rate of serious complications (12.4% less on average). It has been found that the choice of this intervention is mainly related to the incidence of recurrence, and in 51-56% of cases in patients with a previous fine-needle aspiration biopsy.&#x0D; Conclusion. According to this study, taking into account the experience of our clinic, the presence and visualization of a single nodule in the parotid area is the main clinical manifestation of parotid gland cancer. Pleomorphic adenoma is the most common histological type, and facial nerve-sparing subtotal parotidectomy is the best treatment for these patients.

Salivary Gland Tumors: A 20 Year Review From a Single Community Practice.

Objective: Salivary gland tumors are a heterogenous group of lesions with variable pathology and clinical outcomes. Most published data are derived from studies conducted at tertiary care centers. Our study analyzed the experience from a community setting to determine significant differences, if any, in pathological distribution and clinical outcomes compared to the existing literature. Methods: We performed a retrospective analysis of all major salivary gland tumors that presented to a large community practice over a 20 year period. Retrospective chart analysis was performed for demographics, clinical presentation, imaging, cytology, histopathology, and clinical outcome data. Results: Of 806 patients, the parotid gland was the most common site in 683 patients (84.7%), followed by submandibular in 78 (9.7%) and sublingual in 45 (5.6%). A total of 203 patients were managed conservatively with observation without definitive diagnosis or lost to follow-up. A total of 495 patients underwent surgical intervention within the community practice. Twenty-six patients underwent surgical excision at an outside hospital. Eighty-two patients were determined to have a benign diagnosis based on ultrasound-guided fine needle aspiration or excisional biopsy alone. Final histopathology was benign in 505 cases (83.7%), while 98 tumors (16.3%) received a diagnosis of primary or secondary malignancy. For the parotid gland, pleomorphic adenoma (155) and Warthin's tumor (155) were the most common benign diagnoses, while mucoepidermoid carcinoma (13), adenocarcinoma (8), and acinic cell carcinoma (8) were the most common primary malignancies. Conclusions: We found a higher rate of benign tumor pathology compared to the existing literature. While the outcome data on surgical treatment of benign tumors are comparable to the existing literature, the same conclusion cannot be drawn for malignant tumors, given relatively small numbers in our series and likely disparity in the complexity of the surgical cases in tertiary care centers.

Impact of Surgeon's Experience and Tumor's Nature in the Use of Intraoperative Facial Nerve Monitoring in Superficial Parotidectomy. Preliminary Results from a Single-Center Retrospective Analysis.

To assess the effectiveness of intraoperative facial nerve monitoring (IFNM) compared to non-monitoring in the prevention of post-operative facial nerve palsy during superficial parotidectomy. Patients treated with curative intent for parotid gland tumors between January 2020 and January 2022 were included. The study population has been divided in 2 groups, based on IFNM: the group A included patients operated with IFNM, whilst group B was the non-monitoring group. A further classification focused on the pathologies and the surgeons' experience. The study group included 58 patients, 27 female and 31 male. The mean age was 45.7yr (range 36-78). No statistical difference has been found in post-operative HB grade between group A and B. The analysis of patients affected by pleomorphic surface lobe adenomas of the parotid did not show a statistical difference in HB outcome (p > 0.05). The analysis of the effect of surgeons' experience in IFNM advantage did not show statistical difference for superficial parotid tumors. The results of the present study suggest that the use of IFNM during parotid surgery is not mandatory to preserve the VII nerve function, both in case of primary tumor and in case of recurrence, and even when surgery is performed by less experienced surgeon compared to those cases treated by a more experienced surgeon.

Incidental [18F]FDG-avid focuses in parotid glands on PET/CT

Background The number of unexpected focal [18F]FDG-avid findings (incidentalomas) within the parotid gland (PGI) continues to increase with the expanding use of PET/CT scanning. The prevalence of malignancy in PGIs is uncertain and appropriate management is unsettled. Aims We aimed to explore the underlying pathologies associated with PGI. Materials and methods A retrospective review of all patients with parotid gland incidentaloma(s) treated at the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark in the period 2012–2021, was performed. Results In total, 94 patients with one (n = 86) or two (n = 8) PGI(s) were included. In patients with one PGI, 72 (84%) focuses were benign, two (2%) focuses were malignant (both malignant melanoma metastases), and 12 (14%) focuses were undiagnosed. In patients with two PGIs, all 12 lesions with pathological examinations were benign (4 PGIs were undiagnosed). The median SUVmax found in benign lesions was higher (12.0) compared to malignant lesions (5.5) (p = .043). Conclusions and significance The prevalence of malignancy was low (2/94, 2.4%) in PGIs. Based on our findings, PGI in patients without a history of parotid malignancy, who undergo PET/CT scanning for reasons other than head and neck cancer (including malignant melanoma), may be managed similarly to patients with asymptomatic parotid gland tumors.

Beyond Ultrasound: Multimodal Cross-Sectional Imaging for Preoperative Imaging of Parotid Gland Tumors: A Primer for Radiology Trainees

Even if the management of parotid gland tumors depends on the histopathological subtype, preoperative imaging of parotid gland tumors is clinically relevant. Preoperative imaging gives insight into the differentiation between benign and malignant tumors, which might potentially decrease the number of unnecessary aggressive surgeries. Characteristic imaging findings on cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), can help narrow the differential diagnosis and guide the further management of patients presenting with parotid masses. While MRI is imperative for the determination of perineural spread, which is frequently encountered with malignant parotid tumors, CT is important for the evaluation of osseous invasion. Furthermore, multi-parametric MRI protocols provide insights into the tumor behavior and internal composition, which is helpful in the case of benign mixed tumors and others. While distant metastasis is uncommon with parotid neoplasms, PET/CT provides a valuable tool for the improved evaluation of loco-regional and distant metastatic disease. This article discusses the imaging features of common benign and malignant parotid tumors.

A retrospective analysis of 350 cases of parotid gland tumors and the value of ultrasound in the diagnosis of benign and malignant parotid gland tumors

AbstractObjectiveTo retrospective analysis of the epidemiological and clinical characteristics of parotid gland tumors, and to explore the value of ultrasound in the differentiation of benign and malignant parotid gland tumors.MethodsThe clinical data of 350 patients with parotid gland tumors in our hospital from 2002 to 2022 were retrospectively analyzed. These patients were examined by ultrasound. The postoperative pathological test results were used as the “gold standard” to verify and analyze the value of color Doppler ultrasound in the differential diagnosis of benign and malignant parotid tumors (PT).ResultsThe male‐to‐female ratio of 350 patients with parotid gland tumors was 1.16:1. The age of patients ranged from 12 to 87 years old. Patients aged 40–65 years accounted for 54.6%, which was the most common age of parotid gland tumors. Among 350 cases, 259 were benign and 91 were malignant. The top three benign PTs were pleomorphic adenoma, Warthin tumor, and basal cell adenoma. The top three malignant tumors were mucoepidermoid carcinoma, acinar cell carcinoma, and adenoid cystic carcinoma. The specificity, sensitivity, accuracy, positive predictive value, and negative predictive value of ultrasonography in the diagnosis of benign and malignant parotid masses were 96.53%, 69.23%, 89.43%, 87.50%, and 87.72%, respectively.ConclusionThe pathological types of parotid gland tumors are complex and diverse. Ultrasonography has high accuracy in the diagnosis of PT, which can provide important evidence for the differentiation of benign and malignant PT, and then assist in the clinical selection of individualized surgical programs.

A rare case report of metastasizing pleomorphic adenoma ?of parotid gland

Pleomorphic adenoma is one of the most common benign parotid gland tumors. Local recurrence can occur in 1% to 5% of cases after surgery. Metastasizing pleomorphic adenomas are very rare entity and have rarely been reported. Histologically it has benign morphology. Metastasis can occur in bone, lymph nodes, the lung, oral cavity, pharynx, skin, liver, kidney, and central nervous system. We hereby report a case of pleomorphic adenoma of the parotid gland metastasizing to lungs.

Assessment of synthetic MRI to distinguish Warthin's tumor from pleomorphic adenoma in the parotid gland: comparison of two methods of positioning the region of interest for synthetic relaxometry measurement.

To assess the diagnostic potential of the synthetic MRI (SyMRI) for differentiating Warthin's tumors (WT) from pleomorphic adenomas (PA). Forty-nine individuals with parotid gland tumors (PA, n = 23; WT, n = 26) were recruited. Using two distinct regions of interest (ROI), SyMRI quantitative parameters of lesions were calculated, including mean and standard deviation (T1, T2, PD, T1sd, T2sd, and PDsd). Meanwhile, T1ratio, T2ratio, and PDratio (lesion/masseter muscle) were calculated based on the mean SyMRI quantitative parameters of masseter muscle (T1, T2, PD). Using the independent samples t test, we compared PA and WT parameters, while comparing the areas under the curve (AUC) using the DeLong's test. A multi-parameter SyMRI model was constructed using logistic regression analysis. In PA, the T1, T1sd, T2, PD, T1ratio, T2ratio, and PDratio derived from full and partial lesion ROIs were significantly higher than in WT. According to the receiver operating curve analysis, the AUC of the quantitative parameters derived from full-lesion and partial-lesion ROIs ranged from 0.722 to 0.983 for differentiating PA from WT. T1 values derived from partial-lesion ROI delineation demonstrated the best diagnostic performance among all single parameters, achieving an AUC of 0.983. Using 1322 ms as a cutoff value, the sensitivity, specificity, and accuracy were 88.46%, 100% and 93.88%, respectively. The SyMRI-derived quantitative parameters demonstrated excellent performance for discriminating PA from WT in the parotid gland.

Preoperative CT-based intra- and peri-tumoral radiomic models for differentiating benign and malignant tumors of the parotid gland: a two-center study.

To investigate the ability of intra- and peritumoral radiomics based on three-phase computed tomography (CT) to distinguish between malignant and benign parotid tumors. We conducted a retrospective analysis of data from 374 patients with parotid gland tumors, all confirmed by histopathology. A total of 321 patients from Center 1 (January 2014 to January 2023) were randomly divided into the training set and internal testing set at a ratio of 7:3, whereas 53 patients from Center 2 (January 2020 to June 2022) constituted the external testing set. CT images of both the tumor and surrounding areas (2 mm and 5 mm areas surrounding the tumor) were reviewed, and their radiomic features were extracted for the construction of different radiomic models. In addition, a combined clinical-radiomic model was developed using multivariate logistic regression analysis. The model's predictive performance was evaluated using decision curve analysis (DCA) and receiver operating characteristic (ROC) curves. Among the models evaluated, Tumor + External2 model demonstrated superior predictive performance. The areas under the curve (AUCs) of this model were 0.986 in the training set, 0.827 in the internal test set, and 0.749 in the external test set. For the clinical model, independent predictive factors included symptoms, boundaries, and lymph node swelling. The combined clinical-radiomic model achieved AUCs of 0.981, 0.842, and 0.749 in the three cohorts, outperforming both the Tumor model and the clinical model individually. The CT-based radiomic models incorporating intratumoral and peritumoral radiomic features can effectively distinguish malignant from benign parotid tumors, and the predictive accuracy is further improved by incorporating clinically independent predictors.

Basal cell adenoma of the parotid gland: A case report and review of literature

Basal cell adenoma (BCA) is a rare benign tumor of the salivary glands that often involves the parotid gland. It is clinically similar to other benign tumors of the salivary glands, such as pleomorphic adenoma. Histopathology remains the gold standard for definitive diagnosis. The purpose of this study was to report the case of a 50-year-old man who presented with a painless, firm, non-tender, mobile tumor in the left parotid gland for 2 years. A detailed history and histological examination revealed a basal cell adenoma of the parotid gland. This study also provides a review of related literature.

A Rare Case of Pleomorphic Adenoma in the Left Submandibular Salivary Gland

Pleomorphic adenomas, which are benign tumours of the salivary glands, are most commonly found in the parotid gland and comparatively infrequently seen in the submandibular gland. These benign mixed tumours, known as pleomorphic tumours, are composed of different types of myoepithelium, epithelium, and mesenchyme. Regardless of the histologic type, parotid gland neoplasms result in distinct swellings in front of and below the ear. With the exception of neglected malignant tumours, both benign and malignant lesions are normally palpable when they are first discovered. Malignancies are often discovered more quickly due to their rapid growth, even though benign tumours are known to exist for many months to years before gaining clinical attention. Ultimately, there are no reliable clinical criteria to distinguish between benign and malignant lesions. A 58-year-old female patient presented to the general surgery outpatient department with a six-month history of a firm, palpable, slow-growing, painless, freely mobile mass in the submandibular region that was not attached to the surrounding tissue, bone, or skin. There was no significant past history, and the patient was not on any medication. Axial and coronal views of the Computed Tomography (CT) scan showed a well-defined radiolucent mass in the medial aspect of the left submandibular gland. The patient underwent surgical exploration and excision of the mass under general anaesthesia, and the excised specimen was sent for histopathological examination. The entire gland was dissected freely and removed, with utmost care taken not to affect the nearby neurovascular structures. No enlarged lymph nodes were noted. The histopathological examination of the biopsy specimen revealed features of pleomorphic adenoma. Surgery is the treatment of choice for pleomorphic adenoma, and the tumour tissue must be completely removed because any residual tumour tissue has a high risk of recurrence or transformation into a malignant tumour. The patient was followed up for more than two years with no signs of recurrence.

Deep learning-assisted diagnosis of benign and malignant parotid gland tumors based on automatic segmentation of ultrasound images: a multicenter retrospective study.

To construct deep learning-assisted diagnosis models based on automatic segmentation of ultrasound images to facilitate radiologists in differentiating benign and malignant parotid tumors. A total of 582 patients histopathologically diagnosed with PGTs were retrospectively recruited from 4 centers, and their data were collected for analysis. The radiomics features of six deep learning models (ResNet18, Inception_v3 etc) were analyzed based on the ultrasound images that were obtained under the best automatic segmentation model (Deeplabv3, UNet++, and UNet). The performance of three physicians was compared when the optimal model was used and not. The Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were utilized to evaluate the clinical benefit of the optimal model. The Deeplabv3 model performed optimally in terms of automatic segmentation. The ResNet18 deep learning model had the best prediction performance, with an area under the receiver-operating characteristic curve of 0.808 (0.694-0.923), 0.809 (0.712-0.906), and 0.812 (0.680-0.944) in the internal test set and external test sets 1 and 2, respectively. Meanwhile, the optimal model-assisted clinical and overall benefits were markedly enhanced for two out of three radiologists (in internal validation set, NRI: 0.259 and 0.213 [p = 0.002 and 0.017], IDI: 0.284 and 0.201 [p = 0.005 and 0.043], respectively; in external test set 1, NRI: 0.183 and 0.161 [p = 0.019 and 0.008], IDI: 0.205 and 0.184 [p = 0.031 and 0.045], respectively; in external test set 2, NRI: 0.297 and 0.297 [p = 0.038 and 0.047], IDI: 0.332 and 0.294 [p = 0.031 and 0.041], respectively). The deep learning model constructed for automatic segmentation of ultrasound images can improve the diagnostic performance of radiologists for PGTs.

Expression of Periostin in Benign Salivary Gland Tumors.

Parotid tumors present a wide range of histological features, from benign to malignant. Periostin, an extracellular matrix protein specifically expressed in the periosteum and periodontal ligament, is isolated from osteoblast cell lines. It regulates fibrosis and collagen deposition and plays an important role in myocardial repair after myocardial infarction. It is also known to be involved in otorhinolaryngological-diseases. This study included 36 patients [38 specimens; 16 men and 20 women, mean age 59.2 (range 26-82) years] who underwent parotid tumor resection at the Division of Otorhinolaryngology, Tohoku Medical and Pharmaceutical University, between April 2017 and March 2022 and were clinically and pathologically diagnosed as having benign parotid tumors. Formalin-fixed, paraffin-embedded sections from the surgical specimens were autoclaved and immunostained with anti-periostin antibodies to evaluate the expression and distribution of periostin. Histologically, the tumors were diagnosed as pleomorphic adenomas in 15 cases (15 specimens), Warthin's tumors in 13 cases (15 specimens), basal cell adenomas in 2 cases (2 specimens), oncocytomas in 4 cases (4 specimens), and myoepitheliomas in 2 cases (2 specimens). An increased expression of periostin was found in 32 of 38 samples (84.2%) in the stroma of benign parotid tumors. Four distinct patterns of periostin expression were observed in benign parotid gland tumors: negative, superficial, infiltrative, and diffuse. Statistically significant differences were found between periostin expression patterns and histological classification of the tumors. Our results suggest that periostin may be involved in the pathogenesis of benign parotid tumors and could serve as a new biomarker for these tumors.

"Pleomorphic adenoma in salivary glands: Insights from a 100-patient analysis".

Pleomorphic adenoma (PA) is a benign epithelial tumour originating from the salivary gland, specifically the parotid gland. This study aims to comprehensively analyse the clinical and pathological features of PA by examining the characteristics of the tumour, including its histological structure and immunohistochemical profile. Over 8 years, beginning in October 2015 and ending in October 2023, an exhaustive retrospective study was conducted in the Department of Pathology, Kasturba Medical College, Mangalore, Manipal University, Karnataka, India. The research focused on 100 cases of pleomorphic adenoma and involved a meticulous examination of the clinical and pathological characteristics obtained by retrieving the pertinent files. Out of all the primary tumours, the majority (n = 70) was found in the parotid gland, followed by PA that developed from the minor salivary glands of the palate (n = 07), the submandibular gland (n = 17), and the lacrimal gland (n = 04). Only two cases had a primary tumour located in the lips. Females were more susceptible to these tumours than males. The parotid gland tumours showed a distinct trend in laterality, with 73 cases observed on the right side. In 85%, the initial symptom of the condition was painless swelling. Salivary gland PA is typically a benign tumour. However, a subset of these tumours can exhibit a malignant phenotype. The preferred treatment is surgical excision with adequate margins.

Application of retroauricular sulcus incision in the operation of benign tumors in the deep lobe of parotid gland

Objective: To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. Methods: From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People's Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision. Results: Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin's tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances. Conclusion: The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.

Pleomorphic Adenoma Review of Surgical Management with a focus on histopathological aspects

Salivary Gland Tumors arise in the Parotid gland in about 80% of cases[2, 3]. Benign parotid gland tumors account for 80% of cases [3]. Around 80 percent of all benign salivary glands’ tumors are pleomorphic adenomas, which are the most frequent salivary gland tumor overall (between 50 and 70 percent) [2-4]. Despite their benign nature, Pleomorphic Adenomas can occasionally result in benign metastases and carry the potential to evolve into malignancy [1, 5–9]. The main course of treatment is surgical excision, where the optimal extent of surgery has been an area for debate. The Pleomorphic adenoma is known for hard-to-treat multilocular recurrences, hence it is widely advocated to remove the whole or at least the superficial part of the gland with the tumor as a standard treatment to avoid recurrences based on the evidence of histological presence of pseudopods and satellite nodule but other advocate minimal intervention removing only the tumor with cuff of normal tissue around it and presenting evidence of comparable recurrence rates to traditional approach and lower complications rate compared to it. They argue that the cuff of normal tissue will include satellite nodule and pseudopod based on histological measurements. Keywords: Salivary Gland, Parotid, Parotid Gland, Pleomorphic Adenoma, Mixed Tumor, Complete Parotidectomy, Partial Parotidectomy, Superficial Parotidectomy, Lateral Parotidectomy, Extracapsular Dissection,

Characterization of parotid gland tumors: Whole-tumor histogram analysis of diffusion weighted imaging, diffusion kurtosis imaging, and intravoxel incoherent motion – A pilot study

PurposeTo investigate the diagnostic performance of histogram features of diffusion parameters in characterizating parotid gland tumors. MethodFrom December 2018 to January 2023, patients who underwent diffusion weighted imaging (DWI), diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) were consecutively enrolled in this retrospective study. The histogram features of diffusion parameters, including apparent diffusion coefficient (ADC), diffusion coefficient (Dk), diffusion kurtosis (K), pure diffusion coefficient (D), pseudo-diffusion coefficient (DP), and perfusion fraction (FP) were analyzed. The Mann-Whitney U test was used for comparison between benign parotid gland tumors (BPGTs) and malignant parotid gland tumors (MPGTs). Receiver operating characteristic curve and logistic regression analysis were used to identify the differential diagnostic performance. The Spearman’s correlation coefficient was used to analyze the correlation between diffusion parameters and Ki-67 labeling index. ResultsFor diffusion MRI, twenty-three histogram features of diffusion parameters showed significant differences between BPGTs and MPGTs (all P < 0.05). Compared with the DWI model, the IVIM model and combined model had better diagnostic specificity (58 %, 94 %, and 88 %, respectively; both corrected P < 0.001) and accuracy (64 %, 89 %, and 86 %, respectively; both corrected P = 0.006). The combined model was superior to the single DWI model with improved IDI (IDI improvement 0.25). Significant correlations were found between Ki-67 and ADCmean, Dkmean, Kmean, and Dmean (r = -0.57 to 0.53; all P < 0.05). ConclusionsWhole-tumor histogram analysis of IVIM and combined diffusion model could further improve the diagnostic performance for differentiating BPGTs from MPGTs.