Parotid Mass Research Articles

Lymphoepithelial Carcinoma of the Parotid: A Case Report and Review of the Literature

Abstract Lymphoepithelial carcinoma (LEC) is an incredibly rare entity, accounting for less than 0.5% of all salivary gland malignancies. We present a case of a Southeast Asian women who presented with a rapidly enlarging parotid mass causing compressive symptoms. Surgical resection revealed nests of EBV-in situ hybridization positive pleomorphic cells surroundded by a dense lymphoplasmacytic infiltrate, consistent with LEC. The differential diagnosis and literature surrounding this rare entity is discussed.

Giant pleomorphic adenoma of the parotid gland: a case report

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly. Most are 2 to 6 cm in size when resected. We report the resection of a benign mixed tumour of the left parotid gland with a history of bleeding. The resected tumour measured 21 cm in diameter, weighed 1.81 kg, and on pathologic examination was a benign mixed tumour without malignant degeneration. The implications of this unusual case for the management of mixed tumours are discussed with a review of the literature.

A Rare Case of Nodular Lymphocyte Predominance Hodgkin's Lymphoma of the Parotid Gland: Diagnostic Pitfall in Fine Needle Aspiration Cytology.

Primary malignant lymphoma of the salivary glands is a very rare entity, and primary parotid Hodgkin's Lymphoma (HL) is even rarer. It is rare in the initial evaluation to suspect a parotid tumor. Thus, it is important to keep lymphomatous involvement in mind when facing parotid masses in differential diagnosis. This study presented a case of a 56-year-old male with a 5-month history of left cheek enlargement. Fine Needle Aspiration (FNA) biopsy was performed with no suspicion for lymphoma. Parotidectomy was also done and nodular lymphocyte predominance HL within the parotid gland was confirmed by immunohistochemical study. The Nodular Lymphocyte Predominance Hodgkin's Lymphoma has been defined as a specific histopathological subtype of HL. The initial diagnostic approach is usually carried out through FNA, obtaining high sensitivity and specificity, which allows establishing an adjusted for co-correct diagnosis.

Comparative Study of Qualitative and Quantitative Analyses of Contrast-Enhanced Ultrasound and the Diagnostic Value of B-Mode and Color Doppler for Common Benign Tumors in the Parotid Gland.

PurposeTo preliminarily identify three common benign parotid gland tumors: pleomorphic adenomas (PA), Warthin tumors (WT), and basal cell adenomas (BCA) by qualitative and quantitative analyses using contrast-enhanced ultrasound (CEUS).MethodsPreoperative images of parotid gland masses were analyzed, including 129 cases of ultrasonography (US) and color Doppler sonography (CDS) and 110 cases of qualitative and quantitative CEUS. The diagnosis was confirmed by postsurgical pathology outcomes.ResultsPA presented low and heterogeneous enhancement and echo-free area, whereas most WT and BCA presented with high and relatively homogeneous enhancement. Compared with WT and BCA groups, a “slow in” pattern was more common in the PA group and a “slow out” pattern was more frequently noted in the WT group than in the PA and BCA groups. The unique features of qualitative CEUS in the PA group enable distinguishing PA from the 2 other groups. The further distinction among the groups was made based on quantitative parameters of time-intensity curves (TICs), which revealed that the mean peak intensity (PI), mean transit time (MTT), the area under the curve (AUC), and time from peak to one half (HT) exhibited significant differences. ROC analysis was next applied to determine the optimal cutoff points to predict the diagnostic tendency among the groups. When the rising slope (RS) was >2.145, the possibility of BCA was greater than WT.ConclusionsCEUS ultrasound is of significant value in the differential diagnosis of the 3 common benign parotid gland masses.

GRANULOMAS IN WARTHIN TUMORS OF THE PAROTID: REPORT OF TWO NOVEL CASES AND REVIEW OF THE LITERATURE

<h3>Introduction</h3> Warthin tumors often demonstrate striking and easily recognizable histologic features. We present 2 cases containing prominent granulomatous inflammation and a review of the literature. <h3>Case 1</h3> A 55-year-old male patient presented with painless mandibular swelling over 12 weeks. He was a smoker, otherwise fit and well. Magnetic resonance imaging and fine-needle aspiration (FNA) were suggestive of Warthin tumor. Histologic examination confirmed Warthin tumor, with the lymphoid stroma demonstrating reactive hyperplasia along with well-defined, partially confluent, nonnecrotizing granulomas. Special stains for microorganisms were negative, and the background salivary gland showed mild fatty metaplasia. <h3>Case 2</h3> A 73-year-old female patient presented with a rapidly expanding parotid mass over 4 weeks, with no history of trauma. She was cachetic and a smoker but otherwise fit and well. FNA was suggestive of Warthin tumor but magnetic resonance imaging was suggestive of malignancy. Histologic examination revealed Warthin tumor with multiple foci of ulceration to the bilayered epithelium, with the associated stroma containing prominent nonnecrotizing granulomatous inflammation with multinucleate giant cells. Again, special stains for microorganisms were negative. The background parotid showed acinar atrophy, mild intralobular fibrosis, and fatty metaplasia. <h3>Literature Review</h3> Granulomatous inflammation within the stroma and tissues surrounding Warthin tumors is uncommon but well documented in the literature. Many cases are attributed to infection, including tuberculosis, toxoplasmosis, and histoplasmosis. Another reported etiology is rupture of the cystic spaces following FNA or infarction. More rarely, inflammatory systemic conditions such as sarcoidosis and Langerhans cell histiocytosis have been implicated. We will present the literature to date, including recommended histologic investigations.

A CASE REPORT OF CARCINOMA EX BASAL CELL ADENOMA OF THE PAROTID GLAND

<h3>Background</h3> Basal cell adenocarcinoma (BAC) is a rare salivary gland malignancy that occurs primarily in the parotid gland of elder individuals (median 60 years old) without a sex predilection. <h3>Objective</h3> To report a case of intracapsular malignant transformation of basal cell adenoma (BCA) into BAC, thus providing a reference for clinical work. <h3>Method</h3> A case of carcinoma ex BCA of the parotid gland was retrospectively analyzed. <h3>Results</h3> A 63⁃year⁃old female patient with a mass on the right side of the lower ear presented to our hospital. The clinical diagnosis tended to be a benign tumor. She received surgery, and the tumor underwent pathological examination. Microscopically, the tumor essentially showed characteristics of BCA composed of groups of basaloid cells. However, the tumor cells infiltrated the capsule, and malignant transformation occurred in some areas. The final diagnosis was basal cell carcinoma ex BCA. BAC is a malignant tumor composed of basal cell–like cells, which is similar to BCA in cytology and histopathology. The key point of differential diagnosis is whether the atypia of tumor cells and nuclear mitosis are easily seen and whether there is clear invasive growth. <h3>Conclusions</h3> Difficulty can be encountered in clinical manifestation and histologically in differential diagnosis of lesions such as BCA from BAC. As seen in the present case, the patient showed intracapsular malignant transformation of BCA into BAC. In the diagnosis of parotid masses in elderly patients, attention should be paid to the differentiation between BCA and BAC.

Retrospective Study on Clinico-Pathological Presentations and Complications of Parotidectomy

Introduction Salivary gland tumors are rarely seen. It constitutes approximately 3% of all head-neck tumors. 75-80% of these tumors originate from the parotid gland. In this study, 98 patients who underwent parotidectomy in a tertiary otorhinolaryngology clinic were analyzed retrospectively, the frequency of different pathologies and our treatment modalities for parotid masses are presented in the light of current literature. Materials and Methods In this study, 98 patients who underwent parotidectomy in our clinic between 2011 and 2018 were retrospectively analyzed, the frequency of different pathologies, our treatment approach, and complications of treatment for parotid masses are presented in the light of current literature. Results The mean age was 48 years (between the range of 7-82 years). 41 cases were female and 57 cases were male. In the results of FNAB, there were 65 (66%) benign cases, 28 (29%) malignancy suspects and 5 (5%) malignant cases, 68 (69%) benign cases, and 30 (31%) malignant cases in surgical pathologies. The most frequent lesion of all parotid masses was pleomorphic adenoma (24%). The most common benign lesion was pleomorphic adenoma (35%) and the most frequent malignant tumor was mucoepidermoid carcinoma (27%). The most common surgery type was superficial parotidectomy (82 cases). The most common complication was marginal mandibular nerve paresis (6). Conclusion The treatment modality of the parotid tumors varies from case to case according to the nature of the tumor and extension.

Ultrasound-Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren's Syndrome.

To evaluate the safety and utility of core needle biopsy (CNB) for diagnosis of salivary gland lymphoma in Sjögren's syndrome (SS). We analyzed data from consecutive SS patients who underwent ultrasound-guided major salivary gland CNB for lymphoma diagnosis and determined whether CNB yielded an actionable diagnosis without need for further intervention. CNBs were performed in 24 patients to evaluate discrete parotid (n = 6) or submandibular (n = 2) gland masses or diffuse enlargement (n = 16; 15 parotid). One patient had 3 CNBs of the same mass. Of the 26 CNBs, 24 included flow cytometry, using CNB and/or fine needle aspirate material, and 14 targeted sonographically identified focal lesions. No patient reported complications. In the 23 patients with 1 CNB, final diagnoses were marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT; n = 6), atypical lymphoid infiltration (n = 3), benign lymphoepithelial sialadenitis (n = 9), normal gland tissue (n = 4), and lymphoepithelial cyst (n = 1). In the patient with serial CNBs, the initial one without flow cytometry was benign, but the next 2 showed atypical lymphoid infiltration. Monoclonal lymphoid infiltration was detected in 12 patients: 6 with MALT lymphoma, 3 were benign, and 3 with atypical lymphoid infiltration. Of the latter 3, 1 was treated with rituximab and 2 with expectant observation. The diagnosis changed from atypical lymphoid infiltration to MALT lymphoma in 1 patient following biopsy of inguinal adenopathy 6 months post-CNB. CNB provided actionable results and avoided open excisional biopsies in all cases. CNB is safe and useful in the evaluation of suspected salivary gland lymphoma in SS.

Accuracy, predictability and prognostic implications of fine‐needle aspiration biopsy for parotid gland tumours: A retrospective case series

AbstractObjectiveTo evaluate the precision and utility of fine‐needle aspiration (FNA) in differentiating between benign and malignant parotid tumours, and the implications of FNA results on management and outcomes.DesignRetrospective case series.SettingTertiary medical centre.ParticipantsAll adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986 and 2014.Main outcome measuresDifferences in clinical management and outcomes of patients with parotid masses in light of FNA results.ResultsWe analysed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumours in 89% of the cases (362/405) and only 59% of malignant tumours (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false‐positive and false‐negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumours as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalisations were shorter, compared to true malignant FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low‐grade, conversely non‐diagnostic FNA for malignant tumours resulted in decreased survival.ConclusionsOur findings highlight the limitations of FNA as a decision‐making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.

Role of FNAC in diagnosis of parotid lesions

BackgroundSalivary gland masses are considered challenging for diagnosis regarding its origin and whether benign or malignant. Unique features of FNAC as a safe and easy diagnostic procedure with little discomfort to the patient made it a favorable primary diagnostic tool. Information regarding the nature of parotid lesions whether being benign or malignant is the main objective of FNAC. We have done a restrospective study for FNAC for parotid masses performed in John Hunter hospital (Newcastle, NSW, Australia) along the peroid from 2014-2018. Histopathological correlation was done in 74 cases to test the accuracy of FNAC in diagnosis of parotid lesions.ResultsOf the total 74 FNAC done for parotid lesions in which a histopathological correlation was done, we get 46 (62.2%) benign lesions (37 neoplastic and 9 non-neoplastic) while 28 (37.8%) were malignant tumor. Pleomorphic adenoma was the most common in benign tumor side (45.7%) while SCC is the most common in malignant group (53.6%). Compatibility between FNAC and histological diagnosis was found in 74% (55/74), of which 78.3% in benign lesions (36/46) and in 68% of malignant lesions (19/28). FNA cytology was true positive in 21/74 cases (28.4%) and true negative in 41/74 (55.4%) cases. We have 5 (6.8%) false-negative and 7 (9.5%) false-positive results. As a result, we get sensitivity of 81%, specificity of 85%, and accuracy of 84%.ConclusionThe role of FNAC in diagnosis of primary salivary gland pathology is considered with some debate about sensitivity/specificity; however, sometimes it should be repeated or correlated with clinical/histopathological confirmation.

A Case of Xanthogranulomatous Sialadenitis with Facial Palsy Mimicking Malignancy

Parotid mass with facial palsy is often suggestive of malignancy. Facial palsy is present in 12% to 19% of patients with a malignant parotid mass regardless of tumor size. Xanthogranulomatous sialadenitis is a rare chronic inflammatory disorder. This is characterized by suppurative granulomatous inflammation and progressive destruction of the normal parenchyma. Since its first report in 1993, xanthogranulomatous sialadenitis has been reported in no more than 10 reports abroad, and to our knowledge, it has never been reported in Korea. It is hard to distinguish clinically xanthogranulomatous sialadenitis from malignancy because they have similar clinical symptoms and radiologic findings, so they should be diagnosed with pathologic methods. With a review of literature, the authors report a case of a parotid mass considered malignant in a 62-year-old, who has complained of a painful right parotid mass and ipsilateral facial palsy. The patient was managed by superficial parotidectomy and conservative antibitoic therapy.

Symptoms and signs of parotid tumors and their value for diagnosis and prognosis: a 20-year review at a single institution.

Detailed clinical features other than parotid mass have not been investigated in detail for parotid tumors. Symptoms and signs are useful for the differentiation of benign versus malignant, and may also be of value to determine the grade of malignancy and histological type as well as the assessment of prognosis. We reviewed symptoms and signs of 965 patients with benign tumors and 200 patients with malignant tumors. Symptoms and signs included pain/tenderness, adhesion to surrounding tissues, and facial nerve palsy. We reviewed the incidence in benign and malignant tumors, in histological type of benign tumors, and in grade and histology of malignant tumors. For each symptom or sign, covariates were analyzed, and their correlation with the prognosis was investigated. The incidence of symptoms and signs was significantly higher in malignant than benign tumors, and more frequent in higher grade of malignancy. Facial nerve palsy was observed in 18.0% of malignant tumor cases, while none occurred in benign tumor cases. Pain/tenderness was more commonly observed in adenoid cystic carcinoma, while adhesion to surrounding tissues and facial nerve palsy were most frequently noted in salivary duct carcinoma. The prognosis of patients with these symptoms and signs was significantly poor. A detailed investigation of symptoms and signs in parotid gland tumors is the first step that leads to the diagnosis of malignant tumors. Symptoms and signs are also useful for estimating the grade of malignancy and histological type, and they are important information for predicting prognosis.

Type II First Branchial Cleft Cyst Presenting as Parotid Mass: A Case Report

Branchial cleft cysts are frequent causes of congenital neck masses-second only to thyroglossal duct cysts. Often asymptomatic, these masses can be missed until adulthood. The branchial apparatus is comprised of 3 parts: Arch, cleft, and pouch; these parts develop into the soft tissue, cartilaginous, and bony structures the mandible and neck. Incomplete obliteration is thought to result in branchial anomalies.

Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin's tumor of the parotid gland.

The purpose of this study was to explore conventional, diffusion, and dynamic contrast-enhanced MRI (DCE-MRI) characteristics for differentiating metaplastic Warthin's tumor (MWT) from other tumor types of the parotid gland, including non-metaplastic Warthin's tumor (non-MWT), pleomorphic adenoma (PA), and malignant tumor (MT). A total of 178 patients with histologically proven tumors of the parotid gland, including 21 MWTs, 49 non-MWTs, 66 PAs, and 42 MTs, were enrolled in the study. Conventional MRI was performed in all patients. One hundred and fifty patients had preoperative diffusion-weighted MR imaging (DWI), and 62 patients had preoperative DCE-MRI. The differences in the conventional, DCE-MRI, and DWI records between MWTs and the other three tumor types were statistically evaluated. Compared with non-MWTs and PAs, there was a statistically significant difference in circumscription (p < 0.01). The ill-defined circumscription was more common in MWTs than non-MWTs and PAs. Compared with PAs, there was a statistically significant difference in morphology (p < 0.05). The lobulated morphology was more common in PAs than MWTs. Compared with PAs and MTs, there was a statistically significant difference in the T2 signal of the solid component (p < 0.01). The T2 moderate intensity of solid components was more common in MWTs than PAs and MTs. The solid components of PAs mostly showed hyperintense on T2-weighted imaging. Cyst/necrosis was more common in MWTs than PAs and MTs. Hyperintense of cyst/necrosis was more common in MWTs and non-MWTs. With respect to contrast enhancement, 52.4% MWTs exhibited moderate or marked enhancement, and most non-MWTs (81.6%) exhibited mild enhancement. Most PAs (84.8%) exhibited marked enhancement. The mean ADC value of MWTs (0.94 × 10-3 ± 0.11 mm2/s) was significantly lower than that of the PAs (1.60 × 10-3 ± 0.17 mm2/s) (p < 0.001). On DCE-MRI, six of eight MWTs demonstrated TIC of type B. Although MWT is rare, conventional MRI characteristics, DWI and DCE-MRI can provide useful information for differentiating MWT from other parotid mass.

Parotid carcinoma following chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids: a case report

BackgroundChronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disorder with unclear causes. Paraneoplastic etiology may be a cause. We report a case of CLIPPERS with parotid carcinoma.Case presentationA 54-year-old man with a history of lymphoma was hospitalized with a pontocerebellar syndrome. Brain MRI revealed that the pons and cerebellum were “peppered” with punctate and curvilinear enhancement lesions that supported the diagnosis of CLIPPERS. The relapse of lymphoma was excluded by a further cerebellum biopsy revealing predominantly CD3+ T cells in white matter. The patient was relieved after pulse therapy with intravenous methylprednisolone and a large dose of corticosteroids, but he complained of a worsening gait problem when corticosteroids were tapered to a lower dose. Although the clinical symptoms gradually improved again by increasing the dosage of corticosteroids with Azathioprine, the patient still had a slight unsteady gait during follow-up. At the 7-month follow-up, a parotid mass was detected by MRI and was verified as carcinoma by biopsy. After resection of parotid carcinoma, the residual symptoms and previous MRI lesions disappeared, and no relapse occurred.ConclusionsCLIPPERS may not be a distinct nosologic entity but an overlapping diagnosis with other diseases. Some cases of CLIPPERS might be a subtype of paraneoplastic neurological syndromes (PNS) due to the similar mechanism of antibody-mediated encephalitis. Tumor screening and serum paraneoplastic autoantibody tests are recommended for patients with CLIPPERS, especially for those who relapse when corticosteroids treatment is stopped or tapered.

Concomitant Low-Grade Mucoepidermoid and Intraductal Carcinomas the Parotid Gland: Case Presentation with a Brief Review

The patient was a Japanese female and a former thyroid cancer patient. A computed tomography scan indicated a small mass in the right parotid gland about 14 years after therapy for thyroid cancer. Pleomorphic adenoma was suspected by contrast-enhanced magnetic resonance imaging. Three years later, when she was 60 years old, fine needle aspiration cytology failed to determine a diagnosis and superficial parotidectomy was performed. There have been no signs of recurrence or metastasis for about 2 years thereafter. Histological examination revealed two histological types of low-grade mucoepidermoid carcinoma and low-grade intraductal carcinoma coexisting within the parotid mass. Although closely located, the two types of carcinoma had not intermingled. The mucoepidermoid carcinoma formed multilocular cystic structures, in which mucous, intermediate, and non-keratinizing squamous cells were intermingled. Exclusively predominant intraductal growth in the intraductal carcinoma showed a combination of cribriform and papillary-cystic patterns and diffuse positive reaction for S100 protein. Fluorescence in situ hybridization demonstrated the mucoepidermoid carcinoma had split signals for the MAML2 gene but no split signals were detected for the MAML2 and ETV6 genes in the intraductal carcinoma. We discuss the histomorphological features and diagnostic problems of the present case and the literature is briefly reviewed.

Concomitant Low-Grade Mucoepidermoid and Intraductal Carcinomas the Parotid Gland: Case Presentation with a Brief Review

The patient was a Japanese female and a former thyroid cancer patient. A computed tomography scan indicated a small mass in the right parotid gland about 14 years after therapy for thyroid cancer. Pleomorphic adenoma was suspected by contrast-enhanced magnetic resonance imaging. Three years later, when she was 60 years old, fine needle aspiration cytology failed to determine a diagnosis and superficial parotidectomy was performed. There have been no signs of recurrence or metastasis for about 2 years thereafter. Histological examination revealed two histological types of low-grade mucoepidermoid carcinoma and low-grade intraductal carcinoma coexisting within the parotid mass. Although closely located, the two types of carcinoma had not intermingled. The mucoepidermoid carcinoma formed multilocular cystic structures, in which mucous, intermediate, and non-keratinizing squamous cells were intermingled. Exclusively predominant intraductal growth in the intraductal carcinoma showed a combination of cribriform and papillary-cystic patterns and diffuse positive reaction for S100 protein. Fluorescence in situ hybridization demonstrated the mucoepidermoid carcinoma had split signals for the MAML2 gene but no split signals were detected for the MAML2 and ETV6 genes in the intraductal carcinoma. We discuss the histomorphological features and diagnostic problems of the present case and the literature is briefly reviewed.

The Diagnostic Value of Fine Needle Aspiration Biopsy in Parotid Tumors.

The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense.

Is there a Role for Frozen Section Evaluation of Parotid Masses After Preoperative Cytology or Biopsy Diagnosis?

Fine-needle aspiration (FNA) biopsy reliably diagnoses parotid gland lesions preoperatively, whereas intraoperative frozen section (FS) has the additional benefit of assessing surgical margins and refining diagnoses; however, the role of FS in the setting of prior FNA diagnosis is not well established. Our aim was to determine whether FS should still be performed after a prior FNA/ CNB diagnosis. Parotid gland resections from January 2009 to January 2020 were identified; however, only patients who had both FNA and FS constituted our study population. For the purpose of statistical analysis, FNA diagnoses were classified into non-diagnostic (ND), non-neoplastic (NN), benign neoplasm (BN), indeterminate, and malignant. FS diagnoses were classified into benign, indeterminate, or malignant. Resections were dichotomized into benign and malignant and regarded as the gold standard to subsequently calculate diagnostic accuracy of FNA and FS. A total of 167 parotid gland resections were identified, but only 76 patients (45.5%) had both FNA and FS. In 35 cases deemed as benign preoperatively, three (8.6%) were reclassified as malignant on FS. Out of 18 lesions reported as malignant on FNA, four (22.2%) were interpreted as benign on FS, with three of these benign lesions confirmed on permanent slides. In addition, in patients with both FNA and FS, compared to FNA, FS was able to provide a definitive diagnosis in all five ND cases and in 61.1% (11/18) of indeterminate tumors. Intraoperative assessment provided a relative increase of 33.3% in specificity and 38.5% in positive predictive value when compared to preoperative FNA. The addition of FS to FNA was helpful to further refine the diagnoses of parotid gland lesions, which may provide better guidance for surgical intervention.

Clinical outcomes of bulky parotid gland cancers: need for self-examination and screening program for early diagnosis of parotid tumors

BackgroundEarly detection and diagnosis of parotid gland cancer (PGC) are essential to improve clinical outcomes, because Tumor-Node-Metastasis stage at diagnosis is a very strong indicator of prognosis in PGC. Nevertheless, some patients still present with large parotid mass, maybe due to the unawareness or ignorance of their disease. In this study, we aimed to present the clinical outcomes of bulky PGC (defined by a 4 cm cutoff point for T3–4 versus T1–2 tumors), to emphasize the necessity of a self-examination tool for parotid gland tumor.MethodsWe retrospectively reviewed 60 consecutive cases with bulky (equal to and greater than 4 cm in the longest diameter, determined radiologically) malignant tumors arising from the parotid gland from 1995 to 2016. The clinical and pathological factors were analyzed to identify risk factors for poor outcomes using Cox proportional hazard models. In addition, we designed a self-examination tool for parotid gland tumors, similar to breast self-examination for breast cancer detection.ResultsPatients with bulky parotid cancer showed 48.9% 5-year and 24.5% 10-year overall survival rates and a 47.9% risk of high-grade malignancy. The common pathological diagnoses were carcinoma ex pleomorphic adenoma (18.3%), adenocarcinoma (16.7%), mucoepidermoid carcinoma (16.7%), salivary duct carcinoma (16.7%), and adenoid cystic carcinoma (11.7%). Survival analyses revealed that tumor size (hazard ratio, HR = 1.262 upon increase of 1 cm, 95% confidence interval, 95%CI 1.059–1.502), lymph node metastasis (HR = 2.999, 95%CI 1.048–8.583), and high tumor grade (HR = 4.148, 95%CI 1.215–14.154) were independent prognostic factors in multivariable analysis. Functional preservation of the facial nerve was possible only in less than half of patients.ConclusionIn bulky PGC, lymph node metastasis at diagnosis and high tumor grade indicated poor survival outcomes, and functional outcomes of the facial nerve were suboptimal. Thus, a public effort seems to be necessary to decrease these patients with bulky PGC, and to increase patients’ self-awareness of their disease. As a way of early detection, we proposed a parotid self-examination tool to detect parotid gland tumors at an early stage, which is similar to breast self-examination.