Parotid Swelling Research Articles

A presentation of basal cell adenoma: a case report

BackgroundWhile statistically rare in comparison to other head and neck tumours, parotid gland swellings are often encountered in clinical practice where one of the primary goals of examination becomes distinction between benign and malignant lesions. Hallmarks of malignancy are characterized by a female preponderance, history of radiation exposure, a positive family history, and clinical features like heterogenous consistency, fixity to skin/underlying tissues and involvement of facial nerve.Case presentationHere we present a case of parotid swelling in a 72-year old gentleman from south India that had a curious amalgamation of both benign and malignant features.ConclusionsWhile benign, the risk of malignant transformation and rare multicentric occurrence indicates a need to keep basal cell adenoma in mind in case of parotid swellings and their surgical management.

Clinical Outcomes and Complications of Parotidectomy for Pleomorphic Adenoma Tumour

Objective: To evaluate the clinical and surgical outcomes in patients treated for pleomorphic adenoma (PA) of the parotid gland. Methods: This retrospective study covered 100 PA cases from 2000 to 2018, all confirmed by histopathology and with at least 24 months of follow-up. Statistical analysis was performed using Student’s t-test, Pearson’s Chi-square test, and Fisher’s exact test, with a significance level of 0.05. Results: The average patient age was 42±12 years, with an even sex ratio. Parotid swelling was the main symptom (94%), with an average tumor size of 2.5cm. Most tumors were in the superficial lobe (94 cases), and there were 3 bilateral cases. Surgical approaches included superficial exofacial parotidectomy (55 cases), total parotidectomy (25 cases), partial exofacial parotidectomy (14 cases), and enucleation (6 cases). Complications occurred in 49 patients, with postoperative facial paralysis (FP) being the most common (20%). Total parotidectomy had a higher transient FP rate (24%) compared to exofacial parotidectomy (11%). Four recurrences were noted, mainly after enucleation or exofacial parotidectomy. Statistical analysis showed significant associations: exofacial parotidectomy had the highest complication rate (47%) and was linked to permanent FP (p=0.02). Total parotidectomy was associated with Frey’s syndrome (p=0.01), partial exofacial parotidectomy with salivary fistula (p<0.001), and enucleation with tumor recurrence (p<0.001). Conclusions: Superficial exofacial parotidectomy is common but associated with complications. Total parotidectomy is linked to Frey’s syndrome, while partial exofacial parotidectomy and enucleation have specific risks of salivary fistula and recurrence. Careful selection of surgical technique is crucial to minimize complications and recurrence.

Low remission rates and high incidence of adverse events in a prospective VEXAS syndrome registry.

We aimed to gather real-world clinical evidence of detailed disease activity, treatments, remission rates, and adverse events (AEs) associated with vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome in a prospective study. Patients in Japan suspected of having VEXAS syndrome were enrolled in a registry study. A novel disease activity measure (VEXASCAF) assessing 11 symptoms associated with VEXAS syndrome was evaluated at enrolment and after 3 months. AEs, survival, CRP levels, and treatments were also recorded at enrolment and 3 months after enrolment. All exons of UBA1 were sequenced using a next-generation sequencer to determine the variant allele frequencies of pathogenic variants in the peripheral blood of all patients. Of the 55 registered patients, 30 patients were confirmed to have pathogenic variants of UBA1. All patients were male, with a median age of 73.5 years. VEXASCAF and CRP levels decreased significantly at 3 months post-enrolment, but the oral prednisolone dose did not change. Only two patients achieved complete remission according to FRENVEX at 3 months after enrolment. During the observation period of 6 months, 28 AEs were observed, including 3 deaths, 4 malignancies from two cases, 2 thromboses, and 13 infections (including 4 mycobacterial infections). Inflammation of the lung and cervical region (i.e. parotid and submandibular gland swelling, tonsillitis, cervical swelling, and pain) were the most common AEs. Patients with VEXAS syndrome required high-dose glucocorticoids to achieve remission, and complications-such as malignancy, thrombosis, and infection-occurred frequently within a short observation period.

Parotite ricorrente giovanile: inquadramento clinico e approccio diagnostico-terapeutico

Juvenile recurrent parotitis is an uncommon condition characterised by recurrent episodes of parotid swelling that affects school-aged and pre-school children and shows a typical tendency to self-resolution during adolescence. To date, etiopathogenetic hypotheses and treatment options are still debated, as there are no current guidelines for its diagnosis and treatment so far. This article aims to provide valid recommendations for the management of children with recurrent episodes of parotitis and tips to identify cases worthy of further investigation and referral to the specialist.

An Atypical Case of Parotid Swelling.

An Atypical Case of Parotid Swelling.

Vaccination Against Mumps, Aren't We Late Already?

Mumps is a highly contagious viral infection caused by paramyxovirus. It usually presents with fever and parotid gland swelling. It may be associated with complications like aseptic meningitis, encephalitis, oophoritis, orchitis, pancreatitis. The incidence of mumps infection is increasing in Nepal. This paper aims to advocate for the introduction of vaccination against mumps in the national immunization schedule.

Cytological diagnosis of lymphoepithelial carcinoma: Simple yet confusing.

Lymphoepithelial carcinoma (LEC) of salivary glands are rare tumours and present as gradually progressing painless masses. LECs have good prognosis and accurate differentiation from secondary tumours and nasopharyngeal carcinoma is essential to dictate management. We present a case of an elderly male presenting with a parotid swelling diagnosed as LEC on fine needle aspiration cytology and confirmed on histopathology and immunohistochemistry.

A case of renal sarcoidosis complicated by parotid gland and uterine lesions

BackgroundSarcoidosis is a systemic disease that can affect multiple organs. While pulmonary sarcoidosis is most commonly observed, renal sarcoidosis occurs less frequently. We herein report a case of sarcoidosis with an exceptionally rare distribution including renal lesions.Case presentationA 51-year-old Japanese female was referred because of bilateral parotid swelling and renal dysfunction. Computed tomography scan showed the swelling of bilateral kidneys, parotid glands, and uterus. Ga scintigraphy also showed remarkable accumulation in these organs. Renal biopsy and cytological evaluations of parotid gland and uterus were performed and she was diagnosed as sarcoidosis of these organs. Treatment was initiated with prednisolone 40 mg/day and then renal dysfunction subsequently improved. In addition, the swelling of parotid glands and uterus improved and Ga accumulation in each organ had disappeared.ConclusionThis is a first case of renal sarcoidosis complicated by parotid glands and uterus lesions. Pathological findings and the reactivity observed in Ga scintigraphy indicated the presence of lesions in these organs.

Lack of pulmonary involvement leads to a 3 years delay of diagnosis in a childhood sarcoidosis case with arthritis, ocular symptoms, and bilateral parotid swelling

Key Clinical MessageThis paper presents a rare sarcoidosis case in a child of 12 years of age presented with arthritis, bilateral parotid enlargement and ocular, but unfortunately the diagnosis has been missed due to lack of pulmonary involvement.AbstractDiagnosis of sarcoidosis is by exclusion, and sometimes, it can be challenging. This paper presents a rare sarcoidosis case in a child of 12 years of age presented with bilateral parotid enlargement. The signs of musculoskeletal and ocular involvement were present before the parotid enlargement, and the parotid swelling persisted for 3 years; but unfortunately the definite diagnosis has been missed by the previous healthcare professionals most probably due to the rarity of the situation, especially lack of pulmonary involvement. Therefore, cooperation between different healthcare specialties is important for an effective diagnosis and management. Despite its rarity, sarcoidosis should always be present in the list of differential diagnosis when encountering multisystem entities like arthritis, ocular symptoms and parotid swelling.

Multispectral optoacoustic tomography of benign parotid tumors in vivo: a prospective observational pilot study

Parotid lumps are a heterogeneous group of mainly benign but also malignant tumors. Preoperative imaging does not allow a differentiation between tumor types. Multispectral optoacoustic tomography (MSOT) may improve the preoperative diagnostics. In this first prospective pilot trial the ability of MSOT to discriminate between the two most frequent benign parotid tumors, pleomorphic adenoma (PA) and Warthin tumor (WT) as well as to normal parotid tissue was explored. Six wavelengths (700, 730, 760, 800, 850, 900 nm) and the parameters deoxygenated (HbR), oxygenated (HbO2), total hemoglobin (HbT), and saturation of hemoglobin (sO2) were analyzed. Ten patients with PA and fourteen with WT were included (12/12 female/male; median age: 51 years). For PA, the mean values for all measured wave lengths as well as for the hemoglobin parameters were different for the tumors compared to the healthy parotid (all p < 0.05). The mean MSOT parameters were all significantly higher (all p < 0.05) in the WT compared to healthy parotid gland except for HbT and sO2. Comparing both tumors directly, the mean values of MSOT parameters were not different between PA and WT (all p > 0.05). Differences were seen for the maximal MSOT parameters. The maximal tumor values for 900 nm, HbR, HbT, and sO2 were lower in PA than in WT (all p < 0.05). This preliminary MSOT parotid tumor imaging study showed clear differences for PA or WT compared to healthy parotid tissue. Some MSOT characteristics of PA and WT were different but needed to be explored in larger studies.

Unusual Presentation of Extra Pulmonary Tuberculosis in Middle aged Female: A Unique Case Report

Pulmonary tuberculosis (TB) is a leading cause of morbidity and mortality among all infectious diseases especially in Pakistan where TB is endemic while extra pulmonary TB often encountered. However, primary salivary gland specifically unilateral parotid gland involvement is exceedingly uncommon. We present a case of 38-year old woman with six months duration of right parotid lump. The lump was firm and non-tender with bilateral cervical lymphadenopathy. No other constitutional symptoms of TB in our patient except weight loss. We presumed it a parotid neoplasm but after workup it reveals parotid TB which responds to first line anti-tuberculous therapy (ATT). So, careful exclusion of parotid neoplasm prevented unwanted surgery in our patient and patient recovered without any residual disease. We proposed that the differential diagnosis of a parotid gland swelling should include the infrequent possibility of parotid gland tuberculosis.

Diagnostic Accuracy of Fine Needle Aspiration Cytology as Compared to Histopathology in Parotid Gland Swelling.

The diagnosis of parotid swelling is challenging and investigations like imaging and needle aspiration cytology are helpful. The objective of this study was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) as compared to the histopathology in parotid gland swelling. It was a descriptive cross sectional study carried out in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu by reviewing the medical record charts of the patients who had undergone surgery for parotid lesions during the study period of seven and half years. All patients whose fine needle aspiration cytology and histopathology reports were available were included in the study. The data were presented as mean, standard deviation, ratio and percentages. Microsoft excel was used for data analysis. There were 75 patients included in the study. The age ranged from nine years to 78 years and the mean age being 38.3 17.42 years. The male to female ratio was 1:1.78. The concordance rate between fine needle aspiration cytology and histopathology was 82.7%. The sensitivity and specificity of the fine needle aspiration cytology were 80% and 95% respectively. Similarly, the positive predictive and negative predictive values were 84% and 93% respectively. The diagnostic accuracy of the fine needle aspiration cytology was 91% for the parotid swelling in our study. The diagnostic accuracy of fine needle aspiration cytology for parotid swellings in our study was excellent. The result of fine needle aspiration cytology is helpful in deciding management plan for parotid lesions.

Parotid Lipomas: Case Series and Literature Review – A Case Report

Background: Lipomas are the most frequent neoplasm of mesenchymal origin in the head-and-neck region. Around 15% of lipomas are found in the head-and-neck region. The usual site where lipomas can be found in the head-and-neck region is in the posterior triangle of the neck but they can also be found in the anterior neck, infratemporal fossa, submandibular space, larynx, pharynx, and parotid gland. The incidence of parotid lipoma ranges from 0.6% to 4.4% of all parotid neoplasms. There are two histological variants, focal lipoma and diffuse infiltrating variant. We describe two cases of rare focal lipoma of the parotid gland, therefore, must be reported. As rare as it may appear, existing relevant literature suggest management to includes definitive radiological investigations such as magnetic resonance imaging (MRI) and complete removal of lipoma with or without a cuff of parotid tissue. Case Report: Two cases were identified with a parotid lipoma on final histology. Case 1 is a 57-year-old male with a history of painless left parotid swelling for 2 years, reported to be 5 cm × 4 cm size on ultrasound, therefore, underwent superficial parotidectomy. Case 2 is a 67-year-old male who presented with right parotid swelling for 15 years, reported on ultrasound to be 5 cm × 5 cm, and underwent excision of intraparotid tumor. He later went on to develop breast carcinoma. The facial nerve was intact of both patients. Conclusion: Parotid lipomas are rare entities that should be a differential for clinically soft parotid swellings. Management includes definitive radiological investigations such as MRI and complete removal of lipoma with or without a cuff of parotid tissue instead of regular ultrasound followed by fine-needle aspiration cytology. Although our cases were managed on the same regular outlines, but reporting these cases would suffice the potential role of MRI and computed tomography scan for parotid swelling as per existing literature.

Diffuse Lymphocytic Infiltration Syndrome (DILS) as a Mode of Revelation of HIV: On a Case

Diffuse Lymphocyte Infiltration Syndrome (DILS) is a rare condition observed in HIV patients, characterized by infiltration of CD8+ T lymphocytes in several organs. In this article, a case of revelation of HIV infection is presented, diagnosed following bilateral parotidomegaly associated with DILS. The patient, aged 60, presented a progressive deterioration in general condition, significant asthenia, weight loss, and local symptoms including bilateral parotid swelling, cervical lymphadenopathy, and intermittent fever. Investigations revealed HIV-1 seropositivity, lymphocytosis with high T-CD8+ levels, salivary gland enlargement on imaging, and benign lymphoepithelial lesions on parotid biopsy. The diagnostic criteria for DILS were met, highlighting the importance of salivary gland involvement in this syndrome. Treatment with HAART resulted in significant regression of symptoms. In summary, DILS represents a multisystem complication of HIV, requiring appropriate management including antiretroviral treatment to improve patient prognosis.

Retrospective audit of Ultrasound guided fine needle aspiration cytology and core biopsy in the assessment of head and neck lumps excluding thyroid nodules at South Warwickshire NHS Foundation Trust

Objectives: Compare rates of diagnostic versus non diagnostic outcomes for fine needle aspiration (FNA) and core biopsy for non-thyroid head and neck lumps.Methods: Audit on biopsy technique used for ultra sound guided biopsies of non-thyroid neck lumps was performed over a 12-month period in South Warwickshire NHS Foundation trust (SWFT) in the year 2022. Data was collected from records in the Histopathology laboratory and electronic patient records.Results: A total of 72 lumps underwent biopsy during this period at SWFT and amongst them were 38 parotid lumps, 3 submandibular lumps, 29 lymph nodes and 2 other head and neck lumps. There were 34 fine needle aspirations were done for parotid lumps and 8 of them were non diagnostic. 4 of them went on to have core biopsies and all of them were diagnostic. There were 21 ultra sound guide core biopsies performed and only 2 of them were non diagnostic and required excision biopsy. There were 8 patients who underwent FNA and only 4 of them were diagnostic. The sensitivity of FNA for lymph nodes and salivary glands was 50% and 77% respectively. Core biopsy showed a 100% sensitivity for salivary gland and a 90.5% sensitivity to lymph nodes.Conclusion: FNAC yields good results with salivary gland lumps. Core needle biopsy has better sensitivity for investigation of enlarged cervical lymph nodes and has added advantage of immunohistochemistry and molecular testing.

Improvement of active salivary gland ultrasonography findings in Sjögren's syndrome in response to short-term glucocorticoid treatment: A case report and review of the literature.

Salivary gland ultrasonography is a non-invasive imaging technique that helps in the diagnosis and assessment of disease activity in Sjögren's syndrome. However, it remains unclear whether the salivary gland ultrasonography findings are reversible in response to treatment. We present a case of a woman in her 20s who presented with parotid swelling and pain lasting for 3 months. The patient was diagnosed with anti-SS-A antibody-positive Sjögren's syndrome with active sialadenitis, and short-term glucocorticoid treatment resulted in resolution of clinical symptoms and improvement of salivary gland ultrasonography findings by the Outcome Measures in Rheumatology Clinical Trials scoring system. Notably, the anechoic/hypoechoic foci and vascular signals in the parotid and submandibular glands were reduced after treatment. Furthermore, peak systolic blood flow velocity of the facial artery entering the submandibular gland was decreased. Our case highlights that the findings of 'inflammatory' structural changes and vascularisation on salivary gland ultrasonography, including the Outcome Measures in Rheumatology Clinical Trials scoring system, reflect the disease active of Sjögren's syndrome and are reversible with treatment. Salivary gland ultrasonography has the potential to be a useful tool for monitoring treatment response and stratifying patients by disease activity in Sjögren's syndrome; therefore, further research is needed on the relationship of salivary gland ultrasonography findings with the pathophysiological mechanisms of sialadenitis and long-term clinical outcomes.

Clinical features of adult patients with allergic parotitis

BackgroundAllergic parotitis (AP), due to its non-specific symptoms, frequently poses a diagnostic challenge, leading to cases being overlooked or misdiagnosed by clinicians. ObjectiveThis study aimed to elucidate detailed clinical characteristics and common diagnostic indicators of AP. MethodsA comprehensive review and analysis of medical records was conducted from patients diagnosed with AP, encompassing demographic, clinical, and laboratory data, at the Affiliated Stomatological Hospital of Nanjing Medical University between January 2019 and March 2022. ResultsThe study enrolled 17 patients, evidenced by an average age of 36.00 ± 12.95 years. Common presentations of AP among the patients included notable symptoms such as parotid gland swelling, associated pain, and xerostomia. Ten patients had other atopic diseases. Palpation revealed the affected parotid glands to be soft and nodular, with an elevated local skin temperature. The unstimulated whole saliva flow rate was decreased. Ultrasonography demonstrated increased volume, reduced echo heterogeneity, and lymph node enlargement in the affected parotid glands. All cases observed increased serum salivary amylase and total IgE levels. Investigation of food allergens and inhaled allergen-specific IgE showed that all patients had suspected food allergies. Food provocation tests (FPT) induced AP in 13 cases, confirming the role of food allergens. ConclusionFood allergens are involved in the etiology of AP, underscoring the importance of comprehensive clinical evaluation, including symptoms, signs, and confirmatory auxiliary tests, such as FPT, for accurate diagnosis and differentiation from other salivary gland pathologies.

Parotid Burkitt Lymphoma: Case Report

Salivary gland tumors are rare counting only 0.5% of all cancers, only 2% among them are lymphomas. Burkitt lymphomas is an aggressive mature non-Hodgkin B-cell lymphoma characterized by MYC oncogene activation, commonly occurring in nodal sites, however the extranodal sites are mostly seen in immunodeficiency associated Burkitt lymphoma as it is seen in patients with HIV infection. Clinically, the symptoms are related to the acute enlargement of gland due to the fast growing of the tumor and its rapid cells turnover. Diagnostic assessment requires biological investigations as well as cytological, histological and immunohistochemical exams to put out the diagnosis of Burkitt lymphoma. However, imaging is paramount by CT and MRI which finds its interest in its sensibility to characterize salivary gland tumors by the diffusion sequence and the estimation of apparent coefficient of diffusion. That being said, the diagnosis of parotid gland lymphoma is a differential diagnosis of parotid tumor because of its rarity. Our case is about a middle-aged woman suffering from a unilateral parotid swelling, its uncommon evolution pushed the investigations which leads to discovering a HIV infection, a diagnose the patient with a HIV-associated Burkitt lymphoma. We put the light on salivary gland location of this cancer by screening literature on this subject which benefitted from important advances of treatments, offering good outcomes in terms of freedom of event and overall survival.

Airway Management of an Infant with a Huge Parotid Swelling Extending to the Neck

Airway Management of an Infant with a Huge Parotid Swelling Extending to the Neck

Unilateral Parotid Gland Enlargement in Newborn: Is it Suppurative Parotitis?

Acute neonatal suppurative parotitis (ANSP) is a rare disease and a novel illness affecting newborns and premature neonates are more likely to contract it. A unilateral parotid swelling and pus discharge from the Stensen’s duct is pathognomonic and sonography is the first line tool to supplement the diagnosis of parotitis. An appropriate parenteral antibiotic therapy and adequate hydration are the mainstays of treatment. Herein, we report a case of ANSP in a 12-day-old baby girl with a 48-hour history of left pre-auricular swelling where a complete resolution of disease was achieved post-treatment.