Desmoid tumor is a proliferation of a mesenchymal, fibroblastic or myofibroblastic tissue. It is a non-capsulated tumor. Despite its benign nature, desmoids tumor have an aggressive behavior.Its localization in the parotidgland has rarely been reported in the literature. The particularity of this location in the head and neck is the proximity of Vascularnervous structures, the facial nerve in the parotid location and the consequence, if affected, on the facial motility especially that this tumor often occurs in young people. The clinical presentation is often about a slow- growing mass characterized by being: painless, ill-defined, firm, non-inflammatory, deeply located, and fixed to the underlying structures. Treatments strategies, always made by a multidisciplinary committee, are based on the natural biological behavior of this deep fibromatosis which is unpredictable and variable. Surgery could be undergone every time it is radical. Radiotherapy could also be played. However, the most relevant point is that actually, most authors highlighted the conservative approach by the “wait and see” policy for primary as well as for recurrence of the disease after surgical resection or radiotherapy.
Multiple parotidgland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphic adenoma affecting the pa- rotid glands in a 28-year-old woman. Clinically, the lesions were similar to solitary pleomorphic adenoma. Both lesions were diagnosed by fine-needle aspiration cytology. A total parotidectomy for left tumor and surgical enucleation for the right tumor, respectively, were performed with no facial nerves injury. A review of the pertinent literature is included.
Considering localization and anatomy of parotidgland, lesions can remain indolent, as well as undiag- nosed, that often happens with lesions in parap- haryngeal region and deep parotid region. As a result, many parotidgland lesions have been found acciden- tally, on the X-ray made for other indications, such as headaches or trauma (1). Enlargements of the biggest salivary gland and associated lymph nodes represent a wide spectrum of pathological processes that are ran-
The head and neck region is the most common site where malignant lymphomas occur, however malignant lymphoma of the parotidgland is relatively rare . The large majority of primary lymphomas of salivary gland involve the parotidgland, but several cases of submaxillary gland disease have been previously reported . In the present article, we report a case of primary non-Hodgkin’s lymphoma of the parotidgland which progressed to the central nervous system of which without invasive investigation would not have otherwise revealed the presenting diagnosis.
Our results suggest there is less restricted diffusion (increase in ADC) in the parotidgland of CTD pa- tients than that found in normal patients, even ac- counting for sex. The increase in ADC seen in early parotid involvement in CTD patients may be due to various causes. Sumi et al (32) suggested that elevated ADC values in the CTD population could be due to intraparotid edema in patients with early sialadenitis (32). By contrast, Sumi et al reported a decrease in ADC in patients with late stage clinically evident disease. The fact that our patients had no radio- graphic abnormalities on standard T1- and T2- weighted images and had no salivary dysfunction in- dicates that the parotid changes in our population are mild and are in the early stages of disease. It is possible that the elevated ADC values in patients with CTD may be due to early cellular infiltration. Studies
Three weeks before, the patient had undergone an ultra- sound (US) examination of the neck and salivary glands, and a fine-needle aspiration biopsy revealed a mass on the superficial lobe of the parotid. The biopsy specimen sug- gested Warthin's tumour, but was negative for malignant cells. The computed tomography (CT) scan made using intravenous contrast medium confirmed the presence of a 3.4 × 2.5 cm mass on the right parotidgland. No patho- logical lymph nodes were identified (Fig. 1).
Case presentation: A 71-year-old female presented with a large asymptomatic mass, which had occupied the left facial area for over the past fifteen years, and she requested surgical excision for a cosmetically better facial appearance. The computed tomography (CT) scan showed a well- defined giant lipoma arising from the left deep parotidgland. The lipoma was successfully enucleated after full exposure and mobilization of the overlying facial nerve branches. The surgical specimen measured 9 × 6 cm in size, and histopathology revealed fibrolipoma. The patient experienced an uneventful recovery, with a satisfying facial contour and intact facial nerve function.
Following surgery, the patient received postoperative radiation therapy. Six months later, he complained of abdominal pain. Abdominal CT showed a distension of small bowel with luminal narrowing and localized high density material in the abdominal cavity (Fig. 4). The lesion was regarded as mechanical obstruction with postoperative adhesion because the patient had under- gone previous abdominal surgery for rectal adenocarcin- oma. After conservative management for several days, he experienced severe abdominal pain and an increased heart rate, and an emergency laparotomy was performed. Multiple hard calcified masses were observed in the abdominal walls, omentum, and mesentery, and mass excision with small bowel resection was done. On gross examination, bulky, gritty, and hemorrhagic mass adhered to the mesentery was identified (Fig. 5). Micro- scopically, the tumors were identified as osteogenic sar- comas, with histologic features identical to those of the osteosarcomatous component of the carcinosarcoma of the parotidgland (Fig. 6a). The tumor cells were positive for vimentin on immunohistochemical staining (Fig. 6b). Because of its rapid development over 6 months and no history of osteosarcoma at any sites, we concluded that the abdominal osteosarcoma was metastatic from the carcinosarcoma of the parotidgland. The patient was postoperatively admitted to the intensive care unit and died of acute respiratory distress syndrome (ARDS) caused by aspiration pneumonia.
Primary solitary extramedullary plasmacytoma of the parotidgland is of rare occurrence. Accurate diagnosis by fine needle aspiration requires a high index of suspicion. The presence of intracytoplasmic crystalline inclusions can further add confusion to the accurate pathological diagnosis of this entity especially at frozen section analysis.
Although at present both the research on and the use of microparticles as a means of trans- port are wide, its application in salivary gland tissue has not been reported. Authors such as Enders , using models of Macacus mulatta, have sought ways to inoculate the parotidgland with inactivated mumps virus to immunize the Table 1. Descriptive statistic of histologycal parameters striated duct lumen, intercalar lumen duct and glandular acinus thickness. Values expressed in microns
Sonography (Figs 1A–B and 2A–B) has impor- tant advantages as a single imaging investigation for parotid masses of infancy. It is safe, inexpen- sive, and does not require sedation of the patient. In our patients, sonography at 10 MHz showed a homogeneous mass enlarging and replacing most of the parotidgland, a lobular structure with fine echogenic internal septations (Fig 1A), and numer- ous large intratumoral vessels (Figs 1B, 2A, and 2B). None of our patients showed an inhomoge- neous pattern at sonography. In infantile HAE oc- curring in other locations in the head and neck, we have observed large vascular spaces, with flow ev- ident at gray-scale imaging, but too slow to be de- tected at color or power Doppler sonography.
Basal cell adenoma is an uncommon benign epithe- lial tumor of the salivary gland, accounting for 1–2% of all salivary gland epithelial tumors. More than 80% of basal cell adenomas arise in the major salivary gland, mostly the parotidgland. It is known to consist of a monomorphic population of basaloid epithelial cells, organized with a prominent basal cell layer and distinct basement membrane-like material; however, it lacks the myxochondroid stromal component, which distinguishes it from the pleomorphic adenoma (1–3). The imaging features of basal cell adenoma in the parotidgland have not previously been described with detail in the English language literature.
Improvement in the accuracy of the preoperative diagnosis of a parotidgland mass is essential to avoid unnecessary surgery, to obviate frozen section biopsy, and to select adequate management (8 –10). A pro- spective randomized study of three sizes of core- cutting needles for renal transplant biopsy revealed that the diagnostic usefulness was higher for 14- or 16-gauge needles than with 18-gauge needles (11). To our knowledge, some investigators published articles regarding usage of 18 or 20 gauge cutting needles in ultrasonography-guided core-needle biopsy (US- CNB) of the parotidgland in 1999 (12) and 2002 (13). Before that report (12), we sometimes used larger needles of up to 14 gauge for USCNB of parotidgland masses because of a concern about obtaining insufficient tissue samples. Since 2000, 18- or 20- gauge needles have been more commonly used. The purpose of our study was to describe our experience regarding the safety and clinical efficacy of USCNB with needles of different sizes in the management of 53 parotidgland lesions involving the superficial lobe.
Few imaging findings of BCA of the parotidgland have been reported. 6-9 In our cases, the morphology of BCAs was a well-defined margin and rounded contour, as with cases in previous reports. High-grade malignant tumors can easily be differentiated from BCAs by the infiltrative margins of malig- nant tumors. The differential diagnosis of BCA includes pleo- morphic adenoma, Warthin tumor, and low-grade malignant tumors. Most pleomorphic adenomas have an area containing abundant fibromyxoid stroma, which shows bright SI on T2WI as well as marked enhancement on postcontrast images. These areas show delayed enhancement on dynamic study. In addition, pleomorphic adenomas show lobulated contours and typically have a thick capsule. 9-11 These characteristic MR
The post-operative course was uneventful and facial function improved to HB grade IV. This was only main- tained for 3 months, however, when her facial function deteriorated again to grade HB VI, a repeat MRI scan Figure 4 revealed a tumour in the deep lobe of right parotidgland 13 mm in diameter and radiologically sepa- rate from the original tumour.
In Western countries, approximately one-third of all cancer-related mortalities are caused by lung cancer. Lung squamous cell carcinoma (SCC) is a common type of non-small-cell lung cancer (NSCLC) and the second leading cause of death related to lung cancer, presenting as locally advanced disease in 25-30% [9-11]. Pulmonary SCC is generally a centrally located lung carcinoma that has been classified histo- logically by World Health Organization (WHO) into four broad categories: Clear cell, small cell, papillary and basaloid. Metastasis is defined as the transfer of disease cells from one organ or part to another site not directly connected with it . Metastasis of lung cancer to the cranio- facial region is not a common characteristic of this tumor. Despite many case reports on me- tastasis of lung cancer to the parotidgland, a
DFML in the parotidgland has never been described. Our study reports a case of an unusual location, which was diagnosed com- prehensively according to typical clinical char- acteristics, morphological and immunohisto- chemical features. It is important for clinicians to recognize the characteristics of this tumor in order to prevent misdiagnosis.
Size, Location, and Shape of Tumors Seventeen patients presented with 19 Warthin tu- mors of the parotidgland. Two cases had bilateral tumors. The average maximal cross-sectional diame- ter was 2.4 cm (range, 0.8–5.0 cm). Eighteen Warthin tumors were located in the caudal portion of the parotidgland. All tumors showed well-defined mar- gins on T1-weighted and T2-weighted images. Six tumors revealed unclear margins on STIR images, because their signal intensities were as low as those of the parotid glands. Fourteen Warthin tumors showed well-defined margins on fat suppression T1-weighted images, with the other five showing unclear margins, because they were enhanced as much as the paren- chyma of the parotid glands did. The average maxi- mal cross-sectional diameter of the 17 malignant pa- rotid tumors was 3.3 cm (range, 1.0–4.7 cm). Six malignant tumors showed well-defined margins, and the other 11 showed partially unclear or invasive mar- gins on all MR images.
SUMMARY: Oncocytomas of the salivary glands are rare benign epithelial tumors which occur most commonly in the parotidgland. The aim of our study was to characterize the clinical-radiologic- pathologic spectrum of parotid oncocytomas in a series of 10 cases seen in our institution between January 2003 and November 2008. The CT features of parotid oncocytomas in the largest imaging series of this rare but important benign lesion include a well-defined enhancing tumor with a “deform- able” appearance when large, and a non-enhancing curvilinear cleft or cystic component. These CT findings are potentially helpful in distinguishing these benign lesions from other parotid tumors in clinical scenarios that preclude surgical resection or when biopsy results are non-diagnostic. Further studies are advocated to validate the specificity and positive predictive value of these imaging features.
Malignant myoepitheliomas are rare malignant salivary gland neoplasms which usually occur in the parotidgland. Very little material on this topic has been published. This tumour represents a therapeutic challenge since there are no spe- cific recommendations or guidelines. We present a case of malignant myoepithelioma arising de novo in the parotidgland. We discuss our therapeutic approach and considerations on appropriate post-surgical treatment. Then we provide a review of international literature on this interesting and rare oncological entity.