Many different treatment modalities for NTM infec- tion of the parotidgland lymph nodes are described in the few existing reports. Shah and Haddad Jr. report that surgical excision of the parotidgland is considered more effective than antibiotic treatment . In their experience, they describe three patients with NTM parotid adenitis (all children between 15 and 30 months of age). In two of their patients, disease improvement was not seen with prolonged antibiotherapy and only resolved after surgical intervention. In the third patient, surgical excision was planned from the start, with a preoperative course of clarithromycin and good postoperative resolution. In another case series performed by Lindeboom et al. (done in children and encompassing all cervicofacial NTM infections), surgical removal of tissues infected with NTM was successful in 96% of patients, compared to a 66% rate of complete regression when the infection was treated with antibiotics alone . Furthermore, only one report published showed successful results with a combination of abscess drainage and antibiotic treatment . In our case, initial drainage by interventional radiology along with antibiotic treatment resulted in slow resolution. The patient required repeated drainage in interventional radiology and resolved with long-term intravenous antibiotic therapy. The patient did achieve complete resolution, despite the delay in pathogen identification and proper treatment. Although several case reports describe better outcomes with surgical intervention preceded by antibiotherapy, complete surgical excision of a parotidgland is not without risks, particularly in an abscessed gland. There always exists the chance of injury to the facial nerve, which can leave the patient with permanent hemifacial paralysis. There is also
histochemistry, multiple sec- tions were positive for S-100, HMB45 (Figure 3B), Melan- A and Ki-67. Melanoma has been ruled out by general check-up in other sites. Bas- ed on the results above, the final pathological diagnosis of PMMP was established. After surgery, patient admit- ted targeted therapy in other hospital. He represented to our hospital in May 2015 with an abdominal pain and dis- tention. The enchanced CT of total abdomen revealed that ileus and multiple nodules located at the root part of abdomen mesentery (Figure 4A). Patient was explored, and biopsy of the mass con- firmed clinical suspicion of malignant melanoma recur- rence (Figure 4B). Then a jeju- na omentectomy along with tumor nodules was perform- ed. The patient died 13 mon- ths later after being diagnos- ed of metastatic disease. Discussion
Abstract: Objective: To determine the clinical and pathological features of basal cell adenoma (BCA) of the parotidgland. Methods: This is a retrospective study of 29 parotid BCAs in 28 patients who underwent surgery at the Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, between October 2000 and June 2013. The tumors were categorized according to their location in the parotidgland as superior superficial lobe, inferior superficial lobe and deep lobe. Results: The mean age was 57.0 years (range, 32-83 years). The clinical manifestations of parotid BCAs were consistent with those of other benign parotid tumors. There were no significant differences in age, average disease duration and tumor size among the three tumor groups. There were 11 deep tumors (11/29, 37.9%), and five of them exhibited cystic degeneration (5/11, 45.5%). A total of 15 patients underwent FNAB examination, and the results were positive in seven patients (7/15, 46.7%). Mild facial nerve function impairment occurred in five patients (House-Brackmann grade II), of whom, three had recovered by the 6-month follow-up. No cases of local recurrence or malignant transformation were observed during follow-up. Conclusion: The clinical features of BCA are consistent with those of other benign tumors. The deep lobe of the parotidgland is more likely to develop BCAs, and thus, this diagnosis should be consid- ered in patients with deep-lobe tumors, especially when accompanied with cystic degeneration. FNAB can increase the rate of preoperative diagnoses.
Summary: Purpose: The head and neck surgeon’s fascination with parotidsurgery arises from the gland’s spectrum of histo- pathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory pa- rotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of saliva- ry fistula, facial nerve paralysis, and recurrence are avoided. Case report: We report a case of mucoepidermoid carcinoma which was assessed pre-operatively as arising from the accessory parotidgland of a 11-year-old female. She had complained of a painless and round mass of the left cheek for a duration of 12 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen’s duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotidgland. The preoperative diagnosis was an accessory parotidgland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous, intermediate and epidermoid cells. The patho- logical diagnosis was low-grade mucoepidermoid carcinoma. Conclusions: Accessory parotidgland neoplasms are rare and may present as innocuous extraparotid mid-cheek masses. A high index of suspicion, prudent diagnostic skills (including fine-needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and scrupulous surgical approach (extended parotidectomy-style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.
Eight patients (44%) eventually underwent surgery, of whom six had an excision biopsy and two underwent superﬁ cial parotidectomy. In the patients who underwent surgical evaluation, four had benign tumors and two had infectious disease. In one patient each, metastatic disease from a melanoma and a non-Hodgkin’s lymphoma was diagnosed. In the melanoma case, it is noteworthy that the primary site was outside the head and neck region, namely the right forearm, and that diagnosis was made 10 years earlier. Moreover, at the time, the sentinel node in the right axilla was free from tumor cells. In the lymphoma case, there was no previous history of lymphoma and at the time of the PET-CT scanning the parotidgland was the sole site involved. Review of the clinical charts in the patients who did not undergo a surgical procedure revealed that during the follow-up period none of them developed symptoms related to the parotid. Repeat PET-CT scan at six to nine months of follow-up was available for two patients. In one patient, focal parotid uptake had not changed both visually and semi- quantitatively. In the other patient, resolution of F-18 FDG hypermetabolism was shown. Follow-up PET-CT data were not available for the remaining eight patients.
and so it was followed by enucleation and post operative irradiation. But this carried on with it risk of radiation induced cancer in the young. So removal of the growth with a good cuff of normal parotid tissue was practiced later. However this resulted in a facial weakness in some cases. A superficial conservative parotidectomy became the accepted surgery for benign lesions confined to the superficial lobe. For lesions in the deep lobe, a total parotidectomy with conservation of the facial nerve is advisable. In all cases, the patent must be informed preoperatively of the possibility of injury to the nerve and should give his knowledge consent for the treatment.
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.
Knowledge of anatomic variations concerning head and neck veins is important to surgeons performing interventions in these regions, as well as to radiologists. The retromandibular vein is used as a guide to expose the facial nerve branches inside the parotidgland, during parotidsurgery and open reduction of mandibular condyle fractures. It is also used as a landmark for localisation of the nerve and compartmentalisation of parotidgland lesions preoperatively, during computed tomography, magnetic resonance imaging and sonography. In this paper, the anomalous retromandibular vein’s course on the left side of a male cadaver is described. The vein was formed around the nerve, while the maxillary vein travelled medial to the facial nerve branches and superficial to the superficial temporal vein. Interestingly, the facial nerve temporofacial division crossed again the superficial temporal vein upwards, forming a “nerve fork”. The incidence of the reported variability of the relationship between the retromandibular vein and the facial nerve are discussed with a detailed literature review. Accordingly, the typical deep position of the retromandibular vein in relation to the facial nerve is estimated to 88.17% to all sides. Furthermore, an updated classification system is proposed, including 4 types and subtypes. (Folia Morphol 2013; 72, 4: 371–375)
Case presentation: This report describes a rare case of carcinosarcoma of the parotidgland with an osteosarcoma as sarcomatous component in a 72-year-old man who had a history of low anterior resection for rectal cancer. Six months after parotidectomy, he presented abdominal pain as a symptom of abdominal metastasis by the sarcomatous component. At that time, the possibility of abdominal metastasis was overlooked because of the history of abdominal surgery. After several days of conservative treatment, emergency laparotomy was done. However, he died of acute respiratory distress syndrome.
EPIDEMIOLOGICAL STUDY OF PAROTIDGLAND TUMOURS is a bonafide record of work done by XXXXX, in the Department of General Surgery, Thanjavur Medical College, Thanjavur, during his Post Graduate Course from 2006-2009 under the guidance and supervision of PROF. DR. T. ANANTHARAMAKRISHNAN M.S., F.I.C.S. and PROF. DR. G. AMBUJAM, M.S. FICS. This is submitted in partial fulfillment for the award of M.S. DEGREE EXAMINATION- BRANCH I (GENERAL SURGERY) to be held in March 2009 under the Tamilnadu Dr. M.G.R. Medical University, Chennai.
All 65 patients underwent MR sialography and digital sub- traction sialography on the same day at our institution. There were 34 male and 31 female patients with a mean age of 47 years (age range, 9–78 years). In the 65 patients undergoing both examinations, a total of 81 glands were examined (33 submandibular and 48 parotid glands). In 51 patients, the clinicians requested visualization of a single glandular duct (30 parotid and 21 submandibular ducts); in 13 patients, two ducts were examined (both parotid glands in seven, both submandib- ular glands in five, and a submandibular and a parotidgland in one patient); and in one patient, all four ducts were investi- gated. The final diagnosis in each patient was made by the referring physician from the department of otorhinolaryngol- ogy and was based on consensus of clinical follow-up and biopsy or surgery results. All patients underwent follow-up that consisted of clinical and US examinations in the department of otorhinolaryngology. Nineteen patients underwent open sur- gery with histopathologic evaluation of resected tissue, and
Parotid LN metastasis is rare in OSCC patients, espe- cially at the initial presentation. Due to this extremely low incidence, and because of the risk of facial nerve injury, dissections of unusual site metastases of the neck have been rarely performed during the initial treatment of OSCC . On the other hand, it was reported that metastasis to the parotid LNs should be considered in patients with OSCC, and that because small numbers of LNs or small tumor extensions infiltrating the surround- ing healthy tissue are often not palpable, resection of the parotidgland tail is warranted during the initial neck dissection . Although our patient underwent MRND surgery that included resection of the tail of the parotidgland as a primary treatment, parotid LN metastases as an unusual site recurrence was observed 9 months later. Our patient had N2b LN metastasis at the time of MRND, with the secondary metastases occurring in the parotid LNs. Olsen et al.’s study of 12 cases of oral and or opharynx SCC with metastasis to the parotid showed that metastasis to the intraparotid LNs could occur, that the inferior parotid nodes were most commonly involved, and that substantial cervical metastases were often ob- served . In that report, parotid LN metastasis was lo- cated in the inferior parotid node in 7 cases, multiple superficial nodes in 3 cases, and in both deep and super- ficial nodes in 2 cases . The regions of parotid LN metastases have been reported for 18 OSCC patients, as 18 extraglandular nodes and 19 intraglandular nodes (Table 1) [3,5,6]. Our patient had an intraglandular node metastasis.
nodules with peripheral enhancement were seen in 8 patients. Five patients had large infiltrative multiloculated T2 hyperin- tense lesions with both peripheral and solid enhancement. These patients had remote surgery ranging from 10 to 35 years (mean, 22.6 years) before presentation. The long time interval between initial surgery and recurrence presumably allowed these lesions to attain a sizeable volume. Two patients had T2 hypointense lesions with peripheral enhancement, which likely reflected the high proteinaceous content of the recurrent cystic lesions. The enhancement pattern of recurrent nodules was variable, ranging from solid and homogeneous to hetero- geneous to rim enhancement (cystic pattern). Heterogeneous enhancement is likely due to areas of fibrosis and necrosis. In our series, no bony destruction or calcification was noted with the recurrent lesions, though this was described in a prior case series. 23
The tumor also has small pro- trusions that extend beyond the central masses. Based on these characters, it is a chal- lenge for doctors to remove the tumor completely for these fragile “false capsule” and pro- trusions during surgery. In order to avoid rupture of the pseudocapsule and plantation of tumor cells, the mass has to be resected expansively with surrounding tissue .
Two-time surgery was indicated to avoid bilateral facial nerve palsy. In May 2011, the left tumor was excised by total parotidectomy with facial nerve preservation under general anesthesia. Six months later no recurrence or facial palsy of the left side were observed. In February 2012, surgical enucleation of the right tumor was per- formed preserving the fibrous capsule integrity with no facial injury. We chose this approach in relation to the early age of our patient and the small size of the right lesion. Histopathology exam confirmed the diagnosis of pleomorphic adenoma in both specimens (Figure 4). One year after the second surgery, no recurrence was ob- served in both parotid areas and no neural dysfunction was reported.
Abstract: Salivary gland tumors are mostly benign, and malignant tumors are rare. Because of this rarity, there is little molecular biology research on salivary gland tumors. Recently, we have published an analysis of the telomere length (TL) in salivary gland tumors. In this paper, we analyzed amplification of the catalytic subunit of phosphati- dylinositol 3-kinase (PIK3CA) and mitochondrial DNA copy number (mtCN) in salivary gland tumors. To investigate mutations in PIK3CA, we performed genomic sequencing on samples of salivary gland tumors extracted from pa- tients. The expression level of PIK3CA mRNA and mtCN were measured by RT-PCR. PIK3CA amplification and mtCN did not differ between Warthin’s tumor (WT), pleomorphic adenoma (PA), and carcinoma of the salivary gland. The size of the tumor and the molecular profile correlated in three relationships: the size of WT with PIK3CA and with mtCN, and the size of PA with TL. We found no correlation between the size of carcinoma and the molecular profile. There was no correlation between age and molecular profile in all histologic groups of salivary gland tumor. We found no correlation between TL and mtCN in each histologic group. Although we have not found any significant results for the molecular profile of salivary gland tumors, our study can be a basis for further studies on other onco- genes in salivary gland tumors.
Radiation-induced xerostomia (dry mouth) is one of the common complications of head and neck irradiation. 1 Radia- tion-induced salivary gland injury often occurs because most of the salivary glands are included in the general irradiation fields for head and neck malignancy and regional lymph nodes. Salivary gland radiation injury leads to salivary secre- tion dysfunction and induces several clinical symptoms such as dysphagia (swallowing difficulty) and xerostomia (with speech difficulty, sleep disturbance, intraoral infection, and dental caries). 2
Abstract: Objective: We investigated the proliferative changes of myoepithelial cells (MECs) in atrophic glands after ligation of the parotid duct in rats. Methods: Seventy-eight Wistar rats were used as experimental animals and the main duct of the right parotidgland of each rat was ligated. Tissue samples of the parotidgland were taken from each group after 0 (control), 1, 3, 5, 7, 14, 21, and 30 days; histological changes in the parotidgland were examined by hematoxylin and eosin staining (n = 6), and the proliferation and distribution of MECs at different time points after ligation were analyzed by immunohistochemical double-staining. Results: After ligation of the parotid duct, the hematoxylin and eosin staining results showed that alveolar cells gradually disappeared, while a large number of duct-like structures appeared; fibrous tissue in the parotidgland proliferated and was infiltrated with inflammatory cells. Quantitative analysis of immunohistochemical staining results indicated that MECs proliferated rapidly, reach- ing a peak on the 5 th day, after which the proliferation rate of MECs decreased and was maintained at a low level
Left total parotidectomy was performed on the 2nd hospital day. The mass was well encapsulated and attached to parotid tissue. The mass measured 3.5 ⫻ 3.0 ⫻ 2.0 cm in diameter. It showed a smooth and lobulated surface and homogeneously pale, yellowish appearance with minute foci of cystic areas. Gross resection showed a well-encapsulated tumor of the pa- rotid gland. The tumor was composed of small uniform basaloid cells arranged in solid or trabecular pattern. The stroma was scanty. There was characteristic palisading in the peripheral portion of the tumor nests and sharp demarcation between the neoplastic cells and stroma. The histologic fea- tures were consistent with basal cell adenoma, rather than pleomorphic, adenoma (Fig 3C and E).
A 28-year-old male was investigated at the Otolaryngology Outpatient Department. He first noted the mass 4 years earlier. Physical examination revealed a tender, hard and fixed, 3 x 2 cm mass at the angle of the left maxillary arch, and it seemed to be attached to underlying structures. No other masses or adenopathy were noted in the head or neck. No related events were present in the patient’s medical history. He reported no other symptoms or complaints. His facial nerve function was intact. A sonographically guided fine-needle biopsy was performed. Cytology revealed only lymphocytes and other blood elements; however, no glandular epithelial cells were present. Magnetic resonance imaging detected a 3 x 2.5 x 2 cm, smooth-surfaced, multilobular mass in the left parotidgland. This mass had a heterogenic opaque appearance after intravenous contrast injection. No pathologic nodes were identified (Figures 1 and 2). Left total parotidectomy was conducted with mass excision and preservation of the facial nerve.