imaging characteristics of benign parotid pleomor- phic adenomas (1–4), the CT characteristics of these tumors have been less rigorously covered in the liter- ature (5–9). The few case reports that have addressed the postcontrast CT appearance of pleomorphic ad- enomas, although noting the importance of contrast administration for improved lesion definition, have all stressed the heterogeneous enhancement pattern and occasional lack of enhancement typical of these lesions. The enhancement characteristics of pleomor- phic adenomas, however, may be a function of the time delay between administration of iodinated con- trast material and CT scan acquisition. Our parotid gland CT scanning protocol, in routine clinical use for 3 years, was introduced after the observation by us and other investigators that small pleomorphic ade- nomas sometimes failed to enhance immediately after administration of IV contrast material but did show conspicuous enhancement on delayedCT scans (10). Our goal in this study, therefore, was to investigate
PURPOSE: To assess the usefulness of MR findings in establishing a specific diagnosis of parotidpleomorphic adenoma. METHODS: T1-weighted and T2-weighted MR images with and without contrast enhancement were obtained in 82 patients with parotid tumors. Imaging findings in the 38 patients in whom surgery subsequently revealed pleomorphicadenomas were compared with findings in the 44 patients who had other types of tumor. Specifically, the homogeneity, signal intensity, contrast enhancement, capsule thickness, lobulation, adenopathy, and infiltration of adjacent fat were compared among the different types of tumor. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: A low-signal capsule on T2-weighted images and a lobulated contour characterized most pleomorphicadenomas. The sensitivity of the first finding for pleomorphic adenoma was 82%; specificity, 85%; positive predic- tive value, 82%; and negative predictive value, 84%. For the second finding, the sensitivity was 53%; specificity, 84%; positive predictive value, 74%; and negative predictive value, 67%. CON- CLUSION: None of the signs evaluated had perfect sensitivity and specificity. The MR findings of a complete capsule, lobulated contour, or high T2 signal intensity have a high predictive value for the diagnosis of pleomorphic adenoma.
its malignant counterpart, basal cell adenocarcinoma, as well as canalicular adenoma. The concept of mono- morphic adenoma as the opposite of pleomorphic adenoma was repudiated. Instead, every adenoma was equated with pleomorphic adenoma (3, 5–7). Basal cell adenoma, as defined by WHO, is a distinc- tive benign neoplasm composed of basaloid cells or- ganized with a prominent basal cell layer and distinct basement membrane-like structure and no myxo- chondroid stromal component as seen in pleomorphicadenomas. Three cellular patterns occur: solid, trabe- cular-tubular, and membranous. The common clinical feature of basal cell adenoma is a slow-growing, asymptomatic, freely movable parotid mass, which is often observed in women ⬎ 50 years of age.
Few imaging findings of BCA of the parotid gland 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 pleomorphicadenomas have an area containing abundant fibromyxoid stroma, which shows bright SI on T2WI as well as marked enhancement on postcontrast images. These areas show delayedenhancement on dynamic study. In addition, pleomorphicadenomas show lobulated contours and typically have a thick capsule. 9-11 These characteristic MR
Such auxiliary examinations as B-ultrasound, computed tomography (CT) and magnetic reso- nance imaging (MRI) are deemed common in diagnosing parotid gland tumors. However, to obtain a more accurate diagnosing result, rich experience and comprehensive understanding of the sufferer’s medical history are necessary. But imaging tests are unreliable when diagnos- ing a co-existence of tumors with different his- tological types. MRI scan is a good choice of diagnosing parotid gland tumors because of its remarkable identifying ability towards soft tis- sue. For instance, pleomorphicadenomas usu- ally reflect round like and are enveloped by a layer of smooth surface , with bright signal areas on the T2-weighted images and prompts low-intensity edges where the envelope exists . Ultrasound guided fine needle aspiration cytology (Ultrasound-guided FNAC) is consid- ered as a relatively simple examination of which the accuracy of identifying the benign tumors with the malignant tumors can reach to 85%- 97% . But it’s diagnostic sensitivity towards the parotid disease sensitivity is not high. Pre- operative physical examinations, especially pal- pation is significant in the diagnosis of parotid tumor. The difficulty arises when diagnosing tumors from the deep lobe of parotid gland. Resection stands in the first place when deal- ing with multiple parotid gland tumors. Ethun- andan M  believes such benign multiple tumors basically happening in the superficial parotid should be adopted palpation during operation and superficial parotidectomy owing to the difficulty of precisely judging the number of tumors and their pathological types before operation. Whether to adopt the surgical meth- od of parotidectomy of total lobe should be decided by the position and features of the tumor.
Images were reviewed prospectively on a PACS workstation by a sin- gle attending neuroradiologist with over 20 years of experience in head and neck imaging, and a certificate of added qualification in neuroradiology. Biochemical information was available at the time of interpretation, including the preoperative PTH levels. Images were reviewed and determined to be positive if a soft tissue lesion in the expected location of parathyroid tissue (orthotopic or ectopic) dem- onstrated early arterial enhancement and qualitatively appreciable contrast washout on early or late delayed images. The radiology re- port provided a descriptive location for our referring surgeons, with anatomic landmarks. Any coexistent pathology that was deemed to potentially alter patient management was also noted.
ules were well circumscribed with smooth margins. On MR imaging, marked hyperintensity on T2-weighted images was noted in 18/21 (85%) patients (Figs 1 and 2). Three patients had lesions that were iso- to hypointense on T2-weighted im- ages relative to the normal parotid tissue. There was a variable pattern of enhancement, ranging from peripheral enhance- ment (9/21 patients) (Fig 3) to solid enhancement (2/21 pa- tients) to mixed heterogeneous solid and peripheral enhance- ment (6/21 patients) (Fig 4B). There was no enhancement in 3/21 patients. Gadolinium-enhanced images were nondiag- nostic in 1 patient. Five patients had large infiltrative mul- tiloculated T2 hyperintense lesions, of which 3 demonstrated peripheral enhancement and 2 demonstrated both peripheral and solid enhancement (Fig 4). The 3 patients who underwent enhanced CT imaging demonstrated marginated solidly en- hancing lesions. Recurrent nodules in the subcutaneous tissue were seen in 14/24 patients (Figs 1A and 5). Several of the lesions were tiny, ranging from 2 to 6 mm (13/24 patients) (Figs 1 and 2). Lesions were not confined to the parotid but were seen in areas distant from the operative bed, including the postauricular region, the masticator space, the parapha- ryngeal space, and inferior to the parotid tail along the carotid sheath (7/24 patients) (Figs 1B and 6).
A surgical procedure was performed under general anesthesia in May 2000. After a modified Blair’s incision (S-shaped preauricular and submandibular incision), the mass was exposed and removed along with the sur- rounding tissue of the membrane by a conservative surgical procedure called extracapsular enucleation. A pa- thologic evaluation of the resected mass identified the tumor as a pleomorphic adenoma (myxoid subtype) of the right parotid gland. Mostly, light eosinophilic, ovate or short spindle-shaped cells with mucinous matrix were scattered. Partially, adepithelial cells were observed in a paving stone arrangement. No malignancy was iden- tified in the specimen.
A retrospective search through the PACS and histopathology records, from October 2006 to January 2011, in a single tertiary hospital ded- icated to tumor diagnosis and treatment revealed 22 consecutive pa- tients with BCA of the parotid gland who underwent superficial or total parotidectomy. All patients underwent preoperative CT and 20 had a preoperative sonography. None of the patients underwent bi- opsy before CT scanning and sonography. CT was performed by us- ing a 16-section scanner (Sensation; Siemens, Erlangen, Germany). The images were acquired with 4-mm contiguous section thickness and a FOV of 230 ⫻ 230 mm, and a matrix of 512 ⫻ 512. Scan coverage included the external auditory canal to the thoracic inlet. For contrast-enhanced images, a bolus intravenous dose of 80 mL of non- ionic iodinated contrast agent (320 mg I /mL) (Optiray; Tyco Health- care, Montreal, Canada) was given to all patients at the rate of 3 mL per second. The scan was initiated 40 seconds after the onset of con- trast injection. Delayed scan was not performed. Sonography was performed by using the sonography system LOGIC-7 (GE Health- care, Milwaukee, Wisconsin) or the Sonoline Elegra (Siemens). The frequencies of the probes ranged from 8 –12 MHz.
Magnetic resonance imaging (MRI) revealed a giant, heterogeneous mass originated from the left parotid gland, comprising part of the tumor tightly adhered to left sternocleidomas- toid muscle. The lesion had highly vascular components, which were mainly supplied by the left external carotid artery and venous dr- ainage in the subclavian vein (Figure 1). Fine- needle aspiration was performed and report-
In conclusion, PA and WT are the most common benign tumors of the parotid gland, and they are known to have malignant transformation potential. We tried to show differences in can- cer-related gene profiles such as PIK3CA ampli- fication, TL, and mtCN. However, there were no differences between WT, PA, and carcinoma. The size of PA showed a significant relationship with TL. Although we have not found any signifi- cant results for the molecular profile of salivary gland tumors, our study can be a basis of fur- ther studies on other oncogenes in salivary gland tumors.
Abstract: Objective: The purpose is to describe the imaging features of intrahepatic mass-forming cholangiogcar- cinoma (IMC) with emphasis on hepatobiliary phase (HBP) on Gd-BOPTA-enhanced MR imaging. Methods: We retrospectively reviewed 93 patients with pathologically proven IMCs with MR hepatocyte-specific contrast agent Gd-BOPOTA. We evaluated the enhancement pattern, degree of enhancement and conspicuity of IMCs. We also analyzed diffusion-weighted (DW) images and measured the apparent diffusion coefficient (ADC) values of IMCs. Results: 80 (86.0%) lesions exhibited peripheral enhancement in arterial phase followed by progressive enhance- ment in portal venous and delayed phases. On HBP, 85 (91.4%) lesions exhibited peripheral hypointensity with cen- tral hyperintensity. On HBP, IMCs exhibited the highest conspicuities, and the degrees of enhancement were higher in moderately differentiated tumors (48.2% ± 15.6%) than in poorly differentiated tumors (35.5% ± 18.9%) and in the lesions without lymph node metastasis (47.6% ± 18.8%) than with lymph node metastasis (33.7% ± 19.6%). Additionally, the ADCs of poorly differentiated tumors were lower than those of moderately differentiated tumors. Conclusion: The typical pattern of IMCs on Gd-BOPTA-enhanced images HBP images was peripheral hypointensity with central hyperintensity. IMCs exhibited better delineation on HBP images, and the ADCs of poorly differentiated IMCs were lower, which may aid reasonable surgical planning and improve prognoses.
PURPOSE: To evaluate the diagnostic potential of three-dimensional image processing of ultrafast CT sialography in comparison with conventional CT sialography in patients with parotid masses. METHODS: In nine patients, CT sialography was done with three-dimensional image processing. The visibility of anatomic details and pathologic findings, derived from three-dimensional images, were graded numerically by three observers and compared with the findings obtained from conventional CT sialograms. Histopathologic specimens were obtained in all cases. RESULTS: Ultrafast CT images showed no motion artifact. Three-dimensional CT sialography offered signif- icant improvement in demonstration of ductal anatomy (2.5 6 0.2 versus 1.5 6 0.1, respectively) and ductal pathology (2.6 6 0.1 versus 1.1 6 0.2, respectively) over conventional CT sialography. In two cases, the therapeutic regimen was altered substantially. CONCLUSION: Ultrafast CT three-dimensional sialography has the potential to allow more precise presurgical planning and contributes to the diagnosis and therapy planning of parotid masses, especially in patients in whom MR image quality is degraded by motion artifact.
pathological grade, or malignant degree, of tumors. Further, the grade and form were also negatively correlated with the MVD, which sug- gests that CT contrast enhancement can reflect the status of microvascular formation inside tumors and accurately evaluate the malignant degree of pancreatic cancer, which are consis- tent with the findings of Wong et al. . Early enhancement of tumors was showed to mainly depend on the density of new vessels . Wan et al.  showed that the enhancement of tumors was correlated with not only the MVD but also other factors, including the microvas- cular structure, the size of the extracellular space, and the vascular permeability of tumors. Therefore, tumor necrosis is an important fac- tor that influences the degree and form of CT contrast enhancement.
Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological di- agnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II - IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclu- sions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.
Carcinoma ex pleomorphic adenoma is a rare tumor arising from the salivary glands that spreads through direct extension, through the lymphatic vessels, and, rarely, hematogenously. When distant metastases have been found, they have been reported mainly in the lung. We present an unusual case of carcinoma ex pleomorphic adenoma of the parotid gland with splenic metastases. The patient presented with a primary carcinoma ex pleomorphic adenoma of the parotid gland and he underwent a total parotidectomy with laterocervical lymphadenectomy ipsilateral and adjuvant radiation therapy to the right parotid area. One year later, the patient showed an ipsilateral supraclavicular lymph node recurrence, treated with surgery and radiation therapy. Two more years later, the patient developed lung and splenic lesions, detected through CT and PET. He underwent splenectomy and pathologic assessment of the specimen showed metastatic carcinoma ex pleomorphic adenoma. To our knowledge, there is no reported case of a carcinoma ex pleomorphic adenoma metastasizing to the spleen. Patients treated for carcinoma ex pleomorphic adenoma should be investigated for distant metastases with a long-term follow-up examination for local and distant metastases and new splenic lesions in these patients should be investigated.