In December 2005, the patient presented with an enlarged mass: an MRI showed a multinodular mass of high intensity on T2-weighted images from the deep lobe into the superficial lobe of the right parotidgland (Figure 2). The maximum dimension of the lesion was its 22-mm dia. A surgical procedure was performed for the mass under general anesthesia in June 2006. An s-shaped preauricular incision and a submandibular extension were used to gain access to the mass. The facial nerve and all of its branches were identified with the aid of a nerve monitor. A possibly recurrent mass in the superficial lobe of the parotidgland was identified, and a nodule was dissected for an intraoperative pathology consultation. The specimen revealed a recurrent pleomorphicadenoma without malignant transformation. Therefore, partial parotidectomy of the superficial and deep lobes was per- formed with an elective neck dissection. A pathological evaluation identified the mass as a recurrent pleo- morphic adenoma of the right parotidgland. No malignant transformation was identified in the specimens. A neck dissection specimen was comprised of three free-of-disease lymph nodes.
Pleomorphicadenoma (PA) is the most common salivary gland neoplasm, accounting for over 60% of parotidgland tumors. Most originate within the superficial lobe, but less frequently involve the deep lobe ; of these, even fewer extend medially through the stylomandibular tunnel into the prestyloid parapharyngeal space (PPS). There may be significant PPS extension before symptom onset; indeed, until the tumor is at least 2.5 cm in diame- ter it cannot be detected by palpation . Symptoms are usually rare or insignificant, most commonly presenting asasymptomatic gradual swelling without facial nerve involvement—a nonspecific finding seen in the majority of parotid masses . Rapid growth, change in consis- tency, pain and onset of facial nerve deficit are signs of carcinomatous transformation, the incidence of which increases with duration of a known PA . Tumor re- currence, radiation therapy and advanced age are addi- tional risk factors. Development of malignancy is esti- mated to occur in less than 10% of cases [3,4].
Our study suggests that no one MR finding distinguished pleomorphic adenomas from other parotidgland tumors. None of the signs evaluated had perfect sensitivity and specificity. However, tumors that had a complete capsule, lobulation, and high signal on T2-weighted im- ages were most likely pleomorphic adenomas. Only benign tumors had both lobulation of the contour and a complete capsule. Well-defined margins were also a good predictor of a benign tumor. Tumor margins and capsule are better defined on T2-weighted than T1-weighted im- ages. Because contrast enhancement improves the demonstration of the capsule on T1- weighted images, intravenous contrast medium may be useful, especially in cases with clinical signs and symptoms of malignancy (pain or facial nerve paralysis).
Abstract: Pleomorphicadenoma (PA) is the most common type of all salivary gland tumors. Although PAs are benign in pathology, they are malignant in biological behavior sometimes. The tumor could transform to malignancy as malignant pleomorphicadenoma (MPA), if the preexisting remains for long time or after multiple recurrent. Cases of giant pleomorphic adenomas (GPA) are rare, according to previous medical literatures, the majority of which were involving in the parotidgland. We presented a 73-year old woman with a giant pleomorphicadenoma in left parotidgland who had kept the mass for more than forty years and was successfully treated with surgery without any facial nerve injury.
On the other hand, SDC was first described by Kleinsasser et al in 1968 , and to date, more than 100 cases have been reported and account for approximately 9% among all salivary gland neoplasms . SDC is a dis- tinctive but relatively common high grade adenocarcin- oma arising from the excretory ductal epithelium of the major salivary glands, especially the parotidgland [8-10]. Clinically, these tumors are characterized by aggressive (i.e., infiltrative and destructive) behavior with local recurrence, early and distant metastasis, invasion of the facial nerve, and/or significant mortality [8-11]. Histopathologically, SDCs have a striking resemblance to ductal carcinoma of the breast, exhibiting intraduc- tal and infiltrating components [8,10,11]. In addition, very intriguingly, they should show a broader clinico- pathological spectrum and many cases of them may develop within PA as a result of malignant transform- ation of ductal epithelial cells [9,12]. It has been actually reported that multifocal origin of SDC from major ex- cretory ducts surrounding a PA was found . By con- trast, Simpson RHW et al. described that the majority of them arise de novo (as in the breast) probably from a pure in situ carcinoma . Similar to Ca ex PA, aggres- sive clinical management in the early stage of SDC appears to be the only hope for good prognosis [5,6,8-11]. Thus, it is critical to establish an accurate preoperative diagnosis by fine-needle aspiration cy- tology, however, previous studies have indicated the dif- ficulty of correct characterization of Ca ex PA and/or SDC due to sampling errors or inadequateness and mis- interpretation [14,15].
In March 2011, a 28-year-old caucasian woman was admitted to our ENT department, at the University Federico II of Naples (Italy), with one-year history of a painless nodules in both pre-auricular areas, that had slowly en- larged. Physical examination revealed a solid mass at the left parotidgland larger than the right parotid one, both well defined, hard-elastic, with no fixation to the adjacent anatomic structures. There weren’t facial nerves palsy or cervical lymphadenopathies.
the cutting surface was gray and white. Pa- thology observation: dominant epithelial com- ponents intermingled with chondroid, myxoid and fibrous stroma. The structure was pleomor- phic showing the glandular epithelium and myo- epithelial epithelium. Two kinds of epithelium formed a double tubular structure, myoepithe- lial cells distributed in the myxoid regions. The tumor infiltrated local capsule. Histological diagnosis: pleomorphic tumor (Figure 2). Figure 1. Enhanced CT scan of the parotidgland. A. Two high density lesions were seen in the left parotidgland. Mild Homogeneous enhancement was seen in both tumors. B. The posterior one was 22 mm in diameter. C. The anterior one was 15 mm in diameter.
Orbital exenteration which included excision of the eyelids and the removal of the conjunctiva, globe, optic nerve, extra- ocular muscles, the lacrimal gland, and all the soft tissues of the orbit was done for one case. Pseudotumor cases were diagnosed as a diagnosis of exclusion after detailed clinical, histopalthological and radiological investigations and were treated conservatively. One case each of metastatic plasmacytoma and meningioma were referred to higher center for management. Overall, dermoids were the most common tumors in our study (33%) followed by pseudotumor (25%) and hemangiomas (10%). Malignant tumors accounted for 10% of cases among which lymphoma was the most common (4%) and benign lesions for 90% among which dermoids were most common (33%).
purposes, a variant topographic relationship between the left RV and FN was encountered and captured by a digital camera. The 90-year-old male cadaver derived from the body donation with informed consent . A pre-auricular incision was made, the parotidgland was carefully dissected and the nerves and vessels were exposed and examined. The course of RV was followed in order to discover the main trunk and divisions of FN inside the parotidgland. On the left side, the RV presented an anomalous course, as it was running superficial to the FN. The crossing point of the RV and FN was found slightly distal to the junction of STV and maxillary vein (MV) by which the left RV was formed. The MV lied deep to the divisions of FN, while STV was found superficial to the cervicofacial division. Noticeably, the STV travelled superficial to the first portion of the temporofacial division, while nerve branches crossed again the STV upwards, forming a “nerve fork” (Fig. 1). The right side did not present any variation, while no evidence of previous surgical procedures or pathological lesions were observed at the region.
tially sutured and pressure dressing was applied. During the immediate post operative period patient status im- proved, but marginal mandibular palsy persisted. But no new iatrogenic trauma to other branches of facial nerve was noticed. High dose Antibiotics and management of diabetes mellitus continued. Blood sugar was controlled in post op period (fasting sugar 100 mg% and post prandial 160 mg%). Pus culture from the cyst revealed Kleb- siella species. Final diagnosis of necrotizing parotitis was made. Patient underwent repeated debridement of slough and finally secondary suturing was done after 10 days and he was put on facial physiotherapy and elec- trical seventh nerve stimulation. He was finally discharged on oral hypoglycemic agents. On further follow-up, after up to 12 weeks, surgical wound was well healed, marginal mandibular palsy improved to Grade II in the House-Brackman scale.
In this report, we described the first document- ed case of primary ductal adenocarcinoma of the lacrimal sac. Ductal adenocarcinoma is a relatively rare malignant tumor that mainly occurs in the salivary gland, especially in the parotidgland, which represents approximately 9% of salivary malignancies, and is referred to as salivary duct carcinoma (SDC) . This type of tumor is also reported in the lacrimal [8, 9] and minor salivary glands [7, 10]. SDC is char- acterized histopathologically by the presence of a cribriform growth pattern with comedone- crosis, which is composed of neoplastic cells containing rich eosinophilic granular cytoplasm and large pleomorphic nuclei with conspicuous nucleoli, and resembles ductal carcinoma of the breast . Positive immunoreactivity for GCDFP-15 and AR is characteristic, and more- over, most SDC show positive membranous staining for HER2/neu protein [7, 10, 11]. The histopathological features of the present case corresponded to SDC because typical cribri- form growth with comedonecrosis, which was composed of neoplastic cells containing rich granular eosinophilic cytoplasm and large round to oval nuclei. Poorly differentiated area comprising of small-sized glands, cords or sin- gle cells as seen in the present case can be Figure 1. Computed tomography shows an irregular-
authors and allows for identification of nerve fibres if a standardized protocol is used 57,58 . The correct timing of sodium fluorescein application makes nerve fibres visible, even in situations of actual wound healing or patients who received radiotherapy 58,59 . Although this technique is new and needs further prospective evaluation, it might be suitable for patients with RPA allowing facial nerve preservation.
weighted images, with more frequent cystic change. The basal cell adenoma is sometimes mistaken for adenoid cystic carcinoma. There are two features that help to distinguish these lesions. One is the circum- scription of the basal cell adenoma, which contrasts with the invasive pattern of adenoid cystic carcinoma. The other is the lack of vascularity in the microcystic areas of adenoid cystic carcinoma, which contrasts with the numerous endothelial-lined channels in basal cell adenoma. Although basal cell adenocarcinoma is an epithelial neoplasm that has the cytological char- acteristics of basal cell adenoma (10), it is character- ized by invasive and destructive morphologic growth, in contrast to the noninvasive appearance of basal cell adenoma. Even in the multinodular forms of mem-
Abstract: Intramedullary spinal cord metastasis (ISCM) is an infrequent lesion of systemic malignant tumors, and the most common primary sources of ISCM are lung and breast cancers, as well as melanoma and lymphoma. Pa- tients with ISCM usually accompany with rapidly progressive neurological compromise and the prognosis of ISCM is poor. We present a case of a 40-year-old male with a history of parotidgland carcinoma ex pleomorphicadenoma (CXPA) who had undergone surgical excision and chemotherapy presented with progressive paralysis and hypotonia of the bilateral upper and lower extremities. Magnetic resonance imaging (MRI) revealed two intramedullary metas- tases at the C5 and T6 level, respectively. The patient underwent surgical resection after intramedullary spinal cord metastasis was diagnosed and survived 8 months without any systemic progression and with partially neurological improvement following surgery. The aim of this study was to present the clinical features, diagnosis, and treatment of a patient with ISCM resulting from parotidgland CXPA. The present case highlighted the importance of early di- agnosis and surgery when ISCM is suspected. Clinicians should choose the optimum management considering the patient’s individual condition when ISCM is suspected.
Myoepithelial cells (MEC) are found in the secretory units of many mammalian exocrine glands such as mammary, sweat, lacrimal and salivary glands. They are interposed between the secretory cells and the basal lamina. Immunohistochemically they are found to contain keratin intermediate filaments and are, therefore, considered to have an epithelial origin but at the same time they contain a large number of myofilaments which represent a massive expression of contractile proteins such as actin, myosin, calponin and caldesmon. Thus have smooth muscle like property also and hence the name. Numerous functions of MEC have been described, the most important of them being important for contraction of the glands and recently it has been found to prevent tumour progression. It should be noted that the diversity in the occurrence and dilemma regarding the pathogenesis of salivary gland tumours is due to lack in uniformity regarding the cells participating in its oncogenesis, especially the MEC. Also proper and extensive studies regarding MEC are very limited and thus have posed difficulty for a pathologist to understand this cell. In this review we try to bring about a thorough description of this cell in both physiological and pathological aspects.
MR imaging findings of BCAs were well-defined and smooth marginal morphologies, dissimilar to the lobulated contour seen in pleomorphic adenomas, relatively low SI on both T1WI and T2WI, and rapid and prolonged enhancement on dynamic study. Although BCAs are a rarity, they should be suspected when a tumor shows all of the characteristics noted here.
has a superficial and a deep lobe. The facial nerve, retromandibular vein and the external carotid artery are enclosed by the Parotid. The gland is situated in the pre - auricular area. It is paired and bilateral and is situated on either side upon the mandibular ramus. It is encapsulated by the masseteric fascia. The parotid plexus is formed by the branches of the facial nerve. It passes through the parotidgland and divides it into a superficial and a deep part but does not innervate it. The parotid duct is called as Stensen's duct. It opens throughparotid papilla opposite to the upper second molar tooth (8) . Accessory parotid
A young male of 22 years presented with 3x2 cm cystic parotid swelling for last 5 months. Aspiration was dark brown fluid and cytology revealed plenty of lymphoid cells with occasional oncocytic cells in a dirty fluidy background. Cytologically it was diagnosed as warthin’s tumor but in histology it was diagnosed as lymphatic cyst. The histiocytes and metaplastic lining epithelial cells were misinterpreted as oncocytic cells. Oncocytic metaplasia of lining epithelium of lymphatic cyst is a close differential diagnosis of warthin’s tumor in cytology. 28
Therapeutic procedures when reviewing the literature were mostly excision, like our case, but three cases of PA of the breast have been reported with inevitable mastectomy . One case that has been misdiagnosed as metaplastic carcinoma (osteoid-chondroid type) was overtreated with a mastectomy .
Salivary gland tissues are distributed in the upper aerodigestive tract; the paro- tid, submandibular and sublingual being the major salivary glands . The mi- nor salivary glands are present in other sites such as lips, palate, tongue and oropharynx  . Salivary gland diseases are relatively common and studies have shown that neoplasms account for the majority followed by obstructive le- sions   . Major salivary gland lesions are often complicated by acute ex- acerbation due to infection and prompt management is therefore necessary to preserve the airway and other vital structures in the neck region.