Pleomorphic adenomas account for approxi- mately half the tumors found in the parotid gland. They are typically found in women ages 30 to 70 years (1–3). Typically, pleomorphic adenomas have high signal intensity on T2- weighted images, inhomogeneity, and sharp demarcation from the adjacent parotid gland (7–10). Other tumors of the parotid gland, such as Warthin tumor, lymphoepithelial cyst, and possibly other benign and malignant tumors, may show the same features (13–15). Parotidpleomorphic adenomas have also been re- ported to show lobulated contours caused by the differential growth rates of different cell types within the tumors (4, 16). This aspect of pleomorphic adenomas has not been empha- sized.
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 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
A 25-year-old female was referred to our department (Oral and Maxillofacial Surgery) in March 2000. She complained of soft tissue swelling and pain on the right side of the subauricular region that had disappeared and relapsed several times over the prior year. On physical examination, this mass was well defined and showed hard elasticity and abundant mobility by palpation. The MRI showed a sharply emarginated round mass in the right superficial parotid gland. The mass was high intensity on T2-weighted images. The size of the mass was 30 × 25 mm (Figure 1). As the clinical differential diagnosis of this mass, pleomorphicadenoma, warthin tumor, and neurogenic tumor, such as trigerminal shwannoma, were considered.
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, pleomorphic adenomas 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.
Case report: A 42-year-old woman presented to Kurume University Hospital in November 1992 with an orange-yellow tumor nasal to the optic disc in the left fundus. The tumor was 9.0 × 9.0 mm in diameter, 6.0 mm thick, and was characterized by high intensity on T1-weighted magnetic resonance imaging (MRI), low intensity on T2-weighted MRI, and enhancement on gadolinium MRI. Fluorescein angiography revealed early hypofluorescence and late hyperfluorescence of the tumor and retinal feeder vessels. By April 1996, exudate had developed around the tumor margins. The patient was treated with external beam radia- tion therapy (20 Gy) in July 1996, but the tumor did not diminish in size. Subsequently, she developed extensive loss of vision due to total retinal detachment. Accordingly, her left eye was enucleated in June 2005 because of severe ocular pain due to absolute glaucoma. Histo- pathological examination indicated that the tumor was contiguous with the normal surrounding RPE and was composed of cords and tubules of mostly non-pigmented spindle-shaped cells with round to oval nuclei and a small amount of cytoplasm containing melanin granules. The tumor cells were immunoreactive for vimentin, S-100 protein, and cytokeratin 18. The final diagnosis was adenoma of the RPE.
Carcinoma ex PleomorphicAdenoma (Ca ex PSA) is a rare and poorly understood malignancy of salivary glands. It accounts for 3-4% of salivary neoplasms and approximately 12% of all salivary malignancies (Gnepp 1991). It has been suggested that Ca ex PSA originates as a result of malignant transformation of ductal epithelial and / or abluminal myoepithelial cells within pre-existing Pleomorphic Salivary Adenomas (PSA), the majority of which are untreated or recurrent in nature (Eneroth and Zetterberg 1974). These cancers are typically high-grade in nature, with frequent metastasis, and have a poor prognosis (Lewis, Olsen and Sebo 2001, Olsen and Lewis 2001).
Fifty percent of all tumors derived from the minor salivary glands are reported to be malignant, adenoid cystic carcinoma being the most malignant tumor. Pleomorphic adenomas of the minor salivary glands, like those on the palate, buccal mucosa or lip, sometimes lack encapsulations and may mix into normal host tissue as tumor growth; hence a wide excision is necessary even if previous biopsies report benign nature. If pleomorphicadenoma is located in the superficial lobe of the parotid gland, an effective way of treatment is superficial parotidectomy. When the tumor is located in the deep lobe of the parotid gland, the method of choice is total parotidectomy. 20, 21
15. Zar H, Jeena P, Argent A, Gie R, Madhi S. Diagnosis and manage- ment of community-acquired pneumonia in childhood-South African Thoracic Society Guidelines. South Afr Med J. 2008;95(12):975 – 990. 16. Nohynek H, Valkeila E, Leinonen M, Eskola J. Erythrocyte sedimen- tation rate, white blood cell count and serum C-reactive protein in assessing etiologic diagnosis of acute lower respiratory infections in children. Pediatr Infect Dis J. 1995;14(6):484 – 490. doi:10.1097/ 00006454-199506000-00004
Fine needle aspiration (FNA) of the neck mass was consistent with poorly differentiated metastatic carci- noma, likely of squamous origin. Computerized tomo- graphy (CT) with contrast revealed a 3.0 × 3.0 × 1.7 cm mass within the left parapharyngeal space contiguous with the deep lobe of parotid, located between the carotid sheath and medial pterygoid muscle; a separate sharply circumscribed homogenous left level II. A lesion measur- ing 2.7 × 2.4 × 3.8 cm was also noted. Positron emitted tomography (PET) revealed hypermetabolic activity within both masses with no other lesions (Figure 1).
of interplay between these elements. Now it is widely accepted that both epithelial and mesenchymal (myxoid, hyaline, chondroid, osseous) elements often arise from same cell clone, which may be a myoepithelial or ductal reserve cell. There is no difference in behavior of this neo- plasm based on proportion of various elements . Lee et al examined formalin-fixed, paraffin-embedded tissues from 13 pleomorphic adenomas of female patients. They used the polymerase chain reaction (HUMRA assay). HUMARA, the human androgen receptor gene, is located on the X chromosome and contains a segment of poly- morphic CAG tandem repeats in exon 1. Several methyla- tion-sensitive HhaI restriction sites are located 5' to these CAG repeats. It is an ideal tool to study clonality of female tissues by examining the methylation pattern. A mono- clonal pattern was seen in the stromal, epithelial elements in the majority of cases. These findings suggest that the
The typical CT appearance of parotidpleomorphicadenoma has been reported as that of a smoothly marginated or lobulated small spherical tumor. Pleo- morphic adenomas have also been described as not significantly enhancing, with larger masses often hav- ing a nonhomogeneous appearance characterized by low-attenuation central foci of necrosis, old hemor- rhage, and cystic change (2, 5–9). Other benign or malignant lesions, however, may also have these im- aging characteristics. Only 10% of parotid pleomor- phic adenomas are reported to occur in the deep gland (11). Normal adult parotid gland parenchyma is relatively fatty, with a reticular interstitium. The usual glandular CT density of 15 to 25 HU is lower than that of muscle, but greater than that of fat (12). Some glands are denser, with lower fat, which can decrease the conspicuity of soft-tissue–density lesions within the gland.
The present study has some limitations. First, the cohort was recruited for a cross-sectional investigation, whereas the effect of aging on respiratory function would be better assessed in a longitudinal study. It is plausible that FEV 1 /FVC decreases significantly even after the age of 65 years, but this can be less reliable when derived by a cross-sectional observation of older people. In fact, they could represent individuals who had higher spirometric values at a younger age, and FEV 1 /FVC similar to those of younger subjects at the time of recruitment. Second, subjects participating in the SARA project were not ran- domly selected from the population, but consisted mainly of subjects with nonrespiratory illnesses attending outpatient clinics; this might have resulted in some selection bias, although it would not explain the higher pulmonary volumes than in other studies. The authors wish to emphasize that FEV 1 /FVC less than the lower limit of normal should not be the only criterion used for diagnosis of airway obstruc- tion, but should always be combined with evaluation of FEV 1 as percent of predicted. Indeed, patients with severe airflow limitation could have an important reduction both in FEV 1 and FVC, with a sustained FEV 1 /FVC ratio. Thus, in doubtful cases, measurement of residual volume and total lung capacity is recommended.
Local recurrence was reported in two cases [4, 13]. Multiple occurrences have been observed by Willen et al. , Moran et al. , and Sheth et al. . Excision with clear margins is the preferred treatment for PA of the breast . Most tumors of PA of the breast reported were benign. Just a few cases of carcinoma expleomorphic adenoma have been reported by Hayes et al. . However, metastasis of PA has not been reported so far.
Volume 3, Issue 9, September – 2018 International Journal of Innovative Science and Research Technology ISSN No 2456 2165 IJISRT18SP88 www ijisrt com 36 Empowerment of Fishing Communities in the Manag[.]
In this retrospective study, we collected information of 418 eyes (209 Keratoconus +209 ages matched controls). The necessary data was collected from the Visante AS OCT and Zeiss atlas topography in a tertiary eye hospital, Udupi. The demographic data of the patients was drawn from the system. . Further details on visual acuity, refractive error, slit lamp findings and fundus examinations were obtained from the MRD. All parameters included in the study were taken from the last 3 year data available in the instruments. Keratoconus diagnosis had been confirmed based on clinical and topographical findings. Results:
On the one hand, twelve cases of PAs were compared to their recurrence, where AgNOR score of area fraction was measured before and after recurrence. The same findings were contrasted to ten cases of nonrecurring PA. On the other hand, all were compared to ten cases of normal glandular mucosa. Diagnosing both pleomorphic adenomas was based on clinical and histological records of the archival submitted cases. AgNOR stain was evaluated to determine the proliferative activity in the lesions. Values of AgNOR score were measured. Groups were categorized as follows:
Salivary gland tumors represent 1% to 4% of all human neoplasias . Pleomorphicadenoma is the most common tumor that a ﬀ ects the aforementioned glands [1–3]. Rarely PA undergoes malignant transformation into Carcinoma Ex-PleomorphicAdenoma (CEPA) or carcinosarcoma. It is even more uncommon that PA metastasizes. Among sali- vary gland neoplasms, metastasizing pleomorphicadenoma (MPA) constitutes an extremely rare group of tumors [2, 3]. Although apparently benign, the MPA-associated mortality could be as high as 22% . According to Nouraei and colleagues’ review of case reports, the 5-year disease-specific and disease-free survivals of patients suﬀering from MPA are 58% and 50%, respectively .
The eye is not only an organ of vision but also an index of et al., 2002). The volume of the orbit is small and confined by bony walls on all sides except anteriorly. Within this space is a juxtaposition of numerous structures that subserve visual as well as extraorbital functions. Therefore, it is not surprising that ophthalmic symptoms are common presenting findings with most orbital The majority of orbital tumors originate between the bony orbital wall and the extraocular muscle cone and 90% of the orbital tumors present with Orbital tumors constitute a heterogeneous array of lesions and, as such, pose numerous challenges in terms of diagnosis, imaging and management. Given the variety of structures within the relatively confined ry to understand the