Top PDF Warthin tumor of the parotid gland: MR pathologic correlation

Warthin tumor of the parotid gland: MR pathologic correlation

Warthin tumor of the parotid gland: MR pathologic correlation

CONCLUSIONS: MR findings such as bilaterality and/ or multiplicity , well-defined margin s, and predo minantl y intermediate signal intensity on T1 W and T2W images with focal areas of h[r]

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Warthin Tumor of the Parotid Gland: Diagnostic Value of MR Imaging with Histopathologic Correlation

Warthin Tumor of the Parotid Gland: Diagnostic Value of MR Imaging with Histopathologic Correlation

Most Warthin tumors were revealed to involve the inferior pole of parotid glands and to have a smooth margin on T1- and T2-weighted images. Warthin tu- mor, epithelial stroma, and lymphoid tissue with mi- croscopic cysts filled with proteinous secretion showed early enhancement, type A or B perfusion curves, and a high washout ratio ( ⱖ 30%) on dynamic contrast-enhanced images and a low ADC value on diffusion-weighted images. The cellular components with accumulated microscopic cysts containing pro- teinous fluid with foamy cells, red cells, and neutro- phils were recognized as high-signal-intensity foci on T1-weighted images and characteristically hypoin- tense areas on STIR and T2-weighted images. These cellular components with accumulated microscopic complicated cysts showed a low washout ratio ( ⬍ 30%) on dynamic contrast-enhanced images. The additional information of ADC, washout ratio, and time– signal intensity curves confirmed that the tumor was a Warthin tumor. A 30% washout ratio threshold tended to be useful for predicting whether salivary gland tumors were benign or malignant. The ADC values of Warthin tumors (0.96 ⫾ 0.13 ⫻ 10 ⫺3 mm 2 /s)
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Basal Cell Adenoma of the Parotid Gland: MR Imaging Findings with Pathologic Correlation

Basal Cell Adenoma of the Parotid Gland: MR Imaging Findings with Pathologic Correlation

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
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Ultrasonography Guided Core Needle Biopsy of Parotid Gland Masses

Ultrasonography Guided Core Needle Biopsy of Parotid Gland Masses

The Table summarizes the final diagnoses of the 40 benign and 13 malignant cases, and Figure 1 shows images from one patient (Figs 1). Of 31 patients who underwent surgery after USCNB, re- sults of core biopsy were completely concordant with those of surgicopathology in 30 (97%). Results in only one patient (3%) were not fully concordant between biopsy and surgery. In this case, core bi- opsy revealed an organized abscess, but surgicopa- thology revealed an additional finding of clear cell adenocarcinoma. Twenty-two (26%) of 53 patients did not undergo surgery; these patients had five lymphomas, two metastatic carcinomas, seven non- neoplastic benign lesions, and eight benign neo- plasms (four pleomorphic adenoma, three Warthin tumors, and one oncocytoma). Four of these pa- tients died 0.3–33 months (mean, 13.6 months) later from causes unrelated to the biopsy proce- dure. The remaining 18 patients did not have local recurrence after 12.2–77.5 months (mean, 38 months) of follow-up. Only one patient (2%) had a
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A comparison of MR sequences for lesions of the parotid gland

A comparison of MR sequences for lesions of the parotid gland

Despite the reported value of gadolinium- enhanced sequences for MR imaging of head and neck lesions in general (7, 24) (Vogl T et al., “MR Imaging with High-Dose . . .”), we have found it to be of limited value in the imaging of parotid masses. We believe this to be related to simultaneous enhancement of both tumor and normal parotid parenchyma resulting in de- creased lesion conspicuity on the enhanced im- ages. Decreased delineation of fat planes on gadolinium-enhanced T1-weighted images also may result in loss of anatomic details and poor demarcation of the various anatomic compart- ments. Nevertheless, gadolinium-enhanced T1- weighted images have been reported to be help- ful in the diagnosis of Warthin tumor, which frequently does not enhance (5). In our experi- ence with 4 Warthin tumors, 3 showed no en- hancement, and one only enhanced minimally, whereas minimal or no enhancement occurred in only 2 of 24 other well-marginated benign and malignant lesions. Characterization of post- operative fibrosis or necrotic or cystic lesions and visualization of perineural spread in malig- nant parotid lesions are other conditions for which we, as well as others, have noted a po- tential adjunctive value for contrast-enhanced MR images (Fig 1) (6, 7, 13, 14). However, FS FSE T2 images often can provide equivalent information without the added cost and incon- venience to the patient and with significant re- duction in imaging time.
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CT and Ultrasound Features of Basal Cell Adenoma of the Parotid Gland: A Report of 22 Cases with Pathologic Correlation

CT and Ultrasound Features of Basal Cell Adenoma of the Parotid Gland: A Report of 22 Cases with Pathologic Correlation

In this series, the sonography features of BCA were mostly consistent with CT features, except for 2 cases. However, for a parotid lesion, it is important to confirm the adjacent relation- ship between tumor and facial nerve (the facial nerve course can be inferred from the retromandibular vein) before oper- ating. Sonography is often the initial imaging examination in patients with parotid gland mass because of its accessibility, low cost, and the capability of guided biopsy. But CT imaging is usually more intuitive for surgeons than sonography. Fur- thermore, CT is better for assessing the full tumor extent than sonography, especially when the tumor is located in or in- volves the deep lobe of the parotid gland.
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MR of the submandibular gland: normal and pathologic states

MR of the submandibular gland: normal and pathologic states

of the gland caused by ductal occlusion and infection not preceded by ductal obstruction (18). Isacsson et al (19) found that salivary calculi caused inflammation in the submandib- ular gland in 83% of patients who had pain in the region, and radiography was 92% accurate in the diagnosis of salivary calculi. In the present study, all patients with sialoadenitis had dif- fusely abnormal signal intensity in the subman- dibular gland, which was different from focal abnormalities of neoplasms. However, MR im- aging is less sensitive than radiography and CT in detecting calcifications like sialolithiasis. In addition, chronic sialadenitis without sialolithi- asis is often difficult to differentiate from such neoplasms as high-grade malignant tumors in clinical situations (20). At MR imaging, high- grade malignant tumors in the parotid gland are reported to show low T2-weighted signal inten- sity as well as poorly defined margins, making their appearance similar to chronic sialoadenitis if they replace the gland diffusely.
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Giant Solitary Fibrous Tumor of the Parotid Gland

Giant Solitary Fibrous Tumor of the Parotid Gland

Copyright © 2014 O. Chis and S. Albu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Solitary fibrous tumors (SFTs) are rare tumors that are mostly found arising from the pleura. SFT of the parotid gland is a rare tumor; only a few cases have been described in the literature. SFTs are benign in most cases. Clinically, SFTs usually manifest as well circumscribed, slow-growing, smooth, and painless masses. CT-Scan and MRI are the most sensitive imaging procedures used. The treatment of choice is complete surgical excision of the lesion. Since recurrence and metastasis can take place after several years, a lifelong clinical and imaging regular follow-up is compulsory. In this paper, we describe the diagnostic and therapeutic challenges of the up-to-now biggest parotid SFT. The clinical presentation, surgical management, and pathological and immunohistochemistry findings are described.
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Malignant Mucoepidermoid Tumor Arising in the Accessory Parotid Gland: A Case Report

Malignant Mucoepidermoid Tumor Arising in the Accessory Parotid Gland: A Case Report

Summary: Purpose: The head and neck surgeon’s fascination with parotid surgery 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 parotid gland 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 parotid gland. The preoperative diagnosis was an accessory parotid gland 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 parotid gland 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.
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Carcinosarcoma of the parotid gland with abdominal metastasis: a case report and review of literature

Carcinosarcoma of the parotid gland with abdominal metastasis: a case report and review of literature

Malignant mixed tumors of the salivary gland can describe three distinct histologic entities: carcinoma ex pleomorphic adenoma (the most common), metastasiz- ing mixed tumor, and carcinosarcoma [1]. More than 99% of these tumors arise from pleomorphic adenomas, with only 0.2% being primary carcinosarcomas or true malignant mixed tumors [17]. Two hypotheses have been advanced to explain the histogenesis of carcinosar- coma. The convergence hypothesis suggests that these tumors are multiclonal and are derived from two or more types of mesenchymal and epithelial stem cells. The divergence hypothesis suggests that these tumors are monoclonal, with a single totipotent stem cell differ- entiating into epithelial and mesenchymal cells [18].
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<p>A Preliminary Study of CT Texture Analysis for Characterizing Epithelial Tumors of the&nbsp;Parotid Gland</p>

<p>A Preliminary Study of CT Texture Analysis for Characterizing Epithelial Tumors of the&nbsp;Parotid Gland</p>

Ultrasound is useful in the diagnosis of parotid tumors, but it is dif fi cult to detect masses located in the deep lobe and the results closely depend on the experience and skill level of the operator. 4 Magnetic resonance imaging (MRI) seems to have the highest potential to determine different histological subtypes of parotid tumors noninvasively. Nevertheless, its disadvantages are limited availability, high cost and the long time needed. Patients with certain pacemakers or implanted metals cannot be examined with MRI. 5 Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure usually used in preopera- tive diagnosis. However, its result is not always conclusive due to insuf fi cient specimens. 6 Open biopsy is not encour- aged in apparently benign tumors as it carries a theoretical risk of seeding, but it sometimes has a role in the frankly malignant tumors, especially when radical surgery is being contemplated. Therefore, it is urgently necessary to fi nd an effective and relatively safe method to characterize parotid tumors before operation.
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Accessory parotid gland tumor: A rare case reports of acinic cell carcinoma

Accessory parotid gland tumor: A rare case reports of acinic cell carcinoma

Acinic cell carcinoma reported to be the second most common malignant tumor of the accessory parotid gland [12]. Characteristically slow growing with clinical behavior reflective of a low-grade tumor, Although 25– 50% of patients with acinic cell carcinoma can recur if not treated adequately [13]. Clinically more aggressive in the subset of acinic cell carcinomas at presentation metastasis to distant sites particularly the lung and regional lymph nodes. Acinic cell carcinoma histological grading is controversial and, unlike clinical stage, has not proven to be reliable in predicting behavior histomorphologically, good prognosis and best survival results in adults are achieved when there is complete tumor excision suggests by surgical outcomes experience. But in the initial
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Radiologic pathologic correlation  Epidermoid tumor of the cerebellopontine angle

Radiologic pathologic correlation Epidermoid tumor of the cerebellopontine angle

A, Precontrast axial T1 WI shows a large irregular cystic-appearing CPA mass large arrows with a nodule small arrows that is inhomogeneously iso/ hypointense compared to brain.. The disp[r]

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Original Article Basal cell adenoma of the parotid gland: clinical and pathological findings in 29 cases

Original Article Basal cell adenoma of the parotid gland: clinical and pathological findings in 29 cases

years (range, 43-83 years). The mean age in this group was slightly higher than that in the other two groups, but the difference was not statistically significant. Five tumors were locat- ed in the left parotid gland, and six were locat- ed in the right gland. The average disease dura- tion prior to surgery was 10.5 ± 11.0 months. One patient received treatment because of local pain. In these patients, ultrasonography revealed a hypoechoic mass located in the deep lobe of the parotid gland. CT examination showed that the maximum tumor diameter was 20.4 ± 5.2 mm. Cystic degeneration was pres- ent in 5 of the 11 tumors (45.5%), which was higher than the incidence in the other two groups (Table 1). The surgical treatment includ- ed dissection of the facial nerve and excision of the tumor, and the superficial and deep lobes of the parotid gland. FNAB was conducted in seven cases (63.6%), and four tumors were confirmed to be BCA on FNAB (4/11, 36.4%). Six tumors (6/11, 54.5%) were confirmed on intraoperative frozen-section biopsy, and the others were confirmed on the final pathological diagnosis. In four cases, the facial nerve func- tion deteriorated to HB grade II after the sur- gery. Two of them recovered within 6 months and in other two cases, this function failed to recover. Two patients died of other diseases during follow-up. The remaining patients had no local recurrence or malignant transformation during the follow-up (Table 2; Figure 2E, 2F). BCA is composed of basaloid cells, which can be divided into the following categories: solid tubular type (Figure 3A), solid trabecular type (Figure 3B), membranous type cells (Figure 3C), and solid type (Figure 3D). The histological subtype was evaluated by examination of par- affin sections and Hematoxylin and Eosin stain- ing. The histological subtypes found in this study were as follows: solid tubular lesions, 6 tumors; trabecular lesions, 4 tumors; membra- nous lesions, 2 tumors; and solid lesions, 17 tumors; (Table 2).
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Warthin Tumor-Like Mucoepidermoid Carcinoma.

Warthin Tumor-Like Mucoepidermoid Carcinoma.

mucicarmine can aid diagnosis. 1 Awareness of Warthin tumor-like variant MEC is therefore crucial, coupled with the knowledge that the occurrence of Warthin tumor would be rare in young patients. The overlap between MEC and Warthin tumor with metaplastic change has been recognized for some time, but more recent knowledge of the genetics of MECs has allowed more accurate diagnosis. Evidence of MAML2 gene rearrangement with fluorescence in situ hybridization can be used to distinguish oncocytic MEC from other oncocytic lesions including Warthin tumor. 2 Ishibashi et al. recently noted that ‘metaplastic Warthin-like’ tumors harboring CRTC1-MAML2 had features more in keeping with MEC than Warthin tumor. 3 Five of 15 ‘metaplastic Warthin-like’ tumors in their series harbored CRTC1-MAML2 gene fusions, with age and gender distributions of fusion-positive cases similar to those of fusion-positive MEC, and differing both from fusion-negative metaplastic Warthin-like tumors and from cases of typical Warthin tumor. Additionally, foci of low-grade MECs were found only in fusion-positive metaplastic Warthin-like neoplasms. These investigators also showed that all fusion-negative cases retained, at least focally, some of the oncocytic bilayered epithelium typical of Warthin tumor, but this was absent in fusion-positive cases and therefore it was possible with a high success rate to distinguish the diagnoses morphologically. They propose that such cases are better regarded as MECs rather than metaplastic Warthin tumors, and the case presented here would be in keeping with such an example.
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Neuroendocrine tumor (paraganglioma) of the cauda equina: MR and pathologic findings

Neuroendocrine tumor (paraganglioma) of the cauda equina: MR and pathologic findings

B, Proton density- 2400/ 35/ 2 and C, T2-weighted spin-echo images 2400/ 70/ 2 reveal bulk of the tumor arrows to be isointense to the spinal cord, but the superior and inferior poles ar[r]

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Spinal Cord Schistosomiasis: MR Imaging Appearance with Surgical and Pathologic Correlation

Spinal Cord Schistosomiasis: MR Imaging Appearance with Surgical and Pathologic Correlation

The gross surgical pathologic specimens included grayish soft tissue fragments. Sections of the excised masses with H & E showed infiltration of the spinal cord by multiple Schistosomal granulomas. Schisto- soma ova with refractile shell were seen in the midst of the granulomas, surrounded by fibroblasts, eosin- ophils, lymphoplasma cells, and macrophage histio- cytes. The gray and white matter were affected equally. Granulomas were mainly present beside blood vessels. There were areas of reactive astroglial tissues and fibrosis in all cases with variable attenua- tion. Infiltration was seen peripherally in the menin- ges in all cases and in the resected spinal nerve roots in four cases. Schistosomal ova were identified in all cases. S mansoni ova were detected in three cases, rec- ognized by their characteristic lateral spines (Fig 2B).
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Immunohistochemical localization of mdm-2, p27Kip1 and bcl-2 in Warthin's tumor of the parotid gland

Immunohistochemical localization of mdm-2, p27Kip1 and bcl-2 in Warthin's tumor of the parotid gland

Brown et al [25] stated that the human oncoprotein mdm2 arrests the cell cycle and elimination of its cell cycle inhibitory function induces tumorigenesis. They attrib- uted this finding to the dual role of mdm2, which suggests that full-length mdm2 can induce growth arrest in some cell lines, including some normal cells. Only elimination or inactivation of the mdm2-induced G0/G1 arrest may contribute to one of the steps of tumorigenesis. Some tumor-derived cells are partially insensitive to the mdm2- mediated cell cycle inhibition and mdm2 can be stably overexpressed in these tumor cells. This dual function of mdm2, suggested by other investigators [26], might explain the high level of expression of mdm2 in Warthin's tumor.
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MR Imaging of the Corpus Callosum: Normal and Pathologic Findings and Correlation with CT

MR Imaging of the Corpus Callosum: Normal and Pathologic Findings and Correlation with CT

8 and C, T2-weighted, 10-mm-thick axial 8 and coronal C SE images, 2300/80, reveal high signal intensity, manifesting edema, involving corpus callosum arrows.. Multiple areas of abnormal[r]

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Plasmacytoid myoepithelioma of minor salivary glands: report of case with emphasis in the immunohistochemical findings

Plasmacytoid myoepithelioma of minor salivary glands: report of case with emphasis in the immunohistochemical findings

Immunoreactivity for S-100 protein is currently con- sidered an important characteristic of this morphologic variant of myoepithelioma [3]. Similar to the findings in the present case, many studies have reported strong S- 100 positivity in this kind of salivary gland tumor [3,8,14,20]. On the other hand, some authors have asserted that these plasmacytoid cells are also positive for GFAP [19], which was confirmed in the current case. Moreover, vimentin was also expressed by tumoral plasmacytoid cells in this case. Although this antigen is frequently detected in mesenchymal cells, in this case, it was extensively expressed in the neoplastic myoepithelial cells [19,26,27]. It is suggested that the immunohisto- chemical expression of vimentin may indicate that myoepithelial cells in tumors such as myoepitheliomas do not reach complete differentiation [24].
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