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Alqaryan S, Alsalamah S, AlHajress R, Alareek L, Alharbi B, Albarrak M, Almayouf M, Aldhahri S, Al Essa M, Al-Qahtani K. Utility of the Milan System for Reporting Salivary Gland Cytopathology in Parotid Gland Masses: The Experience of Two Tertiary Centers. Cureus 2023; 15:e49259. [PMID: 38143710 PMCID: PMC10746347 DOI: 10.7759/cureus.49259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/26/2023] Open
Abstract
Background The application of fine needle aspiration (FNA) in parotid masses via the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) enhances the diagnosis of these lesions alongside radiological investigations. Objectives Our objective was to assess the risk of malignancy, sensitivity, specificity, and false positive and negative results for each category of the MSRSGC. Additionally, we assessed the level of agreement between the FNA results using MSRSGC and post-resection histopathological diagnosis. Methods We conducted a retrospective chart review of parotid gland masses that received FNA and postoperative pathological diagnosis at King Saud University Medical City and King Fahad Medical City between 2018 and 2022. We summarized the categorical variables using frequencies and percentages. Results A total of 172 cases met the inclusion criteria. Males encompassed 102 patients (59.3%) of the study sample, and 89 (51.7%) of parotid masses were on the left side. The risk of malignancy for the MSRSGC categories was 37.5% (Category I), 9.0% (II), 50.0% (III), 4.7% (IVa), 50.0% (IVb), 100.0% (V), and 71.0% (VI). FNA had an overall success rate of 81%. The sensitivity was 64% and specificity was 94% for non-neoplastic masses. For benign masses, the sensitivity was 91% and specificity was 66%; however, the sensitivity was 40% and specificity was 97% for malignant lesions. We found that the percentage of agreement between the FNA and final pathology was 80%. Conclusion FNA using MSRSGC is a valuable preoperative clinical tool. However, the low sensitivity rates based on the diagnosis of malignant lesions should alert clinicians not to be overly reliant on biopsy results and instead defer to definitive surgical management.
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Affiliation(s)
- Saleh Alqaryan
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Shmokh Alsalamah
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Rafeef AlHajress
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
| | - Latefa Alareek
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
| | - Bushra Alharbi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
| | - Majed Albarrak
- Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | - Mohammad Almayouf
- Department of Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | - Saleh Aldhahri
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
| | - Mohammed Al Essa
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
| | - Khalid Al-Qahtani
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, SAU
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Gautam SK, Kumar S, Singh HP, Singh AB, Chandra M. Clinico-pathological profile of parotid gland tumors at a tertiary care center in North India. Natl J Maxillofac Surg 2023; 14:438-443. [PMID: 38273931 PMCID: PMC10806317 DOI: 10.4103/njms.njms_111_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/11/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2024] Open
Abstract
Aim of the Study The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome. Material and Methods Data of 102 patients assessed from hospital records who underwent parotid surgery between the years 2013 and 2018 were obtained. Parameters included age, sex, socio-demographic profile, presenting complaints, examination findings, and cytopathology. Surgical techniques, post-operative complications such as a facial scar, retro-mandibular and pre-auricular depression, facial palsy, Frey's syndrome, and numbness over the ear lobule were analyzed. Result Out of a total of 102 patients, 54.0% of patients were male, and 45.1% were female. The mean age of patients was 33.30 ± 13.87 years ranging from 7 to 65 years. The most common clinical presentation was swelling in the parotid region (95.1%), and associated symptoms with swelling were pain (17.5%), facial palsy (4.9%), discharging sinus (4.9%), and ulcerative lesions (1%) at the time of presentation. Pleomorphic adenoma was the most common benign neoplasm (76.5%), followed by Warthin's tumors (2.9%). Mucoepidermoid carcinoma was the most common malignant neoplasm (3.9%). After parotid surgery, 35% of patients had a sensory impairment or hypoesthesia of the ear lobule, and 23.28% had temporary facial nerve weakness. 5.0% of patients had permanent facial weakness, and 2.06% of patients had weakness of the marginal mandibular nerve. Conclusion Pleomorphic adenoma and mucoepidermoid carcinoma are the most common benign and malignant tumors, respectively, and parotidectomy is the treatment of choice, depending on the tumor location. Successful treatment depends on early diagnosis and histopathological and radiological investigations. Sensory impairment and temporary facial nerve paralysis are the most common post-operative complications, which are minimized by proper knowledge of anatomy and meticulous dissection of the facial nerve during parotid surgery.
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Affiliation(s)
| | - Sunil Kumar
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | | | - Manish Chandra
- King George's Medical University, Lucknow, Uttar Pradesh, India
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Fois P, Mureddu L, Manca A, Varrucciu S, Crescio C, Gallus R, Rizzo D, Cossu A, Bussu F. Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic. J Pers Med 2023; 13:1075. [PMID: 37511688 PMCID: PMC10381898 DOI: 10.3390/jpm13071075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.
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Affiliation(s)
- Paolo Fois
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Luca Mureddu
- U.O.C. Otorinolaringoiatria, Università degli Studi di Cagliari, Policlinico Universitario Duilio Casula, 09042 Monserrato, Italy
| | - Alessandra Manca
- Institute of Pathology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Simona Varrucciu
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Claudia Crescio
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Davide Rizzo
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Antonio Cossu
- Institute of Pathology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
| | - Francesco Bussu
- Division of Otolaryngology, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
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Ayral M, Akil F, Yilmaz U, Toprak SF, Dedeoğlu S, Akdağ M. The Diagnostic Value of Fine Needle Aspiration Biopsy in Parotid Tumors. Indian J Otolaryngol Head Neck Surg 2022; 74:5856-5860. [PMID: 36742705 PMCID: PMC9895172 DOI: 10.1007/s12070-021-02451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to investigate the diagnostic accuracy rates of the patients who underwent an operation for parotid mass, by comparing their fine needle aspiration biopsy (FNAB) cytology results with the final pathology. A total of 136 patient files of those who applied to Otorhinolaryngology clinic due to parotid mass and underwent parotidectomy procedure between 2010 and 2020 at a tertiary center were scanned retrospectively. Database on patient age, gender, preoperative FNAB results, and final surgical histopathology results was created. The mean age of the patients was 48.26 ± 17.37 Superficial parotidectomy was performed to 108 (79.4%) and total parotidectomy to 28 (20.6%) of the patients. The sensitivity of FNAB was found as 85.2%, specificity as 96.2%, positive predictive value as 85.2%, negative predictive value as 96.2% and accuracy as 94.0%. It is found that FNAB has the high specificity and high negative predictive value with high diagnostic accuracy on detecting preoperative malignancy in parotid gland. We think that FNAB is a significant, necessary and safe method in the diagnosis of parotid lesions in preoperative sense.
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Affiliation(s)
- Muhammed Ayral
- Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Ferit Akil
- Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey
- Department of Otorhinolaryngology Clinic, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Umit Yilmaz
- Selahattin Eyyübi Hospital, Diyarbakir, Turkey
| | - Serdar Ferit Toprak
- Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Serkan Dedeoğlu
- SBÜ Gazi Yaşargil Education Research Hospital, Diyarbakir, Turkey
| | - Mehmet Akdağ
- Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey
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Ketterer MC, Konrad Dahlem KK, Häussler SM, Jakob TF, Pfeiffer J, Becker C. Clinical Significance and Indication for Surgical Treatment of Occult Cervical and Intraglandular Nodal Involvement in Parotid Malignancy. J Oral Maxillofac Surg 2019; 77:2355-2361. [DOI: 10.1016/j.joms.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
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Choy KCC, Bundele MM, Li H, Fu EW, Rao NCL, Lim MY. Risk stratification of fine-needle aspiration cytology of parotid neoplasms based on the Milan system-Experience from a tertiary center in Asia. Head Neck 2019; 41:3125-3132. [PMID: 31131938 DOI: 10.1002/hed.25804] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/12/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The recently described Milan system provides a unified way of categorizing salivary gland fine-needle aspiration (FNA) cytology. We aim to use this system to stratify risk of malignancy in parotid FNAs. METHODS In this retrospective case series, 376 FNAs were preoperatively performed for 573 parotidectomies over 14 years. RESULTS Risk of malignancy on FNA is as follows: nondiagnostic 14.5%, non-neoplastic 26.7%, atypia of undetermined significance 29.3%, benign neoplasm 2.7%, neoplasm of uncertain malignant potential 19.1%, suspicious for malignancy 87.5%, and malignant 100%. The specific diagnoses of pleomorphic adenoma and Warthin tumor on FNA have high positive predictive value of 97.5% and 96.6%, respectively. Multivariate regression associates smaller size of lesion with a nondiagnostic or indeterminate result. Seniority of operator is associated with a lower likelihood of a nondiagnostic result. CONCLUSIONS This large Asian series validates the Milan system as a valuable tool in stratifying malignancy risk of parotid FNAs.
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Affiliation(s)
- Kevin C C Choy
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Manish M Bundele
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ernest W Fu
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nandini C L Rao
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ming Yann Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
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Nagliati M, Bolner A, Vanoni V, Tomio L, Lay G, Murtas R, Deidda MA, Madeddu A, Delmastro E, Verna R, Gabriele P, Amichetti M. Surgery and Radiotherapy in the Treatment of Malignant Parotid Tumors: A Retrospective Multicenter Study. TUMORI JOURNAL 2018; 95:442-8. [DOI: 10.1177/030089160909500406] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Major salivary gland cancers are rare, with many histologic types and subtypes. The low incidence and heterogeneity of primary parotid carcinomas makes their outcome difficult to evaluate. Treatment remains primarily surgical, but optimal therapeutic regimens have yet to be fully realized. The present study reviews the experience of three Italian institutions in the treatment of primary parotid carcinomas in order to describe the clinicopathological presentation and treatment options with emphasis on radiotherapy and to analyze the factors influencing survival. Methods and study design The records of 110 patients with primary parotid neoplastic lesions treated at three Italian institutions from 1993 to 2004 were retrospectively reviewed. Six patients were excluded from the study: 3 received surgery alone and 3 were not assessable, for a total of 104 assessable patients. Acute and late toxicity of radiotherapy was quantified following the recommendations of the RTOG/EORTC. Survival was analyzed by the actuarial Kaplan-Meier product-limit method. The influence of selected factors on 10-year disease-specific survival was analyzed. Results The 104 assessable patients were treated as follows: 11 patients received radiotherapy as their only treatment (3 with a palliative purpose) and 93 had postoperative radiotherapy. Thirty-two patients underwent neck dissection: neck lymph node metastases were found in all them. Their mean age was 60 years (range, 14–92). According to the UICC/2002 TNM Classification, 8 patients were stage I, 19 stage II, 34 stage III, 25 stage IVA, 5 stage IVB, 3 recurrent and 10 not assessable (Tx). The most frequent histologies were adenoid cystic carcinoma (n = 16), mucoepidermoid carcinoma (n = 15), and acinic cell carcinoma (n = 15). Twenty-three patients had recurrences: 10 had local recurrences, 3 neck recurrences, 9 distant metastases, and 1 patient had both local recurrence and distant metastases. No factors were observed that would negatively influence the prognosis. Actuarial 10-year disease-specific survival was 71% and actuarial 10-year local control 82%. Conclusions The treatment of salivary gland malignancies remains primarily surgical. Our study confirms the results of the literature with surgery and adjunctive radiotherapy in patients with advanced-stage disease. No variables were observed to influence the prognosis.
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Affiliation(s)
| | | | | | | | | | - Rita Murtas
- Department of Radiation Oncology of Cagliari
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Shkedy Y, Alkan U, Mizrachi A, Shochat T, Dimitstein O, Morgenstern S, Shpitzer T, Bachar G. Fine-needle aspiration cytology for parotid lesions, can we avoid surgery? Clin Otolaryngol 2017; 43:632-637. [DOI: 10.1111/coa.13038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Shkedy
- Departments of Otorhinolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - U. Alkan
- Departments of Otorhinolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - A. Mizrachi
- Departments of Otorhinolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - T. Shochat
- Departments of Medical Statistics; Rabin Medical Center; Petach Tikva Israel
| | - O. Dimitstein
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - S. Morgenstern
- Departments of Pathology & Cytology; Rabin Medical Center; Petach Tikva Israel
| | - T. Shpitzer
- Departments of Otorhinolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - G. Bachar
- Departments of Otorhinolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
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True Parapharyngeal Space Tumors: Case Series from a Teaching Oncology Center. Indian J Otolaryngol Head Neck Surg 2017; 69:225-229. [PMID: 28607895 DOI: 10.1007/s12070-017-1099-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022] Open
Abstract
The Parapharyngeal Space (PPS) tumors are rare tumors accounting for 0.5% of the tumors in head and neck region. A retrospective study conducted at Department of Surgical oncology, Vydehi institute of Medical Sciences & Research center, Bengaluru, between 2010 and 2015 identified nine cases treated for PPS tumors. Patients are diagnosed on the basis of clinical examination fine needle aspiration cytology and imaging and considered for excision by one of the varied surgical approaches {transoral(1), transcervical(4), transparotid(0), transcervical-transparotid(1), transmandibular(3) or intratemporal(0) approach}. The choice of approach is defined by the size of the tumor, suspicion of malignancy and the position of the tumor with regard to the superior extent and proximity to the skull base as well as its relation with neurovascular bundle.
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10
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Abstract
This article reviews the epidemiology, embryology, risk factors, clinical presentation, diagnostic work-up, and basic management principles for the more common benign parotid neoplasms. The various histopathologies are also discussed and summarized.
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Affiliation(s)
- Kevin Y Zhan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Sobia F Khaja
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Allen B Flack
- Department of Pathology, Medical University of South Carolina, 171 Ashley Avenue, MSC 908, Charleston, SC 29425, USA
| | - Terry A Day
- Division of Head & Neck Oncologic Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
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11
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Tesseroli MAS, Zasso FB, Hepp H, Priante AVM, de Mattos Filho ALL, Sanabria A. Parotidectomy under sedation and locoregional anesthesia with monitoring of brain activity. Head Neck 2016; 39:744-747. [PMID: 28000305 DOI: 10.1002/hed.24674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/02/2016] [Accepted: 11/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Parotidectomy is usually performed while the patient is under general anesthesia, however, sedation with locoregional anesthesia could be an alternative. METHODS Fifteen adult patients with parotid tumors of the superficial lobe were included in this study. Anesthetic procedure consisted of sedation associated with cervical plexus and auriculotemporal nerve block. Sedation was managed based on the bispectral index. RESULTS Superficial parotidectomies were performed in 13 patients, and combined partial resections were performed in 2 patients. The mean operative time was 118.2 ± 16.4 minutes. Conversion to general anesthesia was necessary in only 1 patient. Ten surgeries were performed on an outpatient basis. Definitive facial paralysis occurred in 1 patient. All patients reported total satisfaction with the procedure. CONCLUSION In selected cases, parotidectomy under sedation plus locoregional anesthesia is feasible and safe. The careful selection of patients and the close collaboration with an anesthesiologist is the key to a successful procedure. © 2016 Wiley Periodicals, Inc. Head Neck 39: 744-747, 2017.
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Affiliation(s)
| | | | - Humberto Hepp
- Department of Anesthesiology, Regional do Oeste Hospital, Chapecó, Santa Catarina, Brazil
| | | | | | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia-Fundación Colombianana de Cancerología-Clínica Vida, Medellin, Colombia
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Okoturo E, Osasuyi A. Clinical Outcome of Parotidectomy with Reconstruction: Experience of a Regional Head and Neck Cancer Unit. Niger J Surg 2016; 22:26-31. [PMID: 27013855 PMCID: PMC4785688 DOI: 10.4103/1117-6806.176396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Salivary gland pathologies represent a histologically diverse group of benign and malignant neoplasms. Currently, World Health Organization recognizes 13 benign and 24 malignant variants of all salivary gland neoplasms. Surgery continues to remain the main-stay for treatment of parotid gland neoplasms. The aim of this study was to document our experiences of the patients treated for parotid tumors and find out if any compelling variable predicted the relative clinical outcomes. MATERIALS AND METHODS This was a retrospective study, from records of parotidectomies performed at the operating theatre by the head and neck cancer division of the study institution between 2010 and 2013. Eligibility for study inclusion included cases with benign or malignant parotid neoplasms requiring surgical management with or without adjunct radiotherapy. The predictors of postoperative complications, overall survival (OS), and disease-free survival (DFS) were analyzed. RESULTS A total of 20 patients underwent parotidectomy. The mean age was 42 years. Tumors were located on the left parotid in 13 cases (65%) and the right parotid in 7 cases (35%). The surgical procedures comprised 16 superficial parotidectomies, 1 total parotidectomy, and 3 radical parotidectomy (inclusive of facial nerve sacrifice) and 2 neck dissections levels II-V. The reconstructive procedures were 2 facial nerve branch cable grafts, 1 end-to-end facial-facial nerve branch anastomoses, and 2 facial re-animation surgeries (temporalis muscle suspensions). A total of five cases (33.3%) had postoperative complications. 2 variables (length of surgery and neck dissection) were found to have an impact on postoperative complications that were statistically significant. Additionally, length of surgery was a significant predictor on the 2 years OS and DFS. CONCLUSION The result of this study showed good clinical outcome, especially in the benign cases. The comprehensive clinical outcome of the malignant cases could not be objectively assessed, as the OS and DFS were 50% at 2-years follow-up. It is our submission that a larger sample size is utilized in subsequent studies and quality of life evaluation is included in the methodology.
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Affiliation(s)
- Eyituoyo Okoturo
- Division of Head and Neck Surgical Oncology, Department Oral and Maxillofacial Surgery, Lagos State University College of Medicine/Teaching Hospital, Lagos, Nigeria
| | - Anslem Osasuyi
- Department Oral and Maxillofacial Surgery, Lagos State University College of Teaching Hospital, Lagos, Nigeria
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13
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Liu SM, Wang HB, Sun Y, Shi Y, Zhang J, Huang MW, Zheng L, Lv XM, Zheng BM, Reilly KH, Yan XY, Ji P, Wu YF, Zhang JG. The efficacy of iodine-125 permanent brachytherapy versus intensity-modulated radiation for inoperable salivary gland malignancies: study protocol of a randomised controlled trial. BMC Cancer 2016; 16:193. [PMID: 26951097 PMCID: PMC4782516 DOI: 10.1186/s12885-016-2248-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/03/2016] [Indexed: 01/21/2023] Open
Abstract
Background Radiation therapy is the method of choice for subjects with inoperable salivary gland malignancies. I-125 brachytherapy, delivering a high radiation dose to a tumor but sparing surrounding normal tissues, is supposed to be ideal modality for the treatment of salivary gland malignancies. We designed a randomised controlled clinical trial to compare the efficacy of I-125 permanent brachytherapy (PBT) versus intensity-modulated radiation therapy (IMRT) for inoperable salivary gland malignancies. Methods/Design In this study, inclusion criteria are subjects with inoperable salivary gland malignancies, aged 18–80 years, have provided informed consent, with at least one measurable tumor focus, be able to survive ≥3 months, Karnofsky performance status ≥60, have adequate hematopoietic function of bone marrow, have normal liver and kidney function, and are willing to prevent pregnancy. Exclusion criteria include a history of radiation or chemotherapy, a history of other malignant tumors in the past 5 years, receiving other effective treatments, participating in other clinical trials, with circulatory metastasis, cognitive impairment, severe cardiovascular and cerebrovascular diseases, acute infection, uncontrolled systemic disease, history of interstitial lungdisease, and being pregnant or breast feeding. The study will be conducted as a clinical, prospective, randomised controlled trial with balanced randomisation (1:1). The planned sample size is 90 subjects. Subjects with inoperable salivary gland malignancies are randomised to receive either I-125 PBT or IMRT, with stratification by tumor size and neck lymph node metastasis. Participants in both groups will be followed up at 2, 4, 6, 9, 12, 15, 18, 21 and 24 months after randomization. The primary outcome is local control rate of the primary site (based on imaging findings and clinical examination, RECIST criteria) in 1 year. Secondary outcomes are progression-free survival, overall survival, quality of life (QOL) measured with the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30 and QLQ-H&N35) of Chinese version, and safety of treatment. Chi-squared test is used to compare the local control rates in both groups. The survival curves are estimated by the Kaplan-Meier method, and log-rank test is used to test the significant difference. Discussion Only few observational studies have investigated the effect of I-125 PBT on inoperable salivary gland malignancies. To our knowledge, this is the first randomised controlled trial to investigate the efficacy of I-125 PBT for subjects with inoperable salivary gland malignancies, and will add to the knowledge base for the treatment of these subjects. Trial registration The study is registered to Clinical Trials.gov (NCT02048254) on Jan 29, 2014.
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Affiliation(s)
- Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, PR China
| | - Yan Sun
- Department of radiotherapy, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian Dist, Beijing, 100142, PR China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China
| | - Bao-Min Zheng
- Department of radiotherapy, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian Dist, Beijing, 100142, PR China
| | | | - Xiao-Yan Yan
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, PR China
| | - Ping Ji
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, PR China
| | - Yang-Feng Wu
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, PR China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 Zhongguancun South St, Haidian Dist, Beijing, 100081, PR China.
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14
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Schmidt RL, Factor R, Witt B, Hall BJ, Wilson AR, Layfield LJ. Fine-needle aspiration cytology versus core-needle biopsy for major salivary gland lesions. Hippokratia 2016. [DOI: 10.1002/14651858.cd009610.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert L Schmidt
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Rachel Factor
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Benjamin Witt
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Brian J Hall
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
| | - Andrew R Wilson
- ARUP Laboratories; Reasearch and Development; 500 Chipeta Way Salt Lake City Utah USA 84108
| | - Lester J Layfield
- University of Utah, School of Medicine; Department of Pathology; 15 North Medical Drive East Salt Lake City Utah USA 84112
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15
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Tirelli G, Cova MA, Boscolo-Rizzo P, Da Mosto MC, Makuc E, Gardenal N. Charcoal Suspension Tattoo: A New Technique for Intraoperative Detection of Small Tumors of the Parotid Gland. Ann Otol Rhinol Laryngol 2016; 125:529-35. [PMID: 26742545 DOI: 10.1177/0003489415625651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The current surgical trend in the treatment of pleomorphic adenomas of the parotid gland is to limit the extent of resection. This raises the need to correctly identify the mass within the normal parenchyma so as to avoid dissecting the entire superficial lobe of the gland. We describe ultrasound-guided tattooing as a technique to facilitate identification and excision of parotid pleomorphic adenomas. METHODS We reviewed 23 consecutive patients with pleomorphic adenoma of the parotid gland. All patients underwent ultrasound-guided tattooing of the lesions with a charcoal suspension. Baseline tumor and patients' characteristics, major and minor complications, and subjective tolerance to the procedure were recorded. We assessed the number of intralesionally marked masses and the percentage of intraoperatively detected marked lesions. RESULTS The injection was well tolerated. No major complications were recorded. In 2 cases (9%), a transient increase in lesion size was observed. No other minor complications were encountered. Charcoal was found inside the tumor in 19 cases (83%). In 4 cases (17%), it was found in the tissues above the lesion. Twenty-three lesions were intraoperatively detected (100%) and dissected. CONCLUSION Charcoal suspension tattooing is safe and well tolerated for the detection of small pleomorphic adenomas during parotid surgery.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Trieste, Italy
| | | | | | | | - Elisa Makuc
- Department of Radiology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Trieste, Italy
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16
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Liu CC, Jethwa AR, Khariwala SS, Johnson J, Shin JJ. Sensitivity, Specificity, and Posttest Probability of Parotid Fine-Needle Aspiration: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2016; 154:9-23. [PMID: 26428476 PMCID: PMC4896151 DOI: 10.1177/0194599815607841] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/02/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES (1) To analyze the sensitivity and specificity of fine-needle aspiration (FNA) in distinguishing benign from malignant parotid disease. (2) To determine the anticipated posttest probability of malignancy and probability of nondiagnostic and indeterminate cytology with parotid FNA. DATA SOURCES Independently corroborated computerized searches of PubMed, Embase, and Cochrane Central Register were performed. These were supplemented with manual searches and input from content experts. REVIEW METHODS Inclusion/exclusion criteria specified diagnosis of parotid mass, intervention with both FNA and surgical excision, and enumeration of both cytologic and surgical histopathologic results. The primary outcomes were sensitivity, specificity, and posttest probability of malignancy. Heterogeneity was evaluated with the I(2) statistic. Meta-analysis was performed via a 2-level mixed logistic regression model. Bayesian nomograms were plotted via pooled likelihood ratios. RESULTS The systematic review yielded 70 criterion-meeting studies, 63 of which contained data that allowed for computation of numerical outcomes (n = 5647 patients; level 2a) and consideration of meta-analysis. Subgroup analyses were performed in studies that were prospective, involved consecutive patients, described the FNA technique utilized, and used ultrasound guidance. The I(2) point estimate was >70% for all analyses, except within prospectively obtained and ultrasound-guided results. Among the prospective subgroup, the pooled analysis demonstrated a sensitivity of 0.882 (95% confidence interval [95% CI], 0.509-0.982) and a specificity of 0.995 (95% CI, 0.960-0.999). The probabilities of nondiagnostic and indeterminate cytology were 0.053 (95% CI, 0.030-0.075) and 0.147 (95% CI, 0.106-0.188), respectively. CONCLUSION FNA has moderate sensitivity and high specificity in differentiating malignant from benign parotid lesions. Considerable heterogeneity is present among studies.
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Affiliation(s)
- C Carrie Liu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Rodriguez CP, Parvathaneni U, Méndez E, Martins RG. Salivary Gland Malignancies. Hematol Oncol Clin North Am 2015; 29:1145-57. [DOI: 10.1016/j.hoc.2015.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Britt CJ, Stein AP, Patel PN, Harari PM, Hartig GK. Incidental Parotid Neoplasms. Otolaryngol Head Neck Surg 2015; 153:566-8. [DOI: 10.1177/0194599815586764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
Objective To better characterize parotid masses incidentally identified on imaging. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Medical records were reviewed for 771 patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients were stratified into 2 groups: those with tumors identified solely on imaging (parotid incidentalomas [PIs]) and those with palpable masses, pain, facial nerve dysfunction, or other reasons their mass was identified (nonincidentals [NIs]). A χ2 test was employed to compare the prevalence of malignancy in PIs compared with NIs. Trend analysis was performed to determine the prevalence of PIs over the 20-year period. Results Of the 771 patients, 67 (8.7%) had their mass discovered incidentally on imaging (PIs). There was a significant difference in the rate of malignancy in the NI (32.7%) compared with the PI group (6.0%) ( P < .01). During the 1994 to 2003 time period, 4.0% of all parotoidectomies performed were for PIs, while during the second decade (2004-2013), this proportion increased to 10.2%. This represents a 155.0% increase in the percentage of parotidectomies carried out for PIs between these 2 periods. Conclusion In this study, the rate of malignancy in PIs was significantly lower than the rate of malignancy in patients with NIs. The occurrence of PIs has increased over time and now represents greater than 10.0% of all parotidectomies performed at the University of Wisconsin. This information is important to consider when consenting a patient for resection of a PI.
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Affiliation(s)
- Christopher J. Britt
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew P. Stein
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Priyesh N. Patel
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Paul M. Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gregory K. Hartig
- Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Stein AP, Britt CJ, Saha S, McCulloch TM, Wieland AM, Harari PM, Hartig GK. Patient and tumor characteristics predictive of primary parotid gland malignancy: A 20-year experience at the University of Wisconsin. Am J Otolaryngol 2015; 36:429-34. [PMID: 25766621 DOI: 10.1016/j.amjoto.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To identify patient and tumor characteristics predictive of primary parotid malignancy. MATERIALS AND METHODS Records were reviewed for patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients with primary parotid neoplasms were separated into benign or malignant subgroups. A multivariate logistic regression model was employed to compare categorical (gender, lesion side, nature of presentation, recurrence) and numerical variables (age, tumor size) between the benign and malignant groups. Mean BMI was compared between the groups by univariate analysis. RESULTS 771 patients underwent parotidectomy from 1994 to 2013, and 474 had a primary parotid neoplasm. No relationship existed between malignancy and gender (p=0.610), lesion side (p=0.110), or BMI (p=0.196). Mean age (p=0.015) and tumor size (p=0.011) were significantly different between the benign and malignant groups. Patient presentation was classified into three categories: symptomatic (n=109), palpable and asymptomatic (n=303), and incidentally noted on imaging (n=57). From all patients with symptomatic, asymptomatic or incidentally noted masses, 41.3%, 10.6% and 5.3%, respectively, were diagnosed with malignant disease. There was a significant relationship between the patient's initial presentation and malignancy (p<0.001), and patients with facial nerve dysfunction or skin involvement had the greatest likelihood of malignancy. Finally, there was a significant association between malignancy and recurrence (p=0.001). CONCLUSIONS In this study, age, tumor size, and nature of presentation were all associated with primary parotid malignancy. Understanding the impact of these features on the probability of malignancy is valuable in decision making and counseling of patients presenting with a newly diagnosed parotid neoplasm.
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20
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Sepúlveda I, Platín E, Spencer ML, Mucientes P, Frelinghuysen M, Ortega P, Ulloa D. Oncocytoma of the parotid gland: a case report and review of the literature. Case Rep Oncol 2014; 7:109-16. [PMID: 24707257 PMCID: PMC3975758 DOI: 10.1159/000359998] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We report the case of a patient who presented to the ENT service with left facial swelling of 5 months duration. Imaging studies revealed a dense expansive mass confined to the inside of the left deep parotid lobule and moderate enhancement following contrast media injection. Subsequently, a biopsy confirmed the presence of an oncocytoma. The patient was treated with total parotidectomy, complete tumor resection and sparing facial nerve surgery. Today, the patient is disease free and has no complications.
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Affiliation(s)
- Ilson Sepúlveda
- ENT-Head and Neck Surgery Service, General Hospital of Concepcion, Concepcion, Chile ; Department of Oral and Maxillofacial Radiology, Finis Terrae University School of Dentistry, Santiago, Chile
| | - Enrique Platín
- Department of Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, N.C., USA
| | | | | | | | - Pablo Ortega
- ENT-Head and Neck Surgery Service, General Hospital of Concepcion, Chile
| | - David Ulloa
- San Sebastian University, School of Medicine, Concepcion, Chile
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21
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Clinical and oncological outcomes after surgical excision of parotid gland tumours in patients aged over 80 years. Int J Oral Maxillofac Surg 2013; 42:1385-90. [DOI: 10.1016/j.ijom.2013.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/17/2013] [Accepted: 06/20/2013] [Indexed: 11/18/2022]
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23
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Baybay H, Meziane M, Soughi M, Mikou O, Elalami E, Mernissi FZ. [Subcutaneous malar nodule]. ACTA ACUST UNITED AC 2012. [PMID: 23182689 DOI: 10.1016/j.stomax.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- H Baybay
- Service de dermatologie, CHU Hassan II, Fès, Maroc.
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Iro H, Zenk J, Koch M, Klintworth N. Follow-up of parotid pleomorphic adenomas treated by extracapsular dissection. Head Neck 2012; 35:788-93. [DOI: 10.1002/hed.23032] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 12/25/2022] Open
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To VSH, Chan JYW, Tsang RKY, Wei WI. Review of salivary gland neoplasms. ISRN OTOLARYNGOLOGY 2012; 2012:872982. [PMID: 23724273 PMCID: PMC3658557 DOI: 10.5402/2012/872982] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 10/24/2011] [Indexed: 11/26/2022]
Abstract
Salivary gland tumours most often present as painless enlarging masses. Most are located in the parotid glands and most are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as a means of coming to a definitive diagnosis. Benign tumours and early low-grade malignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.
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Affiliation(s)
- Victor Shing Howe To
- Division of Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Mitani Y, Li J, Weber RS, Lippman SL, Flores ER, Caulin C, El-Naggar AK. Expression and regulation of the ΔN and TAp63 isoforms in salivary gland tumorigenesis clinical and experimental findings. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:391-9. [PMID: 21703418 DOI: 10.1016/j.ajpath.2011.03.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/09/2011] [Accepted: 03/08/2011] [Indexed: 01/08/2023]
Abstract
The TP63 gene, a TP53 homologue, encodes for two main isoforms by different promoters: one retains (TA) and the other lacks (ΔN) the transactivation domain. p63 plays a critical role in the maintenance of basal and myoepithelial cells in ectodermally derived tissues and is implicated in tumorigenesis of several neoplastic entities. However, the biological and regulatory roles of these isoforms in salivary gland tumorigenesis remain unknown. Our results show a reciprocal expression between TA and ΔN isoforms in both benign and malignant salivary tumors. The most dominantly expressed were the ΔN isoforms, whereas the TA isoforms showed generally low levels of expression, except in a few tumors. High ΔNp63 expression characterized tumors with aggressive behavior, whereas tumors with high TAp63 expression were significantly smaller and less aggressive. In salivary gland cells, high expression of ΔNp63 led to enhanced cell migration and invasion and suppression of cell senescence independent of TAp63 and/or TP53 gene status. We conclude the following: i) overexpression of ΔNp63 contributes to salivary tumorigenesis, ii) ΔNp63 plays a dominant negative effect on the TA isoform in the modulation of cell migration and invasion, and iii) the ΔN isoform plays an oncogenic role and may represent an attractive target for therapeutic intervention in patients with salivary carcinomas.
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Affiliation(s)
- Yoshitsugu Mitani
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA
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Matthiesen C, Thompson S, Steele A, Thompson D, Ahmad S, Bogardus Jr C. Radiotherapy in treatment of carcinoma of the parotid gland, an approach for the medically or technically inoperable patient. J Med Imaging Radiat Oncol 2010; 54:490-6. [DOI: 10.1111/j.1754-9485.2010.02202.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Burgess AN, Serpell JW. PAROTIDECTOMY: PREOPERATIVE INVESTIGATIONS AND OUTCOMES IN A SINGLE SURGEON PRACTICE. ANZ J Surg 2008; 78:791-3. [DOI: 10.1111/j.1445-2197.2008.04651.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol Head Neck Surg 2007; 136:788-92. [PMID: 17478217 DOI: 10.1016/j.otohns.2006.11.037] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 11/16/2006] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review a single surgeon's experience with parotidectomy with an emphasis on examining the appropriate use of partial superficial parotidectomy and the differences in early outcomes observed with the various types and extent of parotidectomy used. STUDY DESIGN AND SETTING A series of 237 patients who underwent parotidectomy over a 10-year period was reviewed. RESULTS Postoperative complications included facial nerve weakness (18%), sialocele (6.3%), wound infection (3.8%), hematoma (3.8%), and symptomatic Frey's syndrome (1.7%). More extensive surgical procedures, including complete superficial or total parotidectomy, were associated with a 2.7 times greater incidence of immediate postoperative facial nerve weakness compared with partial superficial parotidectomy. CONCLUSION Partial superficial parotidectomy is associated with a decreased incidence of transient postoperative facial nerve weakness compared with more extensive procedures such as complete superficial or total parotidectomy. Intraoperative frozen section was an accurate means of selecting patients for the partial superficial parotidectomy procedure. SIGNIFICANCE Partial superficial parotidectomy is an effective method for treating benign tumors confined to the superficial lobe.
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Affiliation(s)
- David C Upton
- Department of Surgery, Division of Otolaryngology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
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Abstract
Tumors of salivary glands arise mainly from the parotid gland. Magnetic Resonance Imaging (MRI) is mandatory not only to localize precisely the tumor within the gland but also to differentiate between benign and malignant neoplasms, in competition with cytology in fine-needle aspiration biopsy. Tumors without risk of transformation, such as adenolymphoma, are not systematically operated on. Indications of roentgenotherapy and irradiation volumes depend on histologic type, localisation and size of the tumor.
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Affiliation(s)
- P Halimi
- Service de radiologie, hôpital européen Georges-Pompidou, faculté de médecine Paris-V, 20, rue Leblanc, 75908 Paris cedex 15, France.
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