Management of Infantile Parotid Gland Hemangiomas: A 40-Year Experience:

Unilateral parotid gland double hemangiomas in an infant: A rare case report

Parotid hemangiomas, the most common salivary gland tumors in pediatric patients, are rare vascular tumors that typically present within the first year of life and are more common in females. We report the case of a 3-month-old female infant with a palpable, soft, noncompressible swelling at the right mandibular angle, which became more prominent in the evening. Ultrasonography revealed a large, multilobulated, hypoechoic lesion within the right parotid gland, along with a smaller, similarly vascularized lesion, and MRI confirmed the presence of 2 hemangiomas. This case is notable as no previous reports describe double hemangiomas in the same parotid gland. Imaging techniques such as ultrasound and MRI were essential in the differential diagnosis, distinguishing hemangiomas from conditions like acute parotitis and cystic lymphatic lesions. Early recognition and accurate diagnosis of parotid hemangiomas are key to determining the appropriate management, with treatment options ranging from observation to pharmacological therapy or surgery depending on the size and complications. In this case, the patient was referred for beta-blocker therapy.

A Large Parotid Hemangioma Managed Successfully with Propranolol

The treatment of parotid hemangiomas has posed a challenge. A male infant presented with large hemangioma of the right parotid gland diagnosed at the age of 3 months. Starting at the age of 4 months, he was treated with oral propranolol for 10 months, which led to a marked reduction in tumor size and strawberry hemangioma. Our case shows that propranolol is effective and safe in treating large parotid infantile hemangioma.

Infantile Parotid Hemangioma With Diagnostic Dilemma: A Case Report

INTRODUCTION

Salivary gland tumors are uncommon in children; hemangiomas are one of them. We report a case of infantile hemangioma of the parotid gland which posed a diagnostic dilemma.

PATIENTS AND METHODS

Four-month-old infant presented with swelling at the parotid gland region, which was progressively increasing. There was a diagnostic dilemma with initial misdiagnosis as acute parotitis. Imaging studies with ultrasonography and CT with contrast were requested.

RESULTS

Imaging studies revealed hyperintense lobulated mass suggestive of parotid hemangioma. Vascular consultation recommended conservative management with follow-up after 3 months. On follow-up, there was an increase in mass size, and propranolol was started. Swelling showed a good response on the next follow-up visit and is still on medical management.

CONCLUSION

Parotid hemangiomas frequently pose a diagnostic dilemma, but the typical noninflammatory nature of the swelling and radiological evaluation confirms the diagnosis.

Oral propranolol therapy in parotid hemangiomas: A retrospective comparison with other infantile hemangiomas

BACKGROUND

The outcomes of propranolol treatment remain controversial for parotid hemangiomas, which may be inferior to outcomes for infantile hemangiomas (IHs) at other sites.

METHODS

Patients with IHs treated with oral propranolol were retrospectively reviewed. Outcomes of propranolol therapy for parotid hemangiomas and other IHs were examined. Regression models were conducted to analyze the factors associated with the outcomes for parotid hemangiomas.

RESULTS

Longer treatment duration was needed for parotid hemangiomas (p = 0.012) at a comparable efficacy and relapse rate as those of IHs at other sites. The higher efficacy was associated with early intervention before 4 months of age (OR = 5.2, p = 0.011), while, the lower relapse rate was associated with adequate treatment duration over 6 months (OR = 9.2, p = 0.010).

CONCLUSIONS

With a longer propranolol treatment duration, parotid hemangiomas could achieve a comparable efficacy and relapse rate as other IHs. Early treatment initiation and adequate treatment duration benefited the outcomes.

Evaluating the Clinical Outcomes of Parotid Hemangiomas in the Pediatric Patient Population

INTRODUCTION

Infantile hemangiomas (IHs) are the most common tumor of the parotid gland in children; however, there is no standard protocol for the treatment of IH. The generally accepted practice is to begin the patient on β-blocker therapy if there are no contraindications.

OBJECTIVE

The purpose of this study is to better understand the challenges and successes of management of pediatric patients with parotid IH.

METHODS

This retrospective study analyzed 15 patients diagnosed with parotid IH from 2009 to 2016 who were cared for at a tertiary care center. Demographic information, lesion characteristics, and treatment course were obtained through patient chart review.

RESULTS

Fifteen pediatric patients with parotid IH were evaluated. The female:male ratio was 4:1; the average age of diagnosis was 8.75 months. Most lesions were greater than 3 cm in their widest dimension (73.3%), and 13 patients underwent imaging to further clarify the parotid mass in their clinical workup. Fourteen patients began treatment with propranolol; 10 patients saw complete resolution of their IH (66.7%) and 3 had a partial response to β-blocker therapy (20%). After discontinuation of propranolol, 2 patients had regrowth 2 to 3 months later after regression and were restarted on therapy. The average duration of treatment was 9.9 ± 8.45 months. The known adverse effects of propranolol-hypoglycemia, hypotension, bradycardia, and bronchospasm-were not observed in any patient.

CONCLUSION

In the treatment of parotid IH, propranolol is the generally accepted first-line therapy, as compared to corticosteroid or interferon α injections of years past. Parotid hemangiomas, however, have a lower response rate to propranolol and a similar recurrence rate compared to IH at other sites. The treatment duration necessary tends to be longer. Future studies will aim at identifying and evaluating potential predictors of outcomes to help inform the management of parotid hemangiomas.

Surgical Resection of a Parotid Gland Hemangioma in Teenager Managed with External Carotid Artery Ligation

Parotid gland hemangiomas represent <0.6% of the total tumors of the gland and there are <50 tumors reported during adult age, so there is no standard treatment. A 18-year-old female presents with a mass in the right parotid gland of 18 months of a slow progressive asymptomatic growth; on physical examination, only the mass was detected. An angiography was performed, and it reported a possible hemangioma that depends on the right internal maxillary artery and right facial artery and was not suitable for embolization. Total parotidectomy was performed with prior ligation of the right external carotid artery, complete resection was achieved and preservation of the facial nerve and all branches with minimal loss of blood (150 cc). External carotid artery ligation is a safe technique that can be considered in carefully selected patients with vascular tumors that affect the head and neck to achieve a clean and safe surgery with minimal sequels.

Open-label nonrandomized left-right comparison of imiquimod 5% ointment and timolol maleate 0.5% eye drops in the treatment of proliferating superficial infantile hemangioma

BACKGROUND

Infantile hemangiomas (IHs) are common childhood tumors.

OBJECTIVE

Our study aimed to compare the efficacy and side effects of imiquimod and timolol maleate for the treatment of proliferating superficial IHs.

METHODS

A total of 54 patients with superficial IHs were enrolled in this study. Each lesion was evenly divided into two parts. One part was treated with 5% imiquimod cream once every other day, and the other part was smeared with 0.5% timolol maleate eye drops thrice daily. After 16 weeks of treatment, the thickness, color and size of each lesion were measured, and the side effects were recorded.

RESULTS

The efficacy rates for imiquimod and timolol maleate were 81.4 and 88.9%, respectively, but the difference between treatments was not significant. However, timolol maleate showed better effects for color involution, onset time and side effects than imiquimod.

CONCLUSION

Timolol maleate might be the first choice for the topical treatment of superficial IHs.

Involution of a large parotid hemangioma with oral propranolol: an illustrative report and review of the literature

Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.

Vascular and perivascular lesions of skin and soft tissues in children and adolescents

Vascular anomalies in children and adolescents are the most common soft tissue lesions and include reactive, malformative, and neoplastic tumefactions, with a full spectrum of benign, intermediate, and malignant neoplasms. These lesions are diagnostically challenging because of morphologic complexity and recent changes in classification systems, some of which are based on clinical features and others on pathologic findings. In recent decades, there have been significant advances in clinical diagnosis, development of new therapies, and a better understanding of the genetic aspects of vascular biology and syndromes that include unusual vascular proliferations. Most vascular lesions in children and adolescents are benign, although the intermediate locally aggressive and intermediate rarely metastasizing neoplasms are important to distinguish from benign and malignant mimics. Morphologic recognition of a vasoproliferative lesion is straightforward in most instances, and conventional morphology remains the cornerstone for a specific diagnosis. However, pathologic examination is enhanced by adjunctive techniques, especially immunohistochemistry to characterize the type of vessels involved. Multifocality may cause some uncertainty regarding the assignment of "benign" or "malignant." However, increased interest in vascular anomalies, clinical expertise, and imaging technology have contributed greatly to our understanding of these disorders to the extent that in most vascular malformations and in many tumors, a diagnosis is made clinically and biopsy is not required for diagnosis. The importance of close collaboration between the clinical team and the pathologist cannot be overemphasized. For some lesions, a diagnosis is not possible from evaluation of histopathology alone, and in a subset of these, a specific diagnosis may not be possible even after all assembled data have been reviewed. In such instances, a consensus diagnosis in conjunction with clinical colleagues guides therapy. The purpose of this review is to delineate the clinicopathologic features of vascular lesions in children and adolescents with an emphasis on their unique aspects, use of diagnostic adjuncts, and differential diagnosis.