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Ali HM, Keaton AB, Rourk K, Lohse C, Tasche KK, Price DL, Van Abel KM, Yin LX, Moore EJ. Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland: Early post-operative outcomes. Am J Otolaryngol 2024; 45:104185. [PMID: 38104469 DOI: 10.1016/j.amjoto.2023.104185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION There has been historical controversy regarding the extent of resection in the management of pleomorphic adenomas. This study aims to evaluate the extent of surgery and short-term postoperative outcomes of partial superficial parotidectomy (PSP) for the management of pleomorphic adenomas at a tertiary, high-volume center. METHODS A retrospective chart review of patients who underwent PSP was performed. Variables included demographics, pre-operative facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence. RESULTS 151 adults who underwent PSP for pleomorphic adenoma from January 1st, 2000 to December 31st, 2022 were identified. Median age was 55 (IQR 40-66) years with females representing 74 % of the cohort. Median tumor size at presentation was 1.8 (IQR 1.3-2.3) cm. Baseline facial nerve function was excellent for most patients (House-Brackmann I, 99 %). Most patients underwent a superficial inferior parotidectomy (88 %). Modified Blair incision (70 %) was the most common incision. Intraoperatively, the facial nerve was identified in 149 (99 %) patients. The main trunk was identified in 126 (85 %) patients. No patient had tumor spillage. Only two patients required parotid bed reconstruction. The most common complication was ear numbness (60 %). Postoperatively, 114 patients were House-Brackmann grade I at both preoperative and postoperative assessment, 8 went from grade I to II, and 1 went from grade VI to II (Bell's palsy that resolved to grade II following surgery). Median follow-up was 1(IQR 1-5) month. CONCLUSION PSP is efficacious in the management of pleomorphic adenomas with preservation of facial nerve function, and minimal post-operative complications. Future study is needed to assess long term recurrence risk.
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Affiliation(s)
- Hawa M Ali
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Aniya B Keaton
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States; University of Tennessee, Knoxville, TN, United States
| | - Katelyn Rourk
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Christine Lohse
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Kendall K Tasche
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States.
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Lopes-Santos G, Marques NGDO, Tjioe KC, Oliveira DT. Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review. Acta Cir Bras 2024; 39:e390824. [PMID: 38422328 PMCID: PMC10911496 DOI: 10.1590/acb390824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE This systematic review analyzed the clinical behavior and odds of malignancy of the palatal recurrent pleomorphic adenomas. METHODS Systematic review of patients with recurrent pleomorphic adenoma arising in the palate. Database search: MEDLINE, Scopus, Web of Science, Cochrane, EMBASE, Virtual Health Library, Google Scholar, and OpenGrey. A binomial logistic regression was performed to assess the odds of detecting recurrence five, 10 and 20 years after the treatment of primary tumor. RESULTS Thirteen studies (n = 18 patients) out of 336 were included. The recurrent pleomorphic adenoma in palate was more common in females (61.6%), average age was 49 years old (range 9-73 years old). Four patients progressed to malignant transformation. The odds ratio (OR) of detecting a recurrence at 10 (OR = 5.57; 95% confidence interval - 95%CI 1.13-27.52), and 20 years (OR = 18.78; 95%CI 3.18-110.84) after treatment of primary pleomorphic adenoma was significantly higher than at one-year follow-up. CONCLUSIONS The recurrence of pleomorphic adenoma in palate remains a rare event of late occurrence. It mainly affects middle-aged female and carries a risk of malignant transformation. Although uncommon, patients with palatal pleomorphic adenoma should be warned about the possibility of recurrence or malignant transformation of tumor at advanced ages.
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Affiliation(s)
- Gabriela Lopes-Santos
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Departamento de Cirurgia, Estomatologia, Patologia e Radiologia – Bauru (SP) – Brazil
| | - Najara Gomes de Oliveira Marques
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Departamento de Cirurgia, Estomatologia, Patologia e Radiologia – Bauru (SP) – Brazil
| | - Kellen Cristine Tjioe
- Augusta University – Georgia Cancer Center – Augusta (GA) – United States of America
| | - Denise Tostes Oliveira
- Universidade de São Paulo – Faculdade de Odontologia de Bauru – Departamento de Cirurgia, Estomatologia, Patologia e Radiologia – Bauru (SP) – Brazil
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Wierzbicka M, Markowski J, Pietruszewska W, Burduk P, Mikaszewski B, Rogowski M, Składowski K, Milecki P, Fijuth J, Jurkiewicz D, Niemczyk K, Maciejczyk A. Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts. Front Oncol 2023; 13:1298541. [PMID: 38152365 PMCID: PMC10751934 DOI: 10.3389/fonc.2023.1298541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 12/29/2023] Open
Abstract
Summary The algorithm of follow-up in patients with head and neck cancer (HNC) has been prepared by a board of Polish Head Neck and Oncology Experts. The aim of this research is to focus on the specificity of HNC monitoring, to review the current trends in follow-up, and to adapt the evidence-based medicine international standards to the capabilities of the local healthcare service. Materials and methods The first methodological step was to categorize HNCs according to the estimated risk of failure after the adequate first-line treatment and according to the possibility of effective salvage treatment, resulting in improved overall survival. The final method used in this work was to prepare an authors' original monitoring algorithm for HNC groups with a high, moderate, and low risk of recurrence in combination with a high or low probability of using an effective salvage. Results Four categories were established: Ia. low risk of recurrence + effective organ preservation feasible; Ib. low risk of recurrence + effective salvage feasible; II. moderate risk of recurrence + effective salvage feasible; III. high risk of recurrence + effective salvage feasible; and IV. high risk of recurrence + no effective salvage feasible. Follow-up visit consisting of 1. ENT examination + neck ultrasound, 2. imaging HN tests, 3. chest imaging, 4. blood tests, and 5. rehabilitation (speech and swallowing) was scheduled with a very different frequency, at the proposed monthly intervals, tailored to the needs of the group. The number of visits for individual groups varies from 1 to 8 in the first 2 years and from 1 to 17 in the entire 5-year monitoring period. Group IV has not been included in regular follow-up, visits on own initiative of the patient if symptomatic, or supportive care needs, having in mind that third-line therapy and immune checkpoint inhibitors are available. Conclusion Universal monitoring algorithm for HNC four groups with a high, moderate, and low risk of recurrence after the adequate treatment in combination with a high or low probability of using an effective salvage is an innovative approach to redeploying system resources and ensuring maximum benefit for patients with HNC.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Regional Specialist Hospital Wroclaw, Research & Development Centre, Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Jarosław Markowski
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology Head Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Paweł Burduk
- Department of Otolaryngology Phoniatrics and Audiology, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Składowski
- Radiation and Clinical Oncology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Piotr Milecki
- Department of Radiotherapy I, The Greater Poland Cancer Centre, Poznan, Poland
| | - Jacek Fijuth
- Department of Radiation Therapy, Oncology Chair, Medical University of Lodz, Lodz, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Adam Maciejczyk
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
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Chidambaram KS, Muraleedharan M, Keshri A, Mayilvaganan S, Hameed N, Aqib M, Kumar A, Manogaran RS, Kumar R. The Outcomes and Surgical Nuances of Minimally Invasive Parotid Surgery for Pleomorphic Adenoma. Indian J Otolaryngol Head Neck Surg 2023; 75:3256-3262. [PMID: 37974711 PMCID: PMC10645680 DOI: 10.1007/s12070-023-03947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Benign parotid tumors follow an indolent course and present as slow-growing painless swelling in the pre-and-infra-auricular areas. The treatment of choice is surgery. Though the gold standard technique is Superficial Parotidectomy, Extracapsular Dissection (ECD) is an alternative option with the same outcome and decreased complications. This study discusses our experience with extracapsular dissection and the surgical nuances for better results. A retrospective study of histologically confirmed cases of pleomorphic adenoma of the parotid gland, who underwent Extracapsular dissection between September 2019 and March 2023, was done. The demographic details, clinical characteristics, and outcomes were evaluated. There were 33 patients, including 16 females and 17 males, with a mean age of 32.75 years. All cases presented as slow-growing painless swelling for a mean duration of 5 years. Most of the tumors (94%) were of size between 2 and 4 cm, with few tumors more than 4 cm. All underwent extracapsular dissection with complete excision. There was only one complication (seroma) and no incidence of facial palsy in our experience with ECD. The goal of a benign parotid surgery is the complete removal of the tumor with minimum complications, which could be achieved with ECD, which has good tumor clearance and lesser rates of complications with good cosmesis. Thus, this minimally invasive parotid surgery could be a worthwhile option in properly selected cases.
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Affiliation(s)
| | | | - Amit Keshri
- Neurotology Unit, Department of Neurosurgery, SGPGIMS, Lucknow, UP India
| | | | - Nazrin Hameed
- Neurotology Unit, Department of Neurosurgery, SGPGIMS, Lucknow, UP India
| | - Mohd Aqib
- Neurotology Unit, Department of Neurosurgery, SGPGIMS, Lucknow, UP India
| | - Arushi Kumar
- Department of ENT, Nalanda Medical College, and Hospital, Patna, Bihar India
| | | | - Raj Kumar
- Department of Neurosurgery, SGPGIMS, Lucknow, UP India
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Yadav U, Mahendru R, Sharma J, Kakkar A. Diagnosis of Adenoid Cystic Carcinoma with Striking Tubular Hypereosinophilia by MYB and EWSR1 Breakapart Fluorescence In Situ Hybridization. Head Neck Pathol 2023; 17:940-951. [PMID: 38010473 PMCID: PMC10739655 DOI: 10.1007/s12105-023-01596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Adenoid cystic carcinoma (AdCC), associated with MYB/MYBL1 gene rearrangements, shows epithelial and basaloid myoepithelial cells arranged in tubular, cribriform and solid patterns. Variations from this classic morphology make diagnosis challenging, necessitating molecular testing. AdCC with striking tubular hypereosinophilia (AdCC-STE) is one such recently described histological subtype. METHODS A 52-year-old female presented with a floor of mouth swelling for two months, diagnosed elsewhere as polymorphous adenocarcinoma (PAC). A biopsy was obtained. With a diagnosis of oncocytic neoplasm, wide excision of the tumor was undertaken. Histological examination, fluorescence in situ hybridization (FISH) and ultrastructural examination were performed. Archival cases of PAC and epithelial myoepithelial carcinoma (EMC) were reviewed, and MYB immunostaining and FISH were performed to identify potential AdCC-STE cases. RESULTS The excised tumor from the index patient showed bilayered tubules, micropapillae and cribriform pattern. Luminal cells with hypereosinophilic to clear cytoplasm were surrounded by flattened abluminal cells. Focally, basophilic matrix was seen within sharply demarcated pseudocystic spaces. FISH revealed MYB and EWSR1 gene rearrangements, confirmatory of AdCC-STE. Electron microscopy showed features consistent with AdCC; however, mitochondria were not prominent. Among 14 archival PACs, two showed MYB immunopositivity; one showed MYB rearrangement but was classical AdCC. Among 35 EMC, one case showed MYB immunoreactivity and eosinophilia of luminal cells but lacked MYB/MYBL1 rearrangement. CONCLUSION Awareness of unusual histological subtypes of AdCC, such as AdCC-STE, is imperative, as it may be misdiagnosed as PAC and EMC, among others. Presence of basophilic matrix and squamoid morules in a biphasic tumor even with hypereosinophilic rather than basaloid myoepithelial appearance should raise suspicion for AdCC-STE, and prompt molecular testing for confirmation. With wider accessibility, lower cost and significantly shorter turn-around-time when compared to RNA sequencing, FISH can be employed for confirmation of diagnosis, especially in low- and middle-income countries.
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Affiliation(s)
- Urvashi Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ria Mahendru
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jyoti Sharma
- Department of Surgical Oncology, National Cancer Institute - All India Institute of Medical Sciences, Jhajjar, 124105, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Levyn H, Subramanian T, Eagan A, Katabi N, Lin O, Badillo ND, Martinez G, Scholfield DW, Wong RJ, Shah JP, Givi B, Morris LGT, Ganly I, Patel SG. Risk of Carcinoma in Pleomorphic Adenomas of the Parotid. JAMA Otolaryngol Head Neck Surg 2023; 149:1034-1041. [PMID: 37824134 PMCID: PMC10570915 DOI: 10.1001/jamaoto.2023.3212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023]
Abstract
Importance Surgery is the mainstay of treatment for pleomorphic adenomas (PAs) of the parotid to prevent further growth and potential future malignant transformation. While historical case series have reported transformation rates as high as 10%, there is a lack of contemporary methodologically sound data. Objective To examine the rate of carcinoma ex pleomorphic adenoma (CXPA) detection in untreated PAs and investigate factors associated with malignant neoplasm. Design, Setting, and Participants This cohort study reviewed all cases of primary PAs managed at a quaternary referral center between December 1990 and January 2015. Patients whose clinical presentation was compatible with a primary benign PA and whose history indicated tumor duration of over 1 year were included. Data were analyzed from January to April 2023. Exposure Untreated PA. Main Outcomes and Measures Rate of CXPA detection among untreated PAs and association of tumor duration with rates of CXPA detection. Pathology slides of patients who underwent surgery were reviewed by a single expert pathologist for the presence of CXPA. Univariable logistic regression was performed to evaluate possible factors associated with CXPA. Results A total of 260 patients (median age, 47 years [IQR, 38-60 years]; 174 [66.9%] female) had a median tumor duration of 3.2 years (range, 1-30 years; mean [SD], 5.7 [5.5] years). Patients were divided into 4 groups by tumor duration: 1 to 4 years (158 [60.7%]), 5 to 9 years (47 [18.1%]), 10 to 14 years (27 [10.4%]), and 15 to 30 years (28 [10.8%]). In 156 of 170 patients who underwent preoperative fine-needle aspiration (91.8%), a benign tumor was diagnosed; 5 of these patients (3.2%; 95% CI, 1.4%-7.3%) were later diagnosed with CXPA on pathology after eventual excision, and the rate of high grade CXPA was 1.3%. None of the patients had permanent facial nerve paralysis. Tumor size at presentation (odds ratio [OR], 1.66; 95% CI, 1.22-2.24) and incremental (per year) increase in age (OR, 1.04; 95% CI, 1.01-1.08) were found to be associated with CXPA, whereas tumor duration was not (OR, 1.00; 95% CI, 1.00-1.01). Conclusions and Relevance In this study, the rate of malignant neoplasm detection among initially untreated PA was 3.2%. The results suggest that tumor size and older age are associated with the development of CXPA, while tumor duration is not. Observation of PA for longer periods was not associated with serious permanent complications.
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Affiliation(s)
- Helena Levyn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Alana Eagan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - German Martinez
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel W Scholfield
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak Givi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Tenney TB, Mullane PC, Viswanathan K, Shi Q, Lui SK, Lubin DJ. Does Milan affect management? A retrospective analysis of resection rate and time to surgery among Milan categories. Diagn Cytopathol 2023; 51:221-229. [PMID: 36700488 DOI: 10.1002/dc.25104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is an established system with reproducible risk of malignancies (ROM) for salivary gland fine needle aspiration (SGFNA). No studies have reviewed the relationship between Milan categories and the resection rate (RR) and time to resection (TTR). METHODS We searched our database (January 1, 2011 to January 4, 2021) for non-lymphoma SGFNAs and assigned appropriate MSRSGC categories. RR and TTR were calculated and compared for each category. A literature search was performed; RRs and TTRs were compared. RESULTS Seven hundred and eighty SGFNAs were identified, 333 with follow-up. RR was highest in suspicious for malignancy (SUS, V; 70.6%, n = 12/17), followed by the salivary gland neoplasm of uncertain malignant potential (SUMP, IVb; 69.6%, n = 80/115) and malignant (M, VI; 55.6%, n = 75/135). Among M, primary tumors had a higher RR (65.1%, n = 41/63) than metastases (47.2%, n = 34/72, p = .36). In literature review, SUS had the highest RR (69.3%, n = 233/336) followed by M (61.6%, n = 821/1332) and SUMP (60.2%, n = 632/1050). TTR was shorter in SUS (mean = 32.3 days, median = 25 days). Within the benign neoplasms (BN, IVa), Pleomorphic adenomas (PAs) had a higher RR than Warthin tumors (WTs) (66.3% vs. 37.2%, p < .00001), and a shorter TTR (median = 63 days vs. 90 days). CONCLUSIONS Tumors classified as SUS had higher RR and at shorter intervals than those classified as SUMP. PAs have higher RRs and more expedient surgery than WTs. Cases classified as M are less likely to undergo follow-up than SUS, perhaps due to a lower RR for metastases.
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Affiliation(s)
- Troy B Tenney
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patrick C Mullane
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA.,Winship Cancer Center, Decatur, Georgia, USA
| | - Qiuying Shi
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA.,Winship Cancer Center, Decatur, Georgia, USA
| | - Shu K Lui
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Daniel J Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA.,Winship Cancer Center, Decatur, Georgia, USA
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Pei Y, Li W. Clinical parameters predictors of malignant transformation of recurrent parotid pleomorphic adenoma. Sci Rep 2023; 13:4543. [PMID: 36941273 PMCID: PMC10027859 DOI: 10.1038/s41598-023-29714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/09/2023] [Indexed: 03/23/2023] Open
Abstract
Malignant transformation (MT) in recurrent parotid pleomorphic adenomas (PAs) is rare; therefore its occurrence lacks reliable predictive factors. Our goal was to clarify the predictors for MT of recurrent parotid PAs based on preoperative clinical parameters. Patients with a clinical diagnosis of recurrent parotid PA were retrospectively enrolled. The association between clinicopathologic variables and MT of PA was assessed using univariate and multivariate analyses. MT occurred in 11.8% of the 467 patients. In univariate analysis, three or more previous recurrences, newly developed facial nerve paralysis, difficulty in mouth opening, tumors with the largest tumor diameter ≥ 2.4 cm, and abnormal neck lymph node enlargement were associated with MT occurrence. Further, multivariate analysis showed that three or more previous recurrences, newly developed facial nerve paralysis, difficulty in mouth opening, and abnormal neck lymph node enlargement were independently related to MT. MT of recurrent PA was not uncommon. Clinical signs of malignancy included newly developed facial nerve paralysis, difficulty in mouth opening, three or more previous recurrences, and abnormal neck lymph node enlargement.
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Affiliation(s)
- Yu Pei
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenlu Li
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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9
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Syrnioti G, Syrnioti A, Abdullah A, Lui X, Mendoza E. Myoepithelial Carcinoma Ex Pleomorphic Adenoma of the Submandibular Gland: A Case Report. Cureus 2023; 15:e35722. [PMID: 37016641 PMCID: PMC10066903 DOI: 10.7759/cureus.35722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
Carcinoma ex pleomorphic adenoma (Ca-ex-PA) is a rare tumor that arises from the malignant transformation of a primary or recurrent pleomorphic adenoma. Despite being benign, pleomorphic adenomas can rarely undergo malignant transformation. Risk factors include a long-standing primary tumor, a prior history of radiation exposure, increased tumor size, and recurrent disease. Ca-ex-PA usually affects patients between the sixth and eighth decades of life, approximately 10 to 20 years after the development of a pleomorphic adenoma. Patients usually present with the rapid expansion of an already existing mass. We describe a case report of a patient who presented with Ca-ex-PA of the submandibular gland. The patient underwent surgical excision of the affected gland, which was consistent with a widely invasive myoepithelial Ca-ex-PA. The patient underwent postoperative radiation to the neck and the tumor bed. No local or distant recurrence was noted during the one-year follow-up. Due to the rarity of the disease entity and the infrequent location of the tumor, this case presents a particular diagnostic and therapeutic challenge.
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10
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Thompson LDR, Xu B. Top Ten Differentials to Mull Over for Head and Neck Myoepithelial Neoplasms. Head Neck Pathol 2023; 17:1-15. [PMID: 36928733 PMCID: PMC10063767 DOI: 10.1007/s12105-022-01502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Myoepithelial neoplasms of the salivary gland are benign or malignant neoplasms composed exclusively of neoplastic myoepithelial cells. These tumors, including the benign myoepithelioma and the malignant counterpart myoepithelial carcinoma, exhibit a wide range of cytomorphologic features and architectural patterns. METHODS Review. RESULTS Myoepithelial cells can be epithelial, plasmacytoid, clear cell, spindle cell, and/or oncocytic cell, arranging as trabeculae, solid sheets, nests, cords, and/or single cells. A stromal component is commonly but not universally present, Therefore, their differential diagnoses are quite broad, including salivary gland neoplasms especially those with a myoepithelial component, plasmacytoma, melanoma, and various mesenchymal tumors. CONCLUSION In this review, we summarize the characteristic histologic features, useful immunohistochemical panel, and common molecular alterations of myoepithelial tumors and their top differential diagnoses. A logical stepwise algorithmic approach and an immunohistochemical panel to include multiple myoepithelial markers are essential to establish the correct diagnosis.
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Affiliation(s)
- Lester D. R. Thompson
- Head and Neck Pathology Consultations, 22543 Ventura Blvd, Ste 220 PMB1034, 91364 Woodland Hills, CA USA
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
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Xu W, Zhang X, Wu Y, Zhu Y, Liu S, Lu H, Yang W. Recurrent pleomorphic adenoma of the parotid gland: A population-based study with emphasis on re-recurrence and malignant transformation. Head Neck 2023; 45:697-705. [PMID: 36563305 DOI: 10.1002/hed.27286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to analyze the prognostic determinants for re-recurrence and malignant transformation of parotid recurrent pleomorphic adenoma (RPA). METHODS Between January 2011 and December 2020, all the cases of RPA of the parotid gland at our single institution were reviewed. RESULTS A total of 168 patients were included in this study, with a median age of 41.5 years, and 20 (11.9%) patients developed re-recurrence during follow-up. It has been evidenced that recurrence times (single or multiple) was an independent prognostic factor for recurrence-free survival (p = 0.0264). A total of 26 (15.48%) patients experienced malignant transformation of parotid RPA, and older age (>45 year old), male sex, and higher clinical tumor staging (T3-T4) were significantly associated with malignant transformation of parotid RPA. CONCLUSIONS Recurrence times was an independent prognostic factor for re-recurrence of parotid RPA, and older male with high T-stage may more easily develop malignant transformation.
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Affiliation(s)
- Wanlin Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xu Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yifan Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yun Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Shengwen Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hao Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wenjun Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
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Park S, Lee YC, Kim GY, Kim C. Concurrent FDG-Avid and Non-FDG-Avid Pleomorphic Adenomas in the Submandibular Gland and Parapharyngeal Space. Clin Nucl Med 2023; 48:e138-e140. [PMID: 36723900 DOI: 10.1097/rlu.0000000000004514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT Pleomorphic adenoma is the most common benign tumor of salivary glands. Here we present an interesting case of concurrent pleomorphic adenomas in the parapharyngeal space and submandibular gland. The tumors showed stark differences in the imaging findings on FDG PET/CT and MRI. Pathology confirmed the diagnosis of pleomorphic adenomas with the different composition of the cellular component and chondromyxoid stroma. This case suggests that the difference in cellularity of pleomorphic adenomas can affect FDG uptake and diffusion-weighted MRI-derived apparent diffusion coefficient values.
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Affiliation(s)
- Soonchan Park
- From the Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea
| | | | - Gou Young Kim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Chanwoo Kim
- Department of Nuclear Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea
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Mohammad DN, Ibraheem BF, Khudair HH, Mahmood DK. Expression of Syndecan-1 and Cyclin D1 in Salivary Gland Tumors in Relation to Clinicopathological Parameters. Int J Gen Med 2023; 16:823-835. [PMID: 36883123 PMCID: PMC9985872 DOI: 10.2147/ijgm.s401747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023] Open
Abstract
Background Salivary tumors have various morphological features and might share some histopathological findings. They are considered a problematic area in diagnosis due to complex clinicopathological features and different biological behavior. Objective To identify the pathological behavior of salivary tumors immunohistochemically. Methodology This retrospective study involved thirty formalin-fixed paraffin-embedded blocks of salivary gland tumors. These tumors were stained immunohistochemically with syndecan-1 and cyclin D1. Chi-Square test was used to relate immunoscoring, intracellular localization, intensity, and invasion to different salivary tumors. The correlation of these two markers was done by spearman's rho test. P-value <0.05 was considered statistically significant. Results The mean age of the patients was 48.69 ± 17.7. The parotid gland was the most commonly reported site in benign tumors, and regarding malignant tumors, maxilla was the most prevalent site. Syndecan-1 in benign tumors showed a predominate score 3, most widely detected in pleomorphic adenoma. Malignant salivary tumors showed 89.4% positive expression with a more frequent score 3, most commonly found in adenocystic carcinoma. Cyclin D1 expressed in all benign salivary tumors, with prominent diffuse mixed intracellular localization in pleomorphic adenoma. Malignant tumors revealed an expression of 94.7%. Moderate scoring with mixed intracellular localization was recorded in adenocystic carcinoma, followed by mucoepidermoid carcinoma. There was a significant correlation between the two markers in response to the distribution of immunostaining in different cell compartments. Conclusion Syndecan-1 and cyclin D1 showed a significant combined role in salivary tumor progression. Interestingly notable ductal-myoepithelial cells affect epithelial morphogenesis, and growth of pleomorphic adenoma was observed. Furthermore, basophilic cells of cribriform adenocystic carcinomas might control the aggressiveness and proliferation rate of these tumors.
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Affiliation(s)
- Dena Nadhim Mohammad
- Oral Pathology, Oral Diagnosis Department, College of Dentistry, University of Sulaimani, Sulaimani, Iraq
| | - Ban Falih Ibraheem
- Oral Pathology, Oral Diagnosis Department, College of Dentistry, University of Sulaimani, Sulaimani, Iraq
| | - Hassanain Hafidh Khudair
- General Pathology, Pathology Department, College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Darya Khalid Mahmood
- Oral Pathology, Oral Diagnosis Department, College of Dentistry, University of Sulaimani, Sulaimani, Iraq
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Vroonhof LL, Roest S, Datema FR, Manintveld OC, Nagtegaal AP. Evaluation of Routine Ear, Nose, and Throat Screening in Heart Transplant Candidates: A Retrospective Cohort Study. Transplant Proc 2023; 55:208-13. [PMID: 36621350 DOI: 10.1016/j.transproceed.2022.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/20/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with end-stage heart failure refractory to medication can be treated with a heart transplant (HTx). These patients are subjected to a preoperative screening procedure according to International Society for Heart and Lung Transplantation guidelines. Additionally, in our hospital, a routine ear, nose, and throat (ENT) screening is performed, directed toward the identification of asymptomatic infections and head and neck neoplasms. There are no studies demonstrating that this screening has additional value in these patients. METHODS To investigate the yield of protocolled ENT screening in candidates for HTx, we retrospectively reviewed the medical records of patients who were subjected to the screening procedure between 2012 and 2020. RESULTS The study population consisted of 251 patients of whom 177 (70.5%) were male with a median age of 52 years (IQR, 45-59 years). Ten patients (4.0%) were diagnosed with an infection (sinus) or a neoplasm, resulting in a number needed to screen of 25. In all cases, ENT consultation or sinus radiography did not influence the decision to list patients for HTx. Furthermore, no major ENT infections or occurrence of de novo head and neck malignant neoplasm were observed during follow-up after HTx. CONCLUSIONS The clinically relevant yield of protocolled ENT screening in candidates for HTx is low. Based on these findings, we believe that only patients with abnormal findings on a routine sinus computed tomography scan and/or specific ENT complaints should be referred to an otorhinolaryngologist.
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Roh JL. Superficial versus total parotidectomy for recurrent pleomorphic adenoma in the parotid gland. Oral Oncol 2022; 134:106103. [PMID: 36067593 DOI: 10.1016/j.oraloncology.2022.106103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 10/31/2022]
Abstract
Recurrent pleomorphic adenoma (RPA) is a challenging disease because of difficulty in reoperation, a high rate of postoperative facial palsy, and potential malignant transformation. The optimal management of RPA is still arguable regarding the surgical extent and the necessity of radiotherapy. Therefore, this study compared the complication and re-recurrence rates of superficial versus total parotidectomy in a prospective cohort of 29 patients with RPA. Two surgical techniques were allocated to consecutive patients without randomization and blinding processes. Total parotidectomy was applied to lesions in deep or both lobes. Most early and late complication rates were statistically comparable between the two groups (P > 0.05). Transient and permanent facial nerve paralysis frequently occurred in 55 % and 14 % of all cases, respectively, without statistical difference between the two groups (P > 0.5). Only one patient (3 %) had re-recurrence after superficial parotidectomy during the mean follow-up of 89 months. Superficial or total parotidectomy is recommended to reduce the risk of further recurrence in patients with RPA.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do 13496, Republic of Korea.
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Stenman G, Fehr A, Skálová A, Vander Poorten V, Hellquist H, Mikkelsen LH, Saba NF, Guntinas-Lichius O, Chiesa-Estomba CM, Andersson MK, Ferlito A. Chromosome Translocations, Gene Fusions, and Their Molecular Consequences in Pleomorphic Salivary Gland Adenomas. Biomedicines 2022; 10. [PMID: 36009517 DOI: 10.3390/biomedicines10081970] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Salivary gland tumors are a heterogeneous group of tumors originating from the major and minor salivary glands. The pleomorphic adenoma (PA), which is the most common subtype, is a benign lesion showing a remarkable morphologic diversity and that, upon recurrence or malignant transformation, can cause significant clinical problems. Cytogenetic studies of >500 PAs have revealed a complex and recurrent pattern of chromosome rearrangements. In this review, we discuss the specificity and frequency of these rearrangements and their molecular/clinical consequences. The genomic hallmark of PA is translocations with breakpoints in 8q12 and 12q13-15 resulting in gene fusions involving the transcription factor genes PLAG1 and HMGA2. Until recently, the association between these two oncogenic drivers was obscure. Studies of the Silver−Russel syndrome, a growth retardation condition infrequently caused by mutations in IGF2/HMGA2/PLAG1, have provided new clues to the understanding of the molecular pathogenesis of PA. These studies have demonstrated that HMGA2 is an upstream regulator of PLAG1 and that HMGA2 regulates the expression of IGF2 via PLAG1. This provides a novel explanation for the 8q12/12q13-15 aberrations in PA and identifies IGF2 as a major oncogenic driver and therapeutic target in PA. These studies have important diagnostic and therapeutic implications for patients with PA.
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K H, G V V G, Subramani V, M S. Recurrent Palatal Pleomorphic Adenoma: A Case Report With a Long-Term Follow-Up. Cureus 2022; 14:e26363. [PMID: 35911351 PMCID: PMC9328173 DOI: 10.7759/cureus.26363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/08/2022] Open
Abstract
Pleomorphic adenoma is the most common kind of major tumor of the major and minor salivary organs. Although pleomorphic adenoma is a benign tumor, it has a high chance of recurrence and malignancy. In the literature, lower rates of repetitive pleomorphic adenoma of the sense of taste have been detailed while the palate is a common location for an intraoral pleomorphic adenoma. Recurring tumors have been associated with a high risk of malignancy, and surgical excision is the basic treatment option for recurrent adenomas. Revision surgery is quite challenging and has never been standardized. We report a rare case of recurrent pleomorphic adenoma of the palate that occurred 7.5 years after primary ablation.
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Chęciński M, Nowak Z. Maxillary Sinus Pleomorphic Adenoma: A Systematic Review. Surgeries 2022; 3:153-161. [DOI: 10.3390/surgeries3030017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Pleomorphic adenoma (PA), also known as a mixed tumor, is a neoplasm of the glandular tissue. The maxillary sinus (MS) is an atypical location of PA; however, as an empty cavity inside the bone, it predisposes tumors to develop unnoticed. The aim of the following systematic review was to identify and characterize the diagnostics and prognosis of maxillary sinus pleomorphic adenoma (MSPA). Methods: The cases of MSPA that underwent treatment and were observed for possible recurrence were qualified for the review. The medical databases were searched using the following engines: ACM, BASE, Google Scholar and PubMed. The risk of bias was assessed using the JBI Critical Appraisal Tool for Case Reports. The extracted data were tabulated and summarized in a descriptive manner. Results: To the best knowledge of the authors, only seven cases of MSPA were described in the last 20 years. Relapse occurred in three of these cases and malignant transformation occurred in two. The longest recorded time without recurrence was 4 years. The size of the detected MSPA in the largest dimension ranged in various cases from 40 to 60 mm, with an average of 48 mm. Discussion: All but one of the seven included reports showed flaws during the risk of bias assessment. Only in two of seven reported cases was there no reason to suspect that the tumor had penetrated the sinus from the oral or nasal cavity. The MS is disadvantageous as a location as tumors occupying the entire volume of the sinus are often diagnosed. Recurrences and malignant transformations seem to be frequent and often remain undetected for a prolonged period. Other information: This research received no external funding. OSF Registries number: 8KVGM.
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Wen B, Zhang Z, Zhu J, Liu L, Li Y, Huang H, Zhang Y, Cheng J. Apparent Diffusion Coefficient Map–Based Radiomics Features for Differential Diagnosis of Pleomorphic Adenomas and Warthin Tumors From Malignant Tumors. Front Oncol 2022; 12:830496. [PMID: 35747827 PMCID: PMC9210443 DOI: 10.3389/fonc.2022.830496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe magnetic resonance imaging (MRI) findings may overlap due to the complex content of parotid gland tumors and the differentiation level of malignant tumor (MT); consequently, patients may undergo diagnostic lobectomy. This study assessed whether radiomics features could noninvasively stratify parotid gland tumors accurately based on apparent diffusion coefficient (ADC) maps.MethodsThis study examined diffusion-weighted imaging (DWI) obtained with echo planar imaging sequences. Eighty-eight benign tumors (BTs) [54 pleomorphic adenomas (PAs) and 34 Warthin tumors (WTs)] and 42 MTs of the parotid gland were enrolled. Each case was randomly divided into training and testing cohorts at a ratio of 7:3 and then was compared with each other, respectively. ADC maps were digitally transferred to ITK SNAP (www.itksnap.org). The region of interest (ROI) was manually drawn around the whole tumor margin on each slice of ADC maps. After feature extraction, the Synthetic Minority Oversampling TEchnique (SMOTE) was used to remove the unbalance of the training dataset. Then, we applied the normalization process to the feature matrix. To reduce the similarity of each feature pair, we calculated the Pearson correlation coefficient (PCC) value of each feature pair and eliminated one of them if the PCC value was larger than 0.95. Then, recursive feature elimination (RFE) was used to process feature selection. After that, we used linear discriminant analysis (LDA) as the classifier. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of the ADC.ResultsThe LDA model based on 13, 8, 3, and 1 features can get the highest area under the ROC curve (AUC) in differentiating BT from MT, PA from WT, PA from MT, and WT from MT on the validation dataset, respectively. Accordingly, the AUC and the accuracy of the model on the testing set achieve 0.7637 and 73.17%, 0.925 and 92.31%, 0.8077 and 75.86%, and 0.5923 and 65.22%, respectively.ConclusionThe ADC-based radiomics features may be used to assist clinicians for differential diagnosis of PA and WT from MTs.
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Affiliation(s)
- Baohong Wen
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zanxia Zhang
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Zhu
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Liu
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinhua Li
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoyu Huang
- Advanced Technical Support, Philips Healthcare, Shanghai, China
| | - Yong Zhang
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of MRI, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jingliang Cheng,
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Alzumaili B, Xu B, Saliba M, Abuhashem A, Ganly I, Ghossein R, Katabi N. Clinicopathologic Characteristics and Prognostic Factors of Primary and Recurrent Pleomorphic Adenoma: A Single Institution Retrospective Study of 705 Cases. Am J Surg Pathol 2022; 46:854-862. [PMID: 34772841 PMCID: PMC9106806 DOI: 10.1097/pas.0000000000001837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although pleomorphic adenoma (PA) is benign, it may recur and prompt further treatment with radiotherapy (RT). This study investigated the prognostic features of primary and recurrent PAs. A total of 705 PAs (613 primary and 92 recurrent) were analyzed. The following parameters: age, site and size, status of resection, histologic features, and clinical management were documented and correlated with recurrence-free survival. For primary PAs: The mean patient age was 50 years (female/male: 2/1), the median size was 2.1 cm (range: 0.5 to 9.0 cm), and the most common location was the parotid (92%). Tumors showed the following: complete encapsulation (25%), involvement of the surrounding salivary gland/fat (74%), hypercellularity (26%), ≥10 pseudopods (15%), squamous metaplasia (43%), mitoses (49%), intravascular tumor deposit (n=1), close proximity to nerves (n=2), positive margin (15%), and suboptimal resection (2%). The recurrence rate was 3.4% and malignant transformation was <1%. On univariate analysis, age below 30, mitosis ≥3/10 HPFs, squamous metaplasia, hypercellularity, and suboptimal resection correlated with recurrence-free survival. On multivariate analysis, only age below 30, mitosis ≥3/10 HPF and suboptimal resection predicted recurrence. For recurrent PAs: The resected primary PAs were fragmented in 58%. Forty-eight percent of patients had subsequent recurrences, mostly within 10 years, and 1 patient developed a subsequent malignant transformation. Forty-two percent of patients received RT. On univariate analysis, only RT was associated with better outcome (P=0.033). Young age, high mitoses, and specimen integrity predicted recurrence in primary PA. Recurrent PAs are difficult to eradicate, and 48% of these recurred for the second time, mostly within 10 years.
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Affiliation(s)
- Bayan Alzumaili
- Department of Pathology, Mount Sinai Hospital, New York, NY, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maelle Saliba
- Department of Pathology, Colombia University, New York, NY, USA
| | - Abderhman Abuhashem
- Developmental Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Choi SY, Choi J, Hwang I, Cho J, Ko YH, Jeong HS. Comparative Longitudinal Analysis of Malignant Transformation in Pleomorphic Adenoma and Recurrent Pleomorphic Adenoma. J Clin Med 2022; 11:jcm11071808. [PMID: 35407417 PMCID: PMC8999507 DOI: 10.3390/jcm11071808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Recurrence in pleomorphic adenoma (PA) has been debated as a risk factor for malignant transformation (MT). In this study, we investigated whether recurrence is a risk factor for MT, by longitudinally analyzing cases with recurrent PA (RPA), and carcinomas from PA (CXPA) or RPA (CXRPA). Methods: The study population included 24 CXPA, 24 RPA, 6 CXRPA, and 386 PA cases (study period 2010−2018). Time and event data were collected from the medical documents to identify the time−event sequences. Results: The time interval to MT in CXRPA was significant longer than that of benign recurrence (median 342.0 vs. 109.5 months). In CXRPA, the recurrence intervals were not shorter than those in RPA according to recurrence frequency. Crudely, the MT rate was 5.9% among primary cases and 20.0% among recurrent cases. However, the time-adjusted MT rates increased up to 11.4% (incubation time > 60 months) and 20.0% (>120 months) in primary cases, which were not different from recurrent cases. Conclusion: In these longitudinal analyses, we did not find any clinical evidence that recurrence facilitates MT in the background of PA. Instead, a long incubation time seems to be a key factor for MT of underlying RPA.
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Affiliation(s)
- Sung Yong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.C.); (J.C.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Daejeon 34824, Korea
| | - Jaehyuck Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.C.); (J.C.)
| | - Inwoo Hwang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (I.H.); (J.C.); (Y.-H.K.)
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (I.H.); (J.C.); (Y.-H.K.)
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (I.H.); (J.C.); (Y.-H.K.)
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.C.); (J.C.)
- Correspondence: ; Tel.: +82-2-3410-3579
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Chegini S, Sassoon I, McGurk M. Extracapsular dissection (ECD) and extended ECD: Description of the technique and outcome of treatment. Br J Oral Maxillofac Surg 2021; 60:1062-1067. [DOI: 10.1016/j.bjoms.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
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Coopman R, De Bruyne S, Speeckaert M, Vermassen T, Vermeersch H, Creytens D, Delanghe J. A Tissue Section-Based Near-Infrared Spectroscopical Analysis of Salivary Gland Tumors. Cancers (Basel) 2021; 13:5356. [PMID: 34771520 DOI: 10.3390/cancers13215356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Salivary gland tumors (SGTs) are a group of rare tumors that vary in clinical and histological behavior. Histological classification is difficult and requires an experienced pathologist. Based on recent research in other medical fields, this study investigated the value of near-infrared (NIR) spectroscopy in the diagnosis of SGTs supplementary to the histological investigation. The acquired spectra were analyzed with chemometric techniques. Enzymatic treatment (neuraminidase) resulted in spectral peak differences between healthy controls and different SGT types. Some malignant SGTs had higher spectral changes, suggesting bigger alterations in glycosylation of salivary mucins. Future biochemical research based on the further enzymatic dissection of SGTs and infrared spectroscopy could help pathologists to better understand the nature of these types of tumors. Abstract SGTs vary in histological behavior. Mucins, a major component in salivary glands, consist of a glycosylated and sialylated protein core. Rapid evolutions in glycobiology have demonstrated the important role of glycoproteins in cancer development. NIR spectroscopy is a method for the biochemical analysis of substrates. NIR spectra can be analyzed using specific chemometrics. Our aim was to explore the diagnostic possibilities of NIR spectroscopy in SGTs. 238 Hematoxylin and Eosine stained (H&E) SGT tissue sections were examined using NIR spectroscopy. 45 deparaffinized tissue sections were treated with neuraminidase to identify wavelengths in the NIR spectrum related to sialylation. NIR spectra were analyzed with chemometrics. NIR spectra could distinguish malignant SGTs from controls and benign SGTs. Prediction models based on the entire spectral range resulted in a 73.1% accurate classification of malignant SGTs and controls, while, based on neuraminidase experimental spectral peak differences (1436 nm; 1713 nm; 1783 nm; 1924 nm; 2032 nm; 2064 nm; 2178 nm; 2216 nm), an improved overall correct classification rate of 91.9% was obtained between healthy subjects and malignant tumors. H&E tissue section-based NIR spectroscopy can identify malignant SGTs from controls, promising an alternative method in the diagnosis of SGTs.
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Vernuccio F, Arnone F, Cannella R, Verro B, Comelli A, Agnello F, Stefano A, Gargano R, Rodolico V, Salvaggio G, Lagalla R, Midiri M, Lo Casto A. Diagnostic performance of qualitative and radiomics approach to parotid gland tumors: which is the added benefit of texture analysis? Br J Radiol 2021; 94:20210340. [PMID: 34591597 PMCID: PMC8631014 DOI: 10.1259/bjr.20210340] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological approach. METHODS Patients with parotid gland tumors who underwent salivary glands MRI between 2008 and 2019 were retrospectively selected. MRI analysis included a qualitative assessment by two radiologists (one of which subspecialized on head and neck imaging), and texture analysis on various sequences. Diagnostic performances including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of qualitative features, radiologists' diagnosis, and radiomic models were evaluated. RESULTS Final study cohort included 57 patients with 74 tumors (27 pleomorphic adenomas, 40 Warthin tumors, 8 malignant tumors). Sensitivity, specificity, and AUROC for the diagnosis of malignancy were 75%, 97% and 0.860 for non-subspecialized radiologist, 100%, 94% and 0.970 for subspecialized radiologist and 57.2%, 93.4%, and 0.927 using a MRI radiomics model obtained combining texture analysis on various MRI sequences. Sensitivity, specificity, and AUROC for the differential diagnosis between pleomorphic adenoma and Warthin tumors were 81.5%, 70%, and 0.757 for non-subspecialized radiologist, 81.5%, 95% and 0.882 for subspecialized radiologist and 70.8%, 82.5%, and 0.808 using a MRI radiomics model based on texture analysis of T2 weighted sequence. A combined radiomics model obtained with all MRI sequences yielded a sensitivity of 91.5% for the diagnosis of pleomorphic adenoma. CONCLUSION MRI qualitative radiologist assessment outperforms radiomic analysis for the diagnosis of malignancy. MRI predictive radiomics models improves the diagnostic performance of non-subspecialized radiologist for the differential diagnosis between pleomorphic adenoma and Warthin tumor, achieving similar performance to the subspecialized radiologist. ADVANCES IN KNOWLEDGE Radiologists outperform radiomic analysis for the diagnosis of malignant parotid gland tumors, with some MRI qualitative features such as ill-defined margins, perineural spread, invasion of adjacent structures and enlarged lymph nodes being highly specific for malignancy. A radiomic model based on texture analysis of T2 weighted images yields higher specificity for the diagnosis of pleomorphic adenoma compared to a radiologist non-subspecialized in head and neck radiology, thus minimizing false-positive pleomorphic adenoma diagnosis rate and reducing unnecessary surgical complications.
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Affiliation(s)
- Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Federica Arnone
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Barbara Verro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Albert Comelli
- Ri.MED Foundation, Palermo, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Francesco Agnello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Rosalia Gargano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Vito Rodolico
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Antonio Lo Casto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
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Meyer TJ, Gerhard-Hartmann E, Lodes N, Scherzad A, Hagen R, Steinke M, Hackenberg S. Pilot study on the value of Raman spectroscopy in the entity assignment of salivary gland tumors. PLoS One 2021; 16:e0257470. [PMID: 34529739 PMCID: PMC8445432 DOI: 10.1371/journal.pone.0257470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background The entity assignment of salivary gland tumors (SGT) based on histomorphology can be challenging. Raman spectroscopy has been applied to analyze differences in the molecular composition of tissues. The aim of this study was to evaluate the suitability of RS for entity assignment in SGT. Methods Raman data were collected in deparaffinized sections of pleomorphic adenomas (PA) and adenoid cystic carcinomas (ACC). Multivariate data and chemometric analysis were completed using the Unscrambler software. Results The Raman spectra detected in ACC samples were mostly assigned to nucleic acids, lipids, and amides. In a principal component-based linear discriminant analysis (LDA) 18 of 20 tumor samples were classified correctly. Conclusion In this proof of concept study, we show that a reliable SGT diagnosis based on LDA algorithm appears possible, despite variations in the entity-specific mean spectra. However, a standardized workflow for tissue sample preparation, measurement setup, and chemometric algorithms is essential to get reliable results.
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Affiliation(s)
- Till Jasper Meyer
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic & Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
- * E-mail:
| | | | - Nina Lodes
- Chair of Tissue Engineering and Regenerative Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic & Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic & Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Maria Steinke
- Chair of Tissue Engineering and Regenerative Medicine, University Hospital Würzburg, Würzburg, Germany
- Fraunhofer Institute for Silicate Research ISC, Würzburg, Germany
| | - Stephan Hackenberg
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic & Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
- Department of Otorhinolaryngology – Head and Neck Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Lombardi D, Tomasoni M, Nicolai A, Paderno A, Grammatica A, Arcuri M, Lancini D, Battocchio S, Ardighieri L, Bozzola A, Pittiani F, Farina D, Redaelli de Zinis LO, Nicolai P, Piazza C. Parotid pleomorphic and non-pleomorphic adenomas: a mono-institutional series of 512 patients. Eur Arch Otorhinolaryngol 2021; 279:2543-2551. [PMID: 34355271 DOI: 10.1007/s00405-021-07018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Pleomorphic adenoma (PA) is the most common benign parotid tumor, with a well-known propensity to recur. Many factors have been advocated as prognostic, but there is no consensus on how they affect local control. We studied how PA recurrence-free survival (RFS) may be affected by the most relevant risk factors in a time-to-event analysis, comparing them with those observed in a population of non-PA (NPA). METHODS Patients undergoing parotidectomy for benign lesions between 2002 and 2018 in a single academic tertiary referral center were included. A description of patients, tumors, and treatment characteristics was performed, highlighting differences between PA and NPA. Analysis of PA RFS and relative risk factors was also conducted. RESULTS Eight hundred fifty patients underwent parotidectomy for benign lesions, 455 (53.5%) for PA and 57 (6.7%) for NPA. Significant differences between PA and NPA were age at surgery, surgical procedure, and resection margins. Recurrence occurred in 3.1% of PA, with a median disease-free interval of 54 months. 2-, 5-, and 10-year RFS were 99.2, 98.5, and 93.9%, respectively. Age < 18 years (HR = 31.31, p < 0.001), intraoperative tumor spillage (HR = 6.57, p = 0.041), extensive pseudo-capsule interruption (HR = 5.85, p = 0.023), and resection margins < 1 mm (HR = 3.16, p = 0.085) were associated with RFS. CONCLUSION Patients affected by NPA were significantly older and treated with more conservative surgical procedures compared to those with PA. In PA, younger age, major pseudo-capsule defects, and surgical margins were the most relevant factors affecting local control. These results confirm the importance of an appropriate surgical management and long-term follow-up in PA.
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Affiliation(s)
- Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alessio Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Mara Arcuri
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Laura Ardighieri
- Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Unit of Pathology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Frida Pittiani
- Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Almubarak AA, Alotaibi SK, Alghamdi FR, Alqahtani S, Alahmadi RM. Carcinosarcoma ex pleomorphic adenoma of the parotid gland: a case report. J Surg Case Rep 2021; 2021:rjab361. [PMID: 34422256 PMCID: PMC8376289 DOI: 10.1093/jscr/rjab361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022] Open
Abstract
Carcinosarcoma ex pleomorphic adenoma is an extremely rare malignant neoplasm of the salivary gland that originates from a pre-existing benign tumor. Malignant transformation of the pleomorphic adenoma is extremely rare. The management of carcinosarcoma ex pleomorphic adenoma remains challenging because of its rarity, behavioral aggressiveness and resemblance to benign pleomorphic adenoma. Herein, we present the case of a 75-year-old male resident of Saudi Arabia with a history of a swelling in the right parotid gland for more than 25 years, which grew slowly with time. He underwent surgical removal with superficial parotidectomy. Afterward, histological examination of the resected tumor revealed features of carcinosarcoma, and he was diagnosed with carcinosarcoma ex pleomorphic adenoma. He presented again with recurrence of the tumor, which was managed with total parotidectomy and a combination of radiotherapy and chemotherapy. At 12-month follow-up, the patient showed no evidence of disease recurrence or distant metastasis.
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Affiliation(s)
- Ali A Almubarak
- Department of Surgery, College of Medicine, King Saud bin Abdulziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salman K Alotaibi
- Department of Surgery, College of Medicine, Shaqra University, Riyadh, Saudi Arabia
| | - Fareed R Alghamdi
- Department of Otolaryngology, Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saeed Alqahtani
- Department of Otolaryngology, Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rawan M Alahmadi
- Department of Otolaryngology, Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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28
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Wang C, Yu Q, Li S, Sun J, Zhu L, Wang P. Carcinoma ex pleomorphic adenoma of major salivary glands: CT and MR imaging findings. Dentomaxillofac Radiol 2021; 50:20200485. [PMID: 34161740 DOI: 10.1259/dmfr.20200485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To describe the CT and MR imaging characteristics of primary carcinoma ex pleomorphic adenoma (Ca-ex-PA) in major salivary glands and present more information for recognizing this malignancy. METHODS 212 patients with primary Ca-ex-PA in major salivary glands (169 in the parotid gland, 36 in the submandibular gland, 7 in the sublingual gland) underwent CT and MR imaging (plain and contrast-enhanced scans) prior to surgical management and histopathological examination. The CT and MR imaging findings of this condition were retrospectively reviewed and correlated with their pathological types: non-invasive carcinoma (Type I, 37 cases), minimally invasive carcinoma (Type II, 18 cases), and widely invasive carcinoma (TypeIII, 157 cases). The binary logistic regression analysis was used to analyze the independent influencing factors of morphology and boundary for differentiating between Type I/II and Type III of Ca-ex-PA, and the sensitivity, specificity and positive predictive value were calculated. Differences in apparent diffusion coefficient (ADC) values between Type I/II and Type III of Ca-ex-PA were calculated by independent sample t-tests. RESULTS On CT and MR imaging, there were 190/212 cases (89.6%) identified as lobular, 203/212 cases (95.8%) with enhancement, and 173/212 cases (81.6%) with inhomogeneous after contrast administration.Calcification within the mass was shown in 76 of 192 cases (39.6%) on plain CT examination. Of 55 neoplasms with Type I and II, 38 (69.1%) were presented as round or oval and 42 (76.4%) as well-defined margins. Of 157 neoplasms with Type III, 103 (65.6%) were presented as irregular form and 110 (70.1%) as uneven margins or with partial uneven margins.The sensitivity, specificity and positive predictive value for distinguishing Type I/II and Type III tumors according to the morphology and boundary were 78.34%, 63.64% and 86.01%, respectively. The mean ADC value of Ca-ex-PA (22 cases) in major salivary glands was about 0.93 × 10-3 mm2 s-1, and there was no significant difference in mean ADC value between Type I/II and Type III of this neoplasm. Cervical lymph node metastasis and distance metastasis were found in 67 patients (31.6%, Type III) and 32 patients (15.1%, Type I in 1; Type II in 1; and Type III in 30), respectively. CONCLUSIONS Most Ca-ex-PA is characterized by an irregular, lobular, and inhomogeneous enhanced neoplasm with uneven margin or partial uneven margin on CT and MR imaging, which is frequently corresponding with Type III. And a round or oval mass with well-defined margin usually correlates with Type I and II. Morphology and boundary are important basis for distinguishing Type I/II and Type III tumors. Calcification within the neoplasm shown on CT may be regarded as a specific sign for indicating this malignancy. Low ADC value is an important manifestation of this neoplasm.Ca-ex-PA with Type III is more likely to have cervical lymph node metastasis and distant metastasis.
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Affiliation(s)
- Can Wang
- Department of radiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qiang Yu
- Department of radiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Siyi Li
- Department of oral and maxillofacial head and neck oncology, Shanghai NinthPeople's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjing Sun
- Department of pathology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ling Zhu
- Department of radiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Pingzhong Wang
- Department of radiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Buchta P, Thimsen V, Iro AK, Agaimy A, Iro H, Mantsopoulos K. [The influence of the capsular defect as a risk factor for recurrence in pleomorphic adenoma]. Laryngorhinootologie 2021; 101:408-413. [PMID: 34157775 DOI: 10.1055/a-1528-7821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Aim of this study was to enlighten various aspects of the capsular defect of a pleomorphic adenoma and to analyze its influence on recurrence rate with the help of our data and the relevant literature. MATERIAL AND METHODS The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2006 and 2020 were evaluated retrospectively. The histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. The records of the cases with a capsular defect were examined for information on age, gender, type of surgery and surgical outcome. RESULTS A total of 845 patients were included in the primary group. 7 (0.8 %) recurrences were detected, all of these were resected without a capsular rupture. Positive margins were found in 37 cases (4.4 %). In 13/37 cases the capsular defect was detected intraoperatively, whereas the defect was only identified histopathologically in 24 of the 37 cases. In the group of the intraoperative capsular opening, with a median follow-up of 62 months, the sonographic examination suspected a unilocular recurrence of the pleomorphic adenoma in two cases. CONCLUSION The intraoperative capsule opening does not inevitably seem to lead to a pre-programmed recurrence.
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Affiliation(s)
- Peter Buchta
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Vivian Thimsen
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ann-Kristin Iro
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Pathologisches Institut, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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30
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Kligerman MP, Jin M, Ayoub N, Megwalu UC. Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults. JAMA Otolaryngol Head Neck Surg 2021; 146:1027-1034. [PMID: 32970111 DOI: 10.1001/jamaoto.2020.2944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is no consensus regarding optimal management of pleomorphic adenoma in adults. Objectives To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age. Design and Setting This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results. Main Outcomes and Measures Model outcomes were measured with quality-adjusted life-years (QALYs). Results In the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years for patients with superficial lobe tumors (5.37 QALYs in favor of parotidectomy below this age, and 5.37 QALYs in favor of observation above this age) and 83.4 years for patients with deep lobe tumors (7.51 QALYs in favor of surgery below this age, and 7.51 QALYs in favor of observation above this age). There was no significant difference in outcomes between parotidectomy and observation among patients aged 70 to 80 years. Conclusions and Relevance This study suggests that the outcomes associated with parotidectomy and observation are similar at 70 years or older among patients with pleomorphic adenoma and that observation may be the favorable treatment in that age group.
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Affiliation(s)
- Maxwell P Kligerman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael Jin
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Noel Ayoub
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Li Y, Xiao N, Dai Y, Guo S, Zhang Y, Wang D, Cheng J. Comprehensive characterization of pleomorphic adenoma at intraoral unusual sites. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:21-27. [PMID: 34511341 DOI: 10.1016/j.oooo.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The present study aimed to comprehensively characterize the epidemiologic characteristics, clinicopathologic characteristics, clinical treatments, and prognoses of pleomorphic adenoma (PA) identified at unusual intraoral sites. STUDY DESIGN Patients diagnosed with PA in oral and maxillofacial regions at our institution in the past 16 years (2005-2020) were screened from the inpatient disease registry. All data concerning patients with PA found at unusual intraoral sites (defined as intraoral locations except sublingual gland and palate) were retrieved. Previously published cases with adequate clinicopathologic data were collected from PubMed and Embase. Eligible cases were further reviewed and included for statistical analyses. RESULTS Among 1039 cases of PA diagnosed at our institution, 52 lesions were found at unusual intraoral sites. A literature review identified another 63 eligible cases from 32 articles. The upper lip was the most common sites for these lesions (n = 57), followed by buccal mucosa (n = 34), tongue (n = 8), lower lip (n = 8), and retromolar area (n = 2). Recurrence and malignant transformation after surgical resection were extremely rare for these lesions. CONCLUSIONS PA might rarely develop at uncommon intraoral sites with atypical presentations, thus complicating its early diagnosis. Surgical resection is the major therapeutic strategy for this rare entity and has a favorable prognosis.
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Affiliation(s)
- Yuanyuan Li
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, PRC
| | - Na Xiao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, PRC
| | - Yibin Dai
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PRC
| | - Songsong Guo
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PRC
| | - Yuchao Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PRC
| | - Dongmiao Wang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PRC
| | - Jie Cheng
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, PRC.
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Valstar MH, Mast H, Ten Hove I, Moonen LR, Balm AJ, Smeele LE, Koljenović S, Dinjens WN, van Velthuysen MLF. Malignant transformation of salivary gland pleomorphic adenoma: proof of principle. J Pathol Clin Res 2021; 7:432-437. [PMID: 34390320 PMCID: PMC8363925 DOI: 10.1002/cjp2.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/04/2021] [Accepted: 03/28/2021] [Indexed: 12/21/2022]
Abstract
Supposed risk of malignant transformation of salivary gland pleomorphic adenoma (SGPA) is an important reason for aggressive retreatment in recurrent pleomorphic adenoma (RPA). However, although the diagnostic category ‘carcinoma ex‐pleomorphic adenoma’ suggests that malignant transformation of a pleomorphic adenoma is a regular event, this has to date not been shown to occur in sequential lesions of one patient. Here, we show the molecular events in transformation to malignancy of a pleomorphic adenoma of the parotid gland. Detailed molecular analysis revealed an LIFR/PLAG1 translocation characteristic for pleomorphic adenoma and, next to this, a PIK3R1 frameshift mutation and several allelic imbalances. In subsequent malignant recurrences, the same LIFR/PLAG1 translocation, PIK3R1 frameshift mutation, and allelic imbalances were present in addition to TP53 mutations. Thus, this case not only shows malignant transformation of SGPA, but also demonstrates that molecular analysis can be of help in recognising malignancy in the rare instance of RPA.
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Affiliation(s)
- Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura R Moonen
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alfons Jm Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Winand Nm Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marie-Louise F van Velthuysen
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Bartkowiak E, Piwowarczyk K, Bodnar M, Kosikowski P, Chou J, Woźniak A, Wierzbicka M. Expression of p16 Ink4a protein in pleomorphic adenoma and carcinoma ex pleomorphic adenoma proves diversity of tumour biology and predicts clinical course. J Clin Pathol 2021; 75:605-611. [PMID: 33941588 PMCID: PMC9411887 DOI: 10.1136/jclinpath-2021-207440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
Aims The aim of the study is to correlate p16Ink4a expression with the clinical courses of pleomorphic adenoma (PA), its malignant transformation (CaexPA) and treatment outcomes. Methods Retrospective analysis (1998–2019) of 47 CaexPA, 148 PA and 22 normal salivary gland samples was performed. PAs were divided into two subsets: clinically ‘slow’ tumours characterised by stable size or slow growth; and ‘fast’ tumours with rapid growth rate. Results Positive p16Ink4a expression was found in 68 PA and 23 CaexPA, and borderline expression in 80 and 20, respectively. All 22 (100%) normal salivary gland samples presented with no p16Ink4a expression. Significant difference in p16Ink4a expression was observed between normal tissue, PA and CaexPA (χ2 (4)=172,19; p=0.0001). The PA clinical subgroups were also evaluated separately, revealing additional statistical relations: ‘fast’ PA and CaexPA differed significantly in p16Ink4a expression (χ2 (2)=8.06; p=0.01781) while ‘slow’ PA and CaexPA did not (χ2 (2)=3.09; p=0.2129). 3-year, 5-year and 10-year survival among p16Ink4a positive CaexPA patients was 100%, 90.56% and 60.37%, respectively, and in CaexPA patients with borderline p16Ink4a expression was 90.0%, 73.64% and 22.20%, respectively. Statistically significant difference between expression pattern and survival rate was observed (F Cox test – F (16, 24)=2.31; p=0.03075). Conclusions Our study confirms no p16Ink4a expression in normal tissue, but reveals differences in expression between ‘fast’ and ‘slow’ PA. We suggest that p16Ink4a overexpression is connected to PA proliferation and subsequent malignant transformation to CaexPA. Borderline p16Ink4a staining correlates with worse prognosis of CaexPA.
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Affiliation(s)
- Ewelina Bartkowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Piwowarczyk
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Bodnar
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland.,Department of Clinical Pathomorphology, Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Paweł Kosikowski
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jadzia Chou
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Aldona Woźniak
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Feinmesser G, Feinmesser R, Alon E, Leshno M. Is parotidectomy justified in elderly patients with pleomorphic adenoma? A decision analysis model. Am J Otolaryngol 2021; 42:102868. [PMID: 33476972 DOI: 10.1016/j.amjoto.2020.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The value of parotidectomy in older patients is unclear. This study presents a decision model to help resolve this question. MATERIALS & METHODS A Markov model with Monte Carlo simulation was used to compare outcomes in patients of different ages with pleomorphic adenoma of the parotid gland treated by surgery or surveillance. RESULTS In 30-year-old patients, surgery conferred a 3.5-year gain in life expectancy whereas in 75-year-olds, it was only 0.74 months. The expected rate of malignant transformation at age 30 years was 6.5% after surgery and 26.5% after surveillance; at age 65, corresponding rates were 0.8% and 10.7%. Sensitivity analysis showed that age was the only parameter that significantly contributed to life expectancy. The benefit of surgery was restricted in older patients. CONCLUSION Our Markov decision-analysis model suggests that patients older than 65 years with pleomorphic adenoma have a limited survival advantage with surgery compared to surveillance.
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Jia CH, Wang SY, Li Q, Qiu JM, Kuai XP. Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin's tumor of the parotid gland. Sci Prog 2021; 104:368504211018583. [PMID: 34003684 PMCID: PMC10455002 DOI: 10.1177/00368504211018583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to explore conventional, diffusion, and dynamic contrast-enhanced MRI (DCE-MRI) characteristics for differentiating metaplastic Warthin's tumor (MWT) from other tumor types of the parotid gland, including non-metaplastic Warthin's tumor (non-MWT), pleomorphic adenoma (PA), and malignant tumor (MT). A total of 178 patients with histologically proven tumors of the parotid gland, including 21 MWTs, 49 non-MWTs, 66 PAs, and 42 MTs, were enrolled in the study. Conventional MRI was performed in all patients. One hundred and fifty patients had preoperative diffusion-weighted MR imaging (DWI), and 62 patients had preoperative DCE-MRI. The differences in the conventional, DCE-MRI, and DWI records between MWTs and the other three tumor types were statistically evaluated. Compared with non-MWTs and PAs, there was a statistically significant difference in circumscription (p < 0.01). The ill-defined circumscription was more common in MWTs than non-MWTs and PAs. Compared with PAs, there was a statistically significant difference in morphology (p < 0.05). The lobulated morphology was more common in PAs than MWTs. Compared with PAs and MTs, there was a statistically significant difference in the T2 signal of the solid component (p < 0.01). The T2 moderate intensity of solid components was more common in MWTs than PAs and MTs. The solid components of PAs mostly showed hyperintense on T2-weighted imaging. Cyst/necrosis was more common in MWTs than PAs and MTs. Hyperintense of cyst/necrosis was more common in MWTs and non-MWTs. With respect to contrast enhancement, 52.4% MWTs exhibited moderate or marked enhancement, and most non-MWTs (81.6%) exhibited mild enhancement. Most PAs (84.8%) exhibited marked enhancement. The mean ADC value of MWTs (0.94 × 10-3 ± 0.11 mm2/s) was significantly lower than that of the PAs (1.60 × 10-3 ± 0.17 mm2/s) (p < 0.001). On DCE-MRI, six of eight MWTs demonstrated TIC of type B. Although MWT is rare, conventional MRI characteristics, DWI and DCE-MRI can provide useful information for differentiating MWT from other parotid mass.
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Affiliation(s)
- Chuan-Hai Jia
- Department of Radiology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
| | - Sheng-Yu Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Jiading, Shanghai, China
| | - Qin Li
- Department of Radiology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
| | - Jia-Ming Qiu
- Department of Pathology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
| | - Xin-Ping Kuai
- Department of Radiology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China
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Wei PY, Shao C, Huan T, Wang HB, Ding ZX, Han ZJ. Diagnostic value of maximum signal intensity on T1-weighted MRI images for differentiating parotid gland tumours along with pathological correlation. Clin Radiol 2021; 76:472.e19-472.e25. [PMID: 33731262 DOI: 10.1016/j.crad.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/05/2021] [Indexed: 12/27/2022]
Abstract
AIM To investigate the efficacy of the maximum signal intensity of tumour on T1-weighted magnetic resonance imaging (MRI) images for differentiating Warthin's tumours (WTs) from pleomorphic adenomas (PAs) and malignant tumours (MTs). MATERIALS AND METHODS One hundred and fifty-four histopathologically confirmed parotid tumours, including 76 PAs, 45 WTs, and 33 MTs, were analysed. MRI results were compared with pathological findings. The maximum signal intensity of tumour and the average signal intensity of spinal cord were measured on T1-weighted images, then the tumour-to-spinal cord signal intensity ratio (T1-max-SIR) was calculated. The distribution of T1-max-SIRs among the three groups of tumours was analysed using the Mann-Whitney U-test. Receiver operating characteristic curves were generated to assess the ability of T1-max-SIRs to differentiate parotid tumours. In addition, the interobserver agreement between readers was assessed using interclass correlation coefficient (ICC). RESULTS T1-max-SIRs were higher in WTs than in PAs (p<0.001) and MTs (p<0.001), and no significant difference was found between PAs and MTs (p=0.151). The area under the curve (AUC) of T1-max-SIRs for differentiating WTs from PAs was 0.901, with a sensitivity of 91.1% and a specificity of 82.9%. The AUC of T1-max-SIRs for differentiating WTs from MTs was 0.851, with a sensitivity of 88.9% and a specificity of 78.8%. Readers had excellent interobserver agreement on T1-max-SIRs (ICC = 0.989; 95% confidence interval, 0.985-0.992). CONCLUSIONS T1-max-SIRs can be useful for differentiating WTs from PAs and MTs with high diagnostic efficiency.
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Affiliation(s)
- P Y Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - C Shao
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - T Huan
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - H B Wang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Z X Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Z J Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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Piwowarczyk K, Bartkowiak E, Kosikowski P, Chou JTT, Wierzbicka M. Salivary Gland Pleomorphic Adenomas Presenting With Extremely Varied Clinical Courses. A Single Institution Case-Control Study. Front Oncol 2021; 10:600707. [PMID: 33489904 PMCID: PMC7820779 DOI: 10.3389/fonc.2020.600707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
Objective Pleomorphic adenomas (PAs) with divergent clinical behavior, differing from the vast majority of PAs, were distinguished. “Fast” PAs are characterized by an unexpectedly short medical history and relatively rapid growth. The reference group consisted of “slow” PAs with very stable biology and long-term progression. We divide the PA group as a whole into three subsets: “fast,” “normal,” and “slow” tumors. Our goal is a multifactorial analysis of the “fast” and “slow” PA subgroups. Methods Consecutive surgeries in a tertiary referral center, the Department of Otolaryngology and Laryngological Surgery, Poznan University of Medical Sciences, Poland, were carried out between 2002 and 2011. Out of 1,154 parotid tumors, 636 (55.1%) were PAs. The data were collected prospectively in collaboration with the Polish National Registry of Benign Salivary Gland Tumors. The main outcome measure was the recurrence rate in “fast” and “slow” PA subgroups. All surgical qualifications and surgeries were performed by two experienced surgeons. Results Slow PAs, compared to fast PAs, presented in older patients (53.25 ± 15.29 versus 47.92 ± 13.44 years). Multifactor logistic regression analysis with recurrence (yes/no) as the outcome variable, fast/slow as the predictor variable and age, gender, margin, FN status as covariates showed that fast PAs were significantly predicting recurrence vs. slow PAs (p = 0.035). Fast PAs were increasing the risk of PAs 10-fold vs. slow PAs, exp β = 10.20, CI95 [1.66; 197.87]. The variables impacting relapse were recent accelerated growth of the tumor OR = 3.35 (SE = 0.56), p = 0.030, positive margins OR = 7.18 (SE = 0.57), p < 0.001, incomplete or bare capsule OR = 9.91 (SE = 0.53), p = 0.001 and location III OR = 3.12 (SE = 0.53), p = 0.033. In the multivariate model only positive margin was selected as the best predictor of relapse, OR = 5.01 (SE = 0.60), p = 0.007. Conclusions The simple clinical aspect of slow or fast PA progression is of great practical importance and can constitute a surrogate of the final histopathological information that is derived from the surgical specimen. The slow or fast nature of the PA to some extent indicates prognostic features such as recurrence risk. This finding requires correlation with histological and molecular features in further stages of research.
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Affiliation(s)
- Krzysztof Piwowarczyk
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewelina Bartkowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Kosikowski
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jadzia Tin-Tsen Chou
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Facchini V, Colangeli W, Kapitonov A, Bozza F, Becelli R. Long-term follow-up after extracapsular dissection of parotid pleomorphic adenomas - A retrospective study. Ann Maxillofac Surg 2021; 11:287-292. [PMID: 35265500 PMCID: PMC8848710 DOI: 10.4103/ams.ams_362_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Parotid pleomorphic adenoma (PPA) is the most common benign salivary gland neoplasm. Extracapsular dissection (ED) arose as a conservative surgical technique alternative to superficial parotidectomy to reduce complications. Materials and Methods: Patients who underwent ED for superficial, <3 cm, mobile parotid lumps (Quer I) between 2004 and 2008 were retrospectively analysed focusing on those with histological diagnosis of pleomorphic adenoma. A retrospective cohort study on 50 patients who accepted to undergo ultrasonography and clinical evaluation for at least 10 years since surgery was performed. Clinical data, surgical reports, and validated questionnaires for the assessment of complications, quality of life (QoL) and aesthetic satisfaction were analysed. Recurrence rate and complications after ED, with their QoL and aesthetic impact, were evaluated. Statistical analysis was performed setting α=0.05 as the level of significance. Results: Low occurrence of complications related to ED was seen. Overall QoL after ED was very good (range 1–7, mean 6,86), due to low complications incidence of complications and their low severity, as assessed by patients through Parotidectomy Outcome Inventory-8 questionnaire. Overall aesthetic satisfaction was high (range 1–10, mean 9,78). Aesthetic satisfaction and QoL was statistically related to onset of complications (P = 0.02504 and P = 0.001859). Tumour localization and dimension was not statistically related to onset of complications (P = 0.8207 and 0.7586). After a mean follow-up of 12.5 years, no recurrences were detected. Discussion: There is a lack of studies with a long-term follow-up after ED for the evaluation of recurrences and complications. Considering our results, the ED technique should be adopted as the first surgical approach for Quer I PPA without suspicion of malignancy.
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Rooker SA, Van Abel KM, Yin LX, Nagelschneider AA, Price DL, Olsen KD, Janus JR, Kasperbauer JL, Moore EJ. Risk factors for subsequent recurrence after surgical treatment of recurrent pleomorphic adenoma of the parotid gland. Head Neck 2020; 43:1088-1096. [PMID: 33275822 DOI: 10.1002/hed.26570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/26/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recurrent pleomorphic adenoma (PA) can be a lifelong disease, and rates of subsequent recurrence are high. METHODS Patients between 2000 and 2015 were identified. Primary outcome was subsequent recurrence after surgical salvage. RESULTS Twenty-seven of 84 patients developed a subsequent recurrence. Risk factors for subsequent recurrence included a higher number of previous recurrences (P < .01), worse preoperative facial nerve function (P < .01), and deep parotid lesion(s) (P < .01). Interval since last surgery was protective (P < .01), specifically >10 years since last surgery (P < .01). For patients with a >10-year interval since their last surgery, the subsequent recurrence-free rate at 10 years follow-up was 80.2% vs 31.8%. CONCLUSIONS For patients presenting with a >10-year interval since their last surgery, subsequent recurrence rates are low, which may allow for as needed surveillance recommendations. For patients presenting with recurrent PA and ≤10 years since their last surgery, a closer surveillance is warranted.
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Affiliation(s)
- Steven A Rooker
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel L Price
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D Olsen
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Valstar MH, Schaapveld M, van den Broek EC, van Velthuysen MLF, de Ridder M, Schmidt MK, van Dijk BAC, Balm AJM, Smeele LE. Risk of breast cancer in women after a salivary gland carcinoma or pleomorphic adenoma in the Netherlands. Cancer Med 2020; 10:424-434. [PMID: 33247629 PMCID: PMC7826476 DOI: 10.1002/cam4.3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/25/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
Salivary and mammary gland tumors show morphological similarities and share various characteristics, including frequent overexpression of hormone receptors and female preponderance. Although this may suggest a common etiology, it remains unclear whether patients with a salivary gland tumor carry an increased risk of breast cancer (BC). Our purpose was to determine the risk of BC in women diagnosed with salivary gland carcinoma (SGC) or pleomorphic adenoma (SGPA). BC incidence (invasive and in situ) was assessed in two nationwide cohorts: one comprising 1567 women diagnosed with SGC and one with 2083 women with SGPA. BC incidence was compared with general population rates using standardized incidence ratio (SIR). BC risk was assessed according to age at SGC/SGPA diagnosis, follow‐up time and (for SGC patients) histological subtype. The mean follow‐up was 7.0 years after SGC and 9.9 after SGPA diagnosis. During follow‐up, 52 patients with SGC and 74 patients with SGPA developed BC. The median time to BC was 6 years after SGC and 7 after SGPA. The cumulative risk at 10 years of follow‐up was 3.1% after SGC and 3.5% after SGPA (95% Confidence Interval (95%CI) 2.1%–4.7% and 2.6%–4.6%, respectively). BC incidence was 1.59 times (95%CI 1.19–2.09) higher in the SGC‐cohort than expected based on incidence rates in the general population. SGPA‐patients showed a 1.48 times (95%CI 1.16–1.86) higher incidence. Women with SGC or SGPA have a slightly increased risk of BC. The magnitude of risk justifies raising awareness, but is no reason for BC screening.
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Affiliation(s)
- Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Schaapveld
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther C van den Broek
- The Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA, Houten, The Netherlands
| | | | - Mischa de Ridder
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Marjanka K Schmidt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Division of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organization (IKNL, Department of Research and Development, Utrecht, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Zhong H, Yan S, Jiang K, Hu Y, Dong X. A case report of bronchial pleomorphic adenoma in a child in China. BMC Pulm Med 2020; 20:295. [PMID: 33176739 PMCID: PMC7661225 DOI: 10.1186/s12890-020-01338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Paediatric cases of pleomorphic adenoma of the bronchus are rare in clinical practice, despite pleomorphic adenoma being the most common histological form of salivary gland neoplasm. To date, no such cases have been reported in China. CASE PRESENTATION We report a case of pleomorphic adenoma of the bronchus in a 10-year-old child with no obvious positive signs on examination. Chest-enhanced computed tomography and bronchoscopy showed a large white mass in the right principal bronchus. The patient was treated by bronchial mass resection. Biopsy confirmed the diagnosis of pleomorphic adenoma. CONCLUSIONS We not only describe a rare benign bronchial tumour in children but also demonstrate the successful use of surgery as a radical cure for pleomorphic adenoma.
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Affiliation(s)
- Haiqin Zhong
- Department of Respiratory Medicine, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Silei Yan
- Department of Respiratory Medicine, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Kung Jiang
- Department of Respiratory Medicine, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Yijing Hu
- Department of Respiratory Medicine, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Dong
- Department of Respiratory Medicine, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China.
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Vergez S, Fakhry N, Cartier C, Kennel T, Courtade-Saidi M, Uro-Coste E, Varoquaux A, Righini CA, Malard O, Mogultay P, Thariat J, Tronche S, Garrel R, Chevalier D. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenoma. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:269-274. [PMID: 33060032 DOI: 10.1016/j.anorl.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the diagnosis and treatment of pleomorphic adenoma (PA) of the salivary glands. METHOD A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted based on the articles retrieved and the workgroup members' individual experience. Guidelines were graded A, B, C or expert opinion by decreasing level of evidence. RESULTS In clinically suspected salivary gland PA, MRI should be performed, including head and neck lymph node levels. Fine needle aspiration cytology is particularly recommended for tumours difficult to characterise by MRI. Frozen section biopsy should be performed to confirm diagnosis and adapt the surgical procedure in case of intraoperative findings of malignancy. Complete resection of the parotid PA should be performed en bloc, including margins, when feasible according to tumour location, while respecting the facial nerve. Enucleation (resection only in contact with the tumour) is not recommended. For the accessory salivary and submandibular glands, complete en bloc resection should be performed.
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Affiliation(s)
- S Vergez
- Service d'ORL et de chirurgie de la face et du cou, hôpital Larrey, institut universitaire du cancer de Toulouse Oncopole, CHU de Toulouse, Toulouse, France.
| | - N Fakhry
- Service d'ORL et chirurgie de la face et du cou, hôpital de la conception, AP-HM, Aix-Marseille Université, Marseille, France
| | - C Cartier
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - T Kennel
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - M Courtade-Saidi
- Service d'anatomie et cytologie pathologiques, institut universitaire du cancer de Toulouse Oncopole, INSERM CRCT-Équipe 11, Toulouse, France
| | - E Uro-Coste
- Service d'anatomie et cytologie pathologiques, institut universitaire du cancer de Toulouse Oncopole, INSERM CRCT-Équipe 11, Toulouse, France
| | - A Varoquaux
- Service de radiologie, hôpital de la conception, AP-HM, Marseille; AMU, Faculté de Médecine Timone CNRS-Centre for Magnetic Resonance in Biology and Medicine, Marseille, France
| | - C-A Righini
- Service d'ORL et de chirurgie de la face et du cou, CHU de Grenoble Alpes (CHUGA), Grenoble, France
| | - O Malard
- Service d'ORL et de chirurgie de la face et du cou, CHU Hôtel Dieu, Nantes, France
| | - P Mogultay
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, Caen; Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie Université, Caen, France
| | - S Tronche
- Société française d'ORL et chirurgie cervico-faciale, Strasbourg, France
| | - R Garrel
- Service d'ORL et de chirurgie de la face et du cou, CHU de Montpellier, Montpellier, France
| | - D Chevalier
- Service d'ORL et de chirurgie de la face et du cou, CHU de Lille, Lille, France
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Pruijn IMJ, van Herpen CML, Pegge SAH, van Engen van Grunsven ACH, Ligtenberg MJ, van den Hoogen FJA. Myotonic dystrophy and recurrent pleomorphic adenomas: Case report and association hypothesis. Neuromuscul Disord 2020; 30:925-929. [PMID: 33077317 DOI: 10.1016/j.nmd.2020.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/23/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
We report a case of a patient with concurrent myotonic dystrophy and recurrent pleomorphic adenoma and hypothesize the association between both diseases. A 58-year-old man with classic myotonic dystrophy type 1 was diagnosed with pleomorphic adenoma. Appropriate treatment was commenced. Massive recurrences occurred within 15, 28 and 22 months respectively, after repeated surgical removal. Three case reports on similar occurrences of synchronous myotonic dystrophy and pleomorphic adenoma are discussed and an association between both disease entities is hypothesized. A conceivable association between myotonic dystrophy and pleomorphic adenoma is hypothesized by upregulation of the Wnt/Beta-catenin signaling pathway, initiated by a decreased expression of microRNA, pleomorphic adenoma gene 1 induced Beta-catenin accumulations and alterations in tumor suppressor genes and oncogenes due to RNA processing defects induced by the expanded repeat in the DMPK gene.
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Affiliation(s)
- Ineke M J Pruijn
- Department of Otolaryngology and Head and Neck Surgery, Radboud university medical center, Postbus 9101, 6500 Nijmegen, the Netherlands.
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud university medical center, Nijmegen, the Netherlands
| | - Sjoert A H Pegge
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Marjolijn J Ligtenberg
- Department of Human Genetics and Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otolaryngology and Head and Neck Surgery, Radboud university medical center, Postbus 9101, 6500 Nijmegen, the Netherlands
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Lubamba GP, Jian G, Yu WX, Guo liang Z, Bo NS, Peng DX, Bushabu FN. Submandibular gland carcinoma ex pleomorphic adenoma clinically mimicking a benign lesion. Oral and Maxillofacial Surgery Cases 2020. [DOI: 10.1016/j.omsc.2020.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Malard O, Thariat J, Cartier C, Chevalier D, Courtade-Saidi M, Uro-Coste E, Garrel R, Kennel T, Mogultay P, Tronche S, Varoquaux A, Righini CA, Vergez S, Fakhry N. Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part II: Management of recurrent pleomorphic adenoma of the parotid gland. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:45-49. [PMID: 32800715 DOI: 10.1016/j.anorl.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the management of recurrent pleomorphic adenoma (RPA) of the parotid gland. METHOD A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted, based on the articles retrieved and the work group members' individual experience. There were then read and re-edited by an independent reading group. The proposed recommendations were graded A, B or C on decreasing levels of evidence. RESULTS Complete resection under neuromonitoring is recommended in case of RPA. The risks of progression and malignant transformation, which are higher the younger the patient, have to be taken into consideration. The risk of functional sequelae must be explained to the patient. MRI is recommended ahead of any surgery for parotid RPA, to determine extension and detect subclinical lesions. Radiotherapy should be considered in case of multi-recurrent pleomorphic adenoma after macroscopically complete revision surgery at high risk of new recurrence (microscopic residual disease), in case of RPA after incomplete resection, and in non-operable RPA.
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Affiliation(s)
- O Malard
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU Hôtel Dieu, Nantes, France
| | - J Thariat
- Département de Radiothérapie, Centre François Baclesse, Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie Université, Caen, France
| | - C Cartier
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - D Chevalier
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Lille, France
| | - M Courtade-Saidi
- Service d'Anatomie et Cytologie Pathologiques, Institut Universitaire du Cancer de Toulouse Oncopole, Inserm CRCT-Équipe 11, Toulouse, France
| | - E Uro-Coste
- Service d'Anatomie et Cytologie Pathologiques, Institut Universitaire du Cancer de Toulouse Oncopole, Inserm CRCT-Équipe 11, Toulouse, France
| | - R Garrel
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - T Kennel
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - P Mogultay
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Montpellier, France
| | - S Tronche
- Société Française d'ORL et Chirurgie Cervico-Faciale, France
| | - A Varoquaux
- Service de radiologie du Pr Chagnaud, Hôpital de la Conception, AP-HM, AMU, Faculté de Médecine Timone CNRS-Center for Magnetic Resonance in Biology and Medicine, France
| | - C A Righini
- Service d'ORL et de Chirurgie de la Face et du Cou, CHU de Grenoble Alpes (CHUGA), France
| | - S Vergez
- Service d'ORL et de Chirurgie de la Face et du Cou, Hôpital Larrey, CHU de Toulouse, Département de Chirurgie, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - N Fakhry
- Service d'ORL et Chirurgie de la Face et du Cou, Hôpital de la Conception, APHM, Aix-Marseille Université, Marseille, France.
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Baněčková M, Uro-Coste E, Ptáková N, Šteiner P, Stanowska O, Benincasa G, Colella G, Vondrák J, Michal M, Leivo I, Skálová A. What is hiding behind S100 protein and SOX10 positive oncocytomas? Oncocytic pleomorphic adenoma and myoepithelioma with novel gene fusions in a subset of cases. Hum Pathol 2020; 103:52-62. [PMID: 32673681 DOI: 10.1016/j.humpath.2020.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
Oncocytomas (OCs) in salivary glands are rare benign tumors composed of mitochondria-rich epithelial cells (oncocytes), mostly localized in the parotid gland. The treatment of choice is simple excision. Extensive oncocytic metaplasia of pleomorphic adenoma (PA) and myoepithelioma (ME) can be diagnostically challenging and may camouflage the correct diagnosis. These tumors should be treated more carefully compared with OC, given the risk of frequent recurrences and the possibility of malignant transformation. We have investigated 89 oncocytic lesions from our files, including OC (n = 74) and metaplastic oncocytic variant of PA/ME (n = 15). All OCs were stained for S100 protein and SOX10. The tumors with immunohistochemical expression of one or both markers were tested by next-generation sequencing (NGS). The NGS results were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or fluorescence in situ hybridization (FISH). Ten cases originally diagnosed as OC, and 1 low-grade uncertain oncocytic tumor (11/74) revealed nuclear-cytoplasmic and/or nuclear positivity for S100 protein and/or SOX10, respectively. Fusion transcripts CHCHD7-PLAG1 and GEM-PLAG1 were found in 2 cases (1 fusion in each), and these were confirmed by RT-PCR and PLAG1 break-apart FISH probe, respectively. Another 5 cases were positive for PLAG1 rearrangement by FISH. In the control group of 15 oncocytic PA/ME, 4/15 tested tumors harbored gene fusions including NFT3-PLAG1, CHCHD7-PLAG1, FBXO32-PLAG1, and C1orf116-PLAG1 (1 fusion in each case) as detected by NGS. Two fusions were confirmed by RT-PCR, 1 case by FISH, and 1 case was not analyzable by FISH. We additionally tested 24 OCs negative for S100 protein and SOX10 by immunohistochemistry (IHC) and by FISH for rearrangement of PLAG1 gene, but none of them were positive. SOX10 and/or S100 protein immunopositivity in conjunction with rearrangement of the PLAG1 gene assisted in reclassification of a subset of oncocytomas as oncocytic variants of PA and ME. Therefore, we recommend to include S100 protein and SOX10 IHC when diagnosing tumors with predominantly oncocytoma-like differentiation. In addition, by NGS, 3 new gene fusions were detected in oncocytic ME, including NTF3-PLAG1, FBXO32-PLAG1, and GEM-PLAG1, and a new fusion C1orf116-PLAG1 was detected in oncocytic PA.
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Affiliation(s)
- Martina Baněčková
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic.
| | - Emmanuelle Uro-Coste
- Department of Pathology, Toulouse University Hospital, IUC-Oncopole, Toulouse, 31100, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, 31100, France
| | - Nikola Ptáková
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Petr Šteiner
- Molecular and Genetic Laboratory, Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Olga Stanowska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 00 001, Poland
| | - Giulio Benincasa
- Department of Pathology, Clinic Pineta Grande, Castel Volturno (CE), 81030, Italy
| | - Giuseppe Colella
- Department of Maxillo-facial Surgery, University Della Campania "Luigi Vanvitelli", Policlinico Piazza Miraglia, Naples, 81100, Italy
| | - Jan Vondrák
- South Bohemian University, Ceske Budejovice, 37005, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, And Turku University Hospital, Turku, 20500, Finland
| | - Alena Skálová
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, 30605, Czech Republic; Bioptic Laboratory Ltd, Plzen, 32600, Czech Republic
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Schapher M, Koch M, Goncalves M, Mantsopoulos K, Iro H. Extracapsular Dissection in Pleomorphic Adenomas of the Parotid Gland: Results After 13 Years of Follow-up. Laryngoscope 2020; 131:E445-E451. [PMID: 32396221 DOI: 10.1002/lary.28696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/17/2020] [Accepted: 04/01/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess long-term results after the treatment of parotid pleomorphic adenomas (PPAs) using different surgical techniques and focusing on recurrence rates and the risk of adverse effects. STUDY DESIGN Retrospective analysis. METHODS Retrospective analysis of 182 patients treated exclusively for PPAs at a tertiary referral center between 2000 and 2004. Thorough follow-up examinations over a mean period of 13 years were possible in 53.8% (n = 98/182). Tumors were categorized according to the European Salivary Gland Society (ESGS) system to improve the comparison of outcomes. After different surgical resection strategies, recurrence rates, postoperative facial nerve paresis (FNP), and incidence of Frey's syndrome were assessed. The follow-up period included clinical examinations and imaging of every patient in the treating department. RESULTS Of 182 patients, extracapsular dissection (ED) was performed in 29.7%, and other surgical modalities (OSMs), including facial nerve dissection, in 70.3%. After the long-term follow-up, 98% of all the patients (n = 96/98) were recurrence free. When recurrence rates were compared, no significant differences were noted (P < .331). ED resulted in significantly lower FNP rates compared to OSMs (P < .001). FNP rates significantly increased with size and location of the tumors according to ESGS categories (temporary and permanent FNP, P = .04). Surgical invasiveness corresponded to a significant increase in the incidence of Frey's syndrome (P < .001). CONCLUSIONS ED was associated with the lowest complication rates, but not with a higher risk of recurrence, when compared with OSM in the long-term course. As ED can be performed in the majority of PPAs, it can be regarded as the treatment of choice whenever possible. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E445-E451, 2021.
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Affiliation(s)
- Mirco Schapher
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology-Head and Neck Surgery, Friedrich-Alexander University Medical School, University of Erlangen-Nuremberg, Erlangen, Germany
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Niazi M, Mohammadzadeh M, Aghazadeh K, Sharifian H, Karimi E, Shakiba M, Baniasadi M, Rahmaty B, Adel S, Moharreri M. Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions. Int Arch Otorhinolaryngol 2020; 24:e160-e169. [PMID: 32256836 PMCID: PMC6828566 DOI: 10.1055/s-0039-1697005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 07/08/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction
The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors.
Objective
The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors.
Methods
A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow [BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs], Warthin's tumor [WT] and pleomorphic adenomas [PA]).
Results
The mean age of the patients was 55.9 ± 14.1 (26–77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62 ± 7.5 years; 52 ± 14.2 for patients with Pas, and 55.2 ± 17.2 for those with MTs (
p
= 0.32). The mean MIP was 122.7 ± 12.2 in WT, while it was 80.5 ± 19.5 in PA, and 76.2 ± 27.1 in MTs (
p
< 0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher in WTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs.
Conclusion
Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.
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Affiliation(s)
- Masume Niazi
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadzadeh
- Division of Neuroradiology, Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Aghazadeh
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sharifian
- Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Maria Baniasadi
- Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Suzan Adel
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melorina Moharreri
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Speight PM, Barrett AW. Salivary gland tumours: diagnostic challenges and an update on the latest WHO classification. ACTA ACUST UNITED AC 2020; 26:147-58. [DOI: 10.1016/j.mpdhp.2020.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Valstar MH, Andreasen S, Bhairosing PA, McGurk M. Natural history of recurrent pleomorphic adenoma: implications on management. Head Neck 2020; 42:2058-2066. [PMID: 32187769 DOI: 10.1002/hed.26137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/18/2020] [Accepted: 03/05/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Treating recurrent pleomorphic adenoma (RPA) aims to reduce risk of malignant transformation (MT) while avoiding facial nerve injury. Our objective was to systematically investigate this natural history of RPA and address the current rational for its treatment. METHODS The follow-up data of two nationwide series of PA was pooled with a focus on risk of MT and analyzed against the literature. RESULTS The combined nationwide data (n = 9003 PA patients) showed 3.1% with first recurrence of which 6.2% were malignant. In the literature first RPA rate was >7% at 20 years follow-up. MT occurred in 0% to 7%, and facial nerve damage increased from with each surgery 3% to 16% at first RPA to 18% to 30% at second RPA. CONCLUSIONS RPA showed a characteristic course with surgery being unreliable and damage to the facial nerve. The risk of MT was low. This might give flexibility towards a more conservative approach of management.
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Affiliation(s)
- Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral-Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Patrick A Bhairosing
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Scientific Information Service, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark McGurk
- Department of Head and Neck Surgery, University College Hospitals, London, UK
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