Surgical management of pleomorphic adenoma of parotid gland in elderly patients: Role of morphological features.

The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic Adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly this tumors occurs mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is a almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extention and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection

Clinico‐histopathological review of 255 patients who underwent parotidectomy for pleomorphic adenoma: a 10‐year retrospective study—a proposal for an optimal diagnostic and therapeutic algorithm for patients with recurrent pleomorphic adenoma

Purpose Pleomorphic adenoma (mixed tumor) is the most common neoplasm of the parotid gland and one of the most frequent types of salivary gland tumor, generally with benign behavior and relatively slow growing. The adenomas could arise from the superficial, deep or from both superficial and deep parotid’s lobes. Methods The aim of this review is to retrospectively analyze the surgical management of patients with pleomorphic adenoma of the parotid gland performed at the Department of Otorhinolaryngology (Department of Sense Organs of “Azienda Policlinico Umberto I” in Rome), from 2010 to 2020, with a focus on the percentage of recurrence and on the complication related to surgery to suggest an optimal diagnostic and therapeutic algorithm for patients with recurrent pleomorphic adenoma. The analysis of the complications observed in case of different surgical approaches was performed using the X2 test. Results The choice of a surgical approach (superficial parotidectomy—SP, total parotidectomy—TP, extracapsular dissec- tion—ECD) depends on several elements, such as the location and the size of the adenoma, the availability of existing technical facilities and the professional experience of the surgeon. A transient facial palsy was present in 37.6%, 2.7% reported a permanent facial nerve palsy, 1.6% developed a salivary fistula, 1.6% a post-operative bleeding and 2.3% showed Frey Syndrome. Conclusion The surgical management of this benign lesion is required, even in asymptomatic cases, to prevent the progressive growing and to reduce the risk of malignant transformation. The goal of surgical excision is to obtain the complete resection to minimize the risk of tumor recurrence and avoiding facial nerve disability. Therefore, an accurate preoperative study of the lesion and the choice of the most appropriate surgical treatment are essential to minimize the rate of recurrence

Clinical approach and treatment of benign and malignant parotid masses, personal experience

Parotid gland tumours account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. In the present study, data were evaluated referring to 540 patients who underwent parotidectomy for a mass which was discovered to be a benign (470 cases) or a malignant (70 cases) neoplasm, between November 1994 and December 2007, at our Institution. The most significant single parameter in this series of malignancies regarding disease specific survival was the clinical involvement of the facial nerve at diagnosis (p = 0.006). Also for this reason, as there is no evidence that liberal VIIth nerve sacrifice improves prognosis, when it is not clinically involved, every attempt is made to dissect and preserve it. At present, the most complicated situation concerning nerve preservation may be, on the other hand, recurrence of a benign tumour, in particular pleomorphic adenoma, which, in our series, has a higher incidence (8.3%) of permanent facial dysfunction, than surgery with nerve preservation for malignancy (3.7%)

Magnetic resonance imaging of parotid gland tumors: a pictorial essay.

Imaging of parotid gland tumors is challenging due to the wide variety of differential diagnoses. Malignant parotid tumors can have very similar features to benign ones, such as slow growth and displacement instead of infiltration of neighboring structures. Malignant and benign tumors may therefore not be clinically distinguishable. Correct characterization of parotid tumors (i.e., benign or malignant) determines preoperative treatment planning and is important in optimizing the individualized surgical plan. Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluation of suspected parotid gland lesions and differentiation between benign and malignant lesions. Certain conventional MRI features can suggest whether a mass is more likely to be a benign or low-grade malignancy or a high-grade malignancy and adding diffusion-weighted imaging or advanced MRI techniques like perfusion can aid in this distinction. Morphological features seen on MRI, such as low signal on T2-w, infiltrative changes or ill-defined margins, change over time and diffusion restriction can point to the malignant nature of the lesion. MRI is useful for detection and localization of the lesion(s), and associated findings like perineural spread of tumor, lymph node involvement and infiltrative changes of the surrounding tissues. In this pictorial essay, we present selected images of a variety of benign and malignant parotid tumors and emphasize the MRI features that may be useful in their characterization

Tumors of Parotid Gland in Albania, 10 Year Study Results

Objective: To evaluate surgical variations and treatment results of parotids gland masses that require parotidectomy. Methodology: The study group includes patients diagnosed in ENT service of UHC Tirana with tumors of the parotid gland and undergone parotidectomy. We recorded all patient personal data, histology (benign or malignant) of the disease, FNAC reports, type of surgical procedure, complications, and histology of the excised masses. All data was elaborated by statistical analysis with SPSS version 15.0. Results: Of 96 patients treated between years 2005-2014, 47 (49%) were males and 49 (51%) were female, with e median age of 42=/-12.6 years old. All patients presented with and indolent mass around the ear. 90.47% (87) of the patients had a benign tumor, and 9.52% (9) had a malignant tumor. Superficial parotidectomy was performed in 79.36% (n=76) of the patient, total parotidectomy was performed in 19% (n=18) of the cases, and total extended parotidectomy was performed in 2 cases with mucoepidermoid carcinoma. The most frequent post-operative complication was auricular major nerve palsy (n=14; 15%), followed by transitory palsy of the facial nerve (n=8; 9%). Conclusions: Parotid gland masses effect people of both genders. Most of the patients have benign disease and mostly pleomorphic adenoma. The surgical procedure performed more frequently is superficial parotidectomy.Keywords: Parotid gland, superficial parotidectomy, pleomorphic adenoma, facial nerve palsy, mucoepidermoid carcinoma

Evaluation of Extracapsular Excision in the management of Benign Parotid Tumors

OBJECTIVE: To study the incidence of facial nerve palsy post operatively in patients undergoing surgical treatment of benign parotid tumors METHOD: This was a prospective, randomized interventional study wherein 36 patients with benign parotid tumors were included and randomized into two groups: Superficial Parotidectomy and Extracapsular Excision. Post operatively, the facial nerve function was assessed by the House-Brackmann Score on post operative days 2, 7 and 10 and compared between the two groups. RESULTS: Post operatively, there was no significant difference between the two operations with regard to facial nerve palsy

Clinical and pathological study of salivary gland swellings

OBJECTIVES : 1. To study the age and sex distribution among patients presenting with Salivary Gland Swellings. 2. To study the mode of clinical presentation of various Salivary Gland Swellings. 3. To study the accuracy of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of Salivary Gland Swellings. 4. To study the methods of current surgical treatments of Salivary Gland Swellings. BACKGROUND DATA : Salivary Gland Swellings are one of the most common clinical conditions encountered by the general surgeon. There are various causes of salivary swellings and they arouse much interest and debate because of their remarkable variability in structure, clinical presentation and behavior. This study was done with a interest to know the incidence, clinical presentation of swellings of the salivary glands, management, complications and correlation of the FNAC with the histopathology. METHODOLOGY : 50 cases of salivary gland swellings presenting to Surgery Dept. and Surgical Oncology Dept. of Govt. Royapettah Hospital and Surgery Dept. of KMC Hospital at Chennai, from November 2014 to August 2015 were prospectively studied. Age, Sex distribution, mode of clinical presentation would be entered in the proforma. Also correlation of FNAC with histopathological findings would be analysed. The various treatment options of different etiologies of Salivary Gland Swellings will also be studied. RESULTS : Salivary gland swelling occurred more commonly in 3rd and 4th decades of life (28.57%) and 65% of salivary swellings were present in females. All patients presented with salivary gland swelling (100%), 65% of patients presented with pain and 55% of patients presented with tenderness. Among the non inflammatory and neoplastic swellings, 65% of salivary swellings were neoplastic and 35% non inflammatory swellings. Among non inflammatory swellings 80% was sialolithiasis and 20% was ranula. 100% of sialolithiasis were present in submandibular salivary glands. 100% of ranula was present in sublingual salivary glands. Among the neoplastic swellings, 100% of the neoplastic swellings were present in parotid glands. FNAC has overall diagnostic accuracy of 100%. Superficial parotidectomy is the most common surgery performed for neoplastic lesions (56.4%). Wound infection is the most common post operative complications. CONCLUSION: Non-inflammatory and neoplastic salivary swellings are common in the middle age group and in females. Non-inflammatory swellings are more common in submandibular salivary glands. Sialolithiasis predominated the non-inflammatory swellings. Neoplastic swellings are more common in parotid gland and pleomorphic adenoma dominates the neoplastic swellings. FNAC has got a good accuracy in diagnosing salivary gland tumours. Pain X ray has got accuracy in diagnosing sialolithiasis. Surgery is the main modality in the treatment in both non inflammatory and neoplastic salivary gland swellings. Early diagnosis of the condition with subsequent surgical management carries a very good prognosis

Preoperative Multiparametric Ultrasound and Fine Needle Aspiration Cytology evaluation of parotid gland tumors : which is the best technique?

Publisher Copyright: © 2021 Societatea Romana de Ultrasonografie in Medicina si Biologie. All rights reserved.AIMS: To evaluate the pre-surgical diagnostic value of Multiparametric Ultrasound (MPUS) and Fine Needle Aspiration Cytology (FNAC) in differentiating parotid gland tumors, comparing the results with histology. MATERIALS AND METHODS: The study enrolled 84 patients with parotid gland lesions surgically treated in a single tertiary center and evaluated by MPUS. Each patient underwent FNAC. Histological examination was considered the gold standard. RESULTS: Histology identified 62 benign tumors and 22 malignancies. In the differential diagnosis between malignant and benign lesions, B-mode Ultrasound (US), Color-Doppler US, Contrast-Enhanced US (CEUS), Elastography (USE) and FNAC showed the following values of sensitivity: 82%, 81%, 86%, 77%, 73% respectively; specificity: 97%, 61%, 95%, 71%, 97% respectively; PPV: 90%, 43%, 86%, 50%, 89% respectively; NPV: 93%, 90%, 95%, 88%, 91% respectively; and accuracy: 89%, 71%, 90%, 78%, 84% re-spectively. CONCLUSIONS: CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.publishersversionPeer reviewe

Parotid tumours: clinical and oncologic outcomes after microscope-assisted parotidectomy with intraoperative nerve monitoring

I pazienti sottoposti ad intervento chirurgico di parotidectomia per lesioni benigne e maligne possono presentare disfunzioni temporanee o permanenti del nervo facciale. Il monitoraggio intraoperatorio della motilità facciale è uno strumento ampiamente riconosciuto per la sua utilità nella preservazione del nervo, mentre lefficacia del microscopio operatorio è stata raramente discussa. Gli autori riportano la loro esperienza su 198 parotidectomie consecutive eseguite su 196 pazienti con lausilio del microscopio operatorio e del monitoraggio intraoperatorio del nervo facciale. Centoqurantacinque interventi sono stati eseguiti per lesioni benigne e 53 per neoplasie maligne. Tredici pazienti operati per lesioni benigne hanno presentato un deficit della funzionalità del nervo facciale: 11 hanno sofferto di paralisi temporanea e 2 di paralisi permanente (entrambe di secondo grado). Dieci pazienti affetti da patologia maligna presentavano un interessamento preoperatorio del nervo facciale. Cinque e sei pazienti affetti da patologia maligna senza interessamento preoperatorio del nervo hanno presentato un deficit rispettivamente temporaneo e definitivo (in 2 casi il sacrificio di un ramo del nervo macroscopicamente infiltrato dalla neoplasia fu deciso solo durante la procedura chirurgica). Lincidenza di paralisi definitiva di una singola branca del nervo facciale dopo interventi eseguiti per lesioni che non originavano dal nervo facciale o che non lo infiltravano macroscopicamente (n = 185) è stata del 2,7%. I pazienti trattati per tumori benigni non flogistici del lobo superficiale della ghiandola parotide (n = 91) hanno presentato una paralisi facciale postoperatoria temporanea nel 4,4% dei casi e nessun deficit permanente. Luso combinato del microscopio operatorio e del monitoraggio intraoperatorio del nervo sembra garantire la preservazione del nervo facciale nei pazienti sottoposti a parotidectomia