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Becelli R, Facchini V, Piccirilli A, Maesa F, Bozza F, Giovannetti F, Lupi E, Covelli E, Colangeli W. SMAS flap for extracapsular dissection of parotid gland tumors: is it necessary? Braz J Otorhinolaryngol 2024; 90:101462. [PMID: 38991401 PMCID: PMC11295561 DOI: 10.1016/j.bjorl.2024.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/19/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE The aim of this retrospective article is to evaluate postoperative outcomes after extracapsular dissection for small benign superficial parotid neoplasms (<3 cm) in patients who received Superficial Musculoaponeurotic System (SMAS) flap and in patients who did not receive it. METHODS Two groups were created and statistically compared regarding Frey's syndrome and aesthetic satisfaction by data collected through the POI-8 validated questionnaire and through an aesthetic satisfaction scale ranging from 1 to 10. The difference between these two groups was the utilization of SMAS flap. SMAS flap was harvested in one of these two group, meanwhile was not used in the other. RESULTS The p-value analysis between group 1 and group 2 on these complications, resulted statistically not significant. Also, the aesthetic satisfaction resulted not statistically significant between group 1 and group 2. Gender, localization, and facial palsy resulted statistically correlated with the aesthetic satisfaction (p-value < 0.05). CONCLUSION In conclusion, there is no statistical difference in the use of SMAS flap for benign parotid neoformations of the superficial lobe, with a diameter of less than 3 cm for which extracapsular dissection is adopted as a surgical technique. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Roberto Becelli
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, U.O. Chirurgia Maxillo-Facciale, Rome, Italy
| | - Valerio Facchini
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, U.O. Chirurgia Maxillo-Facciale, Rome, Italy.
| | - Alessandro Piccirilli
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, U.O. Chirurgia Maxillo-Facciale, Rome, Italy
| | - Flavia Maesa
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, U.O. Chirurgia Maxillo-Facciale, Rome, Italy
| | - Fabrizio Bozza
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, U.O. Chirurgia Maxillo-Facciale, Rome, Italy
| | - Filippo Giovannetti
- Università Degli Studi Dell'Aquila, Dipartimento di Medicina Clinica e Sanità Pubblica, ASL1 Abruzzo, UOSD Chirurgia Maxillo-Facciale, Rome, Italy
| | - Ettore Lupi
- Università Degli Studi Dell'Aquila, Dipartimento di Medicina Clinica e Sanità Pubblica, ASL1 Abruzzo, UOSD Chirurgia Maxillo-Facciale, Rome, Italy
| | - Edoardo Covelli
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), Rome, Italy
| | - Walter Colangeli
- Università di Roma "La Sapienza", Facoltà di Medicina e Psicologia, Ospedale Sant'Andrea di Roma, U.O. Chirurgia Maxillo-Facciale, Rome, Italy
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Sundarajan K, Subagar AS, Arumugam K. "Unraveling the Tapestry": A Retrospective Exploration of Recurrent Parotid Pleomorphic Adenoma Cases. Indian J Otolaryngol Head Neck Surg 2024; 76:3227-3233. [PMID: 39130327 PMCID: PMC11306486 DOI: 10.1007/s12070-024-04650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/17/2024] [Indexed: 08/13/2024] Open
Abstract
The standard surgical procedure for treating the parotid gland's recurrent pleomorphic adenoma (RPA) is parotidectomy with facial nerve preservation (FN). Treatment of RPA remains challenging since controversies occur regarding recurrence, degree of revision surgery, postoperative radiation, and difficulty in conserving the FN. A retrospective review of patient's medical records treated for benign parotid neoplasms was conducted between 2017 and 2022 to identify individuals who underwent surgery for RPA. Demographic information, surgical intervention details, pre-and postoperative facial nerve function, histopathological analysis, and recurrence rates were collected. These variables were compared in patients with single recurrent tumors versus patients with multiple recurrent tumors. Twenty-one patients met the criteria, including 13 with a first recurrence, 7 with a second recurrence, and 1 with a third recurrence. Following surgery for multiple RPA, long-term FN outcomes were significantly worse (P = 0.005). There were no observable risk factors for tumor recurrence. The interval between the initial revision surgery and subsequent ones was drastically shortened. Our study suggests that the risk of permanent facial paralysis is greater with subsequent surgical procedures. Early detection of recurrence can aid in early re-operation.
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Affiliation(s)
- Karthik Sundarajan
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu 600003 India
| | - A S Subagar
- Department of Otorhinolaryngology, Saveetha Medical college, Thandalam, Chennai, TamilNadu 602105 India
| | - Karthiga Arumugam
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, TamilNadu 602105 India
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Carkic J, Nikolic N, Sango V, Riberti N, Anicic B, Milasin J. MiR-26a and miR-191 are upregulated while PLAG1 and HIF2 are downregulated in pleomorphic adenomas of the salivary glands compared to Warthin tumors. J Oral Pathol Med 2024; 53:451-457. [PMID: 38853518 DOI: 10.1111/jop.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Salivary gland tumors (SGTs) are a heterogenous group of pathologies, which still represents a challenge regarding differential diagnosis and therapy. Although histological findings govern SGTs management, detection of molecular alterations is emerging as an effective additional tool. The aim of this study was to analyze the relative expression levels of three micro RNAs (miR-26a, miR-26b, and miR-191), and three pro-oncogenic molecular markers (PLAG1, MTDH, and HIF2) in SGTs and normal salivary gland (NSG) tissues and evaluate them as potential differential diagnosis markers. METHODS This cross-sectional study included 58 patients with SGTs (23 pleomorphic adenomas, 27 Warthin tumors, and 8 malignant SGTs) and 10 controls (normal salivary gland tissues). Relative gene expression levels of all investigated molecules were determined by reverse transcriptase-real-time polymerase chain reaction. RESULTS All three micro RNAs exhibited highest expression levels in benign SGTs, whereas miR-26a And miR-191 were significantly more expressed in PAs compared to WTs (p = 0.045 and p = 0.029, respectively). PLAG1 And HIF2 were both overexpressed in WTs compared to PAs (p = 0.048 and p = 0.053, respectively). Bioinformatic analysis suggested that all investigated micro RNAs function as negative regulators of MTDH. CONCLUSION The results of this study suggest that all three micro RNAs have a considerable negative impact on MTDH oncogene expression in malignant tumors, while the differences between levels of miR-26a, miR-191, PLAG1, and HIF2 in PA and WT represent possible differential diagnosis markers.
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Affiliation(s)
- Jelena Carkic
- School of Dental Medicine, Implant Research Center, University of Belgrade, Belgrade, Serbia
| | - Nadja Nikolic
- School of Dental Medicine, Implant Research Center, University of Belgrade, Belgrade, Serbia
| | - Violeta Sango
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Nicole Riberti
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Boban Anicic
- School of Dental Medicine, Clinic for Maxillofacial Surgery, University of Belgrade, Belgrade, Serbia
| | - Jelena Milasin
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Crawford KL, Lee YJ, Hom M, Rosenthal EL, Orosco RK, Nguyen QT. Identification of Degenerated Murine Facial Nerves With Fluorescence Labeling After Transection Injury. Otolaryngol Head Neck Surg 2023; 169:234-242. [PMID: 36758958 DOI: 10.1002/ohn.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Delayed peripheral nerve repair is complicated by nerve degeneration and atrophy that can prevent identification. We use a murine facial nerve transection model to demonstrate the efficacy of ALM-488 (bevonescein) in labeling degenerated facial nerves with quantitative image analysis and qualitative survey data. STUDY DESIGN Prospective cohort study. SETTING Laboratory. METHODS Ten wild-type mice underwent transection of the lower facial nerve division with subsequent degeneration. Either 9 (n = 5 mice) or 12 (n = 5 mice) weeks later, mice underwent intravenous infusion of ALM-488 with in vivo real-time fluorescence imaging (FL) of the facial nerve. Using ImageJ, the mean gray value of each nerve segment under white light reflectance (WLR) and FL was compared to that of adjacent soft tissue to calculate the signal-to-background ratio (SBR). A survey was distributed to evaluate the perceived utility of ALM-488 in surgeon identification of degenerated nerves. RESULTS The mean SBR of degenerated nerves was 1.08 (standard deviation [SD]: 0.07) under WLR and 2.11 (SD: 0.31) under FL (p < 0.001). In mice with degenerated nerves, survey participants identified on average 3.01 (SD: 1.84) nerve branches under WLR and 5.73 (SD: 1.88) under FL (p < 0.0001). Under FL, 47 of 48 survey responses correctly identified isolated, degenerated nerves; in contrast, only 12 responses identified degenerated nerves under WLR (p < 0.0001). CONCLUSION Preoperative intravenous infusion of ALM-488 with FL improves the identification of degenerated facial nerves. ALM-488 also improves surgeon confidence in nerve identification, particularly in degenerated nerve branches that are not visible with WLR.
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Affiliation(s)
- Kayva L Crawford
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Marisa Hom
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Ryan K Orosco
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
- Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California San Diego, California, San Diego, USA
| | - Quyen T Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
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5
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Zoccali F, Cialente F, Colizza A, Ralli M, Greco A, de Vincentiis M. 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. Eur Arch Otorhinolaryngol 2023; 280:3329-3335. [PMID: 36872347 PMCID: PMC10219862 DOI: 10.1007/s00405-023-07897-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
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 dissection-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.
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Affiliation(s)
- Federica Zoccali
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Fabrizio Cialente
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
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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] [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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7
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Crosetti E, Arrigoni G, Fantini M, Fondello G, Moniaci D, Carnino R, Succo G. Lipofilling after total parotidectomy: a useful option to prevent functional and aesthetic sequelae. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:516-524. [PMID: 36654517 PMCID: PMC9853102 DOI: 10.14639/0392-100x-n2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023]
Abstract
Objective Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients. Methods 15 patients underwent total conservative parotidectomy, harvesting of a superficial musculoaponeurotic system (SMAS) flap and lipofilling between May 2014 and June 2020 for a benign parotid tumour. Aesthetic, functional sequelae and cosmetic results were assessed with the House-Brackmann scale, Luna-Ortiz's classification and a semiquantitative questionnaire. Lipofilling resorption was analysed by maxillofacial and neck MRI imaging at 2 years after surgery. The results were compared to a group of 21 patients who underwent total parotidectomy without harvesting a SMAS flap and lipofilling. Results No complications were observed. No facial defects were seen during follow-up. Post-operative MRI showed fat resorption was less than 20% in 12 patients and from 20 to 30% in 3 patients. Cosmetic satisfaction was 100% in all cases. Only 1 patient (6%) complained of Frey's syndrome. Conclusions Lipofilling is an excellent solution considering its efficacy, safety, simplicity, duration over time and economic costs. Donor site invasiveness is minimal, and reintervention is always possible. Face-lift incision and SMAS flap can improve aesthetic results and minimise the disfiguring impact of the surgical scar.
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Affiliation(s)
- Erika Crosetti
- ENT Unit, San Luigi Gonzaga Hospital, Orbassano (TO), Italy, Department of Oncology, University of Turin, Orbassano (TO), Italy,Correspondence Erika Crosetti ENT Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy, Regione Gonzole 10, 10043 Orbassano, Turin, Italy Tel. +39 011 9026463 E-mail:
| | | | | | | | - Diego Moniaci
- Vascular Surgery Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Riccardo Carnino
- Plastic Surgery Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo (TO), Italy
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8
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Brar G, Smith S, Block A, Borrowdale R, Marzo SJ, Thorpe E, Leonetti JP. An institutional review of recurrent pleomorphic adenoma of the parotid gland. EAR, NOSE & THROAT JOURNAL 2022:1455613211068574. [PMID: 35081805 DOI: 10.1177/01455613211068574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Surgical resection is standard treatment for pleomorphic adenoma (PA) of the parotid gland. A small number (2-5%) of these tumors recur. Recurrence usually necessitates reoperation, which is technically challenging and puts the facial nerve (FN) at risk. The aim of this study is to characterize the recurrent parotid PA population and compare outcomes after surgery for singly recurrent and multiply recurrent tumors. METHODS This study was a retrospective chart review of patients at a single tertiary care academic medical center who underwent operations for recurrent PA of the parotid gland between 2007 and 2020. Demographic data, details of surgical interventions, pre- and postoperative FN function, and recurrence rates were studied. These factors were compared between patients with singly and multiply recurrent tumors. RESULTS Thirty-eight patients met criteria: 4 patients presented for primary PA and subsequently recurred, 26 with a first recurrence, 7 with a second recurrence, and 1 with a fourth recurrence. Multiply recurrent PAs were more likely to require at least partial nerve sacrifice at the time of reoperation (P = 0.0092). Significantly worse long-term FN outcomes were seen following surgery for multiply recurrent PA (P = 0.008). There was no significant difference between the rate of re-recurrence following first revision surgery vs second-fourth revision surgery. Time to reoperation was significantly shorter between the first and second revision surgery than between the primary surgery and first revision (P = 0.0017). CONCLUSION Surgery for recurrent PA incurs high risk to the FN, and this risk appears to increase in the setting of multiple recurrences.
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Affiliation(s)
- Gurmehr Brar
- 12248Loyola University Chicago, Stritch School of Medicine, Chicago, IL, USA
| | - Sullivan Smith
- Loyola University Medical Center, Department of Otolaryngology, 25815Loyola University Chicago, Chicago, IL, USA
| | - Alec Block
- Loyola University Medical Center, Department of Radiation Oncology, 25815Loyola University Chicago, Chicago, IL, USA
| | - Richard Borrowdale
- Loyola University Medical Center, Department of Otolaryngology, 25815Loyola University Chicago, Chicago, IL, USA
| | - Sam J Marzo
- Loyola University Medical Center, Department of Otolaryngology, 25815Loyola University Chicago, Chicago, IL, USA
| | - Eric Thorpe
- Loyola University Medical Center, Department of Otolaryngology, 25815Loyola University Chicago, Chicago, IL, USA
| | - John P Leonetti
- Loyola University Medical Center, Department of Otolaryngology, 25815Loyola University Chicago, Chicago, IL, USA
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9
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Hintze JM, O’Duffy F, White-Gibson A, O’Neill P, Kinsella J, Timon C, Lennon P. Supporting the use of adjuvant radiotherapy in recurrent pleomorphic adenoma of the parotid. Acta Otolaryngol 2021; 141:971-976. [PMID: 34622733 DOI: 10.1080/00016489.2021.1980226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of adjuvant radiotherapy remains controversial in the treatment of recurrent pleomorphic adenomas. AIMS/OBJECTIVES The aim of this study was to provide the highest level of evidence possible by performing a systematic review and meta-analysis of the literature. MATERIAL AND METHODS We searched the English-language literature between 1985 and 2019.Inclusion criteria included any study on the treatment and outcome of recurrent pleomorphic adenomas. Exclusion criteria included the use of radiotherapy for residual tumors, case reports, and pleomorphic adenomas not arising from the parotid. RESULTS A total of 522 abstracts were studied, data analyzed from 14 studies, on a total of 697 patients. When the data werepooled, the overall risk of further recurrence was 21%. In studies where surgery alone was undertaken this increased to 26% and decreased to 10% in those receiving adjuvant radiotherapy (p = .000). There were 21 recurrences in 159 patients in the radiotherapy group, and 151 recurrences out of 538 patients in the surgery group (p < .0001). CONCLUSIONS These data support the use of radiotherapy to decrease the risk of re-recurrence in recurrent pleomorphic adenoma. SIGNIFICANCE This study is the highest level of evidence currently available in guiding management of recurrent pleomorphic adenoma.
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Affiliation(s)
- Justin M. Hintze
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal O’Duffy
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Ailbhe White-Gibson
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul O’Neill
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Kinsella
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Conrad Timon
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology – Head and Neck Surgery, St. James Hospital, Dublin, Ireland
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
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10
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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] [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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11
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Recurrent Pleomorphic Adenoma of the Parotid Gland: Experience of 128 Patients with First Recurrence. JOURNAL OF ONCOLOGY 2020; 2020:6645340. [PMID: 33424971 PMCID: PMC7775151 DOI: 10.1155/2020/6645340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 11/17/2022]
Abstract
Objective Recurrence is common after inappropriate surgical procedures for parotid pleomorphic adenoma (PA). However, there are some controversies regarding intraoperative tumor rupture and disease recurrence; therefore, our goal was to clarify this relationship by describing our experience with 128 cases of recurrent parotid PA. Methods Patients suffering from a first recurrence of parotid PA were prospectively enrolled, and data regarding the operation, pathology, immunohistochemistry, and recurrence pattern (outside the previous surgical field vs. inside the previous surgical field) were extracted and analyzed. The recurrent lesions were divided into two groups based on the location of nodularity. Results Thirty-five patients had recurrent disease outside the previous surgical field; there were 105 nodules with a mean size of 1.0 (range: 0.4-3.0) cm and 983 nodules with a mean size of 1.55 (range: 0.5-4.5) cm within the field, and the difference was significant (p=0.001). The mean values of Ki-67 in nodules outside of and within the previous surgical field were 4.7% (range: 2%-10%) and 2.1% (range: 1%-7%), respectively, and the difference was significant (p < 0.001). In nodules outside the previous surgical field, cell-rich nodules were noted in 71.6% of cases; in nodules within the previous surgical field, cell-rich nodules were found in 30.4% of cases, and the difference was significant (p < 0.001). Conclusion Tumor rupture is not the only cause of disease recurrence, and recurrent PAs outside the previous surgical field are smaller in size, have higher Ki-67 expression, and have more cell-rich nodules than those within the surgical scar.
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12
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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] [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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13
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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] [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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14
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Psychogios G, Bohr C, Constantinidis J, Canis M, Vander Poorten V, Plzak J, Knopf A, Betz C, Guntinas-Lichius O, Zenk J. Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors. Eur Arch Otorhinolaryngol 2020; 278:15-29. [DOI: 10.1007/s00405-020-06250-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
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15
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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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16
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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: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [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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17
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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] [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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18
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Endoscope-assisted hairline approach for resecting maxillofacial masses. Int J Oral Maxillofac Surg 2020; 49:310-316. [DOI: 10.1016/j.ijom.2019.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/28/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
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19
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Aro K, Valle J, Tarkkanen J, Mäkitie A, Atula T. Repeatedly recurring pleomorphic adenoma: a therapeutic challenge. ACTA ACUST UNITED AC 2019; 39:156-161. [PMID: 31131834 PMCID: PMC6536033 DOI: 10.14639/0392-100x-2307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/29/2018] [Indexed: 12/29/2022]
Abstract
Pleomorphic adenoma (PA) is the most common tumour of the salivary glands, and can recur even after proper surgery. The extent and timing of surgery for recurrent tumours remains controversial, and multiple recurrences pose a special challenge. We evaluated all recurrent PAs (RPAs) treated at the Helsinki University Hospital through 2004-2013 focusing on patients with multiple recurrences. Follow-up data were obtained until January 2018. Of the 47 patients, 70% were women and the median age was 33.5 years. Most of the RPAs were located in the parotid gland (87%), and six (13%) in the submandibular gland. One-third (17/47) of tumours had been primarily excised. This patient population experienced 75 recurrent events in total with two or more recurrences in 14 patients (30%). The time interval between recurrences shortened after each recurrent event and the tumour was more likely to be multifocal. At the end of the follow-up period, 15% had recurrent disease and malignant transformation had occurred in 6%. Treatment for PA and RPA is challenging and requires centralised management. Patients with RPA are often young and recurrences may cause lifelong morbidity, especially when the tumour recurs repeatedly. The utilisation and timing of postoperative radiotherapy needs to be discussed as well as the potential risk for malignant transformation in this patient population.
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Affiliation(s)
- K Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - J Valle
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - J Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Finland
| | - A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - T Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
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20
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Kim JP, Lee DK, Moon JH, Ryu JS, Woo SH. Endoscope‐assisted transoral accessory parotid mass excision: Multicenter prospective observational study. Laryngoscope 2019; 130:1218-1226. [DOI: 10.1002/lary.28190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Jin Pyeong Kim
- Department of OtolaryngologyGyeongsang National University Hospital Changwon Republic of Korea
- Institute of Health Sciences, Gyeongsang National University Jinju Republic of Korea
| | - Dong Kun Lee
- Department of Otolaryngology–Head and Neck SurgeryDong‐A University College of Medicine Busan Republic of Korea
| | - Jeong Hwan Moon
- Department of OtorhinolaryngologyNational Cancer Center Ilsan Republic of Korea
| | - Jun Sun Ryu
- Head and Neck Oncology ClinicNational Cancer Center Ilsan
| | - Seung Hoon Woo
- Department of Otolaryngology–Head and Neck surgeryDankook University College of Medicine Cheonan Republic of Korea
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21
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Roth SH, Faquin WC, Gimenez C, Vadalia B, Frank DK, Li JY. Schwannoma-Like Pleomorphic Adenoma: Two Cases and a Review of the Literature. Head Neck Pathol 2019; 14:166-172. [PMID: 30968284 PMCID: PMC7021839 DOI: 10.1007/s12105-019-01036-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022]
Abstract
Schwannoma-like pleomorphic adenoma is a rare variant of the common benign salivary neoplasm, pleomorphic adenoma. This entity's cytomorphology closely mimics a schwannoma, potentially making a diagnosis of cytologic preparations or of surgical specimens a challenge. To the best of our knowledge, there are only six previous reports of schwannoma-like pleomorphic adenoma with eight total cases in the English language literature prior to the addition of the two cases detailed in this report. Our report includes what we believe to be the first documented case of this entity occurring in the submandibular gland. One of our cases occurred in the submandibular gland of a 90-year-old woman and the other occurred in the left parotid gland of a 40-year-old woman. We also examine the diagnostic considerations used to differentiate these two entities.
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Affiliation(s)
- Stephen H. Roth
- Division of Oral Pathology, Department of Dental Medicine, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, 270-05 76th Ave New, Hyde Park, NY 11040 USA
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY USA
| | - Bhumika Vadalia
- Department of Pathology and Laboratory Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY USA
| | - Douglas K. Frank
- Division of Head and Neck Surgery, Department of Otolaryngology, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Norhtwell Health, New Hyde Park, NY USA
| | - Jian Yi Li
- Department of Pathology and Laboratory Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY USA
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22
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Kuriyama T, Kawata R, Higashino M, Nishikawa S, Inui T, Terada T, Haginomori SI, Kurisu Y, Hirose Y. Recurrent benign pleomorphic adenoma of the parotid gland: Facial nerve identification and risk factors for facial nerve paralysis at re-operation. Auris Nasus Larynx 2019; 46:779-784. [PMID: 30922530 DOI: 10.1016/j.anl.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/11/2018] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Surgery for recurrent pleomorphic adenoma of the parotid gland is challenging since there is a considerable risk of facial nerve injury and a high re-recurrence rate. We investigated surgery for recurrent pleomorphic adenoma, focusing on management of the facial nerve. METHODS We reviewed 29 patients who underwent surgery for recurrent benign pleomorphic adenoma of the parotid gland at our department between 1999 and 2018. We examined clinicopathologic features and risk factors for facial nerve injury during reoperation. RESULTS Factors associated with difficulty in identifying the main trunk of the facial nerve during surgery were bilobar tumors, multiple tumors, and use of an S-shaped skin incision at the previous operation. When the facial nerve was identified intraoperatively, it could be preserved in 2/3 of patients, while the nerve was only preserved in 1/3 of patients when it was not identified. Factors related to permanent postoperative paralysis included recurrence in the deep lobe or both lobes and multiple tumors. CONCLUSION The probability of successfully preserving the facial nerve is relatively high if the nerve can be identified during surgery for recurrent pleomorphic adenoma, although intentional resection is necessary in some patients. Factors associated with difficulty in identifying the facial nerve are similar to those related to permanent postoperative paralysis, including bilobar tumors and multiple tumors. In patients with recurrent pleomorphic adenoma, preservation of the facial nerve is difficult, when they may have undergone previous extensive resection or have multiple tumors requiring subtotal or more extensive resection.
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Affiliation(s)
- Tatsuro Kuriyama
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Masaaki Higashino
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shuji Nishikawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takaki Inui
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tetsuya Terada
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
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Mc Loughlin L, Gillanders SL, Smith S, Young O. The role of adjuvant radiotherapy in management of recurrent pleomorphic adenoma of the parotid gland: a systematic review. Eur Arch Otorhinolaryngol 2018; 276:283-295. [DOI: 10.1007/s00405-018-5205-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 02/03/2023]
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Tobouti PL, Horikawa FK, Matuck BF, de Sousa SCOM, Alves FA. Oral focal mucinosis of the hard palate and gingiva. AUTOPSY AND CASE REPORTS 2018; 8:e2018044. [PMID: 30775321 PMCID: PMC6360821 DOI: 10.4322/acr.2018.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/28/2018] [Indexed: 11/23/2022] Open
Abstract
Oral focal mucinosis (OFM) is an uncommon, asymptomatic, submucosal, slow-growing nodule representing a counterpart of the cutaneous focal mucinosis (CFM). OFM has a female predilection with the highest prevalence in the fifth decade of life. About 68% of OFMs occur in the gingiva and 14% in the palate. We present the case of a 41-year-old woman presenting a progressively growing mass on the palate, since the last 8 months. The diagnostic workup led to the diagnosis of an unusual OFM with the clinical presentation involving the gingiva and hard palate. This case report discusses the clinical and histopathological differential diagnosis.
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Affiliation(s)
- Priscila Lie Tobouti
- Universidade de São Paulo, School of Dentistry, Stomatology Department. São Paulo, SP, Brazil.,Universidade de São Paulo, School of Dentistry, Oral Pathology. São Paulo, SP, Brazil
| | - Fernando Kendi Horikawa
- Universidade de São Paulo, School of Dentistry, Stomatology Department. São Paulo, SP, Brazil
| | - Bruno Fernandes Matuck
- Universidade de São Paulo, School of Dentistry, Stomatology Department. São Paulo, SP, Brazil
| | | | - Fábio Abreu Alves
- Universidade de São Paulo, School of Dentistry, Stomatology Department. São Paulo, SP, Brazil.,A.C. Camargo Cancer Center, Stomatology Department. São Paulo, SP, Brazil
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Malignant Transformation of Pleomorphic Adenoma of Vulva: Report of a Rare Case and Review of Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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26
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Glikson E, Sagiv D, Mansour J, Bedrin L, Talmi YP, Alon EE. Recurrent pleomorphic adenoma: is treatment considerably delayed thus affecting surgical morbidity? Acta Otolaryngol 2018; 138:407-410. [PMID: 29141486 DOI: 10.1080/00016489.2017.1398840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the incidence of late presentation of patients with recurrent pleomorphic adenoma (RPA) of the parotid gland. METHODS This is a retrospective analysis of patients treated in our center. We examined patients demographics, disease characteristics, treatment, and outcome and as well as the time period length from the first discovery of a recurrent mass until seeking treatment at our clinic and its effect on morbidity. RESULTS A total of 30 patients were included. 26% underwent initial enucleation in other institutions. In eight patients (26%), the recurrence of the mass was second or higher. The patients average time period length until seeking treatment was 2.48 years, with 33% of patients showing a time period length of over three years. Multifocal tumor, tumor diameter larger than 2 cm and facial nerve involvement were found in 15 (50%),16 (53.3%) and seven (25%) patients respectively. Patient's delay of presentation by ≥3 years was associated with a tumor size of ≥2 cm (Relative Risk [RR] = 2, p = .02). Patient's delay of presentation by ≥2 years was also associated with a trend towards a higher rate of post-operative facial nerve palsy (RR = 3.37, p = .07, CI = 0.88-12.85). CONCLUSION Most patients with RPA were presented late, thus affecting disease extent and surgical morbidity.
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Affiliation(s)
- Eran Glikson
- Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
| | - Doron Sagiv
- Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
| | - Jobran Mansour
- Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
| | - Lev Bedrin
- Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
| | - Yoav P. Talmi
- Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran E. Alon
- Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kanatas A, Ho MWS, Mücke T. Current thinking about the management of recurrent pleomorphic adenoma of the parotid: a structured review. Br J Oral Maxillofac Surg 2018. [PMID: 29526342 DOI: 10.1016/j.bjoms.2018.01.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients' health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes. Information collected included sample size, recurrence rate, condition of the facial nerve, type of operation, adjuvant treatments associated with recurrence, and clinical outcome. We screened 2301 papers, of which 49 were eligible. There was no consensus among authors about management. There are few if any randomised studies, and so conclusions in most papers were based on coherent arguments. Pleomorphic adenomas of the parotid tend to recur after long intervals, with a propensity towards multifocal disease, and the risk of recurrence (which depends on the initial surgical technique) is higher when the initial operation was done at a young age, after enucleation, and if the initial margins were invaded. Published conclusions suggest that the accepted management varies from observation in selected cases to total parotidectomy with or without postoperative radiotherapy.
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Affiliation(s)
- A Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, LS1 3EX.
| | - M W S Ho
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, LS1 3EX.
| | - T Mücke
- Department of Oral and Maxillofacial Surgery, Malteser Klinikum, Krefeld, North Rhine-Westphalia, Germany.
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Maithani T, Pandey AK, Agrahari AK. An Overview of Parotidectomy for Benign Parotid Lesions with Special Reference to Perioperative Techniques to Avoid Complications: Our Experience. Indian J Otolaryngol Head Neck Surg 2018; 71:258-264. [PMID: 31741970 DOI: 10.1007/s12070-018-1261-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 01/30/2018] [Indexed: 12/12/2022] Open
Abstract
The aim of this analytical study was to assess the reduction in intra- and post-operative complications of parotid surgeries for benign lesions following simple surgical steps and to compare the outcome with the literature. A retrospective study of 77 patients requiring parotidectomy surgery for benign parotid lesions was conducted in Department of Otorhinolaryngology, Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun from the period of January 2011 to January 2016. Patients were followed up for 1-5 years and serial evaluation was done for all cases who developed any of intra- or post-operative complications in their disease course. The ages of presentation varied from 1.5 to 70 years. There were 51 males and 26 female patients. Majority cases were of pleomorphic adenoma followed by warthins tumor. Superficial parotidectomy was done in 69 patients; 4 cases required near total parotidectomy while total conservative parotidectomy was done in 4 cases. The commonest complication was altered sensations around the ear which was seen in 10 cases followed by temporary facial nerve paresis and sialocele formation which occurred in 3 cases each. This study advocates the importance of detailed anatomical knowledge, behavior of various benign pathologies, experience of surgeon and his fine dissection techniques to ensure minimum risks of injury to important structures in surgical field.
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Affiliation(s)
- Tripti Maithani
- Department of ENT, Mahant Indiresh Hospital, Shri Guru Ram Rai Institute of Medical and Health Sciences, 1, Patel Nagar, Dehradun, India
| | - Apoorva Kumar Pandey
- Department of ENT, Mahant Indiresh Hospital, Shri Guru Ram Rai Institute of Medical and Health Sciences, 1, Patel Nagar, Dehradun, India
| | - Alok Kumar Agrahari
- Department of ENT, Mahant Indiresh Hospital, Shri Guru Ram Rai Institute of Medical and Health Sciences, 1, Patel Nagar, Dehradun, India
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30
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Kato MG, Erkul E, Nguyen SA, Day TA, Hornig JD, Lentsch EJ, Gillespie MB. Extracapsular Dissection vs Superficial Parotidectomy of Benign Parotid Lesions: Surgical Outcomes and Cost-effectiveness Analysis. JAMA Otolaryngol Head Neck Surg 2017; 143:1092-1097. [PMID: 28975191 DOI: 10.1001/jamaoto.2017.1618] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The clinical implications of extracapsular dissection over superficial parotidectomy are controversial and limited in data on cost-effectiveness. Objective To compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness. Design, Setting, and Participants This was a retrospective medical record review and cost-effectiveness analysis performed from August 2012 to November 2015 at a tertiary care institution. Adult patients (age ≥18 years) who underwent parotidectomy for benign parotid lesions were included. Exposures Treatment by extracapsular dissection or superficial parotidectomy. Main Outcomes and Measures Differences in postoperative complication rates and health services outcomes, including procedure time, anesthesia time, length of stay, and charges for surgeon, anesthesia, operating room, and hospital. Results A total of 46 parotidectomies consisting of 26 extracapsular dissections and 20 superficial parotidectomies met criteria. Of the 46 patients, 33 were women. Patient ages ranged from 18 to 83 years. Lesion features were similar between groups with most being pleomorphic adenoma. Procedure time (effect size, -1.31; 95% CI, -1.93 to -0.65), anesthesia time (effect size, -1.37; 95% CI, -1.99 to -0.70), and length of stay (effect size, -0.66; 95% CI, -1.25 to -0.05) were significantly shorter for extracapsular dissection compared with superficial parotidectomy. Moreover, anesthesia (effect size, -1.55; 95% CI, -2.19 to -0.86), operating room (effect size, -1.09; 95% CI, -1.69 to -0.45), and total hospital charges (effect size, -1.13; 95% CI, -1.74 to -0.49) were significantly less for extracapsular dissection while remaining charges, including surgeon, showed no difference. Finally, facial nerve weakness, great auricular nerve dysesthesia, and other relevant postoperative complications were comparable between groups. Conclusions and Relevance In the hands of an experienced surgeon, extracapsular dissection is a shorter, less costly, and equally safe alternative to traditional superficial parotidectomy when treating benign parotid lesions. Further follow-up is needed to ensure these perceived advantages are maintained over time.
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Affiliation(s)
- Masanari G Kato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Stony Brook University School of Medicine, Stony Brook, New York
| | - Evren Erkul
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Joshua D Hornig
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
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Pleomorphic Adenoma Originating from Heterotopic Salivary Tissue of the Upper Neck: A Diagnostic Pitfall. Case Rep Otolaryngol 2017; 2017:5767396. [PMID: 29270325 PMCID: PMC5705891 DOI: 10.1155/2017/5767396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022] Open
Abstract
Pleomorphic adenoma directly arising in the neck is thought to originate from heterotopic salivary gland tissue. In this article, we present the case of a 55-year-old female patient with a histologically proven pleomorphic adenoma located at the left mandibular angle, anteriorly to the sternocleidomastoid muscle and posteroinferiorly to the submandibular gland. As the patient also had an ipsilateral thyroid nodule with coarse calcifications, clinical and radiological features suggested a possible level II metastatic lymph node. However, ultrasound-guided fine needle aspiration cytology and postsurgery histopathological examination revealed a pleomorphic adenoma arising from heterotopic salivary gland tissue unrelated to a benign thyroid nodule. In this article, we provide a review of the existing literature on heterotopic salivary gland tissue and related neoplasms and discuss their imaging presentation.
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Pereira NB, do Carmo ACDM, Campos K, Costa SFDS, Diniz MG, Gomez RS, Gomes CC. DNA methylation polymerase chain reaction (PCR) array of apoptosis-related genes in pleomorphic adenomas of the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:554-560. [PMID: 28941993 DOI: 10.1016/j.oooo.2017.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/30/2017] [Accepted: 08/09/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the DNA methylation profile in 22 apoptosis-related genes in pleomorphic adenomas (PAs) of the salivary glands, in comparison with normal salivary glands (NSGs), and to address the differences in methylation patterns between smaller and larger tumors. Additionally, we investigated if the hypermethylation of differentially methylated genes between NSGs and PAs impacted the messenger RNA (mRNA) transcription. DESIGN Twenty-three fresh PA samples and 12 NSG samples were included. The PA samples were divided into 2 groups: PAs with clinical size larger than 2 cm (n = 12) and PAs with clinical size 2 cm or smaller (n = 11). DNA methylation at the promoter region of a panel of 22 genes involved in apoptosis was profiled by using a human apoptosis DNA methylation polymerase chain reaction array, and the transcriptional levels of genes showing differential methylation profiles between PAs and NSGs were assessed. RESULTS TNFRSF25 and BCL2 L11 were highly methylated in PAs, in comparison with NSGs, irrespective of tumor size. However, no difference could be observed in the mRNA transcription between PAs and NSGs. CONCLUSIONS Hypermethylation of the proapoptotic genes BCL2 L11 and TNFRSF25 is observed in PA. However, this phenomenon did not impact mRNA transcription.
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Affiliation(s)
- Núbia Braga Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil
| | - Ana Carolina de Melo do Carmo
- Departament of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil
| | - Kelma Campos
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil
| | - Sara Ferreira Dos Santos Costa
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil
| | - Marina Gonçalves Diniz
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil
| | - Carolina Cavalieri Gomes
- Departament of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Brazil.
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Naunheim M, Wu X, Ryan WR, Wang SJ, Heaton CM. Volumetric Growth Rate of Recurrent Pleomorphic Adenoma. Ann Otol Rhinol Laryngol 2017; 126:544-547. [DOI: 10.1177/0003489417708794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Surgery for recurrent pleomorphic adenoma (PA) can be challenging and may increase the risk of operative complications, particularly facial nerve weakness. As observation may be a viable alternative to surgery for slow-growing tumors, our objective was to assess the growth rate of recurrent PAs. Study Design: This study is a case series of patients at our tertiary academic medical center with recurrent PA. Two magnetic resonance images (MRI) were compared; total volume (TV) of recurrent tumor on both studies was calculated to obtain our main outcomes of percent change in TV and tumor growth rate. Results: Fourteen patients with recurrent PA had a median interval time between MRI of 12.8 months. Though growth rates were variable, the median continuous compound growth per year was 10.2%. Notably, 3 patients (21%) had no growth, and 2 patients (14%) had a reduction in TV. Conclusions: The median growth rate for enlarging tumors is estimated at 10.2% per year. Due to variability, tumor growth rate should be estimated on an individual patient basis. For slow-growing tumors, physicians may weigh the risk of this slow growth with the morbidity of reoperation.
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Affiliation(s)
- Molly Naunheim
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Medical Center, San Francisco, California, USA
| | - Xin Wu
- Department of Radiology and Biomedical Imaging, Division of Neuroradiology, University of California-San Francisco Medical Center, San Francisco, California, USA
| | - William R. Ryan
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Medical Center, San Francisco, California, USA
| | - Steven J. Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tuscon, Arizona, USA
| | - Chase M. Heaton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Medical Center, San Francisco, California, USA
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Bayır Ö, Çelik EK, Saylam G, Tatar EÇ, Saka C, Dağlı M, Özdek A, Korkmaz MH. The Effects of Superficial Musculoaponeurotic System Flap on the Development of Frey's Syndrome and Cosmetic Outcomes After Superficial Parotidectomy. Turk Arch Otorhinolaryngol 2016; 54:158-164. [PMID: 29392039 DOI: 10.5152/tao.2016.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey's syndrome (FS) and cosmetic satisfaction. Methods In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor's starch-iodine test for FS. For the evaluation of the cosmetic results, the patient's satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area. Results Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor's starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05). Conclusion According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction.
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Affiliation(s)
- Ömer Bayır
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Elif Kaya Çelik
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cem Saka
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Muharrem Dağlı
- Department of Otolaryngology, Head and Neck Surgery, Abant İzzet Baysal University School of Medicine, Bolu, Turkey
| | - Ali Özdek
- Department of Otolaryngology, Head and Neck Surgery, Dışkapı Yıldırım Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology, Head and Neck Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Kümüş Ö, İkiz AÖ, Sarıoğlu S, Erdağ TK. Recurrent Parotid Pleomorphic Adenomas: Our Clinical Experience. Turk Arch Otorhinolaryngol 2016; 54:112-117. [PMID: 29392029 DOI: 10.5152/tao.2016.1802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/17/2016] [Indexed: 01/28/2023] Open
Abstract
Objective The aim of our study was to present our findings in a series of patients who were treated for recurrent parotid pleomorphic adenoma with their clinical, surgical, and follow-up information and to discuss them in light of the recent literature. Methods Eleven patients who had revision surgery for recurrent pleomorphic adenoma at our institution were retrospectively analyzed for the clinical and radiological features of their lesions, surgery type, facial nerve management, and follow-up period. Results Seven patients were females and four were males with an average age of 45 years. All patients underwent previous surgeries at other institutions. Revision surgery was performed with superficial parotidectomy in six patients and total conservative parotidectomy with preservation of the facial nerve in five patients. Two patients had lesions involving the facial nerve branches necessitating sacrifice of involved branches. One patient was given adjuvant radiotherapy because of adjacent lymphatic vessel involvement with tumor cells. During the mean follow-up period of 9.1 years, there were no recurrences in any of the patients. Conclusion Management of patients with recurrent parotid pleomorphic adenomas must be carefully planned according to the size, location, and multicentricity of the tumor and involvement of the facial nerve. Surgery should aim at reaching tumor-free surgical margins. Sacrifice of the facial nerve should be considered only in cases with direct involvement. In the postoperative period, patients must be followed up regularly for early diagnosis of recurrences.
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Affiliation(s)
- Özgür Kümüş
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ahmet Ömer İkiz
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Sülen Sarıoğlu
- Department of Pathology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Taner Kemal Erdağ
- Department of Otorhinolaryngology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Abu-Ghanem Y, Mizrachi A, Popovtzer A, Abu-Ghanem N, Feinmesser R. Recurrent pleomorphic adenoma of the parotid gland: Institutional experience and review of the literature. J Surg Oncol 2016; 114:714-718. [PMID: 27468730 DOI: 10.1002/jso.24392] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/19/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recurrent pleomorphic adenoma (PA) of the parotid gland is a challenging surgical issue with controversy regarding management and long term outcome. METHODS All patients who were operated for recurrent PA of the parotid gland between the years 1991 and 2013 were reviewed. Patient demographics, clinicopathologic variables, and operative details were collected retrospectively. RESULTS A total of 22 patients were operated for recurrent PA of the parotid gland. Mean interval between recurrences was 7 and 6 years for first recurrence and second recurrence, accordingly. Second recurrence was significantly influenced by younger age at initial treatment (P = 0.009). Only two patients (9%) with a recurrence developed facial nerve paralysis following surgery. Adjuvant radiotherapy was given to nine patients with no evidence of disease progression or recurrence. There were no cases of malignant transformation. CONCLUSIONS Recurrent PA of the parotid gland tends to occur in long intervals in a multifocal pattern. Adjuvant radiotherapy could be suggested as an alternative for surgery. J. Surg. Oncol. 2016;114:714-718. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviram Mizrachi
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Nora Abu-Ghanem
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Feinmesser
- Department of Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Park SY, Han KT, Kim MC, Lim JS. Recurrent Pleomorphic Adenoma of the Parotid Gland. Arch Craniofac Surg 2016; 17:90-92. [PMID: 28913262 PMCID: PMC5556878 DOI: 10.7181/acfs.2016.17.2.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/11/2022] Open
Abstract
Pleomorphic adenoma is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Because of its propensity for invasion, pleomorphic adenoma of the parotid requires superficial parotidectomy or total parotidectomy to minimize the risk of tumor recurrence. We report a case of pleomorphic adenoma of the parotid gland with repeated recurrences. A 23-year-old male patient presented with a protruding neck mass. Six years prior to this presentation, the patient had undergone superficial parotidectomy for the removal of pleomorphic adenoma of the right parotid gland at our institution. The patient experienced recurrence at 17 months after the initial resection, which required a total parotidectomy with partial resection of the facial nerve. Pathologic examination revealed histologic findings consistent with pleomorphic adenoma across the surgical specimen from all three of the operations. The patient suffered from facial nerve paralysis, with facial expressions partially recovered over a year.
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Affiliation(s)
- Soo Yeon Park
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ki-Taik Han
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Min-Cheol Kim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin Soo Lim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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38
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Intratumor molecular heterogeneity in pleomorphic adenoma of the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:158-63. [DOI: 10.1016/j.oooo.2015.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023]
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Dunne JA, Matteucci PL, Foote M, Saleh DB. RE: Pleomorphic adenomas: Post-operative radiotherapy is unnecessary following primary incomplete excision: A retrospective review. J Plast Reconstr Aesthet Surg 2015; 68:878-9. [PMID: 25801277 DOI: 10.1016/j.bjps.2015.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022]
Affiliation(s)
- J A Dunne
- Department of Plastic Surgery, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
| | - P L Matteucci
- Department of Plastic Surgery, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK
| | - M Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road, Wooloongabba, Brisbane 4102, Australia
| | - D B Saleh
- Department of Plastic Surgery, Princess Alexandra Hospital, Ipswich Road Wooloongabba, Brisbane 4102, Australia
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Sood A, Chung S, Datiashvili RO. An incidental finding of pleomorphic adenoma of the minor salivary glands in the skin area of the lower lip. EPLASTY 2014; 14:e39. [PMID: 25525478 PMCID: PMC4215590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Salivary gland tumors are uncommonly seen and account for less than 3% of the head and neck tumors. Pleomorphic adenoma is a well-described benign tumor of the salivary glands, originating from myoepithelial and intercalated duct cells. It is most commonly found in major salivary glands. We present a rare and unusual case of pleomorphic adenoma of the minor salivary glands in the lower lip. The tumor was diagnosed upon excision of 1.5 × 1.2 cm(2) well-circumscribed nodule at the junction of the lower lip and chin in a 46-year-old man. The histopathological analysis confirmed presence of an epithelial salivary gland tumor with islands of plasmacytoid cells, and duct-like structures within a variable and mixed stroma.
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Affiliation(s)
- Aditya Sood
- Division of Plastic Surgery, Department of Surgery, Rutgers University/New Jersey Medical School, Newark, NJ,Correspondence: asood17@gmail@com
| | - Stella Chung
- Division of Plastic Surgery, Department of Surgery, Rutgers University/New Jersey Medical School, Newark, NJ
| | - Ramazi O. Datiashvili
- Division of Plastic Surgery, Department of Surgery, Rutgers University/New Jersey Medical School, Newark, NJ
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Witt RL, Eisele DW, Morton RP, Nicolai P, Poorten VV, Zbären P. Etiology and management of recurrent parotid pleomorphic adenoma. Laryngoscope 2014; 125:888-93. [PMID: 25289881 DOI: 10.1002/lary.24964] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 02/04/2023]
Abstract
The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule are also likely linked to recurrent pleomorphic adenoma. Most recurrent pleomorphic adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Treatment of recurrent pleomorphic adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent pleomorphic adenoma, is appropriate in many patients, but may be inadequate to control recurrent pleomorphic. There is accumulating evidence from retrospective series that postoperative radiation therapy results in significantly better local control.
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Affiliation(s)
- Robert L Witt
- Department of Otolaryngology-Head & Neck Surgery, Christiana Care/Thomas Jefferson University, Newark, Delaware, U.S.A
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42
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Cassoni A, Terenzi V, Della Monaca M, Bartoli D, Battisti A, Rajabtork Zadeh O, Valentini V. Parapharyngeal space benign tumours: Our experience. J Craniomaxillofac Surg 2014; 42:101-5. [DOI: 10.1016/j.jcms.2013.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022] Open
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Jardel P, Fakhry N, Makeieff M, Ferrie JC, Milin S, Righini C, Lacout A, Costes V, Malard O, Marcy PY, Guevara N, Odin G, Bensadoun RJ, Thariat J. [Radiation therapy for pleomorphic adenoma of the parotid]. Cancer Radiother 2014; 18:68-76. [PMID: 24387927 DOI: 10.1016/j.canrad.2013.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/21/2013] [Accepted: 09/04/2013] [Indexed: 10/25/2022]
Abstract
Parotid pleomorphic adenoma is the most frequent tumor of salivary glands. The prognosis depends on the recurrences because they could lead to iatrogenic events (facial paralysis). Moreover the risk of malignant transformation increases with the number of local relapses. This article aims at reviewing histological and radiological criteria and the surgical techniques. To improve local control, adjuvant irradiation (in first intention or after recurrence) may be useful but is still controversial for benign tumors in young patients with a risk of radio-induced cancer. We listed studies in which adjuvant radiotherapy was used so as to define its place in the treatment strategy. Prognostic factors were found by some authors. Other studies have to be done before strong evidence-based recommendations are issued.
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Affiliation(s)
- P Jardel
- Service d'oncologie radiothérapie, PRC, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - N Fakhry
- Service d'ORL et chirurgie cervicofaciale, hôpital de La Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - M Makeieff
- Département d'ORL et chirurgie cervicofaciale, hôpital Gui-de-Chauliac, CHRU de Montpellier, 34295 Montpellier cedex 5, France
| | - J-C Ferrie
- Service d'imagerie médicale, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - S Milin
- Service de cytologie et d'anatomie pathologiques, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - C Righini
- Clinique universitaire d'ORL, pôle tête et cou et chirurgie réparatrice, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - A Lacout
- Service d'imagerie, clinique du Pont-Rouge, 15000 Aurillac, France
| | - V Costes
- Service d'anatomie et cytologie pathologiques, hôpital Gui-de-Chauliac, CHRU de Montpellier, 34295 Montpellier cedex 5, France
| | - O Malard
- Service d'ORL et chirurgie cervicofaciale, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - P-Y Marcy
- Service d'imagerie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - N Guevara
- Service d'ORL et chirurgie cervicofaciale, institut universitaire de la face et du cou, 33, avenue Valombrose, 06189 Nice, France
| | - G Odin
- Service d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France; Institut universitaire de la face et du cou, 33, avenue Valombrose, 06189 Nice, France; Université Nice-Sophia-Antipolis, 33, avenue Valombrose, 06189 Nice, France
| | - R-J Bensadoun
- Service d'oncologie radiothérapie, PRC, CHU de Poitiers, 2, rue de la Milétrie, BP577, 86021 Poitiers, France
| | - J Thariat
- Service d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice, France; Institut universitaire de la face et du cou, 33, avenue Valombrose, 06189 Nice, France; Université Nice-Sophia-Antipolis, 33, avenue Valombrose, 06189 Nice, France.
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Demirci U, Basut O, Noyan B, Demir UL, Afsin Ozmen O, Kasapoglu F, Hakan Coskun H, Onart S. The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response. Indian J Otolaryngol Head Neck Surg 2014; 66:291-8. [PMID: 24533401 PMCID: PMC3918314 DOI: 10.1007/s12070-012-0492-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022] Open
Abstract
The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.
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Affiliation(s)
- Ugur Demirci
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Oguz Basut
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Behzat Noyan
- />Department of Physiology, Uludag University Medical Faculty, Bursa, Turkey
| | - Uygar Levent Demir
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - O. Afsin Ozmen
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Fikret Kasapoglu
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - H. Hakan Coskun
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
| | - Selcuk Onart
- />Department of Ear, Nose and Throat, Uludag University Medical Faculty, 16069 Bursa, Turkey
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Prognostic factors for secondary recurrence of pleomorphic adenoma: a 20-year, retrospective study. The Journal of Laryngology & Otology 2013; 127:902-7. [DOI: 10.1017/s0022215113001801] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurpose:To evaluate the results of treatment of parotid pleomorphic adenoma, and the risk factors for secondary recurrence.Materials and methods:Single-centre, retrospective study of 32 patients with pleomorphic adenoma recurrence managed between 1988 and 2008.Results:The mean age at diagnosis of primary pleomorphic adenoma recurrence was 43.4 years. Twenty-eight per cent of patients had secondary recurrence; 32 per cent had undergone two or more surgical resections and external adjuvant radiotherapy. An age of less than 25 years was significantly associated with an earlier primary recurrence (p = 0.008). The most significant histopathological risk factor for secondary recurrence was the presence of a multifocal tumour (p = 0.019). Other histopathological criteria (i.e. cellularity and capsule rupture) were not significant. Radiotherapy was not associated with a decrease in recurrence. Nine per cent of patients progressed to malignancy. The main surgical complication was definitive facial palsy (14 per cent).Conclusion:Pleomorphic adenoma recurrence requires surgery, with greatly increased risk to the facial nerve. Resection with clear surgical margins is required, especially in young patients with multifocal tumours. Radiotherapy may delay second recurrence in cases of multifocal tumour.
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Abstract
Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.
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Brasnu D. Robot-assisted submandibular gland resection via retroauricular approaches: Does the end justify the means? Laryngoscope 2013; 123:374-5. [DOI: 10.1002/lary.23733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 11/08/2022]
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Accessory parotid gland tumours: 24 years of clinical experience. Int J Oral Maxillofac Surg 2012; 41:1453-7. [PMID: 23062716 DOI: 10.1016/j.ijom.2012.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/09/2012] [Accepted: 09/18/2012] [Indexed: 11/23/2022]
Abstract
The accessory parotid gland (APG) is salivary tissue anterior to and anatomically separate from the parotid gland. APG is a common anatomical variation, but APG tumours are extremely rare. The authors report 6 patients with APG tumours emphasizing the diagnosis, clinical features, indications and rationales for different treatment approaches. Patients with primary tumours of the parotid gland or APG tumours who underwent surgical treatment were included. APG tumours comprised 1.23% of overall parotid tumours (6/488) and had a malignancy rate of 33.3% (2/6). There were three male and three female patients with a mean age of 39 years (range 14-70 years). 5 of 6 parotidectomies entailed superficial lobectomy, while one was a total parotidectomy with composite resection of masseter muscle. Concomitant selective lymphadenectomy was carried out in 3 of 6 patients. At 5 years disease-free survival was 83.3%. Mean follow-up was 161 months (range 14-253 months). Although nonsalivary diagnoses frequently occur in the buccal area, APG tumours should be considered in every differential diagnosis in patients presenting with a mid-cheek mass. From oncosurgical, cosmetic and functional standpoints, treatment by facelift parotidectomy or 'S-incision' with concomitant superficial lobectomy is the recommended surgical approach; high-grade malignancies require total parotidectomy with regional lymphadenectomy.
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Iro H, Zenk J, Koch M, Klintworth N. Follow-up of parotid pleomorphic adenomas treated by extracapsular dissection. Head Neck 2012; 35:788-93. [DOI: 10.1002/hed.23032] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 12/25/2022] Open
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Abstract
Pleomorphic adenoma is the most common mixed benign tumor of major salivary glands. Approximately 80% of these tumors arise in the parotid gland, whereas 7% arise in the minor salivary glands. The most common sites for minor salivary gland where pleomorphic adenoma arises are the palates followed by lips and cheek. We report a palate mass in a 46-year-old male patient. The initial cytologic diagnosis by fine-needle aspiration biopsy was pleomorphic adenoma. This report describes a case of pleomorphic adenoma regarding all distinctive diagnoses with the review of the literature.
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