Rhabdomyosarcoma of the parotid region occurring in childhood and adolescence. A report from the Intergroup Rhabdomyosarcoma Study Group

Parotid gland masses: outcomes in the pediatric age group

BACKGROUND

Childhood parotid neoplasms appear to have different characteristics from adults. This point, in addition to the rarity of these tumors, reflects the challenges faced in diagnosing and treating parotid neoplasms in children.

PATIENTS AND METHODS

This retrospective study included all children who presented to the Children's Cancer Hospital Egypt (CCHE, 57357) with parotid masses from January 2008 to December 2020.

RESULTS

Twenty-one patients were included. Malignant neoplasms were found in 12 (57.1%) of which mucoepidermoid carcinoma was the most common. Benign neoplasms were found in 6 (28.6%) all of them were pleomorphic adenoma, and non-neoplastic lesions were found in 3 (14.3%). Superficial, deep, or total parotidectomy was performed according to the involved lobes. The facial nerve was sacrificed in three cases because of frank invasion by the tumor. Neck dissection was considered in clinically positive lymph nodes and/or T3/4 masses. Complications occurred in 7 (33.3%) all were of the malignant cases. Adjuvant radiotherapy was restricted to high-risk cases (7 cases). Recurrence occurred in two cases, and one patient died of distant metastasis. Fine needle aspiration cytology (FNAC) showed 88.9% sensitivity and 100% specificity for diagnosing malignant neoplasms. The correlation of radiological and pathological staging was fair (66.74% for overall staging).

CONCLUSIONS

Parotidectomy is the backbone treatment for benign and malignant pediatric parotid tumors. Neck nodal dissection should be considered after preoperative FNAC of suspicious nodes. Adjuvant radiotherapy is considered only in high-risk tumors. Preoperative FNAC of parotid masses and clinically suspicious lymph nodes is highly recommended.

Computed tomography and magnetic resonance imaging in pediatric salivary gland diseases: a guide to the differential diagnosis

Salivary gland pathologies in children are frequent, particularly viral infections, but rarely need cross-sectional imaging. However, when a mass involves the salivary spaces (primarily or as a secondary invasion from other neck spaces) it may pose problems in the differential diagnosis and in immediate management. Infrequently, systemic autoimmune diseases can also involve the salivary parenchyma in children and correctly interpreting the constellation of findings in the whole body is critical for the diagnosis. Distinguishing between cystic and solid masses is the first step for radiologists in order to narrow down the diagnosis. Location and spatial extension are the most important elements differentiating cystic masses, while signal characteristics, internal structure and local invasion help in the differential diagnosis of solid masses.

Disorders and tumors of the salivary glands in children

Salivary gland neoplasms are rare in children. In infants most tumors are benign hemangiomas, with some notable exceptions, such as sialoblastomas. An asymptomatic swelling in the periauricular region is the most common presenting complaint in older children. Approximately 50% of these lesions are malignant, which dictates a thorough diagnostic evaluation by a head and neck surgeon. Surgical excision is the primary treatment modality. Prognosis is primarily determined by histopathologic findings. This review discusses neoplastic lesions of the salivary glands in children, and malignant epithelial tumors in particular.

Primary sarcomas of the salivary glands: case series and literature review

BACKGROUND

Mesenchymal malignancies of salivary origin are rare and are histologically diverse. We reviewed our experience with these tumors, as well as the published literature, with an emphasis on treatment modalities and prognosis.

METHODS

We identified 17 patients treated for malignant mesenchymal cell tumors at The University of Texas MD Anderson Cancer Center between 1990 and 2007. We compared our results to the literature from January 1990 to July 2010.

RESULTS

Tumors were located primarily in the parotid gland and were primarily T1 tumors (<5 cm). All patients were treated with surgical resection, and 13 patients were given adjuvant therapy. Seven patients (41%) had recurrence, and 4 developed distant metastases. The overall 5-year and 10-year survival rates were 42% and 20%, respectively.

CONCLUSIONS

Our case series and literature review show that sarcomas of the salivary glands have a high rate of recurrence and are associated with a poor prognosis.

Update on rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is a malignant childhood tumor of mesenchymal origin that currently has a greater than 70% overall 5-year survival. Multimodality treatment is determined by risk stratification according to pretreatment stage, postoperative group, histology, and site of the primary tumor. Pretreatment staging is dependent on primary tumor site, size, regional lymph node status, and presence of metastases. Unique to RMS is the concept of postoperative clinical grouping that assesses the completeness of disease resection and takes into account lymph node evaluation. At all tumor sites, the clinical grouping, and therefore completeness of resection, is an independent predictor of outcome. Overall, the prognosis for RMS is dependent on primary tumor site, patient age, completeness of resection, extent of disease, including the presence and number of metastatic sites and histology and biology of the tumor cells. Therefore, the surgeon plays a vital role in RMS by contributing to risk stratification for treatment, local control of the primary tumor, and outcome. The current state-of-the-art treatment is determined by treatment protocols developed by the Soft Tissue Sarcoma Committee of the children's Oncology Group.

Pediatric head and neck malignancies

PURPOSE OF REVIEW

Although head and neck masses represent a common entity in children, malignancy is uncommon. The otolaryngologist may be the first physician to see these children, and early recognition of malignancy is of obvious importance. This review aims to discuss the cause, diagnosis, investigation, treatment options, and prognosis for the most common head and neck malignancies of childhood.

RECENT FINDINGS

Over recent years, significant developments have been made in characterizing the epidemiologic, phenotypic, and genotypic variability of childhood head and neck cancers. Improved awareness of tumor biology is reflected by more sophisticated diagnostics, estimates of prognosis, and an increasing individualization of treatment regimens.

SUMMARY

The latest evidence for the diagnosis and management of childhood head and neck malignancy is summarized. The rarity of these tumors inevitably results in a paucity of high-level evidence to guide treatment. A combination of translational research from tumor biology studies, multicenter clinical trials, and smaller case series and case reports will continue to guide new advances in diagnosis and treatment.

Pediatric salivary gland imaging

A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces.

Results of treatment of patients with superficial facial rhabdomyosarcomas on protocols of the Intergroup Rhabdomyosarcoma Study Group (IRSG), 1984-1997

PURPOSE

We analyzed the outcome of 47 patients with superficial facial rhabdomyosarcoma (RMS) treated on Intergroup Rhabdomyosarcoma Study Group (IRSG) Protocols-III, -IV-Pilot, and -IV.

METHODS

We reviewed patients' records. Clinico-pathologic features, treatment, and outcome were examined to identify prognostic factors.

RESULTS

Thirty-two patients were males; 35 patients were 1-9 years old at diagnosis. Tumor sites were buccal/cheek (N = 21), external nasal/nasolabial (N = 12), lip/chin (N = 9), and masseter (N = 5). Patients (46/47) had localized disease: 18 biopsy only (Group III), 17 microscopic residual tumor (Group II), and 11 complete resection without residual tumor (Group I). Eight-year estimated event-free survival (EFS) and overall survival (OAS) rates were 61% and 65%. Patients <12 months old had inferior EFS, 21%, compared to approximately 68% in older patients (P = 0.077). Eight-year EFS rates were 80% for females and 50% for males (P = 0.096). Eight-year EFS rates were 72% in 33 patients without regional lymph-nodal tumor and 39% in 14 patients with regional nodal tumor (P = 0.07). Eight-year EFS rates were 72% for 22 patients with embryonal RMS and 53% for 23 patients with alveolar RMS (P = 0.28). Location of the primary tumor was not significantly related to outcome.

CONCLUSIONS

Patients with superficial facial RMS often have localized, grossly resectable lesions at the time of presentation. Favorable prognostic factors include age >12 months, female gender, embryonal histology, and no lymph-nodal tumor.

[Alveolar rhabdomyosarcoma of the parotid gland]

INTRODUCTION

Alveolar rhabdomyosarcoma of salivary glands is a rare malignant neoplasm, presenting a striated muscular differentiation. It is typically observed in children, adolescents, and young adults but can sometimes be diagnosed in older people.

OBSERVATION

We report the case of a 57 year-old man presenting with a primary alveolar rhabdomyosarcoma of the parotid gland. The patient was treated by surgery and radiotherapy.

DISCUSSION

According to literature data, alveolar rhabdomyosarcoma of the parotid gland is exceptionally described after 40 years of age. In that case it has the worst prognosis and its lethality is due mainly to its very early metastasis.

Pediatric surgical oncology: management of rhabdomyosarcoma

A malignant tumor of striated muscle origin, Rhabdomyosarcoma (RMS) is a childhood tumor that has benefited from 30 years of multimodality therapeutic trials culminating in a greater than 70% overall current 5-year survival. Prognosis for RMS is dependent on anatomic primary tumor site, age, completeness of resection, presence and number of metastatic sites, histology and biology of the tumor cells. Multimodality treatment is based on risk stratification according to pretreatment stage, postoperative group, histology and site. Therefore, pretreatment staging is vital for assessment and is dependent on primary tumor site, size, regional lymph node status, and presence of metastases. Unique to RMS is the concept of postoperative clinical grouping that assesses the completeness of disease resection and takes into account lymph node evaluation both at the regional and metastatic basins. At all sites, if operative resection of all disease is accomplished, including microscopic disease, survival is improved. Therefore, the surgeon plays a vital role in determining risk stratification for treatment and local control of the primary tumor for RMS.

Pediatric rhabdomyosarcoma of the head and neck

Pediatric rhabdomyosarcoma is not exclusive to the head and neck. However, the unique anatomy of the head and neck requires special consideration and treatment modifications. The low incidence of these tumors has prevented the development of rigorous treatment protocols. Treatment strategies must be individualized on the basis of histopathologic subtype, prognostic indicators, tumor location, tumor extent, available clinical trial data, and hospital resources. The primary treatment of these tumors typically involves a combination of surgery, radiation, and chemotherapy. Advancements in surgical and radiotherapy techniques have reduced patient morbidity, whereas new chemotherapeutic protocols have improved local disease control and overall survival. Because of the infrequency and complexity of these tumors, patients may benefit from referral to centers with a comprehensive multidisciplinary team that has experience treating these tumors in the pediatric population. If possible, patients should be enrolled and treated on the current Children's Oncology Group protocol.

Adult paratesticular rhabdomyosarcoma

BACKGROUND

A 29-year-old male patient presented with a history of painless enlargement of the left hemiscrotum.

INVESTIGATIONS

Laboratory tests for beta-human chorionic gonadotrophin, alpha-fetoprotein, and lactate dehydrogenase, physical examination, and CT of the chest, abdomen and pelvis. Histologic examination, nerve-sparing retroperitoneal lymph-node dissection.

DIAGNOSIS

Paratesticular rhabdomyosarcoma with lymph node metastasis.

MANAGEMENT

Inguinal radical orchiectomy and adjuvant chemotherapy for 48 weeks. Radiotherapy and additional chemotherapy were administered following local recurrence.

[Malignant fibrous histiocytoma in the parotid gland. Case series and literature review]

BACKGROUND

Malignant fibrous histiocytoma (MFH), a soft tissue sarcoma that is predominantly localized in the extremities and retroperitoneum, rarely occurs in the head and neck. This study presents the clinicopathological features of three patients with MFH of the parotid gland treated at the ENT department of the University Hospital of Muenster (Germany) between 1991 and 2002.

PATIENTS

The clinical course of all three patients was defined by a rapidly growing mass in the parotid area. Surgical therapy was the first treatment of choice. In two patients, radical parotidectomy was performed, whereas one patient underwent partial parotidectomy. Selective neck dissection was performed in one case. In two cases, post-surgical treatment involved radiation and/or chemotherapy. Two patients died as a consequence of local recurrence within the first year after diagnosis, whereas one patient is alive and free of disease after a follow up of 14 months.

CONCLUSION

Our own experiences, taken together with those reported in the literature, suggest that clear surgical margins are probably the most important factor for avoiding a recurrence and to improve disease free survival.

Soft-tissue sarcoma in childhood and adolescence

This review summarizes and comments on the major articles that have been published in English concerning pediatric soft-tissue sarcomas in the past 2 years. Studies of rhabdomyosarcoma and undifferentiated sarcoma, including late sequelae of treatment; nonrhabdomyosarcomatous soft-tissue sarcoma; and the pathology of soft-tissue sarcomas are included.