Diseases of the pre-auricular lymph nodes mimicking parotid tumours

Intraglandular toxoplasmic lymphadenitis of the parotid gland

Most preauricular masses are parotid neoplasms; however, some infectious and inflammatory causes may exhibit similar presentation. Toxoplasmosis is a worldwide parasitary disease. The clinical presentation of toxoplasmosis is mostly asymptomatic and may include subfebrile fever, fatigue, and lymphadenopathy. Only 13 clinical reports of intraglandular toxoplasmic lymphadenitis have been previously reported in the English literature. A careful history and examination with appropriate investigations, including immunoglobulin G avidity assay, will frequently provide the diagnosis of intraparotid toxoplasmosis. Surgery might therefore have been delayed or avoided depending on a satisfactory clinical improvement in consequence of proper medical treatment.

Intraglandular toxoplasmosis of the parotid gland pre- or postoperative diagnosis?

Toxoplasmosis is an ubiquitous protozoan infection, caused by the coccidian Toxoplasma gondii. It usually presents clinically with lymphadenopathy, mainly in the head and neck region. However, in the English literature, very scarce cases of intraparotid Toxoplasma exist, none having been diagnosed preoperatively. In this article, we present 2 cases of intraglandular parotid toxoplasmosis, one diagnosed postoperatively and the other preoperatively. We also review the relevant literature concerning Toxoplasma infection of the parotid gland.

Toxoplasmosis Lymphadenitis Presenting as a Parotid Mass: A Report of 2 Cases

Toxoplasmosis manifesting as a parotid mass is rare; our review of the literature found only 6 previously reported cases. We report 2 new cases. Both patients presented with a small, mobile left parotid mass, and both were successfully treated with a diagnostic superficial parotidectomy. In both cases, the patient had been regularly exposed to cats and had recently eaten undercooked meat. When evaluating a parotid mass, otolaryngologists should be aware of the infectious causes of parotid swelling and lymphadenopathy and consider the possibility of toxoplasmosis when the history and pathologic findings are not suggestive of more common diseases.

Unicentric angiofollicular hyperplasia (Castleman's disease) of the parotid: a case report

Angiofollicular lymph node hyperplasia, or Castleman's disease, is a condition of uncertain cause usually presenting with mediastinal lymphadenopathy. Occasionally other lymph node groups may be involved with or without associated systemic manifestations. A case of Castleman's disease involving parotid lymph nodes is reported in a 16-year-old female patient who presented with a painless swelling that initially was noticed at the age of 3 years. Diagnosis was established by histopathologic examination of the respected specimen. Histologic and clinical features of Castleman's disease are also discussed.

Superficial parotidectomy in the treatment of cutaneous melanoma of the head and neck

The preauricular lymph nodes are frequently the first site of metastatic disease from primary malignant melanoma of the upper two-thirds of the face or the anterior scalp. For these patients, or those with adjacent metastatic nodal disease, the prognosis is poor. The median survival of 13 such patients presented was 2 years, with two long-term survivors at 4 and 6 years. Palliative surgery can, however, prevent uncontrolled locoregional disease. Patients with palpable preauricular and cervical node disease should be treated by facial nerve-preserving parotidectomy and radical neck dissection. When no cervical nodes are palpable in patients with preauricular node metastasis, peroperative jugulodigastric node biopsy and frozen-section histopathological examination are useful to select patients for radical neck dissection.

Intraglandular toxoplasmosis lymphadenitis of the parotid gland

Toxoplasmosis is a protozoan infection manifested by systemic findings as well as generalized or localized lymphadenopathy. Although lympadenitis is the most common clinical form, involvement of the intraglandular nodes within the parotid gland found is a rare occurrence during the course of the disease. This unusual form may mimic a parotid mass, and can cause difficulties in differential diagnosis. In this article, a case of intraglandular parotid lymphadenitis which developed due to toxoplasmosis is presented, and the relevant literature is reviewed.

Angiofollicular lymph node hyperplasia of the parotid

Angiofollicular lymph node hyperplasia (AFLNH) is a condition of uncertain aetiology usually presenting with mediastinal lymphadenopathy. Occasionally other lymph node groups are affected and there may be associated wide ranging systemic manifestations. A case of AFLNH affecting parotid lymph nodes is presented. The histological features of AFLNH and its variants are discussed, and current ideas on its pathogenesis are summarised.

Management of parotid metastases from cutaneous melanoma of the head and neck

Parotid metastases from a cutaneous malignant melanoma are uncommon. Although the long-term prognosis is poor, loco-regional palliation is important. In a group of eight patients with parotid metastases, local control was obtained by superficial parotidectomy. Occult cervical lymph node metastases were identified in five cases in whom radical neck dissection provided regional control. Superficial parotidectomy with elective neck dissection is advocated for patients with parotid metastases from cutaneous melanoma to ensure optimal loco-regional palliation.

Is parotid lymphadenopathy a new disease or part of AIDS?

This report describes a series of 15 patients who presented with masses in the tail of the parotid gland which proved at biopsy to be benign hyperplastic lymphadenopathy similar to lymphoepithelial hyperplasia. There were 11 male and 4 female patients. All had a history of intravenous drug use. Ten patients complained of pain. Six patients had smaller masses on the contralateral side of the gland, whereas seven patients had minor axillary adenopathy. Needle aspiration was performed in 12 patients; although not conclusively diagnostic, it ruled out primary salivary tumors. Thick purulent material was aspirated in five patients. All 15 patients underwent parotid exploration. It was apparent after raising the flap that the disease was related to intraparotid and periparotid lymph nodes. Lymphadenopathy in the jugular region, which was not appreciated preoperatively, was also noted in all patients. Each patient underwent exposure of the main trunk of the facial nerve and limited superficial parotidectomy. The postoperative course in each patient was uneventful and no patient had a facial nerve deficit. Cerebral toxoplasmosis developed in one patient who died 3 months after surgery; AIDS developed in one other patient. Human immunodeficiency virus (HIV) titers were not performed routinely because none of the patients came for regular follow-up. None of these patients demonstrated lymphoma at the time of this procedure. Parotid lymphadenopathy, which occurs primarily in intravenous drug users, appears to be an early manifestation of pre-AIDS or AIDS-related complex. If patients have no other sizable lymphadenopathy for biopsy, we advocate exploration of the parotid region and excision of periparotid and intraparotid lymph nodes.