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Mai W, Tan J, Zhang L, Wang L, Zhang D, Shi C, Liu X. Predicting High-risk Capsular Features in Pleomorphic Adenoma of the Parotid Gland Through a Nomogram Model Based on ADC Imaging. Acad Radiol 2024:S1076-6332(24)00362-3. [PMID: 38908917 DOI: 10.1016/j.acra.2024.06.003] [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: 04/30/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/24/2024]
Abstract
RATIONALE AND OBJECTIVES Based on Apparent Diffusion Coefficient (ADC) images, a nomogram model is established to accurately predict the high-risk capsular characteristics associated with pleomorphic adenoma of the parotid gland (PAP) recurrence. MATERIALS AND METHODS This retrospective study analyzed 190 patients with PAPs. Significant clinical radiological factors were identified through univariate difference analysis and multivariate regression analysis. The optimal threshold was determined by analyzing the average ADC value of the entire tumor, using the best Youden index and sensitivity analysis, and tumor subregions were delineated accordingly. Three radiomic models were constructed for the whole tumor and for high/low ADC areas, with the best model determined through statistical analysis. Ultimately, a nomogram model was constructed by combining the independent predictive factor of high-risk capsular features with the optimal radiomic predictive score. Model performance was comprehensively assessed by the area under the receiver operating characteristic curve (ROC AUC), accuracy, sensitivity, and specificity. RESULTS The best ADC division threshold as 1.25 × 10-3 mm2/s. Multivariate analysis identified High-ADC Zone Volume Percentage as an independent predictor for PAPs with high-risk capsular characteristics. The radiomic model based on the low ADC tumor subregion was optimal (AUC 0.899). The nomogram model, combining independent predictors and optimal imaging studies predictive score, demonstrated high performance (AUC 0.909). Decision curve analysis confirmed the nomogram's clinical applicability. CONCLUSION The nomogram model constructed from ADC quantitative imaging can predict PAPs patients with high-risk capsular features. These patients require intraoperative preventive measures to avoid tumor spillage and residuals, as well as extended postoperative follow-up.
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Affiliation(s)
- Wenfeng Mai
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou 510630, PR China
| | - Jingyi Tan
- Department of Radiology, YueBei People's hospital, Shaoguan 512026, PR China
| | - Lingtao Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou 510630, PR China
| | - Liaoyuan Wang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou 510630, PR China
| | - Dong Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou 510630, PR China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou 510630, PR China
| | - Xiangning Liu
- The First Affiliated Hospital of Jinan University, Clinical Research Platform for Interdiscipline of Stomatology, School of Stomatology, Jinan University, Guangzhou 510630, PR China.
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Li S, Su X, Ning Y, Zhang S, Shao H, Wan X, Tan Q, Yang X, Peng J, Gong Q, Yue Q. CT based intratumor and peritumoral radiomics for differentiating complete from incomplete capsular characteristics of parotid pleomorphic adenoma: a two-center study. Discov Oncol 2023; 14:76. [PMID: 37217656 DOI: 10.1007/s12672-023-00665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE Capsular characteristics of pleomorphic adenoma (PA) has various forms. Patients without complete capsule has a higher risk of recurrence than patients with complete capsule. We aimed to develop and validate CT-based intratumoral and peritumoral radiomics models to make a differential diagnosis between parotid PA with and without complete capsule. METHODS Data of 260 patients (166 patients with PA from institution 1 (training set) and 94 patients (test set) from institution 2) were retrospectively analyzed. Three Volume of interest (VOIs) were defined in the CT images of each patient: tumor volume of interest (VOItumor), VOIperitumor, and VOIintra-plus peritumor. Radiomics features were extracted from each VOI and used to train nine different machine learning algorithms. Model performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). RESULTS The results showed that the radiomics models based on features from VOIintra-plus peritumor achieved higher AUCs compared to models based on features from VOItumor. The best performing model was Linear discriminant analysis, which achieved an AUC of 0.86 in the tenfold cross-validation and 0.869 in the test set. The model was based on 15 features, including shape-based features and texture features. CONCLUSIONS We demonstrated the feasibility of combining artificial intelligence with CT-based peritumoral radiomics features can be used to accurately predict capsular characteristics of parotid PA. This may assist in clinical decision-making by preoperative identification of capsular characteristics of parotid PA.
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Affiliation(s)
- Shuang Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaorui Su
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Youquan Ning
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Simin Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Hanbing Shao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xinyue Wan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qiaoyue Tan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital of Sichuan University, #37 GuoXue Xiang, Chengdu, 610041, Sichuan, China
| | - Juan Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, #37 GuoXue Xiang, Chengdu, 610041, Sichuan, China.
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Hernandez-Prera JC, Skálová A, Franchi A, Rinaldo A, Vander Poorten V, Zbären P, Ferlito A, Wenig BM. Pleomorphic adenoma: the great mimicker of malignancy. Histopathology 2021; 79:279-290. [PMID: 33368685 DOI: 10.1111/his.14322] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
Pleomorphic adenoma (PA) is the most common salivary gland neoplasm, and its diagnosis is straightforward in the majority of cases. However, not infrequently, PA shows unusual and uncommon histological features that can be confused with those of malignancy. The difficulties in diagnosing PA arise from its ability to mimic invasion, show atypical or metaplastic cytomorphology, and show morphological features that overlap with those of established salivary gland carcinomas. In addition, recognising early malignant transformation to carcinoma ex-pleomorphic adenoma continues to be a frequent challenge. This review describes the diagnostic pitfalls of PA, and offers a systematic approach to avoid them by combining classic histopathology with novel immunohistochemical and molecular tests.
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Affiliation(s)
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.,Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Peter Zbären
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| | - Bruce M Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
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Mantsopoulos K, Iro AK, Sievert M, Müller SK, Agaimy A, Koch M, Iro H. Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas. Acta Otolaryngol 2021; 141:414-418. [PMID: 33470131 DOI: 10.1080/00016489.2021.1871947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Traditional surgical philosophy condemns extracapsular dissection for pleomorphic adenoma as a euphemism for the enucleation of this lesion. OBJECTIVES The aims of the study were to trace the development of surgical treatment by pleomorphic adenomas of the parotid gland over the last 15 years and explore its effects on the histopathology specimen. MATERIALS AND METHODS The medical records of all cases with pleomorphic adenomas of the parotid gland between 2006 and 2020 were examined for information on age, gender, and type of surgery. An experienced head and neck pathologist re-evaluated the histology slides from all the cases. RESULTS The study included 844 patients. Our analysis showed an increase in the performance of extracapsular dissection from 52.8% (2006) to 63.3% (2020), and an increase in histopathology specimens with tumours completely covered by healthy tissue from 27.7% (2006) to 50% (2020). CONCLUSIONS Our decision-making process reached its peak in the last study years, in terms of reduced surgical invasiveness and quality of the pathology specimen. SIGNIFICANCE Extracapsular dissection has gained a firm hold as an indispensable tool for the experienced parotid surgeon. Proper indication is based on careful selection of cases and the correct interpretation of preoperative features on palpation and imaging.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ann-Kristin Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
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5
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Mantsopoulos K, Sievert M, Iro AK, Müller SK, Koch M, Schapher M, Agaimy A, Iro H. Histopathological comparison of pleomorphic adenomas of the parotid and submandibular gland. Oral Dis 2021; 28:1131-1136. [PMID: 33772981 DOI: 10.1111/odi.13858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to investigate and compare the histopathological findings in pleomorphic adenomas (PA) of the parotid and submandibular gland with emphasis on the histological subtype and capsular characteristics. MATERIALS AND METHODS The histopathological specimens of all patients with PAs of the parotid and submandibular gland between 2000 and 2020 were re-examined by an experienced head and neck pathologist. Patients without representative slides allowing evaluation of the whole periphery of the PA were excluded from our study sample. RESULTS Nine hundred and thirty-four patients formed our study sample (327 men, 607 women, male-to-female ratio: 0.53:1). Eight hundred and forty-four cases had a PA in the parotid gland and the remaining 90 in the submandibular gland. Our comparative analysis showed that submandibular PAs are characterized by the consistent presence of an intact anatomical capsule, infrequent occurrence of pseudopodia and satellite nodules, and a low proportion of the high-risk myxoid subtype. CONCLUSION Our study highlights significant differences between PAs of the parotid and submandibular glands in their histopathological characteristics. Their differences likely underlie the favorable surgical outcome observed in PAs of the submandibular glands and may explain the propensity of PAs of the parotid glands for local recurrences.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ann-Kristin Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarina Katrin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mirco Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Mantsopoulos K, Iro AK, Sievert M, Müller SK, Agaimy A, Schapher M, Koch M, Iro H. Is extracapsular dissection for pleomorphic adenoma rather a euphemism for enucleation that jeopardises the intactness of the capsule? Br J Oral Maxillofac Surg 2021; 59:1204-1208. [PMID: 34274171 DOI: 10.1016/j.bjoms.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare several surgical modalities with respect to the incidence of positive margins and focal capsular exposure of pleomorphic adenoma of the parotid gland. The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2006 and 2020 were retrospectively evaluated (n = 845). The lesion was removed by extracapsular dissection in 577 cases (68%) and facial nerve dissection in 268 (32%). Our analysis did not reveal a statistically significant difference between the examined modalities regarding positive margins (p=0.648) or capsular exposure (p=0.112). Recurrences were detected in 7/845 cases (0.82%) with a mean (range) follow-up time of 82.3 (6-183) months. The choice of surgical method does not seem to have a significant effect on the incidence of positive margins, or on the capsular exposure of a pleomorphic adenoma.
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Affiliation(s)
- K Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - A-K Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S K Müller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - M Schapher
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Koch
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Iro AK, Agaimy A, Müller SK, Sievert M, Iro H, Mantsopoulos K. Satellite nodules in pleomorphic adenomas of the parotid gland: A nightmare for less invasive parotid surgery? Oral Oncol 2021; 115:105218. [PMID: 33618078 DOI: 10.1016/j.oraloncology.2021.105218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to thoroughly investigate the incidence of satellite nodules (SN) and some of their characteristics (number, distance to main lesion) in a large series of pleomorphic adenomas (PA) and to compare several surgical modalities regarding their efficacy in addressing this critical morphological feature. MATERIALS AND METHODS The records of all patients treated for primary PA of the parotid gland between 2006 and 2020 were studied retrospectively. All the histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. RESULTS 845 cases made up our initial study sample. SNs were detected in 68/845 cases (8%). No statistically significant difference could be detected in the incidence of SNs in the surgical specimens between the patient groups managed by extracapsular dissection (46/577, 7.9%) and facial nerve dissecting surgery (22/268, 8.2%, p = 0.502). In the group of cases with SNs, no recurrences were detected (mean follow-up time: 71.4 months). The mean distance from the main lesion to the most distant SN was 1.1 mm (0.08-6.3 mm). The mean size of the SN was 1.9 mm (0.1-9.7 mm). Altogether, the mean distance from the main lesion to the outer periphery of the most distant SN was 3.1 mm (0.4-10.5 mm). CONCLUSION Our analysis could not award SNs the title of an "extracapsular dissection's nightmare". In the majority of cases, their favourable histological patterns offer the ideal circumstances for their surgical inclusion in a tumour specimen.
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Affiliation(s)
- Ann-Kristin Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Germany
| | - Sarina Katrin Müller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Germany
| | - Matti Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Germany
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Germany
| | - Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Germany.
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Piwowarczyk K, Bartkowiak E, Kosikowski P, Chou JTT, Wierzbicka M. Salivary Gland Pleomorphic Adenomas Presenting With Extremely Varied Clinical Courses. A Single Institution Case-Control Study. Front Oncol 2021; 10:600707. [PMID: 33489904 PMCID: PMC7820779 DOI: 10.3389/fonc.2020.600707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
Objective Pleomorphic adenomas (PAs) with divergent clinical behavior, differing from the vast majority of PAs, were distinguished. “Fast” PAs are characterized by an unexpectedly short medical history and relatively rapid growth. The reference group consisted of “slow” PAs with very stable biology and long-term progression. We divide the PA group as a whole into three subsets: “fast,” “normal,” and “slow” tumors. Our goal is a multifactorial analysis of the “fast” and “slow” PA subgroups. Methods Consecutive surgeries in a tertiary referral center, the Department of Otolaryngology and Laryngological Surgery, Poznan University of Medical Sciences, Poland, were carried out between 2002 and 2011. Out of 1,154 parotid tumors, 636 (55.1%) were PAs. The data were collected prospectively in collaboration with the Polish National Registry of Benign Salivary Gland Tumors. The main outcome measure was the recurrence rate in “fast” and “slow” PA subgroups. All surgical qualifications and surgeries were performed by two experienced surgeons. Results Slow PAs, compared to fast PAs, presented in older patients (53.25 ± 15.29 versus 47.92 ± 13.44 years). Multifactor logistic regression analysis with recurrence (yes/no) as the outcome variable, fast/slow as the predictor variable and age, gender, margin, FN status as covariates showed that fast PAs were significantly predicting recurrence vs. slow PAs (p = 0.035). Fast PAs were increasing the risk of PAs 10-fold vs. slow PAs, exp β = 10.20, CI95 [1.66; 197.87]. The variables impacting relapse were recent accelerated growth of the tumor OR = 3.35 (SE = 0.56), p = 0.030, positive margins OR = 7.18 (SE = 0.57), p < 0.001, incomplete or bare capsule OR = 9.91 (SE = 0.53), p = 0.001 and location III OR = 3.12 (SE = 0.53), p = 0.033. In the multivariate model only positive margin was selected as the best predictor of relapse, OR = 5.01 (SE = 0.60), p = 0.007. Conclusions The simple clinical aspect of slow or fast PA progression is of great practical importance and can constitute a surrogate of the final histopathological information that is derived from the surgical specimen. The slow or fast nature of the PA to some extent indicates prognostic features such as recurrence risk. This finding requires correlation with histological and molecular features in further stages of research.
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Affiliation(s)
- Krzysztof Piwowarczyk
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewelina Bartkowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Kosikowski
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jadzia Tin-Tsen Chou
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Extracapsular dissection via sternocleidomastoid muscle–parotid space approach—a new operative technique for treating clinically benign tumor in the parotid tail. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:109-114. [DOI: 10.1016/j.oooo.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/04/2019] [Accepted: 03/09/2019] [Indexed: 11/20/2022]
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Dulguerov P, Todic J, Pusztaszeri M, Alotaibi NH. Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables. Front Surg 2017; 4:26. [PMID: 28555187 PMCID: PMC5430411 DOI: 10.3389/fsurg.2017.00026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy. Methods A systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data. Results Pathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage. Conclusion Myxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.
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Affiliation(s)
- Pavel Dulguerov
- Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Jelena Todic
- Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Marc Pusztaszeri
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Naif H Alotaibi
- Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
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Guerra G, Testa D, Montagnani S, Tafuri D, Salzano FA, Rocca A, Amato B, Salzano G, Dell'Aversana Orabona G, Piombino P, Motta G. Surgical management of pleomorphic adenoma of parotid gland in elderly patients: role of morphological features. Int J Surg 2014; 12 Suppl 2:S12-S16. [PMID: 25159550 DOI: 10.1016/j.ijsu.2014.08.391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 12/11/2022]
Abstract
The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection.
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Affiliation(s)
- Germano Guerra
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
| | - Domenico Testa
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Italy.
| | - Stefania Montagnani
- Department of Public Health, University of Naples "Federico II", Naples, Italy.
| | - Domenico Tafuri
- Department of Sport Sciences and Wellness, University of Naples "Parthenope", Naples, Italy.
| | | | - Aldo Rocca
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Giovanni Salzano
- Department of Neuroscience Reproductive and Dentistry Sciences, University of Naples "Federico II", Naples, Italy.
| | | | - Pasquale Piombino
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Italy.
| | - Gaetano Motta
- Department of Anesthesiologic, Surgical and Emergency Sciences, Otolaryngology, Head and Neck Surgery Unit, Second University of Naples, Italy.
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Modified partial superficial parotidectomy versus conventional superficial parotidectomy improves treatment of pleomorphic adenoma of the parotid gland. Am J Surg 2014; 208:112-8. [DOI: 10.1016/j.amjsurg.2013.08.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 11/17/2022]
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13
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Goerke D, Meyers JA, Amin K, Khariwala SS. Primary Multifocal Pleomorphic Adenoma of the Parotid Gland with Dermal Involvement. Otolaryngol Head Neck Surg 2014; 150:1092-3. [PMID: 24571934 DOI: 10.1177/0194599814524723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/30/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Derek Goerke
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jason A Meyers
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Khalid Amin
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samir S Khariwala
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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14
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Strub GM, Georgolios A, Graham RS, Powers CN, Coelho DH. Massive transcranial parotid pleomorphic adenoma: recurrence after 30 years. J Neurol Surg Rep 2013; 73:1-5. [PMID: 23946917 PMCID: PMC3658653 DOI: 10.1055/s-0032-1329189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pleomorphic adenoma, also known as benign mixed tumor, is the most common tumor affecting the parotid gland and can reach massive size; however, intracranial invasion is rare. Recurrence of pleomorphic adenoma after excision is a well-known phenomenon and can present decades after resection of the primary tumor. Here we present the case of a 53-year-old man who presented to our clinic with ear fullness, otalgia, and hearing loss 30 years after undergoing total parotidectomy and external beam radiotherapy for pleomorphic adenoma. Magnetic resonance imaging revealed a massive transcranial tumor invading the mastoid cavity, the dura of the posterior fossa, the fallopian and semicircular canals, the jugular foramen, the lateral infratemporal fossa skull base, the sigmoid and transverse sinuses, and the superior parapharyngeal region. Gross examination and histopathological studies confirmed that the mass was a recurrent pleomorphic adenoma. Here we discuss the features of recurrent pleomorphic adenoma and review the current literature.
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Affiliation(s)
- Graham M Strub
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
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15
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Zbären P, Vander Poorten V, Witt RL, Woolgar JA, Shaha AR, Triantafyllou A, Takes RP, Rinaldo A, Ferlito A. Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Am J Surg 2012; 205:109-18. [PMID: 23062782 DOI: 10.1016/j.amjsurg.2012.05.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 04/16/2012] [Accepted: 05/10/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optimal surgery for pleomorphic adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid pleomorphic adenoma capsule and its influence on surgery. DATA SOURCES PubMed literature searches were performed to identify original studies. CONCLUSIONS Almost all pleomorphic adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.
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Affiliation(s)
- Peter Zbären
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Freiburgstrasse, 3010 Bern, Switzerland.
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16
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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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