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Ismawati NDS, Nugraha AP, Baehaqi R, Taufiqurrahman I. Comprehensive perioperative and minimally invasive post-operative defect approach of massive palatal pleomorphic adenoma: Case series. Int J Surg Case Rep 2024; 123:110208. [PMID: 39213926 PMCID: PMC11401163 DOI: 10.1016/j.ijscr.2024.110208] [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: 10/28/2023] [Revised: 08/18/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Extensive Palatal post-operative defect management following excision of neoplasm is one of the most difficult challenges for oral and maxillofacial surgeons regarding its limited surgical access and visibility on narrow area, airway management difficulty during intubation, richness of maxillary vascular network resulting in enormous bleeding risk. Decision making regarding its surgical approach and impact on speech and mastication is important. This case series aim to describe comprehensive step by step perioperative and palatal defect management approach based on tumor pathological characteristic and anatomical perspective to achieve good surgical outcome. CASES PRESENTATION Two cases of massive palatal pleomorphic adenoma were presented. Both of cases occurs in female patients. Lesions was crossing the midline, impair speech and causing discomfort. Preoperative diagnostic from CT scan and FNAB result was pleomorphic adenoma. CLINICAL DISCUSSION Surgery for both cases done with wide periosteal sacrificing excision, ostectomy and surgical obturator placement from intraoral approach under general anesthesia with nasal intubation. Eventually the wounds healed without wound dehiscence and fistula, no speech impairment and no sign of reccurency. CONCLUSION Understanding pathological characteristic of pleomorphic adenoma and basic anatomy of surrounding structure are important to formulate minimal invasive surgical and post-operative defect management planning and improve patient's quality of life.
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Affiliation(s)
- Nining Dwi Suti Ismawati
- Oral and Maxillofacial Surgery Division, Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia; Department of Oral and Maxillofacial Surgery, Universitas Lambung Mangkurat, Banjarmasin, Indonesia.
| | - Andreas Pratama Nugraha
- Oral and Maxillofacial Surgery Division, Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia; Medical Faculty, Universitas Airlangga, Indonesia
| | - Ronny Baehaqi
- Oral and Maxillofacial Surgery Division, Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia
| | - Irham Taufiqurrahman
- Department of Oral and Maxillofacial Surgery, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
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Takumi K, Nakanosono R, Nagano H, Hakamada H, Kanzaki F, Kamimura K, Nakajo M, Eizuru Y, Nagano H, Yoshiura T. Multiparametric approach with synthetic MR imaging for diagnosing salivary gland lesions. Jpn J Radiol 2024; 42:983-992. [PMID: 38733471 PMCID: PMC11364709 DOI: 10.1007/s11604-024-01578-4] [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: 02/23/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE To determine whether synthetic MR imaging can distinguish between benign and malignant salivary gland lesions. METHODS The study population included 44 patients with 33 benign and 11 malignant salivary gland lesions. All MR imaging was obtained using a 3 Tesla system. The QRAPMASTER pulse sequence was used to acquire images with four TI values and two TE values, from which quantitative images of T1 and T2 relaxation times and proton density (PD) were generated. The Mann-Whitney U test was used to compare T1, T2, PD, and ADC values among the subtypes of salivary gland lesions. ROC analysis was used to evaluate diagnostic capability between malignant tumors (MTs) and either pleomorphic adenomas (PAs) or Warthin tumors (WTs). We further calculated diagnostic accuracy for distinguishing malignant from benign lesions when combining these parameters. RESULTS PAs demonstrated significantly higher T1, T2, PD, and ADC values than WTs (all p < 0.001). Compared to MTs, PAs had significantly higher T1, T2, and ADC values (all p < 0.001), whereas WTs had significantly lower T1, T2, and PD values (p < 0.001, p = 0.008, and p = 0.003, respectively). T2 and ADC were most effective in differentiating between MTs and PAs (AUC = 0.928 and 0.939, respectively), and T1 and PD values for differentiating between MTs and WTs (AUC = 0.915 and 0.833, respectively). Combining T1 with T2 or ADC achieved accuracy of 86.4% in distinguishing between malignant and benign tumors. Similarly, combining PD with T2 or ADC reached accuracy of 86.4% for differentiating between malignant and benign tumors. CONCLUSIONS Utilizing a combination of synthetic MRI parameters may assist in differentiating malignant from benign salivary gland lesions.
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Affiliation(s)
- Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan.
| | - Ryota Nakanosono
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Hiroaki Nagano
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Hiroto Hakamada
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Fumiko Kanzaki
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Kiyohisa Kamimura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Masatoyo Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Yukari Eizuru
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Hiromi Nagano
- Department of Otolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan
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Wang X, Liu Y, Liu H, Chen Y, Song L, Xian J. Evaluation of multiparametric MRI differentiating pleomorphic adenoma from schwannoma in parapharyngeal space. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08841-4. [PMID: 39069574 DOI: 10.1007/s00405-024-08841-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE This study aimed to investigate whether multiparametric magnetic resonance imaging (MRI) including dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI can differentiate pleomorphic adenoma (PA) from schwannoma in the parapharyngeal space. METHODS Forty-six patients with pathologically proven PAs and 47 schwannomas in the parapharyngeal space were enrolled. All patients underwent conventional MRI, and DW-MRI and DCE-MRI were performed in 30 and 33 patients, respectively. Fisher's exact, Mann-Whitney-U tests and Independent samples t-test were used to compare variables between PAs and schwannomas. Multivariate logistic regression analysis was used to examine the diagnostic performance of MRI parameters. RESULTS The PAs usually show lobulation sign, posterior displacement of ICA and attached to the parotid gland deep leaf, while bird beak configuration, anterior displacement of ICA and involvement of foramen jugular were more commonly seen in the schwannomas(all p < 0.001). The washout rate of PAs was found to be higher than that of schwannomas (p = 0.035), whereas no significance was found in the other DCE-MRI parameters and in ADCs(p > 0.05). Using a combination of conventional MRI features including lobulation sign, bird beak configuration, direction of internal carotid artery(ICA) displacement and attached to the parotid gland in multivariate logistic regression analysis, sensitivity, specificity, and accuracy in differential diagnosis of PAs and schwannomas were 97.8%, 91.5% and 94.6%, respectively. CONCLUSION Conventional MRI can effectively differentiate PAs from schwannomas in the parapharyngeal space with a high diagnostic accuracy. The DCE-MRI and DWI have limited added diagnostic value to conventional MRI in the differential diagnosis.
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Affiliation(s)
- Xinyan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yunfu Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Hangzhi Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yun Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, 213003, Jiangsu, China
| | - Liyuan Song
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Johnson F, Kloppenburg M, Hofauer B, Wollenberg B, Hoch CC, Stögbauer F, Haller B, Knopf A, Strassen U, Notohamiprodjo S. Novel Detection of Pleomorphic Adenomas via Analysis of 68Ga-DOTATOC PET/CT Imaging. Cancers (Basel) 2024; 16:2624. [PMID: 39123352 PMCID: PMC11311107 DOI: 10.3390/cancers16152624] [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: 06/13/2024] [Revised: 07/14/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Currently, the diagnosis of salivary gland tumors using imaging techniques is unreliable. METHODS In this monocentric retrospective study, we examined patients who received a 68Ga-DOTATOC PET/CT and subsequently underwent a salivary gland tumor resection between 1 January 2010 and 31 December 2021. PET/CT image assessment was compared with somatostatin receptor (SSTR) expression and histology. RESULTS Thirteen patients (five pleomorphic adenoma (PA) and eight other parotid lesions (OPL)) received a 68Ga-DOTATOC PET/CT. Imaging displayed strong focal tracer uptake in all PA except for one with strong tumor to background discrimination. PA revealed higher SUVmax, SUVmean, liver and blood pool quotients than those of Warthin tumors (WT) and of OPL. In comparison to the contralateral parotid, SUVmax (p = 0.02), SUVmean (p = 0.02), liver quotient (p = 0.03) and blood pool quotient (p = 0.03) were all significantly higher. In contrast, WT and OPL showed in relation to the contralateral parotid no significant differences of SUVmax (WT p = 0.79; OPL p = 0.11), SUVmean (WT p = 1.0; OPL p = 0.08), liver quotient (WT p = 0.5; OPL p = 0.08) and blood pool quotient (WT p = 0.8; OPL p = 0.19). Two PA and one granuloma were not available for examination. In the immunohistochemal analysis, all PA demonstrated the highest intensity of SSTR2 expression (grade 3). Furthermore, PA had a high percentage of cells expressing SSTR2 (20%, 80% and 55%). CONCLUSIONS A strong tracer uptake in PA was shown in 68Ga-DOTATOC PET/CT. This may allow physicians to utilize radioligated somatostatin analogue PET CT/MR imaging to accurately diagnose PA. Additionally, it may be possible in the future to treat the PA with a noninvasive peptide receptor radionuclide therapy or with somatostatin analogues.
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Affiliation(s)
- Felix Johnson
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Marcel Kloppenburg
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Benedikt Hofauer
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Barbara Wollenberg
- Department of Otorhinolaryngology, Klinikum rechts der Isar, TUM School of Medicine and Health, Ismaninger Str. 22, 81675 Munich, Germany
| | - Cosima C. Hoch
- Department of Otorhinolaryngology, Klinikum rechts der Isar, TUM School of Medicine and Health, Ismaninger Str. 22, 81675 Munich, Germany
| | - Fabian Stögbauer
- Institute of General and Surgical Pathology, Klinikum rechts der Isar, TUM School of Medicine and Health, 81675 Munich, Germany
| | - Bernhard Haller
- Institut für KI und Informatik in der Medizin, Klinikum rechts der Isar, TUM School of Medicine and Health, 81675 Munich, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology, Head and Neck Surgery, Albert-Ludwigs-Universität Freiburg, 79106 Freiburg, Germany
| | - Ulrich Strassen
- Department of Otorhinolaryngology, Klinikum rechts der Isar, TUM School of Medicine and Health, Ismaninger Str. 22, 81675 Munich, Germany
| | - Susan Notohamiprodjo
- Department of Nuclear Medicine, Klinikum rechts der Isar, TUM School of Medicine and Health, 81675 Munich, Germany
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Cáceres Puerto M, García Teno M, Porras Alonso E, Maira González MN. Cavernous hemangioma of the head and neck in adults. Differential diagnosis of neck and salivary gland masses. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:265-267. [PMID: 38432618 DOI: 10.1016/j.otoeng.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/14/2023] [Indexed: 03/05/2024]
Affiliation(s)
- María Cáceres Puerto
- Servicio de Otorrinolaringología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain.
| | - Miguel García Teno
- Servicio de Otorrinolaringología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Eulalia Porras Alonso
- Servicio de Otorrinolaringología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
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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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Yang J, Bi Q, Jin Y, Yang Y, Du J, Zhang H, Wu K. Different MRI-based radiomics models for differentiating misdiagnosed or ambiguous pleomorphic adenoma and Warthin tumor of the parotid gland: a multicenter study. Front Oncol 2024; 14:1392343. [PMID: 38939335 PMCID: PMC11208325 DOI: 10.3389/fonc.2024.1392343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Purpose To evaluate the effectiveness of MRI-based radiomics models in distinguishing between Warthin tumors (WT) and misdiagnosed or ambiguous pleomorphic adenoma (PA). Methods Data of patients with PA and WT from two centers were collected. MR images were used to extract radiomic features. The optimal radiomics model was found by running nine machine learning algorithms after feature reduction and selection. To create a clinical model, univariate logistic regression (LR) analysis and multivariate LR were used. The independent clinical predictors and radiomics were combined to create a nomogram. Two integrated models were constructed by the ensemble and stacking algorithms respectively based on the clinical model and the optimal radiomics model. The models' performance was evaluated using the area under the curve (AUC). Results There were 149 patients included in all. Gender, age, and smoking of patients were independent clinical predictors. With the greatest average AUC (0.896) and accuracy (0.839) in validation groups, the LR model was the optimal radiomics model. In the average validation group, the radiomics model based on LR did not have a higher AUC (0.795) than the clinical model (AUC = 0.909). The nomogram (AUC = 0.953) outperformed the radiomics model in terms of discrimination performance. The nomogram in the average validation group had a highest AUC than the stacking model (0.914) or ensemble model (0.798). Conclusion Misdiagnosed or ambiguous PA and WT can be non-invasively distinguished using MRI-based radiomics models. The nomogram exhibited excellent and stable diagnostic performance. In daily work, it is necessary to combine with clinical parameters for distinguishing between PA and WT.
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Affiliation(s)
- Jing Yang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Qiu Bi
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yiren Jin
- Department of Radiation, The Cancer Hospital of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yong Yang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Ji Du
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Hongjiang Zhang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Kunhua Wu
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
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Monestier L, Del Grande J, Haddad R, Santini L, Michel J, Varoquaux A, Fakhry N. Correlation between MRI (DWI and DCE) and cellularity of parotid gland pleomorphic adenomas. Eur Arch Otorhinolaryngol 2024; 281:2655-2665. [PMID: 38498193 DOI: 10.1007/s00405-024-08562-8] [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: 11/23/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Parotid pleomorphic adenomas present a risk of recurrence, higher when the tumour is a hypocellular subtype. The aim of the study was to determine whether it is possible to characterize this histological subtype with diffusion and perfusion sequences of the preoperative MRI. METHODS This retrospective study included 97 patients operated between 2010 and 2020. Histologic slides review was performed to classify tumours into three histologic subtypes: hypocellular, classical and hypercellular. Univariate and multivariate analyses studied the correlation between histology and diffusion and perfusion MRI parameters obtained with OleaSphere® software. RESULTS The hypocellular subtype had higher apparent diffusion coefficient values than the other two subtypes: 2.13 ± 0.23, 1.83 ± 0.42, and 1.61 ± 0.4 × 10-3 mm2/s for hypocellular, classical and hypercellular subtype respectively (p < 0.0001). Multivariate analysis showed that an ADCmean > 1.88 × 10-3 mm2/s was suggestive of a hypocellular pleomorphic adenoma in 79% of the cases, with a specificity and PPV of 94 and 96% (p < 0.001), respectively. CONCLUSION The histological subtype of a pleomorphic adenoma can be predicted preoperatively with ADC values. A prospective and multicentric study on a larger cohort is needed to confirm our results.
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Affiliation(s)
- Laura Monestier
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Jean Del Grande
- Department of Pathology, La Timone University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Ralph Haddad
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Laure Santini
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Justin Michel
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Arthur Varoquaux
- Department of Radiology, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France
| | - Nicolas Fakhry
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix-Marseille University, Marseille, France.
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Su HZ, Wu YH, Hong LC, Yu K, Huang M, Su YM, Zhang F, Zhang ZB, Zhang XD. An ultrasound-based histogram analysis model for prediction of tumour stroma ratio in pleomorphic adenoma of the salivary gland. Dentomaxillofac Radiol 2024; 53:222-232. [PMID: 38426379 PMCID: PMC11056798 DOI: 10.1093/dmfr/twae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/25/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Preoperative identification of different stromal subtypes of pleomorphic adenoma (PA) of the salivary gland is crucial for making treatment decisions. We aimed to develop and validate a model based on histogram analysis (HA) of ultrasound (US) images for predicting tumour stroma ratio (TSR) in salivary gland PA. METHODS A total of 219 PA patients were divided into low-TSR (stroma-low) and high-TSR (stroma-high) groups and enrolled in a training cohort (n = 151) and a validation cohort (n = 68). The least absolute shrinkage and selection operator regression algorithm was used to screen the most optimal clinical, US, and HA features. The selected features were entered into multivariable logistic regression analyses for further selection of independent predictors. Different models, including the nomogram model, the clinic-US (Clin + US) model, and the HA model, were built based on independent predictors using logistic regression. The performance levels of the models were evaluated and validated on the training and validation cohorts. RESULTS Lesion size, shape, cystic areas, vascularity, HA_mean, and HA_skewness were identified as independent predictors for constructing the nomogram model. The nomogram model incorporating the clinical, US, and HA features achieved areas under the curve of 0.839 and 0.852 in the training and validation cohorts, respectively, demonstrating good predictive performance and calibration. Decision curve analysis and clinical impact curves further confirmed its clinical usefulness. CONCLUSIONS The nomogram model we developed offers a practical tool for preoperative TSR prediction in PA, potentially enhancing clinical decision-making.
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Affiliation(s)
- Huan-Zhong Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Yu-Hui Wu
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Kun Yu
- Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Mei Huang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Yi-Ming Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
- Department of Ultrasound, Siming Branch Hospital, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Feng Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Zuo-Bing Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Xiao-Dong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
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Wang Y, Guo X, Yu K, Shen X, Liu J, Zhao T, Gu H. Adenoid cystic carcinoma of head and neck: Summary and review of imaging findings. Heliyon 2023; 9:e21901. [PMID: 38027910 PMCID: PMC10665720 DOI: 10.1016/j.heliyon.2023.e21901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Current reports of adenoid cystic carcinoma of the head and neck (ACC) are all case reports, and there is no basilar summary of its imaging findings. This study aims to summarise ACC's computed tomography (CT) and magnetic resonance imaging (MRI) findings to improve radiologists' knowledge of this disease. Methods We collected clinical and imaging data of patients with ACC during the last decade, and two radiologists retrospectively analysed the imaging characteristics. Results Of the 16 patients included, six were able to self-perceive bulkiness, and 11 had regional pain. Tumour morphology was regular in six cases, with clear borders in 11 cases, invasion of the surrounding bony mass in 12 cases, and invasion of peripheral nerves in 15 cases. CT mostly shows an irregular soft-tissue density mass with mild-to-moderate enhancement after contrast medium administration. On MRI, the ACC showed isointense or hypointense signals on T1-weighted images (T1WI) and hyperintense or slightly hyperintense signals on T2-weighted images (T2WI). All signals were markedly enhanced after gadolinium enhancement. Conclusions ACC often has an irregular morphology, sometimes with a cystic component, enhancement on enhancement scans, easy destruction of adjacent bone, and invasion of peripheral nerves. The diagnosis should be considered when these features are encountered in clinical practice.
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Affiliation(s)
- Yidan Wang
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Xiaoli Guo
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Ke Yu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Xiying Shen
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Jia Liu
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong University, Nantong, China
| | - Tianye Zhao
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong University, Nantong, China
| | - Hongmei Gu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China
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11
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Vegni F, Feraco A, Policardo F, Tralongo P, De Stefano I, Ferraro G, Zhang Q, Carlino A, Navarra E, Mulè A, Rossi ED. Cystic lesions in the salivary gland. Pitfalls to be avoided on cytology. Cytopathology 2023; 34:542-550. [PMID: 37377125 DOI: 10.1111/cyt.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Cystic lesions of the salivary glands are very uncommon entities. However, on occasion, some neoplasms of the salivary glands show a cystic component, which may be predominant or only partially cystic. Basal cell adenoma, canalicular adenoma, oncocytoma, sebaceous adenoma, intraductal papilloma, epithelial-myoepithelial carcinoma, intraductal carcinoma, and secretory carcinoma are such cystic entities. Cystic degeneration and necrosis, which can develop within solid tumours, represent another possibility. The ability to recognise this type of lesion is a challenge in diagnostic cytology because hypocellular fluid is frequently recovered. Furthermore, evaluating all of the differential diagnoses for cystic lesions of the salivary glands is helpful in obtaining the correct diagnosis. Herein, we evaluate the various types of cystic lesions within the salivary glands.
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Affiliation(s)
- Federica Vegni
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Policardo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Ilenia De Stefano
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Giulia Ferraro
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Qianqian Zhang
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Carlino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Elena Navarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Antonino Mulè
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
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12
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Saraniti C, Burrascano D, Verro B, De Lisi G, Rodolico V. A solitary fibrous tumor of the parotid gland: Case report. Int J Surg Case Rep 2023; 111:108855. [PMID: 37742355 PMCID: PMC10520796 DOI: 10.1016/j.ijscr.2023.108855] [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: 08/22/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Solitary fibrous tumor is a rare neoplasm that can affect any part of the body, also head and neck region. Etiology is unknown. The incidence is slightly higher in males, the age ranges from 11 to 79 years. PRESENTATION OF CASE It's the first case in our country of left parotid solitary fibrous tumor, removed by partial parotidectomy with facial nerve preservation. Histology examination showed diffuse spindle-shaped cells proliferation, moderate polymorphism, low mitotic index (<4 mitoses per 10 HPF), partially bordered by fibrous capsule. Immunohistochemistry showed STAT6, CD34, CD99 positivity. Six-months follow-up didn't show sign of recurrence. DISCUSSION Solitary fibrous tumor is a mesenchymal spindle cell neoplasm with fibroblastic differentiation ubiquitous in soft tissues, that involved the head and neck region in 6 % of cases. Etiology is unknown. The possible pathogenesis is NAB2-STAT6 gene fusion. It's asymptomatic or symptoms are related to space-occupying mass. Diagnostic work up involves imaging, immunohistochemistry, histology. Radiographic finding may lead to incorrect assessment of the mass: the same imaging features are present in pleomorphic adenoma, the most frequent tumor of salivary glands. CONCLUSION This case report aims to stress that, although rare, solitary fibrous tumor should be considered in differential diagnosis in case of indolent salivary gland mass, since it may require more invasive approach (e.g., total parotidectomy, adjuvant radiotherapy). It would like to highlight the role of multidisciplinary team to define the best therapy, tailored for the patient, as well as to give awareness to a rare but sometimes aggressive tumor.
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Affiliation(s)
- Carmelo Saraniti
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy.
| | - Davide Burrascano
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Barbara Verro
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Giovanni De Lisi
- Pathology Unit, Department of Health promotion Sciences maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Vito Rodolico
- Pathology Unit, Department of Health promotion Sciences maternal and Infantile Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
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13
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Kalwaniya DS, Meena R, Kumar D, Tolat A, Arya SV. A Review of the Current Literature on Pleomorphic Adenoma. Cureus 2023; 15:e42311. [PMID: 37614271 PMCID: PMC10442517 DOI: 10.7759/cureus.42311] [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] [Accepted: 07/22/2023] [Indexed: 08/25/2023] Open
Abstract
Pleomorphic adenomas (PA) are the most common benign salivary gland tumors. They arise from the major salivary glands, as well as the minor salivary glands. They may arise rarely from the palate, oral cavity, neck, and nasal cavity also. Yet, the fourth, fifth, and sixth decades of life are the most common for them to manifest. Forty percent of them occur in males and 60% in females. It is a benign mixed tumor, which has three components: an epithelial component, a myoepithelial cell component, and a mesenchymal component. A fibrous capsule separates these cells from the surrounding tissues. It generally presents as a slowly progressing painless swelling, which is well-delineated, nonsymptomatic, and not involving the facial nerve. Salivary gland tumors can be accurately diagnosed before surgery using fine-needle aspiration (FNA), ultrasonography (USG), and computed tomography (CT) scan. Calponin, cluster of differentiation 9 (CD9), glial fibrillary acidic protein (GFAP), Mcl-2, metastasis suppressor gene (NM23), p63, S-100, smooth muscle actin (SMA), and SRY-box transcription factor 10 (SOX10) exhibit the majority of the positive reactions in pleomorphic adenomas. The diagnostic marker pleomorphic adenoma gene 1 (PLAG1) is frequently employed since it is specific for pleomorphic adenoma. Although benign, these epithelial tumors have a propensity to recur and undergo malignant transformation if incompletely excised, leading to increased morbidity in these patients. A review of the consensus guidelines and literature was conducted, and the online literature on the subject from 2002 was included. This article is not a complete review of all the available literature; rather, it is a comprehensive review of the topic.
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Affiliation(s)
- Dheer S Kalwaniya
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Reena Meena
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Devender Kumar
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Aditya Tolat
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Satya V Arya
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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14
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Kato H, Kawaguchi M, Ando T, Shibata H, Ogawa T, Noda Y, Hyodo F, Matsuo M. Current status of diffusion-weighted imaging in differentiating parotid tumors. Auris Nasus Larynx 2023; 50:187-195. [PMID: 35879151 DOI: 10.1016/j.anl.2022.07.002] [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: 05/13/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
Recently, diffusion-weighted imaging (DWI) is an essential magnetic resonance imaging (MRI) protocol for head and neck imaging in clinical practice as it plays an important role in lesion detection, tumor extension evaluation, differential diagnosis, therapeutic effect prediction, therapy evaluation, and recurrence diagnosis. Especially in the parotid gland, several studies have already attempted to achieve accurate differentiation between benign and malignant tumors using DWI. A conventional single-shot echo-planar-based DWI is widely used for head and neck imaging, whereas advanced DWI sequences, such as intravoxel incoherent motion, diffusion kurtosis imaging, periodically rotated overlapping parallel lines with enhanced reconstruction, and readout-segmented echo-planar imaging (readout segmentation of long variable echo-trains), have been used to characterize parotid tumors. The mean apparent diffusion coefficient values are easily measured and useful for assessing cellularity and histological characteristics, whereas advanced image analyses, such as histogram analysis, texture analysis, and machine and deep learning, have been rapidly developed. Furthermore, a combination of DWI and other MRI protocols has reportedly improved the diagnostic accuracy of parotid tumors. This review article summarizes the current state of DWI in differentiating parotid tumors.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | | | - Takenori Ogawa
- Department of Otolaryngology, Gifu University, Gifu, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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15
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Abubakar M, Mohammed I, Abubakar M, Adebayo W, Kabir M, Abass O, Ibrahim A. Keloid masking a parotid tumor: A rare case presentation. Ann Afr Med 2023; 22:235-238. [PMID: 37026207 DOI: 10.4103/aam.aam_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
A 37-year-old Nigerian woman presented with an itchy and occasionally painful scar that appeared after the healing of an acne lesion over the left parotid region, 13 years ago. She noticed a progressive increase; however, there was no history of facial weakness. Examination revealed a keloid lesion overlying a firm nontender mass. Ultrasound scan and fine-needle aspiration cytology indicated a benign tumor of the left parotid. Superficial parotidectomy was performed, and the histology revealed a keloid overlying a pleomorphic adenoma. This is an unusual presentation of keloid which developed over a pleomorphic adenoma. Hence, we report the above case for its rarity.
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16
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Gökçe E, Beyhan M. Advanced magnetic resonance imaging findings in salivary gland tumors. World J Radiol 2022; 14:256-271. [PMID: 36160835 PMCID: PMC9453317 DOI: 10.4329/wjr.v14.i8.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/22/2022] [Accepted: 08/07/2022] [Indexed: 02/08/2023] Open
Abstract
Salivary gland tumors (SGTs) make up a small portion (approximately 5%) of all head and neck tumors. Most of them are located in the parotid glands, while they are less frequently located in the submandibular glands, minor salivary glands or sublingual gland. The incidence of malignant or benign tumors (BTs) in the salivary glands varies according to the salivary gland from which they originate. While most of those detected in the parotid gland tend to be benign, the incidence of malignancy increases in other glands. The use of magnetic resonance imaging (MRI) in the diagnosis of SGTs is increasing every day. While conventional sequences provide sufficient data on the presence, localization, extent and number of the tumor, they are insufficient for tumor specification. With the widespread use of advanced techniques such as diffusion-weighted imaging, semi-quantitative and quantitative perfusion MRI, studies and data have been published on the differentiation of malignant or BTs and the specificity of their subtypes. With diffusion MRI, differentiation can be made by utilizing the cellularity and microstructural properties of tumors. For example, SGTs such as high cellular Warthin’s tumor (WT) or lymphoma on diffusion MRI have been reported to have significantly lower apparent diffusion values than other tumors. Contrast agent uptake and wash-out levels of tumors can be detected with semi-quantitative perfusion MRI. For example, it is reported that almost all of the pleomorphic adenomas show an increasing enhancement time intensity curve and do not wash-out. On quantitative perfusion MRI studies using perfusion parameters such as Ktrans, Kep, and Ve, it is reported that WTs can show higher Kep and lower Ve values than other tumors. In this study, the contribution of advanced MRI to the diagnosis and differential diagnosis of SGTs will be reviewed.
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Affiliation(s)
- Erkan Gökçe
- Department of Radiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat 60100, Turkey
| | - Murat Beyhan
- Department of Radiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat 60100, Turkey
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17
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Suto T, Kato H, Kawaguchi M, Kobayashi K, Miyazaki T, Ando T, Noda Y, Hyodo F, Matsuo M, Ishihara H, Ogawa T. MRI findings of epithelial-myoepithelial carcinoma of the parotid gland with radiologic-pathologic correlation. Jpn J Radiol 2022; 40:578-585. [PMID: 34982376 PMCID: PMC9162990 DOI: 10.1007/s11604-021-01243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/20/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE This study aimed to describe the MRI findings of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. MATERIALS AND METHODS Seven patients (four males and three females) aged 40-86 years (mean age, 64 years) with histologically proven EMC of the parotid gland who underwent surgical resection after preoperative MRI were enrolled. MRI images were retrospectively reviewed and contrasted with pathological findings. RESULTS Five patients (71%) had predominantly solid lesions, and two (29%) had predominantly cystic lesions. All seven lesions had well-demarcated margins and capsules without the invasion of adjacent structures. The capsules were incomplete in five lesions (71%) and complete in two (29%). Four lesions (57%) exhibited a multinodular structure with internal septa. Cystic components were observed in three lesions (43%). On T1-weighted images, the solid components were frequently homogeneous (5/7, 71%), and demonstrated isointensity in five lesions (71%) and hypointensity in two (29%) relative to the spinal cord. On T2-weighted images, the solid components were usually heterogeneous (6/7, 86%), and demonstrated hyperintensity in five lesions (71%) and isointensity in two (29%) relative to the spinal cord. The mean apparent diffusion coefficient value of the solid components was 0.967 × 10-3 mm2/s. CONCLUSION Parotid gland EMCs usually appeared as predominantly solid lesions with well-demarcated margins and capsules. A multinodular structure with internal septa was characteristics of EMCs.
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Affiliation(s)
- Taketo Suto
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | | | | | - Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | | | - Takenori Ogawa
- Department of Otolaryngology, Gifu University, Gifu, Japan
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18
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Limardo A, Blanco L, Menendez J, García L, Ortega A. The development of a clinical algorithm for the diagnosis of tumours in the parapharyngeal space. A systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:141-150. [DOI: 10.1016/j.otoeng.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/21/2020] [Indexed: 11/24/2022]
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19
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Galluzzi F, Garavello W. Surgical treatment of pleomorphic adenoma of parotid gland in children: a systematic review. Auris Nasus Larynx 2022; 49:547-553. [DOI: 10.1016/j.anl.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/08/2022] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
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20
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Vernuccio F, Arnone F, Cannella R, Verro B, Comelli A, Agnello F, Stefano A, Gargano R, Rodolico V, Salvaggio G, Lagalla R, Midiri M, Lo Casto A. Diagnostic performance of qualitative and radiomics approach to parotid gland tumors: which is the added benefit of texture analysis? Br J Radiol 2021; 94:20210340. [PMID: 34591597 PMCID: PMC8631014 DOI: 10.1259/bjr.20210340] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological approach. METHODS Patients with parotid gland tumors who underwent salivary glands MRI between 2008 and 2019 were retrospectively selected. MRI analysis included a qualitative assessment by two radiologists (one of which subspecialized on head and neck imaging), and texture analysis on various sequences. Diagnostic performances including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of qualitative features, radiologists' diagnosis, and radiomic models were evaluated. RESULTS Final study cohort included 57 patients with 74 tumors (27 pleomorphic adenomas, 40 Warthin tumors, 8 malignant tumors). Sensitivity, specificity, and AUROC for the diagnosis of malignancy were 75%, 97% and 0.860 for non-subspecialized radiologist, 100%, 94% and 0.970 for subspecialized radiologist and 57.2%, 93.4%, and 0.927 using a MRI radiomics model obtained combining texture analysis on various MRI sequences. Sensitivity, specificity, and AUROC for the differential diagnosis between pleomorphic adenoma and Warthin tumors were 81.5%, 70%, and 0.757 for non-subspecialized radiologist, 81.5%, 95% and 0.882 for subspecialized radiologist and 70.8%, 82.5%, and 0.808 using a MRI radiomics model based on texture analysis of T2 weighted sequence. A combined radiomics model obtained with all MRI sequences yielded a sensitivity of 91.5% for the diagnosis of pleomorphic adenoma. CONCLUSION MRI qualitative radiologist assessment outperforms radiomic analysis for the diagnosis of malignancy. MRI predictive radiomics models improves the diagnostic performance of non-subspecialized radiologist for the differential diagnosis between pleomorphic adenoma and Warthin tumor, achieving similar performance to the subspecialized radiologist. ADVANCES IN KNOWLEDGE Radiologists outperform radiomic analysis for the diagnosis of malignant parotid gland tumors, with some MRI qualitative features such as ill-defined margins, perineural spread, invasion of adjacent structures and enlarged lymph nodes being highly specific for malignancy. A radiomic model based on texture analysis of T2 weighted images yields higher specificity for the diagnosis of pleomorphic adenoma compared to a radiologist non-subspecialized in head and neck radiology, thus minimizing false-positive pleomorphic adenoma diagnosis rate and reducing unnecessary surgical complications.
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Affiliation(s)
- Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Federica Arnone
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Barbara Verro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Albert Comelli
- Ri.MED Foundation, Palermo, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Francesco Agnello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Rosalia Gargano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Vito Rodolico
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
| | - Antonio Lo Casto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Palermo, Italy
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21
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Bartkowiak E, Piwowarczyk K, Bodnar M, Kosikowski P, Chou J, Woźniak A, Wierzbicka M. Expression of p16 Ink4a protein in pleomorphic adenoma and carcinoma ex pleomorphic adenoma proves diversity of tumour biology and predicts clinical course. J Clin Pathol 2021; 75:605-611. [PMID: 33941588 PMCID: PMC9411887 DOI: 10.1136/jclinpath-2021-207440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
Aims The aim of the study is to correlate p16Ink4a expression with the clinical courses of pleomorphic adenoma (PA), its malignant transformation (CaexPA) and treatment outcomes. Methods Retrospective analysis (1998–2019) of 47 CaexPA, 148 PA and 22 normal salivary gland samples was performed. PAs were divided into two subsets: clinically ‘slow’ tumours characterised by stable size or slow growth; and ‘fast’ tumours with rapid growth rate. Results Positive p16Ink4a expression was found in 68 PA and 23 CaexPA, and borderline expression in 80 and 20, respectively. All 22 (100%) normal salivary gland samples presented with no p16Ink4a expression. Significant difference in p16Ink4a expression was observed between normal tissue, PA and CaexPA (χ2 (4)=172,19; p=0.0001). The PA clinical subgroups were also evaluated separately, revealing additional statistical relations: ‘fast’ PA and CaexPA differed significantly in p16Ink4a expression (χ2 (2)=8.06; p=0.01781) while ‘slow’ PA and CaexPA did not (χ2 (2)=3.09; p=0.2129). 3-year, 5-year and 10-year survival among p16Ink4a positive CaexPA patients was 100%, 90.56% and 60.37%, respectively, and in CaexPA patients with borderline p16Ink4a expression was 90.0%, 73.64% and 22.20%, respectively. Statistically significant difference between expression pattern and survival rate was observed (F Cox test – F (16, 24)=2.31; p=0.03075). Conclusions Our study confirms no p16Ink4a expression in normal tissue, but reveals differences in expression between ‘fast’ and ‘slow’ PA. We suggest that p16Ink4a overexpression is connected to PA proliferation and subsequent malignant transformation to CaexPA. Borderline p16Ink4a staining correlates with worse prognosis of CaexPA.
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Affiliation(s)
- Ewelina Bartkowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Piwowarczyk
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Bodnar
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland.,Department of Clinical Pathomorphology, Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Paweł Kosikowski
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jadzia Chou
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Aldona Woźniak
- Department of Clinical Pathology, 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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22
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Limardo A, Blanco L, Menendez J, García L, Ortega A. The development of a clinical algorithm for the diagnosis of tumours in the parapharyngeal space. A systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30192-8. [PMID: 33810827 DOI: 10.1016/j.otorri.2020.11.001] [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: 08/27/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Parapharyngeal space (PPS) is defined as a deep space, located around the upper pharynx, in the shape of an inverted pyramid. Primary tumours in this region are rare, accounting for 0.5% of head and neck neoplasms, and most are benign. The objective of this study is to propose a new study algorithm based on a systematic review and our experience. MATERIALS AND METHODS A cross-sectional and analytical study was carried out through review of the clinical records of our hospital. Patients with tumours of the parapharyngeal space operated from January 2010 to December 2019 and a systematic review of Pubmed studies from the last 5years were included. We considered clinical signs, diagnostic methods, presumptive diagnosis and histopathological findings. Statistical analysis was performed with STATA v.14 software. RESULTS 53 of our cases and 1392 from the review were included. The clinical algorithm showed a sensitivity of 76.4% and a specificity of 96.3%, with an AUC of 0.57 for diagnosis. DISCUSSION Complementary radiological examinations are essential in the topographic diagnosis of the tumour. Angio-MRI links the tissue of origin of the tumours and provides the highest diagnostic certainty. FNA has some disadvantages in PPS, but it is useful in some patients. CONCLUSION The proposed algorithm contributes to obtaining excellent results in the management of these tumours because it turned out to be effective in diagnosis, and this enables improved surgical planning.
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Affiliation(s)
- Andrés Limardo
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
| | - Luis Blanco
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - José Menendez
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | - Laura García
- Sección de Cirugía de Cabeza y Cuello, Hospital Regional Gobernador Ernesto M. Campos, Ushuaia, Tierra del Fuego, Argentina
| | - Adrián Ortega
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
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23
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Wei PY, Shao C, Huan T, Wang HB, Ding ZX, Han ZJ. Diagnostic value of maximum signal intensity on T1-weighted MRI images for differentiating parotid gland tumours along with pathological correlation. Clin Radiol 2021; 76:472.e19-472.e25. [PMID: 33731262 DOI: 10.1016/j.crad.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/05/2021] [Indexed: 12/27/2022]
Abstract
AIM To investigate the efficacy of the maximum signal intensity of tumour on T1-weighted magnetic resonance imaging (MRI) images for differentiating Warthin's tumours (WTs) from pleomorphic adenomas (PAs) and malignant tumours (MTs). MATERIALS AND METHODS One hundred and fifty-four histopathologically confirmed parotid tumours, including 76 PAs, 45 WTs, and 33 MTs, were analysed. MRI results were compared with pathological findings. The maximum signal intensity of tumour and the average signal intensity of spinal cord were measured on T1-weighted images, then the tumour-to-spinal cord signal intensity ratio (T1-max-SIR) was calculated. The distribution of T1-max-SIRs among the three groups of tumours was analysed using the Mann-Whitney U-test. Receiver operating characteristic curves were generated to assess the ability of T1-max-SIRs to differentiate parotid tumours. In addition, the interobserver agreement between readers was assessed using interclass correlation coefficient (ICC). RESULTS T1-max-SIRs were higher in WTs than in PAs (p<0.001) and MTs (p<0.001), and no significant difference was found between PAs and MTs (p=0.151). The area under the curve (AUC) of T1-max-SIRs for differentiating WTs from PAs was 0.901, with a sensitivity of 91.1% and a specificity of 82.9%. The AUC of T1-max-SIRs for differentiating WTs from MTs was 0.851, with a sensitivity of 88.9% and a specificity of 78.8%. Readers had excellent interobserver agreement on T1-max-SIRs (ICC = 0.989; 95% confidence interval, 0.985-0.992). CONCLUSIONS T1-max-SIRs can be useful for differentiating WTs from PAs and MTs with high diagnostic efficiency.
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Affiliation(s)
- P Y Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - C Shao
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - T Huan
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - H B Wang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Z X Ding
- Department of Radiology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Z J Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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24
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Takumi K, Nagano H, Kikuno H, Kumagae Y, Fukukura Y, Yoshiura T. Differentiating malignant from benign salivary gland lesions: a multiparametric non-contrast MR imaging approach. Sci Rep 2021; 11:2780. [PMID: 33531644 PMCID: PMC7854671 DOI: 10.1038/s41598-021-82455-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/19/2021] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study is to determine whether multiparametric non-contrast MR imaging including diffusion-weighted imaging (DWI), arterial spin labeling (ASL), and amide proton transfer (APT) weighted imaging can help differentiate malignant from benign salivary gland lesions. The study population consisted of 42 patients, with 31 benign and 11 malignant salivary gland lesions. All patients were evaluated using DWI, three-dimensional pseudo-continuous ASL, and APT-weighted imaging on 3 T MR imaging before treatment. Apparent diffusion coefficient (ADC), tumor blood flow (TBF), and APT-related signal intensity (APTSI) values within the lesion were compared between the malignant and benign lesions by Mann-Whitney U test. For each parameter, optimal cutoff values were chosen using a threshold criterion that maximized the Youden index for predicting malignant lesions. The performance of ADC, TBF, APTSI, individually and combined, was evaluated in terms of diagnostic ability for malignant lesions. Diagnostic performance was compared by McNemar test. APTSI was significantly higher in malignant lesions (2.18 ± 0.89%) than in benign lesions (1.57 ± 1.09%, p = 0.047). There was no significant difference in ADC or TBF between benign and malignant lesions (p = 0.155 and 0.498, respectively). The accuracy of ADC, TBF, and APTSI for diagnosing malignant lesions was 47.6%, 50.0%, and 66.7%, respectively; whereas the accuracy of the three parameters combined was 85.7%, which was significantly higher than that of each parameter alone (p = 0.001, 0.001, and 0.008, respectively). Therefore, the combination of ADC, TBF, and APTSI can help differentiate malignant from benign salivary gland lesions.
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Affiliation(s)
- Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Hiroaki Nagano
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hidehiko Kikuno
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yuichi Kumagae
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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25
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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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26
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Pérez-de-Oliveira ME, Leonel ACLDS, de Castro JFL, Carvalho EJDA, Vargas PA, Perez DEDC. Histopathological Findings of Intraoral Pleomorphic Adenomas: A Retrospective Study of a Case Series. Int J Surg Pathol 2019; 27:729-735. [PMID: 31187672 DOI: 10.1177/1066896919854181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to describe the clinicopathological features of 21 cases of intraoral pleomorphic adenoma (PA), with emphasis on histopathological findings. Between 2000 and 2016, all patients diagnosed as intraoral PA were retrieved and histopathological slides stained with hematoxylin and eosin reviewed to confirm the diagnosis. All tumors were classified histologically according to Seifert et al (1980). The clinical and histopathological variables were analyzed using the Fisher's exact test, considering a significance level of 5% (P < .05). Plasmacytoid (85.7%), spindle (38.1%), and epithelioid (9.5%) myoepithelial cells were observed. Oncocytic (47.6%) and mucous (19%) cells were also found. The stroma was predominantly fibrous (95.2%), followed by myxoid (66.7%), hyaline (61.9%), and chondromyxoid (33.3%). Squamous (57.1%), adipose (47.6%), sebaceous (14.3%), and bone (14.3%) differentiations were found. Additionally, a group of tumors presented pleomorphism (23.8%), mitoses (14.3%), capsule infiltration (9.5%), and necrosis. The presence of cystic structures occurred significantly in patients older than 30 years (P = .04) and mitoses were more observed in PA from buccal mucosa (P = .026). All cases that presented plasmacytoid cells were smaller than 1.5 cm (P = .015). All tumors with up to 50% stroma area presented with size smaller than 2.0 cm (P = .013). Intraoral PA presents a large morphological spectrum and several microscopic features are associated with clinical findings.
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Affiliation(s)
| | | | | | | | - Pablo Agustin Vargas
- 1 Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, SP, Brazil
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