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Park C, Min S, Park JK, Kim JH. Basal cell adenoma and basal cell adenocarcinoma of the parotid gland: clinical findings and surgical outcomes in a single-institution study. World J Surg Oncol 2024; 22:102. [PMID: 38637826 PMCID: PMC11025202 DOI: 10.1186/s12957-024-03378-6] [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: 02/10/2024] [Accepted: 04/03/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Basal cell adenoma (BCA) is a rare benign tumor within the salivary glands. Basal cell adenocarcinoma (BCAC), the malignant counterpart of BCA, is also an exceedingly rare tumor with very limited clinical studies conducted. This study aims to investigate the clinical characteristics, demographics, and surgical outcomes of patients diagnosed with BCA and BCAC within the parotid gland. METHODS A retrospective analysis from May 2003 to August 2023 was performed for all patients undergoing parotidectomy for masses. Retrospective data on gender, age, tumor characteristics, and outcomes were collected. Surgical approaches, including negative margin attainment, capsule removal, and histological diagnosis, were also detailed. RESULTS The study included 1268 patients who underwent parotidectomy, resulting in 81 cases of BCA and 7 cases of BCAC. BCA patients, with a mean age of 55.1 years, showed diverse age distribution and predominantly presented in the 50s. In BCAC cases, seven female patients exhibited a predominant location in the deep lobes. FNA revealed BCAC in three out of seven cases, and subsequent parotidectomy was performed, resulting in no observed recurrences or metastases. CONCLUSION This study reports the largest number of BCA cases from a single institution and provides comprehensive insights into the demographics, tumor characteristics, and clinical outcomes of both BCA and BCAC. Although further research should be conducted, based on clinical follow-up results, appropriately including the capsule in the tumor excision indicates favorable outcomes, especially when the tumor size is not large.
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Affiliation(s)
- Chongsoo Park
- Department of Plastic and Reconstructive Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sally Min
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Korea
| | - Joseph Kyuhyung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Korea
| | - Jong-Ho Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, 463-707, Korea.
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Goel A, Kapatia G, Gupta S. Commentary on the "Diagnostic value of the 'triple diagnosis method' in salivary gland tumors". Diagn Cytopathol 2023; 51:724-725. [PMID: 37642244 DOI: 10.1002/dc.25218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Archit Goel
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Shruti Gupta
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rae Bareli, India
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3
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Chen CN, Yang TL. Application of ultrasound in distinguishing the incipient microtumor from inherent lymph nodes of the parotid glands. J Formos Med Assoc 2023; 122:994-1000. [PMID: 37391337 DOI: 10.1016/j.jfma.2023.05.014] [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: 01/30/2023] [Revised: 03/18/2023] [Accepted: 05/12/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Parotid microtumors (size ≤ 1 cm) pose a significant clinical challenge due to their malignant potential and risks associated with surgery. It is imperative to explore the diagnostic workflow that incorporates ultrasound (US) in order to make appropriate clinical decisions with minimal invasiveness. METHODS The patients receiving both US and ultrasound-guided fine needle aspiration (USFNA) for the parotid microtumors in a medical center were retrospectively recruited. The ultrasonic features, cytology of USFNA, and final surgical pathology were analyzed to differentiate the tumor origins and their malignant potential. RESULTS From August 2009 to March 2016, a total of 92 patients were enrolled in the study. The short axis, long-to-short axis ratio, and presence of an echogenic hilum were found to be significantly useful in distinguishing lymphoid tissue origin from salivary gland origin, which was confirmed by USFNA. An irregular border was predictive for malignant parotid microtumors from both origins. Intra-tumoral heterogeneity was also identified as a significant feature associated with malignant lymph nodes. USFNA was able to confirm all malignant lymph nodes, but it had a false negative rate of 8.5% in parotid microtumors of salivary gland origin. Based on the analysis of US and USFNA results, a diagnostic workflow for parotid microtumors was proposed. CONCLUSION US and USFNA can be helpful in classifying the origins of parotid microtumors. US-FNA carries the risk of producing false negative results specifically for microtumors originating from salivary glands, but not lymphoid tissue. The diagnostic workflow, which incorporates both US and USFNA, assists in determining the clinical decision for diagnosing and managing parotid microtumors.
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Affiliation(s)
- Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan; Center of Industry-Academia Cooperation, National Taiwan University, Taiwan.
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Mourouzis C, Schoinohoriti O, Mastagkas D, Rallis G. Fine-Needle Aspiration Cytology in the Diagnosis of Salivary Gland Tumors Before the Milan System: A Ten-Year Experience From a Tertiary Care Center in Greece. Cureus 2023; 15:e42737. [PMID: 37654959 PMCID: PMC10467328 DOI: 10.7759/cureus.42737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Objective The objective of this study was to determine the diagnostic value of fine-needle aspiration cytology (FNAC) for salivary gland tumors. Methodology A retrospective file analysis of patients with salivary gland pathology, attending the Department of Oral and Maxillofacial Surgery of a tertiary care center in Athens, Greece, over a 10-year-long period, was conducted. Sensitivity, specificity, accuracy, positive prognostic value (PPV), and negative prognostic value (NPV) of FNAC for benign and malignant tumors separately were assessed and compared with histology. Results A total of 82 patients (46 male and 36 female) with salivary gland tumors, submitted to both FNAC and histology, were included. The mean age was 55 years. A total of 73 tumors were histologically diagnosed as benign and nine as malignant. FNAC identified 62 benign and seven malignant tumors but was inconclusive in 13 cases. The most common diagnosis of both histology and FNAC was pleomorphic adenoma. FNAC sensitivity, specificity, accuracy, PPV, and NPV were 98.3% and 100%, 87.5% and 100%, 97.1% and 100%, 98.3% and 100%, and 87.5% and 100% for benign and malignant tumors, respectively. Conclusions FNAC is highly sensitive but moderately specific for the preoperative identification of benign salivary gland tumors. Its use as an initial diagnostic modality is warranted, thanks to its safeness, rapidity, and lack of pain.
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Affiliation(s)
| | - Ourania Schoinohoriti
- Department of Oral and Maxillofacial Surgery, Dental School, University of Athens, Athens, GRC
| | - Dimitris Mastagkas
- Department of Oral and Maxillofacial Surgery, 401 Military Hospital of Athens, Athens, GRC
| | - George Rallis
- Department of Oral and Maxillofacial Surgery, KAT Attica General Hospital, Athens, GRC
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5
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Preston P, Esebua M, Layfield LJ. Diagnosis of salivary gland tumors: Does the triple diagnosis method have value? Diagn Cytopathol 2023; 51:527-531. [PMID: 37260131 DOI: 10.1002/dc.25171] [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: 04/10/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Appropriate clinical management of salivary gland lesions requires a determination as to whether a salivary gland nodule is benign or malignant. Approximately three-quarters of all salivary gland nodules represent benign neoplasms. Separation of salivary gland carcinomas from benign lesions can be diagnostically challenging. The Milan System for Reporting Salivary Gland Cytopathology recommends the correlation of cytologic diagnoses with imaging and clinical findings creating a diagnostic triplet. How often the "Triple Diagnosis" method is used and its accuracy in separating salivary gland nodules into benign and malignant groups are unknown. METHODS An electronic records search of cytology files at the University of Missouri was performed for fine needle aspirates of the salivary gland obtained between September 2018 and August 2022. Chart review was performed for preoperative clinical and imaging diagnoses. Diagnostic "Triplets" constructed from cytologic, clinical, and imaging diagnoses were correlated with final surgical pathology diagnosis. RESULTS One hundred and thirty-six FNAs were identified. Eighty-seven cases had preoperative imaging with 52 of these cases having clinical diagnoses. Due to the lack of a definitive clinical or imaging diagnosis for a nodule as benign or malignant, only 12 (23%) cases had definitive "Triplets." Nine (17%) "Triplets" were benign and three (6%) were malignant. Accuracy of concordant triplets was 100% for the prediction of malignancy and 89% for the prediction of a benign result as determined by final histologic diagnoses. CONCLUSION While highly accurate in predicting the benign or malignant nature of a salivary gland nodule, concordant triplets made up only 23% of cases limiting their clinical utility.
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Affiliation(s)
- Peace Preston
- Department of Pathology and Anatomical Science, University of Missouri, Columbia, Missouri, USA
| | - Magda Esebua
- Department of Pathology and Anatomical Science, University of Missouri, Columbia, Missouri, USA
| | - Lester J Layfield
- Department of Pathology and Anatomical Science, University of Missouri, Columbia, Missouri, USA
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Kapoor A, Bakshi J, Panda NK, Sharma V, Bal A, Rampal M, Sedai R, Saharan D, Agarwal G, Gautamjit. Pathological Inconsistencies in Advanced Malignancies of the Parotid Gland. Indian J Otolaryngol Head Neck Surg 2023; 75:311-317. [PMID: 37275068 PMCID: PMC10235400 DOI: 10.1007/s12070-022-03160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Archit Kapoor
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Naresh K Panda
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Vikas Sharma
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Amanjeet Bal
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Mayank Rampal
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Raghab Sedai
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Deepak Saharan
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Ganesh Agarwal
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
| | - Gautamjit
- Department of Otolaryngology & Head and Neck Surgery, PGIMER, 160012 Chandigarh, India
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Tenney TB, Mullane PC, Viswanathan K, Shi Q, Lui SK, Lubin DJ. Does Milan affect management? A retrospective analysis of resection rate and time to surgery among Milan categories. Diagn Cytopathol 2023; 51:221-229. [PMID: 36700488 DOI: 10.1002/dc.25104] [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: 10/25/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is an established system with reproducible risk of malignancies (ROM) for salivary gland fine needle aspiration (SGFNA). No studies have reviewed the relationship between Milan categories and the resection rate (RR) and time to resection (TTR). METHODS We searched our database (January 1, 2011 to January 4, 2021) for non-lymphoma SGFNAs and assigned appropriate MSRSGC categories. RR and TTR were calculated and compared for each category. A literature search was performed; RRs and TTRs were compared. RESULTS Seven hundred and eighty SGFNAs were identified, 333 with follow-up. RR was highest in suspicious for malignancy (SUS, V; 70.6%, n = 12/17), followed by the salivary gland neoplasm of uncertain malignant potential (SUMP, IVb; 69.6%, n = 80/115) and malignant (M, VI; 55.6%, n = 75/135). Among M, primary tumors had a higher RR (65.1%, n = 41/63) than metastases (47.2%, n = 34/72, p = .36). In literature review, SUS had the highest RR (69.3%, n = 233/336) followed by M (61.6%, n = 821/1332) and SUMP (60.2%, n = 632/1050). TTR was shorter in SUS (mean = 32.3 days, median = 25 days). Within the benign neoplasms (BN, IVa), Pleomorphic adenomas (PAs) had a higher RR than Warthin tumors (WTs) (66.3% vs. 37.2%, p < .00001), and a shorter TTR (median = 63 days vs. 90 days). CONCLUSIONS Tumors classified as SUS had higher RR and at shorter intervals than those classified as SUMP. PAs have higher RRs and more expedient surgery than WTs. Cases classified as M are less likely to undergo follow-up than SUS, perhaps due to a lower RR for metastases.
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Affiliation(s)
- Troy B Tenney
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patrick C Mullane
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Kartik Viswanathan
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA.,Winship Cancer Center, Decatur, Georgia, USA
| | - Qiuying Shi
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA.,Winship Cancer Center, Decatur, Georgia, USA
| | - Shu K Lui
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Daniel J Lubin
- Department of Pathology, Emory University Hospital Midtown, Atlanta, Georgia, USA.,Winship Cancer Center, Decatur, Georgia, USA
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DOG1 as an Immunohistochemical Marker of Acinic Cell Carcinoma: A Systematic Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms23179711. [PMID: 36077107 PMCID: PMC9456024 DOI: 10.3390/ijms23179711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022] Open
Abstract
DOG1 is a transmembrane protein originally discovered on gastrointestinal stromal tumors and works as a calcium-activated chloride channel protein. There are a limited number of articles on the potential utility of this antibody in the diagnosis of salivary gland tumors in routine practice. In this study, we aimed to investigate the role of DOG1 as an immunohistochemical marker in patients with salivary acinic cell carcinoma (ACC) through meta-analysis. A literature search was performed of the PubMed, Scopus, and Web of Science databases for English-language studies published from January 2010 to September 2021. The literature search revealed 148 articles, of which 20 were included in the study. The overall rate of DOG1 expression in salivary acinic cell carcinoma was 55% (95% CI = 0.43–0.58). Although ACC is a challenging diagnosis, paying careful attention to the cytomorphological features in conjunction with DOG1 immunostaining can help to reach an accurate diagnosis.
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An Extremely Rare Case of Sebaceous Adenoma Involving the Parotid Gland. Diagnostics (Basel) 2022; 12:diagnostics12051232. [PMID: 35626386 PMCID: PMC9140677 DOI: 10.3390/diagnostics12051232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Sebaceous adenoma is an extremely rare tumor located in the parotid gland. In the English literature, less than 10 cases have been reported. Sebaceous adenoma represents 0.5% of all monomorphic adenomas. The authors are presenting a case of sebaceous adenoma of the parotid gland in a 65-year-old female who presented a mass on the left parotid area that had been gradually enlarging for one year without symptoms of pain. On imaging (ultrasound), a well-defined mass lesion in the left parotid area was seen. Histopathological findings were consistent with sebaceous adenoma. Surgical excision is curative. The prognosis is excellent, with a low recurrence rate. The present case report will increase the awareness and possibility of this rare tumor occurring at an unusual site, thereby avoiding any chance of misdiagnosis.
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Paluszkiewicz C, Roman M, Piergies N, Pięta E, Woźniak M, Guidi MC, Miśkiewicz-Orczyk K, Marków M, Ścierski W, Misiołek M, Drozdzowska B, Kwiatek WM. Tracking of the biochemical changes upon pleomorphic adenoma progression using vibrational microspectroscopy. Sci Rep 2021; 11:18010. [PMID: 34504182 PMCID: PMC8429647 DOI: 10.1038/s41598-021-97377-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/23/2021] [Indexed: 02/08/2023] Open
Abstract
Head and neck tumors can be very challenging to treat because of the risk of problems or complications after surgery. Therefore, prompt and accurate diagnosis is extremely important to drive appropriate treatment decisions, which may reduce the chance of recurrence. This paper presents the original research exploring the feasibility of Fourier transform infrared (FT-IR) and Raman spectroscopy (RS) methods to investigate biochemical alterations upon the development of the pleomorphic adenoma. Principal component analysis (PCA) was used for a detailed assessment of the observed changes and to determine the spectroscopic basis for salivary gland neoplastic pathogenesis. It is implied that within the healthy margin, as opposed to the tumoral tissue, there are parts that differ significantly in lipid content. This observation shed new light on the crucial role of lipids in tissue physiology and tumorigenesis. Thus, a novel approach that eliminates the influence of lipids on the elucidation of biochemical changes is proposed. The performed analysis suggests that the highly heterogeneous healthy margin contains more unsaturated triacylglycerols, while the tumoral section is rich in proteins. The difference in protein content was also observed for these two tissue types, i.e. the healthy tissue possesses more proteins in the anti-parallel β-sheet conformation, whereas the tumoral tissue is dominated by proteins rich in unordered random coils. Furthermore, the pathogenic tissue shows a higher content of carbohydrates and reveals noticeable differences in nucleic acid content. Finally, FT-IR and Raman spectroscopy methods were proposed as very promising methods in the discrimination of tumoral and healthy tissues of the salivary gland.
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Affiliation(s)
- Czesława Paluszkiewicz
- grid.413454.30000 0001 1958 0162Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
| | - Maciej Roman
- grid.413454.30000 0001 1958 0162Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
| | - Natalia Piergies
- grid.413454.30000 0001 1958 0162Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
| | - Ewa Pięta
- grid.413454.30000 0001 1958 0162Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
| | - Monika Woźniak
- grid.413454.30000 0001 1958 0162Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
| | - Mariangela Cestelli Guidi
- grid.463190.90000 0004 0648 0236INFN-Laboratori Nazionali di Frascati, Via E. Fermi 40, 00044 Frascati, Italy
| | - Katarzyna Miśkiewicz-Orczyk
- grid.411728.90000 0001 2198 0923Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia Katowice, 41800 Zabrze, Poland
| | - Magdalena Marków
- grid.411728.90000 0001 2198 0923Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia Katowice, 41800 Zabrze, Poland
| | - Wojciech Ścierski
- grid.411728.90000 0001 2198 0923Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia Katowice, 41800 Zabrze, Poland
| | - Maciej Misiołek
- grid.411728.90000 0001 2198 0923Department of Otorhinolaryngology and Laryngological Oncology in Zabrze, Medical University of Silesia Katowice, 41800 Zabrze, Poland
| | - Bogna Drozdzowska
- grid.411728.90000 0001 2198 0923Department of Pathomorphology Zabrze, Medical University of Silesia, Katowice, Poland
| | - Wojciech M. Kwiatek
- grid.413454.30000 0001 1958 0162Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland
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Boldes T, Hilly O, Alkan U, Shkedy Y, Morgenstern S, Shpitzer T, Bachar G, Mizrachi A. Accuracy, predictability and prognostic implications of fine-needle aspiration biopsy for parotid gland tumours: A retrospective case series. Clin Otolaryngol 2021; 46:1065-1072. [PMID: 33942516 DOI: 10.1111/coa.13795] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/06/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the precision and utility of fine-needle aspiration (FNA) in differentiating between benign and malignant parotid tumours, and the implications of FNA results on management and outcomes. DESIGN Retrospective case series. SETTING Tertiary medical centre. PARTICIPANTS All adults who underwent preoperative FNA, followed by postoperative histological examination, between 1986 and 2014. MAIN OUTCOME MEASURES Differences in clinical management and outcomes of patients with parotid masses in light of FNA results. RESULTS We analysed 505 samples from 485 patients. According to histopathological results, preoperative FNA successfully identified benign tumours in 89% of the cases (362/405) and only 59% of malignant tumours (59/100). Overall sensitivity and specificity of FNA in distinguishing between different subtypes of benign lesions were 80% and 99%, respectively, whereas positive predictive value (PPV) and negative predictive value (NPV) were 85% and 98%. Moreover, malignant lesions subtyping had high false-positive and false-negative rates with sensitivity, specificity, PPV and NPV of 44%, 100%, 75% and 99%, respectively. Additionally, when FNA falsely classified malignant tumours as benign, surgeries were inappropriately delayed and the durations of surgeries and hospitalisations were shorter, compared to true malignant FNA results. Interestingly, survival was not affected in falsely benign lesions that were mostly low-grade, conversely non-diagnostic FNA for malignant tumours resulted in decreased survival. CONCLUSIONS Our findings highlight the limitations of FNA as a decision-making tool in preoperative evaluation of parotid masses. Clinicians should take into account that FNA is inaccurate for identifying specific subtypes of malignant lesions, which may eventually delay treatment and influence outcome.
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Affiliation(s)
- Tomer Boldes
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Alkan
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Morgenstern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Aksoy Altinboga A, Yildirim F, Ahsen H, Kiran MM, Kesici GG, Yuce G. The effectiveness of the Milan system for risk stratification of salivary gland lesions: The 10-year cytohistopathological correlation results of salivary gland FNA cytology at a tertiary center. Diagn Cytopathol 2021; 49:928-937. [PMID: 34009744 DOI: 10.1002/dc.24768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/08/2021] [Accepted: 04/29/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Milan system reporting salivary gland cytopathology (MSRSGC) is a tiered classification scheme that is based on risk stratification. The aim of the current study was to assess the risk of malignancy (ROM) and risk of neoplasia (RON) in each of the diagnostic categories proposed by the MSRSGC. METHODS A retrospective analysis and categorization according to the MSRSGC was made of salivary gland fine needle aspirations (FNA) performed from January 2007 to December 2017. The FNA cytology results were correlated with subsequent histological follow-up. RESULTS A total of 578 FNAs were evaluated and histopathology was available for 198 cases (34.2%). The RON and ROM for individual diagnostic categories were: Non-diagnostic: 52.2% to 13%, non-neoplastic: 21.4% to 10.7%, atypia of undetermined significance: 74% to 22.2%, benign neoplasm: 100% to 1.1%, salivary gland neoplasm of uncertain malignant potential: 93.3% to 53.3%, suspicious for malignancy (SFM): 100% to 100%, and malignant: 100% to 100%. A diagnosis of 'SFM' or 'malignant' with FNA cytology carried a 100% risk for malignancy, while a diagnosis of "non-neoplastic," "benign neoplasm" reduced the probability of malignancy to 3.4%. CONCLUSION The MSRSGC is useful for the management of salivary gland lesions as it can successfully differentiate between benign and malignant cases. It will bring uniformity in salivary gland FNA cytology reporting across various institutions globally.
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Affiliation(s)
| | - Fatma Yildirim
- Department of Pathology, Ankara City Hospital, Ankara, Turkey
| | - Hilal Ahsen
- Department of Pathology, Ankara City Hospital, Ankara, Turkey
| | | | - Gulin Gokcen Kesici
- Department of Otolaryngology Head and Neck Surgery, Yenimahalle Education and Research Hospital, Ankara, Turkey
| | - Gokhan Yuce
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
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Haq S, Kalakkunath S, Bakshi P, Verma K. Cytological Diagnosis of Acinic Cell Carcinoma. A Study of Four Cases with Emphasis on Differential Diagnosis and DOG1 Expression. J Cytol 2020; 37:155-156. [PMID: 33088038 PMCID: PMC7542039 DOI: 10.4103/joc.joc_175_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/24/2020] [Accepted: 04/24/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sheefa Haq
- Department of Cytopathology, Sir Ganga Ram Hospital, Old Rajinder Nagar, Delhi, India.,Department of Pathology, Pushpawati Singhania Hospital & Research Institute, Sheikh Sarai, Delhi, India
| | - Sankar Kalakkunath
- Department of Cytopathology, Sir Ganga Ram Hospital, Old Rajinder Nagar, Delhi, India
| | - Pooja Bakshi
- Department of Cytopathology, Sir Ganga Ram Hospital, Old Rajinder Nagar, Delhi, India
| | - Kusum Verma
- Department of Cytopathology, Sir Ganga Ram Hospital, Old Rajinder Nagar, Delhi, India
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Paluszkiewicz C, Pięta E, Woźniak M, Piergies N, Koniewska A, Ścierski W, Misiołek M, Kwiatek WM. Saliva as a first-line diagnostic tool: A spectral challenge for identification of cancer biomarkers. J Mol Liq 2020. [DOI: 10.1016/j.molliq.2020.112961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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15
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Acinic cell carcinoma of the parotid gland: from pathogenesis to management: a literature review. Eur Arch Otorhinolaryngol 2020; 277:2673-2679. [PMID: 32367151 DOI: 10.1007/s00405-020-05998-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/18/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Acinic cell carcinoma (ACCs) is uncommon malignant epithelial neoplasm of the salivary glands; the most common presentation is a well-defined painless solid mass. Diagnosis of ACCs is frequently complicated, due to its similarity with benign tumors. METHODS A review of the literature available on ACCs was carried out. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing. RESULTS There are no clear characteristics of ACCs found on CT, MRI and ultrasound imaging. The management of the ACC, a rare malignancy of the parotid gland, is often difficult and controversial. Radical surgery is the best treatment option. The role of radiotherapy remains controversial: the precise indications and oncologic effects of adjuvant radiotherapy in ACC of the parotid gland are not well known. There is insufficient literature regarding the chemotherapy for metastatic ACC. CONCLUSION Knowledge about ACC, a rare malignancy of parotid gland, has changed over the past few decades. More clinical randomized works would be needed, both to assess the real effectiveness of radio and chemotherapy and to have an unanimous consensus about their indications.
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Altin F, Alimoglu Y, Acikalin RM, Yasar H. Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy. Braz J Otorhinolaryngol 2019; 85:275-281. [PMID: 29936215 PMCID: PMC9442885 DOI: 10.1016/j.bjorl.2018.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Fine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable. Objective We aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors. Methods Patients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated. Results 217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5 ± 15.88 (7–82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ = 0.52). The sensitivity was 54.54% in tumors less than 2 cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%. Conclusion Fine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.
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Affiliation(s)
- Fazilet Altin
- Health Sciences University, Haseki Training and Research Hospital, Otolaryngology Department, Istanbul, Turkey.
| | - Yalcin Alimoglu
- Health Sciences University, Haseki Training and Research Hospital, Otolaryngology Department, Istanbul, Turkey
| | - Resit Murat Acikalin
- Health Sciences University, Haseki Training and Research Hospital, Otolaryngology Department, Istanbul, Turkey
| | - Husamettin Yasar
- Health Sciences University, Haseki Training and Research Hospital, Otolaryngology Department, Istanbul, Turkey
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Venkatesh S, Srinivas T, Hariprasad S. Parotid Gland Tumors: 2-Year Prospective Clinicopathological Study. Ann Maxillofac Surg 2019; 9:103-109. [PMID: 31293936 PMCID: PMC6585209 DOI: 10.4103/ams.ams_179_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Context: Parotid gland tumors account for 80% of all salivary gland neoplasms. Most parotid masses are operated on before obtaining the final histological diagnosis, which complicates the management of the facial nerve damage during parotid surgery. Aims: The aim of this study is to analyze the age- and gender-wise incidence of parotid gland tumors, the incidence of various types of tumors, to assess their clinical modes of presentation, the efficacy of treatment, and to evaluate the complications ensuing therein, because of intervention. Settings and Design: The present study was conducted in the Department of Oral and Maxillofacial Surgery, A. B. Shetty Memorial Institute of Dental Sciences and Justice K. S. Hegde Charitable Hospital, Nitte University, Mangalore. Subjects and Methods: A clinicopathological study of parotid gland tumors was undertaken in a tertiary care hospital. Patients with parotid swelling were clinically evaluated, followed by fine-needle aspiration cytology (FNAC). Surgery was planned and performed based on the tumor location and FNAC report. Patients were followed up for postoperative complications. Results: The study comprised 59 patients with parotid gland tumors. The age range of the patient affected was between 18 and 75 years. Benign tumors are more common than malignant tumor in the ratio of 3.5:1. Slow progressively parotid swelling was the common presenting complaint. Superficial parotidectomy was the most common surgery (69.49%) performed. The most common postoperative complication encountered was transient facial palsy (22.03%). Benign tumors were more common (77.97%). The most common benign tumor was pleomorphic adenoma, and malignant tumor was mucoepidermoid carcinoma. Conclusions: The incidence of parotid salivary gland tumors is increasing in recent years. Parotidectomy is safe procedure for treating parotid tumors. Transient facial palsy is the most common postoperative complication, which is reduced in superficial parotidectomy.
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Affiliation(s)
- S Venkatesh
- Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
| | - Teerthanath Srinivas
- Department of Pathology, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - S Hariprasad
- Department of Surgery, Navodaya Medical College, Raichur, Karnataka, India
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18
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Values of fine‐needle aspiration cytology of parotid gland tumors: A review of 996 cases at a single institution. Head Neck 2018; 41:358-365. [DOI: 10.1002/hed.25503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/15/2018] [Indexed: 01/14/2023] Open
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Song SJ, Shafique K, Wong LQ, LiVolsi VA, Montone KT, Baloch Z. The utility of the Milan System as a risk stratification tool for salivary gland fine needle aspiration cytology specimens. Cytopathology 2018; 30:91-98. [PMID: 30303566 DOI: 10.1111/cyt.12642] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To perform a retrospective investigation of our institutional experience with salivary gland fine needle aspirations (FNA) through the framework of The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and assess the risks of neoplasm and malignancy for each diagnostic category. METHODS All salivary gland FNAs performed from January 2009 to December 2016 were retrospectively categorised according to the MSRSGC. When available, pre-operative cytological results were correlated with subsequent histological follow-up. RESULTS In total, 893 FNAs were reviewed. The specimens were retrospectively classified as nondiagnostic (ND: 13.5%), non-neoplastic (NN: 16.1%), atypia of undetermined significance (AUS: 10.8%), benign neoplasm (BN: 34.9%), salivary gland neoplasm of uncertain malignant potential (SUMP: 8.2%), suspicious for malignancy (SM: 2.7%) and malignant (M: 13.8%). Histological follow-up was available for 429 cases (48%); the majority (68.1%) were benign. The risks of neoplasm and malignancy for each category were as follows: ND: 64.5%, 16.1%; NN: 42.9%, 17.9%; AUS: 79.6%, 30.6%; BN: 100%, 2.2%; SUMP: 100%, 46.6%; SM: 94.7%, 78.9%; and M: 100%, 98.5%. CONCLUSIONS The MSRSGC is a useful classification scheme for stratifying salivary gland lesions according to their associated risk of malignancy and guiding clinicians toward appropriate management. Diagnostic pitfalls are seen in a small proportion of cases and a multidisciplinary approach for assessing salivary gland pathology is essential in their evaluation.
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Affiliation(s)
- Sharon J Song
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Khurram Shafique
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Q Wong
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Carta F, Chuchueva N, Gerosa C, Sionis S, Caria RA, Puxeddu R. Parotid tumours: clinical and oncologic outcomes after microscope-assisted parotidectomy with intraoperative nerve monitoring. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:375-386. [PMID: 29165432 PMCID: PMC5720865 DOI: 10.14639/0392-100x-1089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 01/15/2017] [Indexed: 01/18/2023]
Abstract
Temporary and permanent facial nerve dysfunctions can be observed after parotidectomy for benign and malignant lesions. Intraoperative nerve monitoring is a recognised tool for the preservation of the nerve, while the efficacy of the operative microscope has been rarely stated. The authors report their experience on 198 consecutive parotidectomies performed on 196 patients with the aid of the operative microscope and intraoperative nerve monitoring. 145 parotidectomies were performed for benign lesions and 53 for malignancies. Thirteen patients treated for benign tumours experienced temporary (11 cases) or permanent facial palsy (2 cases, both of House-Brackmann grade II). Ten patients with malignant tumour presented with preoperative facial nerve weakness that did not improve after treatment. Five and 6 patients with malignant lesion without preoperative facial nerve deficit experienced postoperative temporary and permanent weakness respectively (the sacrifice of a branch of the nerve was decided intraoperatively in 2 cases). Long-term facial nerve weakness after parotidectomy for lesions not directly involving or originating from the facial nerve (n = 185) was 2.7%. Patients treated for benign tumours of the extra facial portion of the gland without inflammatory behaviour (n = 91) had 4.4% facial nerve temporary weakness rate and no permanent palsy. The combined use of the operative microscope and intraoperative nerve monitoring seems to guarantee facial nerve preservation during parotidectomy.
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Affiliation(s)
- F Carta
- Department Otorhinolaryngology, Università degli Studi di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Italy
| | - N Chuchueva
- Department Otorhinolaryngology, Università degli Studi di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Italy
| | - C Gerosa
- Department of Pathology, Università degli Studi di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Italy
| | - S Sionis
- Department Otorhinolaryngology, Università degli Studi di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Italy
| | - R A Caria
- Department Otorhinolaryngology, Università degli Studi di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Italy
| | - R Puxeddu
- Department Otorhinolaryngology, Università degli Studi di Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, Italy
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A clinicopathological study of parotid carcinoma: 18-year review of 171 patients at a single institution. Int J Clin Oncol 2018; 23:615-624. [PMID: 29564569 PMCID: PMC6097105 DOI: 10.1007/s10147-018-1266-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/14/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND This study investigated the clinical outcomes of patients with parotid carcinoma at a single institution during an 18-year period, with the focus on diagnosis, treatment, and survival. METHODS The subjects were 171 patients with parotid carcinoma treated at our department during the 18-year period from September 1999 to August 2017. There were 19 patients in stage I, 65 patients in stage II, 22 patients in stage III, and 65 patients in stage IV. The symptoms, preoperative diagnosis, node metastasis, survival rate, prognostic factors, and immunohistological findings were investigated. RESULTS Preoperative diagnosis of the histological grade by fine-needle aspiration cytology was only possible in 34% of the patients, while the histological grade was correctly determined by frozen section biopsy in 72%. The overall frequency of lymph node metastasis was 29%, with 59% in patients with high-grade carcinoma and only 6% in those with low-/intermediate-grade tumors. The disease-specific 5-year survival rate was 100% for patients in stage I, 95.2% in stage II, 70.4% in stage III, and 45.1% in stage IV. Multivariate analysis showed that the pathological grade was the most important prognostic factor. Immunohistological investigation showed patients with HER-2 or androgen receptor-positive tumors had a significantly worse prognosis. CONCLUSIONS Although a high-grade tumor is the most important prognostic factor, preoperative diagnosis of the grade was not always accurate. Since advanced cancer has a poor prognosis with a limited response to surgery and radiation therapy, development of new treatment strategies, such as molecular-targeting therapies directed against HER-2 and AR, is required.
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22
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Barats R, Evrard S, Collin L, Vergez S, Gellée S, Courtade-Saïdi M. Ultrasound-guided fine-needle capillary cytology of parotid gland masses coupled with a rapid-on-site evaluation improves results. Morphologie 2018; 102:25-30. [PMID: 28732678 DOI: 10.1016/j.morpho.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE OF THE STUDY To test whether a direct-on-site microscopic examination of fresh, unstained puncture slides by the radiologist decreases the rate of false-negative cases on ultrasound-guided fine-needle cytology of parotid gland masses. PATIENTS Thirty parotid gland masses from 28 patients were punctured under ultrasound guidance. The same group was used as its control group. METHODS After one or two passes, the material was spread on slides and air-dried (control group, without microscopic examination). For the study group, it was thus analyzed unstained under the microscope. A sample was considered adequate if at least six clusters of parotid cells were found per slide on at least two slides. For the study group, new punctures were obtained and slides prepared until this condition was fulfilled. RESULTS Of the 30 evaluated masses, 100% benefited from a cytological diagnosis after microscopy. Twenty-four were adequate in the control group, while 30 were adequate in the study group. The maximum number of punctures to obtain an adequate sample was six. On-site direct microscopy significantly increased the number of adequate specimens by 20% (P=0.03, CI [1.63-20%]). CONCLUSION Direct and systematic examination of slides by a radiologist avoided the risk of false-negative results caused by having insufficient sample material.
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Affiliation(s)
- R Barats
- Service de radiologie, neuroradiologie diagnostique et thérapeutique, CHU Rangueil, 1, avenue Jean-Poulhes, TSA 50032, 31059 Toulouse cedex 9, France
| | - S Evrard
- Département d'anatomie et cytologie pathologiques, institut universitaire du cancer (IUC) Toulouse oncopôle, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; Laboratoire d'histologie-embryologie, faculté de médecine Rangueil, 31059 Toulouse, France
| | - L Collin
- Département d'anatomie et cytologie pathologiques, institut universitaire du cancer (IUC) Toulouse oncopôle, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; Laboratoire d'histologie-embryologie, faculté de médecine Rangueil, 31059 Toulouse, France
| | - S Vergez
- Oto-rhino-laryngologie (ORL) et chirurgie cervico-faciale, hôpital Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| | - S Gellée
- Service de radiologie, neuroradiologie diagnostique et thérapeutique, CHU Rangueil, 1, avenue Jean-Poulhes, TSA 50032, 31059 Toulouse cedex 9, France
| | - M Courtade-Saïdi
- Département d'anatomie et cytologie pathologiques, institut universitaire du cancer (IUC) Toulouse oncopôle, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; Laboratoire d'histologie-embryologie, faculté de médecine Rangueil, 31059 Toulouse, France.
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Eytan DF, Yin LX, Maleki Z, Koch WM, Tufano RP, Eisele DW, Boahene KDO, Fakhry C, Bishop JA, Westra WH, Gourin CG. Utility of preoperative fine needle aspiration in parotid lesions. Laryngoscope 2017; 128:398-402. [DOI: 10.1002/lary.26776] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/11/2017] [Accepted: 06/01/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Danielle F. Eytan
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Linda X. Yin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Zahra Maleki
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Wayne M. Koch
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Ralph P. Tufano
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Kofi D. O. Boahene
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Justin A. Bishop
- Department of Pathology; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - William H. Westra
- Department of Pathology; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland U.S.A
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Ramírez-Pérez F, González-García R, Hernández-Vila C, Monje-Gil F, Ruiz-Laza L. Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors? J Craniomaxillofac Surg 2017; 45:1074-1077. [DOI: 10.1016/j.jcms.2017.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 02/16/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022] Open
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Kumar U. Acinic Cell Carcinoma Papillary-Cystic Variant: Diagnostic Pitfalls in Fine Needle Aspiration Cytology. J Clin Diagn Res 2017; 11:ED05-ED06. [PMID: 28658776 DOI: 10.7860/jcdr/2017/21347.9772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/16/2017] [Indexed: 11/24/2022]
Abstract
Acinic cell carcinoma is a rare tumour comprising 1%-3% of all salivary gland neoplasms. Acinic Cell Carcinoma Papillary Cystic Variant (ACC-PCV) is a distinct subtype and shows variegated appearance on cytology. It is important to differentiate it from other malignant lesions because of its poor prognosis. We describe a case of 20-year-old female with swelling on left cheek for the last four months. Fine needle aspiration was done and diagnosed as intermediate grade mucoepidermoid carcinoma on cytology. Histological study of the resected tumour showed features of ACC-PCV. We are presenting this case to illustrate the diagnostic problems encountered in cytology and important points to be kept in mind while reporting FNA of salivary gland tumours.
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Affiliation(s)
- Uma Kumar
- Specialist Pathology, Department of Pathology, Veer Savarkar Aarogya Sansthan, Karawal Nagar, Delhi, India
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26
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Mifsud MJ, Burton JN, Trotti AM, Padhya TA. Multidisciplinary Management of Salivary Gland Cancers. Cancer Control 2017; 23:242-8. [PMID: 27556664 DOI: 10.1177/107327481602300307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Salivary carcinomas are a rare group of biologically diverse neoplasms affecting the head and neck. The wide array of different histological entities and clinical presentations has historically limited attempts to establish well-defined treatment algorithms. In general, low-risk lesions can be managed with a single treatment modality, whereas advanced lesions require a more complex, multidisciplinary approach. METHODS The relevant literature was reviewed, focusing on diagnostic and treatment algorithms for salivary malignancies. RESULTS Salivary carcinomas with high-risk features require an aggressive treatment approach with complete surgical resection, neck dissection to appropriate cervical lymph-node basins, and postoperative radiotherapy. CONCLUSIONS The heterogeneity of salivary neoplasms represents a unique clinical challenge. Despite the multidisciplinary management paradigm detailed in this review, outcomes for advanced disease are unsatisfactory. Future progress will likely require the addition of novel systemic therapeutic strategies.
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Affiliation(s)
- Matthew J Mifsud
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Toronto, ON M5G1X5, Canada.
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Diagnostic Accuracy of Fine-Needle Aspiration for Parotid and Submandibular Gland Lesions. Otolaryngol Head Neck Surg 2016; 155:431-6. [DOI: 10.1177/0194599816643041] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/15/2016] [Indexed: 12/30/2022]
Abstract
Objective To assess the diagnostic accuracy of fine-needle aspiration (FNA) of the parotid and submandibular glands. Study Design Case series with chart review. Setting Tertiary referral academic center. Subjects and Methods Retrospective analysis was performed for all parotid and submandibular gland FNAs from a single center from 2001 to 2014. There were 1283 FNAs performed for 1076 patients. Of these, 343 cases had surgical follow-up (parotid gland, n = 272; submandibular gland, n = 71). Cases were included where the patient had a preoperative FNA, followed by surgical excision. Correlation of preoperative FNA results to final surgical pathology was performed, with measures of diagnostic accuracy computed. Results Malignancy was identified in 29.0% of parotid tumors and 42.3% of submandibular tumors, based on final pathology. FNA was nondiagnostic due to insufficient cellularity for evaluation in 22 of 343 cases (6.4%) and indeterminate in 39 of 343 cases (11.4%). Diagnostic accuracy in the parotid and submandibular glands for distinguishing benign from malignant pathology was determined as follows, respectively: sensitivity, 75.0% and 91.3%; specificity, 95.1% and 94.1%; positive predictive value, 84.9% and 91.3%; and negative predictive value, 91.2% and 94.4%. Conclusion FNA has high accuracy in identifying malignancy in parotid and submandibular gland lesions when performed at a high-volume center. Preoperative FNA results provide otolaryngologists with valuable diagnostic information that may influence the surgical management of salivary gland tumors. FNA, in conjunction with cross-sectional imaging, is useful in counseling patients for a complete informed consent.
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28
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Lieder A, Franzen A. Management of primary malignant lymphoma of the parotid gland in a series of seven hundred and forty-five patients. Clin Otolaryngol 2016; 42:477-480. [DOI: 10.1111/coa.12635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 12/28/2022]
Affiliation(s)
- A. Lieder
- Department of Otorhinolaryngology, Head and Neck Surgery; Plastic Operations; Medical University Brandenburg - Theodor Fontane; Neuruppin Germany
| | - A. Franzen
- Department of Otorhinolaryngology, Head and Neck Surgery; Plastic Operations; Medical University Brandenburg - Theodor Fontane; Neuruppin Germany
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29
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Negahban S, Shirian S, Khademi B, Oryan A, Sadoughifar R, Mohammad MP, Aledavood A, Daneshbod K, Daneshbod Y. The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology by Cytopathologists in the Diagnosis of Major Salivary Gland Tumors. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316634320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of the typical sonographic appearances of many salivary gland masses, as well as the normal appearance and anatomy of the glands, differentiation of salivary glands tumors based only on clinical and imaging criteria is difficult. We compared the utility, safety, specificity, and accuracy of ultrasound-guided fine needle aspiration cytology (UG-FNAC) in the detection of nonpalpable tumors in the major salivary glands. A retrospective review was done of a 5-year experience of 102 consecutive patients undergoing UG-FNAC. Clinical opinion, FNA results, and final pathologic findings were examined. Histological evaluation showed 29 malignant tumors and 54 benign lesions (neoplasms and nonneoplastic lesions). The cytologic findings were nondiagnostic in 19 cases (18.6%), true negative in 50 (49%), true positive in 20 (19.6%), false negative in 9 (8.8%), and false-positive in 4 (3.9%) cases for detecting malignant tumors. Six of 20 (30%) malignant tumors (true positive) and 41 of 50 (82%) benign lesions (true negative) were classified accurately. The accuracy, sensitivity, and specificity were 84.3%, 68.9%, and 92.6%, respectively. Ultrasound guided FNAC was found to be highly specific for malignancy and its sensitivity for malignancy was good. It is a reliable and accurate diagnostic technique with minimal complications and easy to perform with high specificity 92.5% (95% CI: 82.09%-97.90%). It should be the preferred primary approach for initial investigation in diagnosing salivary gland tumors.
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Affiliation(s)
- Shahrzad Negahban
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Sadegh Shirian
- Department of Pathology, School of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
- Shefa Neuroscience Research Center, Khatam-Al-Anbia Hospital, Tehran, Iran
- Brain and Spinal Cord Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bijan Khademi
- Head and Neck Cancer, Endoscopic Sinus Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz Iran
| | - Roshanak Sadoughifar
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz Iran
| | | | - Azita Aledavood
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Khosrow Daneshbod
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Yayha Daneshbod
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
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Chislett SP, Liming BJ, Rogers DJ. Dystrophic calcification: A rare pediatric parotid mass. Int J Pediatr Otorhinolaryngol 2016; 81:38-40. [PMID: 26810287 DOI: 10.1016/j.ijporl.2015.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
Dystrophic calcification, the ectopic deposition of calcium in previously damaged or inflamed tissues, is an uncommon finding in the head and neck. Only a few cases have been reported in the parotidomasseteric region, and all of them have been located within and adjacent to the masseter. We present a case of dystrophic calcification occurring entirely within the parotid gland in a 7-year-old girl without apparent inciting inflammation, infection, or trauma. Our patient's presentation highlights the diagnostic challenge associated with parotid masses in the pediatric population. To our knowledge, this is the first reported case of dystrophic calcification occurring entirely within the parotid gland in a child.
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Affiliation(s)
- Sean P Chislett
- Madigan Army Medical Center, Otolaryngology-Head and Neck Surgery, 9040 Jackson Ave., ATTN: MCHJ-CLS-E, Tacoma, WA 98431, United States.
| | - Bryan J Liming
- Madigan Army Medical Center, Otolaryngology-Head and Neck Surgery, 9040 Jackson Ave., ATTN: MCHJ-CLS-E, Tacoma, WA 98431, United States
| | - Derek J Rogers
- Madigan Army Medical Center, Otolaryngology-Head and Neck Surgery, 9040 Jackson Ave., ATTN: MCHJ-CLS-E, Tacoma, WA 98431, United States
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Parotid gland metastases of distant primary tumours: A diagnostic challenge. Auris Nasus Larynx 2015; 43:187-91. [PMID: 26526643 DOI: 10.1016/j.anl.2015.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/20/2015] [Accepted: 09/30/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Metastatic disease is common among parotid malignancies. The majority of primary tumours are located in the head and neck, but primary tumours below the clavicle must also be considered, especially in histological types not usually found in primary parotid or skin tumours. METHODS We performed 644 consecutive parotidectomies between 1980 and 2012. Benign tumours were found in 555 patients (86%) and malignant tumours in 89 patients (14%). RESULTS Of 89 malignant tumours, 39 were metastases (44%). In 5 cases, the primary tumour was located below the clavicle (6% of malignant tumours). A carcinoma of the bronchus was subsequently diagnosed in three patients: one patient had breast carcinoma and one renal cell carcinoma. CONCLUSION The majority of metastases in the parotid gland arise from primary tumours of the head and neck. In 10-20% of metastases, the primary tumour arises below the clavicle. Parotid metastases can be the first clinical manifestation of a malignant tumour, and can also occur years after curative intent treatment. Histopathology and immunohistochemistry will offer clues to a possible metastatic process and to primary tumour location. Parotidectomy with complete excision of the tumour can be a curative measure or form an essential part of symptom control and should be considered in all but the most moribund patients.
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Assessing the histological type and grade of primary parotid carcinoma by fine-needle aspiration and frozen section. Auris Nasus Larynx 2015; 42:463-8. [PMID: 26065980 DOI: 10.1016/j.anl.2015.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/12/2015] [Accepted: 03/18/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study is to compare preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section (FS) for the correct identification of malignancy, histological grade, and histological type. METHODS FNAC was performed on all 105 patients and FS on 71 patients with parotid carcinoma. RESULTS The rate of correctly determining the histological grade by FNAC and FS was 32% and 73%, respectively. The correct diagnosis rate for both the histological type and grade by FNAC and FS was 20% and 48%, respectively. CONCLUSIONS The correct grading of both high and low/intermediate grade carcinoma is possible in 70-80% of patients by FS. If the histological grade is identified correctly, the extent of resection can usually be decided appropriately. Therefore, we should put emphasis on determining the histological grade.
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Zerpa Zerpa V, Cuesta Gonzáles MT, Agostini Porras G, Marcano Acuña M, Estellés Ferriol E, Dalmau Galofre J. [Diagnostic accuracy of fine needle aspiration cytology in parotid tumours]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:157-61. [PMID: 24598025 DOI: 10.1016/j.otorri.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Fine needle aspiration cytology (FNAC) is a globally accepted technique in the preoperative evaluations of head and neck tumours; however, the effectiveness in the interpretation of salivary glands neoplastic lesions is still controversial. The objective of this study consisted of assessing the efficacy of FNAC in preoperative diagnosis of parotid tumours. METHODS This retrospective study was conducted using 93 patient samples with parotid gland tumoral pathology, treated at the Otorhinolaryngology Department in our institution during the 2007-2011 period. Preoperative FNAC was employed and the patients subsequently submitted to surgical excision with histopathological diagnosis of the specimen. Cytology results were classified as negative for malignancy, positive for malignancy or insufficient sample, and later compared with the definitive histological diagnosis. RESULTS The mean age of the studied sample was 52.9 years (range: 11 to 88 years); 55.9% were men. The FNAC showed significant sensitivity of 57.1%, with a specificity of 95.1%, for detecting malignancy in parotid gland tumours. The positive and negative predictive values for malignancy were 50 and 96.3%, respectively. CONCLUSIONS FNAC is considered a simple test but of limited use for diagnostic guidance in tumour pathology of the parotid gland in our environment, mainly because of its low sensitivity. However, the high specificity and high negative predictive value of FNAC makes it a more accurate test in benign or negative result cases.
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Affiliation(s)
- Vanessa Zerpa Zerpa
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España.
| | | | | | - Martin Marcano Acuña
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España
| | | | - José Dalmau Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia, España
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Hajiioannou JK, Florou V, Kousoulis P, Kretzas D, Moshovakis E. Reversible facial nerve palsy due to parotid abscess. Int J Surg Case Rep 2013; 4:1021-4. [PMID: 24096025 PMCID: PMC3825968 DOI: 10.1016/j.ijscr.2013.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 08/26/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A facial nerve palsy combined with parotid enlargement usually suggests malignancy. It is highly unusual for facial nerve palsy to result from a benign situation such as inflammation or infection of the gland. PRESENTATION OF CASE We present a rare case of facial nerve palsy due to parotid abscess. DISCUSSION A literature search retrieved thirty-two cases of facial nerve palsy due to benign parotid lesions since 1969. Only nine reported the presence of a parotid abscess. The etiology of paralysis remains unknown although certain factors such as the virulence of the offending organisms or perineuritis, have been suggested. Best diagnostic evaluation and management are discussed. CONCLUSION In clinical practice, exclusion of malignancy is mandatory, as it represents the most common cause of facial palsy in the presence of a parotid lump.
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Affiliation(s)
| | - Vasiliki Florou
- Corresponding author at: 25 Kathigitou Rossidou St., Thessaloniki, pc 54655, Greece. Fax: +30 2310812341.
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Dynamic contrast-enhanced ultrasound for differential diagnosis of submandibular gland disease. Eur Arch Otorhinolaryngol 2013; 271:163-9. [PMID: 23625388 DOI: 10.1007/s00405-013-2523-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/19/2013] [Indexed: 12/12/2022]
Abstract
Intensity-time gradients (ITGs) of contrast-enhanced ultrasound (CEUS) can be used for non-invasive monitoring of gland-preserving treatment effects in sialolithiasis-related chronic sialadenitis as well as for imaging vascularization in tumors. The aim of this clinical trial was to evaluate feasibility to distinguish different entities of submandibular gland disease including inflammatory alterations of the submandibular gland as well as benign and malignant tumors. In this prospective clinical study, ITGs in 30 patients with sialolithiasis-related chronic sialadenitis or an unilateral submandibular mass and 18 disease-free submandibular gland controls were quantitatively analyzed by CEUS using the contrast agent SonoVue. In addition, clinical complaints according to visual analog scales (VAS) were documented. VAS data documented significantly less complaints only in benign tumors compared with the other pathologies of the submandibular gland. In parallel, CEUS-derived ITGs revealed significantly reduced ITGs only in benign tumors (n = 5) compared to the controls (n = 18). Despite of comparably reduced wash-in velocities in malignant lesions (n = 3) statistical significance was not reached. Chronic sialadenitis (n = 18) and its sclerosing variant (Küttner tumor, n = 4) revealed comparable ITGs as controls. Tumors of the submandibular gland present with reduced functional microcirculatory networks comparing with healthy gland controls and chronically inflamed submandibular glands. Thus, dynamic CEUS-derived ITGs in combination with conventional clinical measures--for example VAS--appear as a safe and promising strategy for non-invasive diagnostic workup of submandibular lesions and warrant further validation in a larger set of patients.
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Jeong WJ, Park SJ, Cha W, Sung MW, Kim KH, Ahn SH. Fine needle aspiration of parotid tumors: diagnostic utility from a clinical perspective. J Oral Maxillofac Surg 2013; 71:1278-82. [PMID: 23540432 DOI: 10.1016/j.joms.2013.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/12/2013] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The utility of fine needle aspiration (FNA) for parotid tumors is limited owing to its low diagnostic accuracy. In this study, the authors sought to analyze and interpret FNA results for parotid tumors from a clinical perspective. MATERIALS AND METHODS Parotid tumors subjected to preoperative FNA and subsequent complete excision were the subject of this study. Patient demographics, medical records, FNA findings, and final pathology of 158 consecutive cases were analyzed. RESULTS The accuracy of FNA was 77.8%. The positive predictive value and likelihood ratio for malignancy were 90.0% and 52.8% (95% confidence interval, 7.02-397), respectively. The positive predictive value and likelihood ratio for benign pathology of Warthin tumor plus pleomorphic adenoma were 97.8% and 7.67% (2.03-29.0), respectively. CONCLUSIONS The FNA diagnosis of Warthin tumor or pleomorphic adenoma is reliable and can be safely regarded as a benign tumor. Based on the high positive predictive value and likelihood ratio, FNA of the parotid gland can offer valuable information in surgical planning and patient counseling in many centers.
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Affiliation(s)
- Woo-Jin Jeong
- Seoul National University Bundang Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Obad-Kovačević D, Kardum-Skelin I, Jelić-Puškarić B, Vidjak V, Blašković D. Parotid gland tumors: Correlation between routine cytology and cytomorphometry by digital image analysis using conventional and newly introduced cytomorphometric parameters. Diagn Cytopathol 2013; 41:776-84. [DOI: 10.1002/dc.22950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 12/04/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Dragica Obad-Kovačević
- Department of Diagnostic and Intervention Radiology; University Hospital Merkur; University School of Medicine; Zajćeva 19; 1000 Zagreb; Croatia
| | - Ika Kardum-Skelin
- Department of Clinical Cytology and Cytogenetics; University Hospital Merkur; University School of Medicine; Zagreb; Croatia
| | - Biljana Jelić-Puškarić
- Department of Clinical Cytology and Cytogenetics; University Hospital Merkur; University School of Medicine; Zagreb; Croatia
| | - Vinko Vidjak
- Department of Diagnostic and Intervention Radiology; University Hospital Merkur; University School of Medicine; Zajćeva 19; 1000 Zagreb; Croatia
| | - Darko Blašković
- Department of Diagnostic and Intervention Radiology; University Hospital Merkur; University School of Medicine; Zajćeva 19; 1000 Zagreb; Croatia
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Wyss E, Mueller-Garamvölgyi E, Ghadjar P, Rauch D, Zbären P, Arnold A. Diagnosis and treatment outcomes for patients with lymphoma of the parotid gland. Laryngoscope 2012. [PMID: 23203388 DOI: 10.1002/lary.23750] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES/HYPOTHESIS Lymphoma of the parotid gland (LPG) is a rare disease. Clinical diagnosis is difficult, due to a lack of specific symptoms and findings. The aim of this study is to evaluate the diagnostic workup based on the analysis of our cases of LPG and to present the stage-dependent treatment outcome. STUDY DESIGN Retrospective case-control study. METHODS From 1992 to 2008, 697 patients at our institution underwent surgery because of a parotid tumor. Among 246 malignancies, an LPG was found histologically in 28 cases (4%). Staging was performed according to the Ann Arbor classification, and treatment was performed by radiotherapy and/or chemo/immunotherapy. The patients were retrospectively analyzed. RESULTS No specific symptoms were found, with the main finding being a unilateral, painless, slowly progressing parotid mass. The sensitivities of imaging and fine-needle aspiration cytology in detecting LPG were 41% and 12%, respectively. Histology was the key to diagnosis, and frozen sections often revealed the diagnosis during surgery, which obviated the need for more extensive surgery in 89% of cases. The 5-year disease-specific survival estimates were 100% and 75% for early tumor stages (I and II) and advanced stages (III and IV), respectively. CONCLUSIONS When the precise nature of a parotid mass remains obscure after fine-needle aspiration cytology and imaging, but LPG is clinically suspected, surgical tissue sampling with frozen sections appears to be a valid option and can prevent the need for more extensive surgery. The treatment outcome for LPG is favorable.
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Affiliation(s)
- Etienne Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University of Bern, Bern, Switzerland
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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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Tryggvason G, Gailey MP, Hulstein SL, Karnell LH, Hoffman HT, Funk GF, Jensen CS, Van Daele DJ. Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically. Laryngoscope 2012; 123:158-63. [PMID: 22991236 DOI: 10.1002/lary.23613] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/18/2012] [Accepted: 07/02/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Fine-needle aspiration (FNA) biopsy and imaging are commonly used in the preoperative assessment of salivary gland mass lesions. The goal of this retrospective study was to clarify the role of FNA and imaging in the workup of salivary gland masses. STUDY DESIGN Retrospective cohort study. METHODS A computer search identified patients with an FNA of a salivary gland lesion with subsequent excision during a 10-year study period. Chart review of study patients was performed, and information on site of lesion, age, gender, radiologic diagnosis, pain in the tumor area, and facial paralysis was recorded and analyzed. RESULTS There were 543 patients who had an FNA and subsequent histopathology. The majority of the tumors were in the parotid gland (n = 492, 90.9%), followed by submandibular gland (n = 45, 8.3%). The incidence of malignancy across all sites was 29.7%. The mean patient age was 54.1 years, and 54.1% were female. The sensitivity and specificity of FNA were 85.7% and 99.5%, respectively. Positive predictive value (PPV) was 98.6%, and negative predictive value (NPV) was 94.3%. A total of 464 patients had available radiologic studies. For the radiological diagnoses, sensitivity was 81.8% and specificity was 67.3%, whereas PPV and NPV were 52.7% and 89.3%, respectively. CONCLUSIONS FNA is a reliable method of preoperatively assessing both benign and malignant salivary gland lesions. Preoperative imaging has a lower sensitivity and specificity than FNA in differentiating malignant from benign tumors. Older age, pain, and facial paralysis are clinical features independently associated with malignancy.
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Affiliation(s)
- Geir Tryggvason
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Huang YC, Wu CT, Lin G, Chuang WY, Yeow KM, Wan YL. Comparison of ultrasonographically guided fine-needle aspiration and core needle biopsy in the diagnosis of parotid masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:189-194. [PMID: 21953076 DOI: 10.1002/jcu.20873] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 08/12/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND To retrospectively compare the accuracies of ultrasound-guided fine-needle aspiration (USFNA) and ultrasound-guided core needle biopsy (USCNB) in the diagnosis of parotid masses. METHODS A total of 171 patients (aged 17-86 years, mean 54 years) with parotid masses (35 malignant and 136 benign lesions) underwent either USFNA (n = 107) or USCNB (n = 64). The diagnostic accuracies for differentiating benign from malignant lesions of both examinations were compared. Surgical histopathology (n = 104) and clinical diagnosis (n = 67) were used to establish the final diagnoses. RESULTS USCNB had a significantly higher sensitivity (94.1%) than USFNA (55.6%) (p < 0.05) in differentiating benign lesions from malignant conditions. The specificity and overall accuracy of USCNB were higher than those of USFNA (100% and 98.4% versus 93.3% and 86.9%, respectively). USCNB provided more specific diagnosis than USFNA (100% versus 93.3%, p < 0.05). All six patients with lymphomas who underwent USCNB were accurately diagnosed, whereas all four patients with lymphomas who underwent USFNA were not. CONCLUSIONS USCNB should be preferred to USFNA when a definite diagnosis of a parotid solid mass is needed.
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Affiliation(s)
- Yu-Chieh Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, 5 Fushing Road, Taoyuan, Taiwan
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Patel ND, van Zante A, Eisele DW, Harnsberger HR, Glastonbury CM. Oncocytoma: the vanishing parotid mass. AJNR Am J Neuroradiol 2011; 32:1703-6. [PMID: 21757520 DOI: 10.3174/ajnr.a2569] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parotid gland oncocytoma is an uncommon, benign salivary neoplasm composed of mitochondria-rich oncocytes. The purpose of this study was to correlate MR imaging and histopathology of parotid gland oncocytomas and to define the features that may distinguish these neoplasms from other benign and malignant parotid gland tumors. The MR imaging features in 9 patients with a pathologic diagnosis of oncocytoma were retrospectively reviewed. The imaging features were strikingly similar for 8 of the 9 patients. All lesions appeared T1 hypointense but isointense to the native parotid gland on fat-saturated T2 and postcontrast T1 imaging. On MR imaging, parotid gland oncocytomas share specific imaging characteristics that have not been described for benign or malignant parotid gland tumors. Oncocytomas are isointense to native parotid gland on fat-saturated T2 and T1 postcontrast MR images. Preoperative identification of correct histology may help surgical planning.
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Affiliation(s)
- N D Patel
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA.
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Dyckhoff G, Warta R, Gonnermann A, Plinkert PK, Flechtenmacher C, Volkmann M. Carbohydrate antigen 19-9 in saliva: possible preoperative marker of malignancy in parotid tumors. Otolaryngol Head Neck Surg 2011; 145:772-7. [PMID: 21746840 DOI: 10.1177/0194599811414512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Facial nerve preservation and oncological safety are crucial in surgery of parotid tumors. An unexpected histopathologic diagnosis of a malignant parotid tumor, however, may unfavorably require a second, more radical surgery. The aim of this study was to find out whether the assessment of serological tumor markers in parotid saliva might have some diagnostic significance in the preoperative differentiation between benign and malignant parotid lesions. STUDY DESIGN, SETTING, PATIENTS, AND METHODS: In a prospective pilot study performed at a university medical center in 28 patients with a unilateral parotid tumor, 7 serological tumor markers established in the clinical routine were quantitatively assessed in parotid saliva collected simultaneously on both sides after stimulation. The results were correlated with the histopathological diagnosis. RESULTS Of the 4 investigated tumors that were malignant neoplasms, 3 had a sufficient quantity of saliva available for tumor marker measurements. Carbohydrate antigen 19-9 (CA 19-9) consistently revealed high levels compared with the unaffected side in all malignant tumors, thus allowing malignant tumors to be differentiated from benign lesions. CONCLUSION The results of this pilot study are encouraging, showing that preoperative tumor marker investigation in saliva from parotid glands is feasible and merits further investigation. CA 19-9 might be a valuable new diagnostic tool in the preoperative differentiation between malignant and benign parotid tumors and should be investigated in a larger number of patients.
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Affiliation(s)
- Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
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Wang SJ, Eisele DW. Parotidectomy-Anatomical considerations. Clin Anat 2011; 25:12-8. [DOI: 10.1002/ca.21209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 04/08/2011] [Accepted: 05/01/2011] [Indexed: 11/07/2022]
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Palluch F, Lehmann M, Volz J, Upile T, Sudhoff H. The rapid growth of a pleomorphic adenoma of the parotid gland in the third trimester of pregnancy. J Med Case Rep 2011; 5:141. [PMID: 21477329 PMCID: PMC3086854 DOI: 10.1186/1752-1947-5-141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/09/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction We report a case highlighting the multidisciplinary management of a giant pleomorphic adenoma of the parotid gland that showed rapid growth in the third trimester of pregnancy. Case presentation A 43-year-old Caucasian woman presented in her 32nd week of gestation with a tumor of the parotid gland. Ultrasonography of her neck showed a parotid lesion of 40 × 30 × 27.5 mm. A follow-up magnetic resonance imaging scan of the neck four weeks later revealed that the tumor had grown to 70 × 60 × 60 mm, reaching the parapharyngeal space with marked obstruction of the oropharynx of about 50%. After discussing the case with our multidisciplinary tumor board and the gynecologists it was decided to deliver the baby by caesarean section in the 38th week of gestation, and then to perform a surgical resection of the tumor. Conclusion Indications for early surgical intervention of similar cases should be discussed on an individual patient basis in a multidisciplinary setting.
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Affiliation(s)
- Frederike Palluch
- Department of Otorhinolaryngology, Head and Neck Surgery Klinikum Bielefeld, Bielefeld, Germany.
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Cembranos JLLC, Búa JA, Amezaga JA, Zuazua JS. An unusual intraparotid foreign body simulating a tumour: shrapnel from the Spanish Civil War. Int J Oral Maxillofac Surg 2011; 40:880-3. [PMID: 21419602 DOI: 10.1016/j.ijom.2011.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 01/04/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
A foreign body lodged for decades in the parotid gland, entering through the oral cavity or the skin, is extremely rare. Even less common is the clinical presentation of a foreign body lodged in the parotid gland simulating a tumour. The authors report the finding of a fragment of shrapnel lodged in the parotid gland for 63 years. The case is unusual owing to the rare clinical presentation, the length of time between the injury and the occurrence of symptoms and the associated mandibular osteolysis in the panoramic radiograph. Initial diagnoses considered were a tumour emerging in the parotid gland, a large odontogenic cyst or an odontogenic tumour with soft tissue extension. Sometimes neither fine needle aspiration nor radiology is capable of providing an accurate diagnosis before surgery.
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Affiliation(s)
- J L López-Cedrún Cembranos
- Oral and Maxillofacial Surgery Department, Complejo Hospitalario, Universitario de A Coruña, La Coruña, Spain
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Al-Zaher NN, Obeid AA. Acinic cell carcinoma in pregnancy: a case report and review of the literature. J Med Case Rep 2011; 5:91. [PMID: 21375732 PMCID: PMC3058089 DOI: 10.1186/1752-1947-5-91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 03/04/2011] [Indexed: 12/04/2022] Open
Abstract
Introduction We report an observational study on the etiology and recurrence of acinic cell carcinoma of the parotid gland that seemed to be related to pregnancy. The medical literature has never reported such an association; therefore, our case report is probably the first to mention this observation. Case presentation This report is of a 25-year-old Arabic female patient from the United Arab Emirates, who, during her first pregnancy, developed acinic cell carcinoma of the right parotid gland that was managed with surgical excision in the form of superficial parotidectomy. During her second pregnancy, which occurred four years later, she had a recurrence of the same malignant neoplasm associated with ipsilateral malignant cervical lymphadenopathy. The patient was managed with total parotidectomy and neck dissection, as well as postoperative adjuvant radiotherapy. Our observation on this particular case of acinic cell carcinoma is that the initial onset of her neoplasm was during her first pregnancy, and the recurrence of the same malignant disease was during a subsequent pregnancy. This chronologic association raised our suspicion that there might be a possible etiologic effect of pregnancy or its associated hormonal or physiologic changes or both on the pathogenesis or etiology of acinic cell carcinoma. Conclusion Some association might exist between pregnancy and the pathogenesis or etiology of acinic cell carcinoma.
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Affiliation(s)
- Nabil N Al-Zaher
- MBC 47, Department of Otolaryngology, Head & Neck Surgery and Communication Disorders, King Faisal Specialist Hospital & Research Centre, P,O, Box 3354, Riyadh 11211, Kingdom of Saudi Arabia.
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Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years. The Journal of Laryngology & Otology 2010; 124:975-9. [PMID: 20497621 DOI: 10.1017/s0022215110001088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history. DESIGN We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis. RESULTS One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434). CONCLUSION In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.
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Correlación citohistológica en tumores de la glándula parótida. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:184-8. [DOI: 10.1016/j.otorri.2009.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 12/01/2009] [Accepted: 12/03/2009] [Indexed: 11/21/2022]
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