Hemangiomas of the salivary glands

Mesenchymal Neoplasms of Salivary Glands: A Clinicopathologic Study of 68 Cases

Salivary gland neoplasms are uncommon, and most exhibit epithelial differentiation. Mesenchymal neoplasms of the salivary gland are rare, and the incidence ranges from 1.9% to 5%. The aim of this study is to identify the types and clinical-pathological features of mesenchymal salivary neoplasm and review their differential diagnosis. A retrospective search for mesenchymal neoplasms of salivary glands from our institution's pathology archives from the 2004-2021 period and consultation files of one of the authors (AER) was performed. The clinical data were obtained from available medical records, and the histological slides and ancillary studies were retrieved and reviewed. We identified a total of 68 cases that form the study cohort. Thirty-five patients were male, and thirty-three patients were female, with a mean age of 48 years (range, 7 months-79 years), and the male to female ratio was 1:.94. Sixty-three (92.6%) of sixty-eight tumors were benign and included: 38 (56%) lipomas, 9 (13%) hemangiomas, 7 (10.3%) schwannomas, 3 (4.4%) neurofibromas, 3 (4.4%) lymphangioma, 2 (3%) solitary fibrous tumors, 1 (1.5%) myofibroma. Five of sixty-eight (7.4%) were malignant and included: 3 (4.4%) Adamantinoma-like Ewing sarcomas, 1 (1.5%) malignant peripheral nerve sheath tumor (MPNST), and 1 (1.5%) malignant solitary fibrous tumor. The involved sites included: parotid (55), submandibular gland (5), parapharyngeal space (5), buccal mucosa minor salivary gland (2), and sublingual gland (1). Sixty-seven patients underwent surgical resection. One patient with lymphangioma manifested a recurrence/persistence a week post-surgery. One patient with a parotid hemangioma developed post-operative numbness, and another patient developed chronic postauricular pain after surgery. Two patients with MPNST and one patient with adamantinoma-like Ewing sarcoma underwent neoadjuvant chemoradiation and were disease-free after treatment. The remaining 37 patients with available follow-up ranging from 7 days to 96 months (mean, 18 months) had a favorable outcome and were disease-free after treatment. Mesenchymal neoplasms of salivary gland are rare; most are benign and demonstrate adipocytic, endothelial, and schwannian differentiation; awareness of their development is important for adequate diagnosis. The mainstay of treatment is surgical excision, with the extent determined by tumor type. Adjuvant therapy is reserved for high-grade sarcomas and may be given in a neoadjuvant or adjuvant setting.

Management of vascular malformations of the parotid area

OBJECTIVES

To describe our experience in the management of vascular malformations of the parotid area.

MATERIALS AND METHODS

This was a retrospective study. Among 614 parotidectomy performed between 1998 and 2008 at our institution, 10 cases (1.6%) of vascular malformations have been identified. Clinical features and management of these patients were analyzed.

RESULTS

Clinical presentation was usually related to that of a benign, slow-growing and asymptomatic tumor. There was a marked female predominance (90%). In any case, the diagnosis of vascular malformation could be obtained with certainty preoperatively. Surgical excision was performed most often referred to diagnosis. Sixty percent of vascular malformations were located in the superficial lobe of the parotid gland. On the histological we found a classic look with benign vascular proliferation of endothelial cells in the walls. The vessel lumen was either the head of a congestion or thrombosis or calcification (phleboliths).

CONCLUSION

Vascular malformations of the parotid gland, rare disease, are mainly venous. The terminology is based on clinical data, scalable, histological and hemodynamic as classified by the International Society of Study of Vascular Anomaly (ISSVA). Despite advances in imaging including MRI they remain difficult to diagnose. The treatment of reference is surgical excision.

Submandibular cavernous hemangiomas with multiple phleboliths masquerading as sialolithiasis

Vasoformative tumors (almost exclusively hemangiomas) are the most common lesions of the major salivary glands during infancy and early childhood. They are more common in the parotid gland but are particularly rare in the submandibular gland. Changes in blood flow dynamics within hemangiomas result in thrombus formation and phleboliths. Hemangiomas of the salivary glands in adults are histologically unlike those in infants, the former being characteristically of the cavernous variant. Most cavernous hemangiomas require surgery since they do not show a tendency to regress. A case of an adult man with cavernous hemangioma affecting the submandibular salivary gland that clinically simulated sialolithiasis is presented to alert surgeons to the possibility of such a lesion. We describe the clinical course and review the literature.

The 'turkey wattle' sign revisited: diagnosing parotid vascular malformations in the adult

The turkey wattle sign describes enlargement of a facial mass on dependency of the head and when the sign is present it is pathognomonic of a vascular malformation or haemangioma. We present a case of vascular malformation of the parotid gland in which this sign was demonstrated. The clinical and radiological features of this rare parotid mass are discussed with reference to the literature.

Parotid haemangiomas in childhood: a case for MRI

Seven infants with unilateral parotid haemangiomas seen at one centre are presented. Their case notes and special investigations are reviewed. Magnetic resonance imaging (MRI) is revealed as the investigation of choice because of picture quality, definition of soft tissues and lack of exposure to ionizing radiation. MRI allows a definite diagnosis to be made without any invasive procedure being required. A future study following up these infants may be of interest because of controversy regarding the spontaneous resolution of these lesions.

Vascular neoplasms of the parotid gland. Parotid vascular tumors

Vascular neoplasms of the parotid gland are common in early childhood, particularly in females. We reviewed the clinical, histologic, and treatment details of 10 cases of hemangiomas and one case of lymphangioma that involved the parotid gland. Histologically, the cellularity and increased division figures in these lesions should not be interpreted as a sign of a malignant condition. A watchful expectancy for spontaneous regression and preservation of the facial nerve at surgery are advocated.

Parotid haemangioma in infants: MR imaging at 1.5T

Parotid gland neoplasms are uncommon and account for less than 2% of human tumours. Haemangiomas account for about 50% of parotid tumours in infants and children compared to only 2% in adults. As the clinical course of infantile haemangiomas may be self limiting and the initial treatment is expectant, early and accurate diagnosis is essential. We report 3 cases of paediatric parotid haemangioma and discuss the Magnetic Resonance (MR) characteristics of these tumours. In two cases the diagnosis was proven histologically and in one case Computed Tomography (CT) was also performed.

Tumors of the major salivary glands in children

During the 30-year period 1955-1985, 21 children with neoplasms of the major salivary glands were treated at the Johns Hopkins Hospital. A thorough review of the English literature revealed an additional 472 cases. The cases were studied as to age, sex, site, histopathologic characteristics, mode of treatment, and results. The majority of the patients were between 8 and 20 years of age. There was a female preponderance of 1.42:1. The parotid gland was the site of origin in 85.1%, the submandibular in 11.7%, and the sublingual in 3.2%. An equal incidence of benign (50.1%) and malignant (49.9%) lesions is noted. Pleomorphic adenoma was the most common benign neoplasm and mucoepidermoid carcinoma the most common malignant neoplasm. The final prognosis seems to be similar with superficial or total parotidectomy, provided the tumor has been completely removed at the initial surgery. Re-excision is recommended for tumor recurrence, and the use of radiation therapy should be individually determined in cases of aggressive malignancies.

Vascular tumors of the salivary glands

Tumors of a vascular origin in the major salivary glands are nearly always hemangiomatous, rarely malignant, occur most often in the parotid glands, and are found predominantly in newborns and infants.

Intraparotid hemangioma in an adult. Case report and review of the literature

We have reported a case of a vascular malformation within the parotid gland of an adult. The first symptom was acute onset of pain and swelling, consistent, in retrospect, with a thrombophlebitis and associated vascular congestion. Although the hemangioma of the parotid is not uncommon in young children, it is rare in the adult. Several clues to the diagnosis have been reviewed, all absent in the case reported. The potential confusion with primary salivary pathology is emphasized by this report.

Intraparotid haemangioma in an adult: case report and review of the literature

Capillary haemangiomas are among the common benign tumours of the parotid during infancy and childhood. Cavernous haemangiomas are rare lesions in the adult parotid. A cavernous haemangioma of the parotid is described in a 63-year-old woman. The literature is reviewed and the adult and childhood haemangiomas of the parotid are compared.

Hemangiomas of the head and neck

Hemangiomas are an interesting group of lesions which affect many anatomical structures of the human body. Interest today is confined to head and neck lesions which can occur in the infant, child or adult. Benign lesions affect the great majority of patients as contrasted to malignant ones. Diagnosis of the superficial lesions is usually made by inspection and palpation while additional diagnostic procedures (radiological studies and surgical exploration) may be indicated in patients with deep lesions.