Sclerosing Polycystic Adenosis of the Parotid Gland: A Systematic Review and Report of 2 New Cases

PURPOSE

We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to report 2 new cases.

MATERIALS AND METHODS

We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies published in or before June 2016. The inclusion criteria were as follows: final diagnosis of SPA affecting the parotid gland and articles published in Spanish or English. The exclusion criteria were as follows: unclear diagnosis after pathologic analysis and patients affected by other conditions in the major salivary glands. We added 2 new cases.

RESULTS

Our review ultimately included 21 articles and 45 cases. The mean patient age was 41 years (range, 7-84 years). The female-to-male ratio was 2:1. In all patients the tumor showed progressive growth. The evolution range was 7 days to 11 years. In 17.7% of cases, the tumor was associated with pain. The average tumor size was 30.3 mm (range, 12-60 mm). Fine needle aspiration biopsy (FNAB) was unable to diagnose 30 cases. Benign tumors comprised 58% of tumors (18), whereas malignancy was present in 25.8% (8). Thirty-five tumors were well circumscribed. There were 8 multinodular or lobed cases. The tumor was described as encapsulated in 1 case, partially encapsulated or pseudo-encapsulated in 16, and not encapsulated in 12. Five cases showed different degrees of degenerative changes, ranging from dysplasia to invasive carcinoma. All cases underwent surgical treatment. Superficial parotidectomy with preservation of the facial nerve was performed in 22 cases (61.1%), total parotidectomy in 8 (22.2%), and tumor enucleation in 6 (16.6%). The mean follow-up period was 51.5 months (range, 5-276 months). Of documented cases, 74.2% had 2 or more years of follow-up. Recurrences occurred in 6 cases (16.6%).

CONCLUSIONS

We consider SPA a benign tumor with progressive growth, which is occasionally painful. It occurs around age 40 years and occurs more often in female patients. Fine needle aspiration biopsy does not provide an adequate preoperative diagnosis. Recurrences are infrequent. Follow-up should be customized according to the pathologic findings. Malignant transformation may occur. Superficial parotidectomy with facial nerve preservation is the treatment of choice.

Contribution of molecular diagnosis of allergy to the management of pediatric patients with allergy to pollen

BACKGROUND

Component-resolved diagnosis based on recombinant allergens facilitates treatment of multiple sensitization and/or crossreactivity in allergic patients.

OBJECTIVE

To assess the usefulness of molecular diagnosis in childhood allergies.

METHODS

A total of 162 children aged 4-16 years diagnosed with allergic rhinitis or asthma/rhinitis caused by pollen were referred for recombinant allergen-based diagnosis in 2006. Specific immunoglobulin (Ig) E against pollen allergens and purified recombinant Phleum pratense pollen allergens were measured using an in vitro quantitative assay, and considering the recombinant allergens Phl p 1+Phl p 5 as P pratense--specific allergens and Phl p 7+Phl p 12 as cross-reacting allergens. Conditional probability was calculated to determine the relationship between values for specific IgE against major allergens and those for cross-reacting allergens.

RESULTS

Specific IgE antibodies against P pratense were detected in 99.4% of serum samples, and cross-reacting allergens in 46%. Multiple sensitization to pollen was documented in 38% of patients, with Plantago lanceolata as the main cause. Conditional probability calculations showed that patients with specific IgE values of 75-80 kU(A)/L to Phl p 1+Phl p 5 were 75% (95% confidence interval) more likely to present values > or = 2 kUA/L to Phl p 7+Phl p 12.

CONCLUSIONS

Our results show that recombinant DNA technology can help diagnose allergy in cases of multiple sensitization and crossreactivity, and is therefore a promising option for improving prognosis and management of allergic pediatric populations.