Le carcinome canalaire de la parotide : une entité rare et agressive

We report a rare case of salivary duct carcinoma and we study its clinical and evolutionary features. A 64-year-old patient was referred for right peripheral facial paralysis. MRI showed suspected formation of the right parotid gland. Treatment included total parotidectomy and ipsilateral neck lymph node dissection. The histology concluded to a ductal carcinoma of the parotid with lymph node metastasis. Radiation therapy has been indicated. Salivary duct carcinoma of the parotid gland is a highly aggressive and uncommon tumor. Treatment of localized forms is based on surgery and radiotherapy.     

Parotid gland metastasis of a breast cancer

Abstract Parotid gland metastases from malignant tumors are extremely rare. A 61-year-old woman was diagnosed with an early breast cancer with no expression of oestrogen and progesterone receptors. Five years later the patient presented a tumour in parotid gland. After total parotidectomy, microscopic analysis of the gland demonstrated an invasive duct carcinoma (IDC) with positive expression of oestrogen receptor. The patient was treated with chemotherapy followed by complementary local radiotherapy. Diagnosis of a metastasic tumour in parotid gland poses a challenge. In our case an immunohistochemical study of oestrogen receptor was fundamental to establish a diagnosis.     

Conservative parotidectomy for the treatment of parotid cancers

A conservative parotidectomy is defined as any procedure that is less than a classic superficial parotidectomy, and where less than a full facial nerve is dissected. The aim of this study was to evaluate the oncologic effects of a conservative parotidectomy in a series of patients with malignant tumors of the parotid gland.

The medical records of 43 patients treated at Severance Hospital from 1992 to 2002 who had been diagnosed with parotid cancers confined to the superficial lobe, and had also undergone conservative parotidectomies were reviewed. There were 16 males and 27 females, ranging in age from 8 to 84 years. Sixteen tumors (37%) were high-grade and 27 tumors (63%) were low-grade cancers. Twenty-four patients underwent neck dissection simultaneously with the primary lesion. Surgical treatment was followed by radiotherapy in 10 patients. The follow-up period ranged from 8 to 130 months, with a mean duration of time at 57.7 months.

The overall survival rate and the disease-free rate at five years were 88% and 79%, respectively. Univariate analyses showed histologic tumor grade (p = 0.003) and pathologic neck node metastasis (p < 0.001) to be significant variables. Based on multivariate analysis, only the presence of pathologically positive lymph nodes proved to be significant (p = 0.001). Occult metastases rates was 25% (3 of 12 cases) for high-grade tumors and none of the low-grade tumors had microscopic metastases. Recurrences developed in eight cases (19%). Four cases (9%) had a local or locoregional failure. Of these cases, two cases were high-grade tumors (13%, 2 of 16) and the other two cases were low-grade tumors (7%, 2 of 27). The six cases (14%) of which four cases were high-grade (25%) and two cases were low-grade (7%) had positive surgical margin but showed no evidence of local recurrence after additional postoperative radiotherapy. The incidence of postoperative facial nerve paralysis (HB > 1) was 12% (5 outof 43) for a temporary deficit, but there was no permanent paralysis.

Conservative parotidectomy with appropriate postoperative radiotherapy may be an acceptable procedure without potential morbidity, such as postoperative facial palsy, in the treatment of low-grade parotid cancers confined to the superficial lobe if the facial nerve is sufficiently distant from the tumor.     

Role of radiotherapy in ductal (endometrioid) carcinoma of the prostate

BACKGROUND: Ductal carcinoma of the prostate is a rare variant of prostate cancer that presents most commonly with obstructive urinary symptoms or hematuria. This case series of 6 patients is the first to report the outcome of ductal carcinoma treated with external beam radiotherapy. METHODS: A retrospective review was performed of patients treated between 1980 and 2006 at Fox Chase Cancer Center, Philadelphia, Penn. Six patients were identified with ductal carcinoma. RESULTS: Five of the 6 patients were treated definitively and the sixth patient was treated at recurrence 3 years after a radical prostatectomy. Patient ages ranged from 66-80 years and the initial prostate-specific antigen (iPSA) ranged from 1.69-100.3 ng/mL. Three patients had a mixed acinar and ductal carcinoma, 2 with a Gleason score (GS) of 8 and 1 with a GS of 7. Of the patients treated definitively, 4 had clinical stage T2A-T2C and 1 had clinical stage T1B. Definitive radiotherapy was delivered to the prostate with doses between 72 Gy and 78 Gy. Pelvic lymph nodes were treated in all patients. One patient was treated postradical prostatectomy to the prostate bed to a dose of 60 Gy. Adjuvant androgen deprivation was given in 5 of the patients. Two of the patients died from metastatic disease at 1.4 and 7.1 years after treatment. The remaining 4 patients remain alive between 3.2 and 4.8 years from treatment, with 3 patients biochemically without evidence of disease. No patients have developed a local recurrence. CONCLUSIONS: Ductal carcinoma of the prostate may be treated effectively with external beam radiotherapy. Aggressive management is indicated, even with low-volume metastatic disease.     

Salivary gland tumours—Analysis of 162 cases

The clinical records of 162 cases of salivary gland tumours were studied. Parotid gland was the commonest site for origin of tumour (110 cases.) Commonest benign tumour was pleomorphic adenoma (42 cases) and the commonest malignant tumour was mucoepidermoid carcinoma (26 out of 162 cases). The next common tumours were adenoidcystic and undifferentiated carcinoma which constituted 23 and 20 cases respectively. Surgery or surgery with radiotherapy were the main modalities of treatment for the primary tumours. Twenty patients had recurrence within three years after the treatment. These patients were treated with either revision surgery or external radiations. Chemotherapy was given to one patient of soft tissue sarcoma. Twenty nine patients had post-operative complications like facial paralysis, parotid fistula, skin necrosis and Frey’s syndrome.     

Functional gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland

IntroductionGland-preserving surgery is often used for benign tumours in the parotid gland. Partial superficial parotidectomy via a periauricular incision may bring satisfactory cosmetic outcomes but the disease control outcome remains unrevealed. This study evaluated functional and disease control outcomes after gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland.MethodsThis longitudinal study included 248 consecutive patients with parotid pleomorphic adenoma who underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumours via periauricular incision. Postoperative complications, subjective satisfaction, salivary function, and tumour recurrence were assessed in each patient. The secretory function of the salivary gland was measured using salivary scintigraphy at 6 months after surgery, and ultrasonography was regularly followed.ResultsMedian tumour size was 2.5 cm (range, 0.8–5.2 cm) and median operation time was 55 min (range, 39–88 min). All tumours were safely removed by gland-preserving surgery via periauricular incision without extension to Blair or hairline incision and tumour spillage. Temporary and permanent paralysis of the facial nerve was 14 (5.6%) and none of the study patients, respectively. Postoperative complications were minor and Frey's syndrome was found in 6 (2.4%) patients. The Secretary function of the affected gland was equal to that of the unaffected gland. No patients had a recurrence for a median follow-up of 78 months (range, 24–126 months).ConclusionsFunctional gland-preserving surgery via periauricular incision can treat pleomorphic adenoma in the parotid gland with satisfactory functional, cosmetic, and disease control outcomes.     

Acinic cell carcinoma of the salivary glands. A long term follow-up study of 15 cases.

Fifteen cases of acinic cell carcinoma of the salivary glands were evaluated retrospectively with respect to histological and clinical data. DNA content assessment was carried out in six cases by cytophotometry. The majority of tumors were located in the parotid gland and were Stage I at presentation. There was a female predominance and the mean age at primary diagnosis was 51.2 years for females and 41.0 for males. The solid-acinar cell pattern was the most frequently observed and the tumors were 'diploid' in all the six cases studied. Surgery was the therapeutic modality in all cases (enucleation in seven, superficial parotidectomy in three and total parotidectomy in five) and, in four of them, was complemented with radiotherapy. The clinical course was characterized by recurrence in 10 cases, metastases occurred in three patients and one patient died of the tumor. Of the seven recurrent cases, six were treated by enucleation and one by superficial parotidectomy. The histological pattern showed no correlation with the clinical course or DNA content. Acinic cell carcinoma has a significant morbidity with a high recurrence rate which seems to be largely influenced by the type of surgery employed. Wide surgical excision of the neoplasia, which includes total parotidectomy in the parotid cases, is recommended in order to reduce the frequency of recurrence of the tumor.     

This is how I do it. Minimizing the blood loss during flap raising in thyroidectomy

Accessory parotid gland tumors are defined as masses within salivary gland tissue located adjacent to Stensen's duct, but separate from the main body of the parotid gland. These tumors usually present as asymptomatic cheek masses. There is a temptation to excise these masses locally; however, the likelihood of injury to branches of the facial nerve is high. The best surgical approach to tumors in the accessory parotid region is via a standard parotid incision and concomitant superficial parotidectomy. Eight patients have been surgically treated with accessory parotid gland masses. Six patients had mixed tumors, one had a low grade mucoepidermoid carcinoma, and one had a localized parotitis. Our approach included a standard parotid incision, raising an anterior flap beyond the mass, and exposing the main trunk of the facial nerve, with careful tracing of all its branches. This approach to accessory parotid gland tumors is superior in that it provides a better margin of resection and minimizes functional and cosmetic deformities. Most importantly, there is less danger of injury to branches of the facial nerve. © 1993 Wiley-Liss, Inc.     

Oral cavity and oropharynx squamous cell carcinoma with metastasis to the parotid lymph nodes

To increase awareness of the potential of oral and oropharyngeal squamous cell carcinoma (SCC) to metastasize to the parotid region. We retrospectively reviewed patients who had undergone parotidectomy for metastatic oral or oropharyngeal SCC at a single tertiary care facility from January 1988 to January 2004. Exclusion criteria were a history of cutaneous SCC of head and neck or extension of primary tumor into the parotid gland. Twelve patients met study criteria. Parotid metastasis represented the initial disease manifestation in 4 cases. In 1 case, parotid metastasis presented synchronously with the primary tumor. Parotid metastasis represented recurrent disease in the other 7 cases. Primary subsites included tongue base (n=4), tonsil (n=3), lateral pharyngeal wall (n=2), oral floor (n=1), maxillary alveolus (n=1), and retromolar trigone (n=1). Pathologic findings showed grade 3 or 4 SCC in all patients. Parotid metastasis was located in the inferior parotid nodes in 7 cases; multiple superficial nodes, 3 cases; and both deep and superficial nodes, 2 cases. Oral and oropharyngeal SCC can metastasize to the intraparotid lymph nodes. The inferior parotid nodes are most commonly involved, and patients generally have substantial associated cervical metastases. When treating patients who have oral or oropharyngeal cancer with substantial cervical metastasis, physicians should consider removing the inferior parotid lymph nodes. We recommend that when intraparotid lymph node metastasis is detected, total parotidectomy and multidisciplinary adjuvant therapy should be conducted.     

Primary malignant lymphoma of the salivary glands

Five cases of primary malignant lymphomas of the salivary glands are reported. Four lymphomas arose in the parotid gland and one in the submandibular gland. All were non-Hodgkin lymphomas. In 4 cases the lymphomas were of low-grade malignancy, viz. 2 immunocytomas and 2 centroblastic/centrocytic malignant lymphomas, and 1 was a T-immunoblastic malignant lymphoma of high-grade malignancy. Four patients with localized disease were treated with radiotherapy and 1 patient with disseminated disease was treated with chemotherapy. One patient died from a disease unrelated to the malignant lymphoma, and 4 patients were alive at 66-136 months after treatment.     

A case of parotid carcinoma with hepatic metastasis that responded remarkably to combination chemotherapy of docetaxel, cisplatin and 5-fluorouracil

A patient who had parotid gland carcinoma with hepatic metastasis (T4N2bM1) underwent 3 cycles of neoadjuvant chemotherapy with docetaxel, cisplatin and fluorouracil (TPF). After this treatment, the patient showed a PR in the primary site and a CR in the hepatic metastasis. Left total parotidectomy and modified radical neck dissection were then performed followed by postoperative irradiation of 40 Gy. No recurrence in the primary site or the neck was seen, but in the metastatic site a recurrence was observed at 8 weeks after the first chemotherapy. The same chemotherapy is now applied in an outpatient setting. Toxicities with neutropenia, nausea and vomiting of CTC Grade 3 were observed, but these toxicities were mild and manageable. TPF is considered to show clinical activity for advanced parotid gland carcinoma, and we consider further investigation necessary.     

腮腺恶性肿瘤外科治疗130例分析

[目的]探讨腮腺恶性肿瘤的手术方法、面神经处理及预后.[方法]回顾分析130例住院手术病例,其中初治85例、复治45例、术前面瘫18例.行腮腺及肿块切除保留面神经87例,腮腺、肿块及面神经切除33例,扩大切除10例.[结果] 5年生存率为76.2%.其中术前有无面瘫分别33.3%、81.3%(P＜0.01),有无颈淋巴结转移为54.2%、80.4%(P＜0.01).[结论]腮腺恶性肿瘤的预后因素主要是术前有无颈淋巴结转移、面瘫、肿瘤的临床分期及恶性程度,首次术式选择合理是减少局部复发的关键.     

Rhabdomyosarcoma of the salivary glands. Report of 3 cases]

Rhabdomyosarcoma of the salivary glands is rare. Tumours develop mostly in children and young patients but can be diagnosed in older people. We report three new cases in women 7, 14 and 75 years old. Tumefaction of the parotid region and facial paralysis were the principle clinical symptoms. Two patients underwent a total parotidectomy and radiotherapy. The third patient had a locally advanced tumour and received chemotherapy followed by radiotherapy. Loco-regional recurrence was observed in all cases and median survival was 12 months. Rhabdomyosarcoma of the salivary glands is locally aggressive. Treatments include surgery and radiotherapy. The role of chemotherapy remains to be discussed.     

腮腺肿瘤手术20例临床分析

目的探讨腮腺肿瘤的手术方式、手术范围及预后。方法对1998--2004年间行解剖面神经的腮腺肿瘤切除术20例临床随访资料进行分析。结果腮腺浅叶切除术13例中，并发腮瘘1例；全腺叶切除术7例中，并发暂时性面瘫1例，无Frey综合征。随访10个月至6年无复发。结论腮腺良性肿瘤需行解剖面神经的浅叶及肿瘤切除术或全腮腺切除术；恶性肿瘤在面神经未受累时行保留面神经的腮腺全切术，术后辅以放疗，可以减少肿瘤复发和面瘫等并发症。     

原发腮腺淋巴上皮癌临床特征与诊断及疗效分析

目的 分析原发腮腺淋巴上皮癌的临床特征、诊断特点及预后。方法 回顾性分析2009-2017年经中国医学科学院肿瘤医院确诊的13例腮腺淋巴上皮癌患者临床资料,中位随访时间38.5个月,所有患者均先行手术+放疗。结果 全组13例患者中男9例,女4例,中位年龄33岁。确诊时局限于腮腺9例、区域淋巴结转移4例,均为Ⅰ b、Ⅱ区。UICC2010分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为1、1、6、5例。11例患者手术病理标本EBER检测10例阳性。全组无死亡事件,3年总生存率100%,3年无进展生存率76%,3年局部控制率92%,3年无远处转移率84%。结论 腮腺淋巴上皮癌发病率较低,病变与EBV相关,容易发生颈部淋巴结转移,疗前应除外鼻咽癌转移至腮腺的可能。目前治疗模式是以手术+放疗,总体预后较好,治疗失败主要原因为局部复发和远处转移。     

Carcinome neuroendocrine de la vessie : étude rétrospective monocentrique

PurposeNeuroendocrine carcinoma of the bladder is a rare tumour representing 0.5 to 1 % of bladder tumours. It is a specific histological entity characterized by rapid metastatic dissemination and poor prognosis. The aim of this study was to describe the epidemiological, clinical, therapeutic modalities and the evolutive aspects of patients receiving a treatment for bladder neuroendocrine carcinoma.Patients and methodsBetween January 2004 and January 2014, seven patients received a treatment for a neuroendocrine carcinoma of the bladder, at the department of oncology, Habib-Bourguiba Hospital, in Sfax, Tunisia.ResultsThe median age was 58 years. All patients were male. Neuroendocrine carcinoma was pure in four cases and associated with urothelial carcinoma in the other three cases. Two patients were diagnosed at a metastatic stage. A cystectomy was performed in two cases. One patient received a chemotherapy and radiotherapy. The other four patients received chemotherapy alone. A single case of complete remission was observed. Median survival was 15 months (5–30 months). One patient is still alive 30 months after diagnosis.ConclusionThe management of neuroendocrine carcinoma of the bladder is not standardized and requires a multidisciplinary consultation.     

Prognostic value of a three-grade classification in primary epithelial parotid carcinoma: Result of a histological review from a 20-year experience of total parotidectomy with neck dissection in a single institution

BackgroundThe tumour grading of primary parotid cancers (PPCs) remains controversial.MethodsA 20-year standardised single centre treatment has been assessed retrospectively. The histological review of 155 consecutively treated parotid malignancies identified 96 suitable cases for univariate and multivariate survival analyses.ResultsTreatment involved total parotidectomy, neck dissection and post-operative radiotherapy in, respectively, 91.7%, 83.3% and 70.4% of cases. The 5-year overall survival, disease-specific and recurrence-free survival rates were 79.4%, 83.5% and 70.8%, respectively. Univariate analysis confirmed the classical prognostic factors, i.e. age > 60 years, male gender, facial palsy, hardness of the tumour, clinical stage, tumour grade, facial nerve invasion and lymph node metastases. Multivariate analysis identified a three-grade classification just after the clinical stage as the most important prognostic factor.ConclusionThis study identifies the prognostic significance of intermediate grade tumours.     

Metachronous bilateral mucoepidermoid carcinoma of the parotid gland

We report a very rare case of bilateral muco-epidermoid carcinoma of the parotid gland that underwent bilateral parotidectomy with neck dissections and radiotherapy. This case has done well for three years and suggests that metachronous bilateral mucoepidermoid carcinoma of the parotid gland, if treated as per the merits of each side, has a reasonable survival.     

Metastasis of oral cancer to the parotid node

Background

The parotid node is an uncommon site of metastasis in head and neck cancer. This study was intended to clarify the incidence and indicators of oral cancer metastases to the parotid node.

Patients and methods

We reviewed the records of 253 patients with oral carcinomas who had undergone a total of 289 neck dissections between April 2001 and December 2006. The histologic diagnoses of the primary tumors were squamous cell carcinoma in 239 patients, mucoepidermoid carcinoma in 5, adenoid cystic carcinoma in 4, and miscellaneous others in 5. In all neck dissections, the tail of the parotid gland below the marginal mandibular branch of the facial nerve was resected. The cervical and parotid lymph nodes were isolated from the surgical specimens. One section through the maximum cross-sectional area of each node was examined histologically.

Results

From 183 of the 289 neck specimens, we collected 539 parotid nodes: 222 extraglandular and 317 intraglandular. Of the 253 patients, 10 (4.0%) had 19 parotid node metastases, of which 4 were extraglandular and 15 intraglandular. Parotid node involvement occurred in 2.5% of oral squamous cell carcinoma cases. For the other cancers, there were too few cases to determine a meaningful frequency. In terms of indicators, the likelihood of metastasis to the parotid nodes increased with the number of cancer-positive cervical nodes.

Conclusions

Metastasis to the parotid nodes should be considered in patients with oral cancer. Resection of the tail of the parotid gland is warranted during the neck dissection.     

Radiotherapy in treatment of carcinoma of the parotid gland, an approach for the medically or technically inoperable patient

Introduction: Initial surgical resection is considered the standard of care for patients diagnosed with tumours involving the salivary glands. We reviewed our institutional outcomes of patients treated with initial radiation therapy (RT) for diagnosed carcinoma of the parotid gland. Methods: This review examined seventeen patients that received RT as initial therapy for tumours involving the parotid gland. Fifteen patients had primary salivary gland cancer, and two patients had metastatic carcinoma to the parotid gland. Sixteen patients (94.1%) following surgical evaluation had operative risk of facial nerve impairment or sacrifice with initial surgery, four (23.5%) had clinical objective evidence of nerve involvement at evaluation, five (29.4%) were poor surgical candidates and three (17.6%) refused initial surgery. Primary tumour stages ranged T2-T4b, and disease stages ranged II-IVb. RT median dose was 70 Gy, and median follow-up was 12 months. Results: Eleven patients (64.7%) achieved a clinical complete response (CR) to therapy. Of these CR patients eight (72.7%) received definitive RT and three (27.3%) underwent surgery following RT. Two surgical patients avoided facial nerve impairment while one required nerve sacrifice. The other six patients (35.3%) achieved an unfavourable response to RT and had unresectable or metastatic disease at follow-up. No long-term complications were reported. Conclusion: Initial radiation therapy for tumours involving the parotid gland is effective to achieve clinical CR, eliminate surgical resection for many patients, and decrease risk of facial nerve impairment or sacrifice for those patients requiring surgery following RT.