Sialadenoma papilliferum of the parotid gland

A case of sialadenoma papilliferum of the parotid gland in a 35-year-old woman is described. The tumor was locally excised and no recurrence was evident after a follow-up period of 30 months.     

Partial parotidectomy--alternative method in surgical management of parotid gland Warthin tumours

82 patients with adenolymphoma of parotid gland treated with surgery in Department of Oncological Surgery Cancer Center, Gliwice in the period of 1986-2004 were retrospectively analyzed. They were about 22% of all patients with parotid gland tumors operated in that period. In almost 70% of cases partial parotidectomy with facial nerve preservation was performed as a treatment of choice. In that group DFS was over 95%. Local recurrence occurred in less then 5%, only in cases with multiple tumor in histopathological examinations. Quality of life parameters were also analyzed. In the analysis complications rate increased with the extension of surgical treatment. It revealed in the postoperative cosmetic defect evaluation. Partial resection of the parotid gland could be useful method of surgical treatment of adenolymphoma selected cases. It allows to achieve the same results as classic parotidectomy with lower risk of significant complications. In analyzed group the local recurrence was always combined with multi lesional growth of the tumor.     

Das solitäre intraparotideale Neurofibrom des N. facialis

Neurogenic neoplasms of the parotid gland are extremely uncommon. We present the case of a solitary intraparotid neurofibroma of the N. facialis occurring in a 55-year-old female who noted a painless left-side enlargement in the region of the parotid gland over a period of 2 years. Facial function was normal. Magnetic resonance imaging revealed a well-demarcated round mass within the left parotid. At surgery, a tumor was found involving the main trunk of the facial nerve, histopathologically representing a neurofibroma. Since solitary intraparotid neurofibromas are characterized by a very slow growth lacking the propensity for malignant transformation, the tumor was left to preserve facial nerve function. The clinical course over months or even years and the non-specific symptomatology are characteristic of intraparotid facial neurofibromas. Surgical management depends on the clinical setting in the individual case. Conservative treatment based on facial nerve preservation and leaving the tumor in situ is recommended, rather than radical tumor removal with resection of the segment of the N. facialis involved.     

Parotid lipoblastoma in an infant

We report a case of 'matured' lipoblastoma occurring within the parotid gland of a 7-month-old male. This benign fatty tumor is considered to represent localized continuation of fetal fat development into the post-birth period. At least 7 cases have been reported in the head and neck region, but this is the first known occurrence within a salivary gland.     

Collagenous spherulosis in epithelial-myoepithelial carcinoma of the parotid gland. Histological and immunohistological study of a case

Previously unreported histological and immunohistochemical features of collagenous spherulosis in an epithelial-myoepithelial carcinoma found in an 80-year-old woman are described. The multinodular tumor located in the right parotid gland was completely removed surgically. No local recurrence of the tumor appeared during the 22-month period of periodic checkups. This is believed to be the first report on collagenous spherulosis in an epithelial-myoepithelial carcinoma of the salivary gland. Different immunohistochemical characteristics of epithelial and myoepithelial neoplastic cells were found very useful for their analysis namely in parts of the tumor where one cell type greatly predominated (e.g. clear cell-type predominance). The double staining of histological sections can in this sense be recommended for the differentiation from other clear cell tumors of salivary glands allowing the correct categorization of the neoplasm.     

Warthin's tumor of the parotid gland. Epidemiological and clinical analysis of 127 cases

The aim of this study was a review of 127 patients treated for Warthin's tumor of parotid gland during 15-years period 1988-2003 in Pomeranian Voivodeship of Poland. The age-standardised incidence rate of this tumor was 0.32/100,000. There were 73.2% males and 26.8% females. Age ranged at presentation from 18 to 88 years (average 59.8+/-11.6). Workers from cities over 100,000 inhabitants, with technical education constituted the largest group. Almost 70% of the patients were smokers. Most frequently patients reported slow enlargement of tumor (55.9%), presence of tumor (24.4%) and rapid tumor enlargement (7.1%). Average duration of symptoms was 27 months. The average size of the tumor was 36+/-19 mm. More than half of tumors had less than 30 mm in diameter. After histopathological assessment the average size of tumor was 21+/-17 mm and the tumors less than 30 mm in diameter were 73.1%. There were 2.4% of bilateral neoplasms. Pre-operative cytological examination was not correlated with histopathological examination in less than half of cases (39.5%). All patients were treated surgically and in 81.9% the parotidectomy was performed. The most common localization of the tumor (52.4%) was lower pole of parotid gland. There were also stated 12.4% multifocal neoplasms and 3.8% tumors arising extraglandularly. The main complication after surgical treatment was temporary or permanent facial nerve palsy (10.8%). In 1 case the residual tumor was observed which required reoperation. In time of postoperative observation up to 15 years 1 case (0.9%) of recurrence which required surgical intervention. We noted an increase in number of Warthin's tumor in the analysed period of time.     

Histopathologic review of salivary gland tumors in childhood

During the 58-year period from 1928 through 1986, 80 patients 18 years of age or younger were treated or seen in consultation at Children's Hospital, Boston, for an epithelial or nonepithelial tumor of salivary gland origin. Using established criteria, ten (40%) of the 25 epithelial tumors were pleomorphic adenomas and the remaining tumors were classified as histologically malignant growths including mucoepidermoid carcinoma (n = 6), acinic cell carcinoma (n = 5), and adenocarcinoma most likely of duct cell origin (n = 2). Two other carcinomas presented as congenital parotid salivary gland tumors in newborns and were considered to have biphasic composition including both epithelial and myoepithelial cells, with the latter type predominating. There was only one tumor-related death due to metastases among the 15 children with malignant epithelial tumors (7%); four other patients experienced a local recurrence of tumor (27%). Of the 55 nonepithelial tumors, capillary hemangioma was the most common and showed distinct predilection for female infants with localization in the left parotid gland. The histologic spectrum of primary salivary gland tumors in infancy and childhood is distinctive and merits careful correlation with therapeutic strategies.     

Malignant peripheral nerve sheath tumor in the parotid gland developed on the basis of neurofibromatosis type 1

Malignant peripheral nerve sheath tumors arising from the parotid gland are very rare. They can develop as sporadic cases, or on the basis neurofibromatosis type 1. Tumors originating from the parotid gland are generally easy to palpate and have a solid characteristic. Even if the tumor is malignant in character, the incidence of facial paralysis at the time of diagnosis is around 15% in various studies. However, a malignant tumor originating from the nerve itself may not be noticed during the physical examination for a long period time although it cases facial paralysis and may be mistaken with other non-neoplastic diseases involved in the etiology of facial paralysis leading to a delay in the diagnosis and treatment. Especially patients with type 1 neurofibromatosis have a great tendency to develop malignant peripheral nerve sheath tumors. In this article a case of malignant peripheral nerve sheath tumor developed on the basis of neurofibromatosis type 1 was reported.     

Superior mediastinal paraganglioma initially suspected of being a mediastinal thyroid goiter

Paraganglioma is a rare tumor arising from paraganglia. Few reports have described paragangliomas in the superior mediastinum. We report a case of superior mediastinal paraganglioma treated in our department. A 28-year-old woman visited our department because of suspected mediastinal tumor during a medical checkup. Contrast-enhanced CT showed a 39 × 35 × 65-mm tumor with a well-defined border extending from the lower pole of the left thyroid gland to the superior mediastinum. Laboratory tests showed no evidence of catecholamine overproduction. Mediastinal thyroid goiter was the most suspected preoperative diagnosis. We decided to perform a transcervical excision for both diagnosis and treatment. The tumor was easily detached from the lower pole of the left thyroid gland and was not continuous. The tumor capsule was brittle and bled easily. The operating time was 3 h and 11 min, and the amount of bleeding was 571 mL. The pathological diagnosis was paraganglioma. Paragangliomas are characterized by abundant blood flow and are likely to result in a high intraoperative bleeding volume. In addition, if the tumor is functional, circulatory abnormalities can occur during the perioperative period. Accurate preoperative diagnoses are important, and the possibility that paragangliomas can develop in the superior mediastinum should be considered.     

Oncocytic Sialolipoma of the Submandibular Gland

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.     

Papillary cystadenocarcinoma of the submaxillary gland. A rare diagnosis

The authors describe a case of a "separate" type of salivary adenocarcinoma-like tumor. The growth is described as a papillary cystadenocarcinoma of the submaxillary gland, which should be distinguished from degenerate adenolymphoma. This malignant tumor, which remains "enclosed" until late, grows slowly and should be checked regularly over a protracted period of time following surgical excision performed in accordance with cancer therapy specifications.     

Primary neurilemoma of the thyroid gland: a case report

Primary nonepithelial tumors of the thyroid gland are rare. We present the case of a neurilemoma of the right lobe of the thyroid gland in a 20-year-old female patient. The tumor was asymptomatic and measured 2.5 x 1.2 cm in size. Histologic examination was consistent with an Antoni A-type neurilemoma. The tumor was excised without difficulty. Only 12 other cases of neurilemomas of the thyroid gland have been reported in the literature. We discuss the clinical, radiologic, and pathologic findings of this rare tumor.     

Metastatic sweat gland carcinoma

Only 48 cases of metastatic sweat gland carcinoma have been published. Our case report is of an elderly lady with a sweat gland carcinoma of the scalp with metastatic disease in the neck. She was treated with radical neck dissection and wide local excision. Follow-up of three years has revealed no recurrence. The most common location of sweat gland carcinoma is on the scalp. The diagnosis of malignant non-metastatic sweat gland carcinoma is difficult because there are no definite histologic criteria for diagnosing these tumors. Of the tumors that metastasize, most involve the regional lymph nodes. The differentiation between apocrine and eccrine metastatic sweat gland carcinoma is quite difficult and the criteria are not adequate to be of practical use. Sweat gland tumors may remain the same size for many years and then show a rapid period of growth followed by metastasis. Most metastases are in the regional lymph nodes, however, systemic disease does occur. Wide local excision of the primary tumor with resection of the involved regional lymph nodes is the recommended initial treatment. Prognosis of metastatic sweat gland carcinoma is poor although a few cases may have rather long survivals.     

Mucoepidermoid carcinoma arising in the accessory parotid gland.

A rare case of a 9-year-old female with mucoepidermoid carcinoma arising in the accessory parotid gland is reported. She had complained of a painless and round mass of the left cheek for a duration of 14 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen's duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotid gland. The preoperative diagnosis was an accessory parotid gland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous and epidermoid cells. The pathological diagnosis was low-grade mucoepidermoid carcinoma.     

Warthin's tumor. A high incidence and no sex predominance in central Pennsylvania.

Papillary cystadenolymphoma, or Warthin's tumor, is a monomorphic adenoma found in salivary glands. It nearly always occurs in the parotid gland, and is reported to occur in 5% to 14% of all parotid tumors according to most studies. The tumor has a universally accepted male predominance, with an increasing incidence in females having been reported over the last four decades. A review of all primary parotid gland tumors seen at York (Pa) Hospital for the last 10 years was performed. Warthin's tumor was diagnosed histologically in 42 (30%) of 138 primary parotid gland tumors, with no significant sex predominance identified (22 men, 20 women). A significantly higher percentage of all parotid gland tumors, and especially Warthin's tumor, was associated with smoking in both males and females.     

Rare tumors of the parotid gland. Lymphadenoma of a sebaceous gland and extracranial metastasis from glioblastoma

Tumors of the parotid gland can be benign or malignant lesions.The pathophysiology of rare tumors of the parotid gland is often not sufficiently explored in this paper two rare histological entities are described. In one patient a benign sebaceous lymph-adenoma was histologically diagnosed. This type of tumor accounts for only 0.196 of all adenomas. The international literature is not conclusive about whether the tumor originates in the parotid gland itself or in the parotid lymph nodes. The second patient presented with a metastasis from a glioblastoma in the parotid gland. Again, the mechanism for metastasis of an intra-cerebral tumor to the parotid gland remains unknown. Iatrogenic seeding during a neurosurgical intervention is a probable explanation. The actual clinical course of his patient and the cases described in literature render surgical removal of such a metastasis questionable.     

Primary chondrosarcoma arising in the parotid gland

We report an extremely rare case of chondrosarcoma arising in the left parotid gland in a 45-year-old man who complained of painless swelling of the postauricular region. Computed tomography revealed a well-circumscribed tumor in the parotid area with a rim of scattered calcification. Under the diagnosis of benign parotid tumor, the tumor mass was removed with adequate margin. Histologic features were consistent with a low-grade chondrosarcoma showing lobular growth but clearly separated from adjacent glandular tissue of the parotid gland. Entire examination of the tumor disclosed no component of pleomorphic adenoma. There has been no evidence of recurrence for 2 months after the operation. The current case indicates that the parotid gland could be the site of occurrence of de novo primary chondrosarcoma.     

Benign mixed tumor of the lacrimal gland. Clinical diagnosis and surgical management

The accurate clinical diagnosis of benign mixed tumors of the lacrimal gland is important for the proper therapeutic management. We present an adult case with a benign mixed tumor of the orbital lobe of the lacrimal gland, 8 years after periorbital blunt injury. The tumor lesion was diagnosed later in the persisting traumatic tumefaction region. Clinical examination, ultrasonography and MRI revealed a soft-tissue mass with high density and peripheral enhancement over the superior lateral portion of the right eye with expansion to and invasion of the orbital roof and lateral wall. Lateral orbitotomy was performed to resect the tumor. Histopathology disclosed a pleomorphic adenoma of the orbital lobe of the lacrimal gland. Pleomorphic adenomas of the lacrimal gland are seen rarely. The awareness of the clinical and diagnostic features of benign mixed tumors of the orbital lobe should help to avoid complications arising from an incisional biopsy or incomplete tumor resection.     

Zervikaler Riesentumor bei einer 56-jährigen Patientin

We report the case of a 56-year-old female patient with a giant tumor on the left side of the neck, which appeared to be localised outside the large salivary glands. Due to the extensive vascularisation seen on MRI, digital subtraction angiography was performed. To reduce intraoperative bleeding, the vasculature was embolized. The tumor was resected together with the submandibular gland, since a connection between gland and tumor could not be excluded intraoperatively. Histology showed a pleomorphic adenoma with an intact capsule and no indication of malignancy. Pleomorphic adenomas are typical tumors of the salivary glands; however, they can also occur outside the gland. The tumor and its pseudocapsule must be fully resected to prevent recurrence.