Lacrimal adenocarcinoma and anophtalmos

INTRODUCTION: The classical symptoms of orbital tumors are modified in the event of an anophthalmic socket.CASE REPORT: We report a case of primary malignant neoplasm of the lacrimal gland in an enucleated 70-year-old women.DISCUSSION: Patients with an anophthalmic orbit often present postenucleation socket syndrome: problems of tolerance and rocking of the ocular prothesis, enophthalmos, ptosis, lower eyelid ectropion. Development of a malignant tumor of the lacrimal gland is however exceptional. An oversized lacrimal gland is suggestive of tumor development. Rigorous clinical and radiological follow-up (CT, MRI) is essential. We discuss diagnostic and therapeutic aspects including the type of exenteration, radiotherapy, and reconstruction technique.     

Facial nerve in recurrent benign pleomorphic adenoma.

Improvements in the treatment of benign and malignant tumors in the parotid gland have substantially reduced the incidence of recurrence. This has come about primarily be the abandonment of the enucleation techniques and the development of lateral lobectomy operation. The recurrence rate for benign mixed tumor in the parotid gland is variously reported in the ranges of 0.5% to 10%. Because the benign mixed tumor comprises approximately 65% of the tumors in this gland, this complication assumes an important and specific role. A review of this problem establishes the principles of management, extending from simple reexcision through total parotidectomy with preservation of the facial nerve, and radical parotidectomy with resection of the facial nerve and immediate nerve grafting.     

腮腺良性肿瘤切除附143例报告

目的 分析腮腺良性肿瘤的外科治疗.方法 回顾分析1995年8月～2009年12月143例行腮腺良性肿瘤手术资料,其中腮腺浅叶肿瘤115例,深叶肿瘤28例.病理诊断Warthin瘤69例(占48.28%),混合瘤63例(占44.06% ).其中有5例为双侧.行腮腺浅叶区域切除术73例,腮腺浅叶切除术42例,腮腺部分浅叶切...     

儿童眼眶疾病67例分析

目的研究儿童眼眶疾病的临床分类、诊断和治疗。方法回顾分析67例眼眶病住院患儿的临床资料,其中65例行手术治疗,结合病理检查进行统计学分析。结果67例中肿瘤51例,前3位是皮样囊肿、血管瘤、横纹肌肉瘤;然后是血囊肿9例。眼眶异物3例,先天性小眼球合并囊肿2例,蜂窝织炎和先天性泪腺瘘各1例。结论儿童眼眶病以肿瘤和血囊肿最常见,多与先天性、胚胎性肿瘤或先天性发育畸形有关,治疗方法以手术为主。     

Management of lacrimal fossa masses

Mass lesions of the lacrimal fossa are evenly divided between epithelial and nonepithelial diseases. Nonepithelial lesions include pseudotumor, benign lymphoid hyperplasia, lymphoma, and sarcoid. Epithelial lesions are evenly divided between benign and malignant neoplasia, and are similar to those of the salivary glands. Benign mixed tumors compose 25% of lacrimal gland tumors, and are very slow-growing, painless lesions that should be removed en bloc without a biopsy to avoid seeding the orbit. Adenoid cystic and malignant mixed carcinomas are the most common malignancies, and present with rapid growth and pain. These require incisional biopsy to establish the diagnosis, and then a radical exenteration and postoperative radiation therapy.     

腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿瘤切除术的临床分析

目的 探讨腔镜辅助下耳后发际线径路面神经顺行解剖后腮腺肿瘤切除手术的临床效果。方法 选择2022年7月—2022年9月诊治的3例腮腺肿瘤位于浅叶并且直径小于3cm患者，采用发际线径路，在全腔镜下顺行解剖面神经后，行腮腺肿瘤和部分浅叶切除治疗。结果 3例患者均顺利完成手术，均无术后出血、涎瘘及面瘫，收到良好的美容效果。结论 腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿物切除术是一种安全可行、有良好美容效果的手术方式。     

The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results

PurposeMajor salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors.Materials and methodsWe retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013–December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis.ResultsThe number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14–86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628).ConclusionsFNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.     

Temporary facial nerve dysfunction after parotidectomy correlates with tumor location

Objective

To investigate the clinical factors associated with temporary facial nerve dysfunction (TFND) following surgery for benign parotid gland tumors.

Methods

We reviewed the records of 175 patients with benign parotid gland tumors who underwent partial parotidectomy at Yokohama City University Medical Center in Japan. TFND was found in 33 patients (18.9%). We used two hypothetical lines in magnetic resonance imaging (MRI) images to define the tumor location (upper/lower or anterior/posterior) in the parotid gland. We then studied the associations of TFND with the following clinical factors: patient age, tumor size, histopathological diagnosis, and the location of the tumor within the parotid gland (superficial lobe/deep lobe; upper part/lower part; and anterior part/posterior part).

Results

Tumors located in the upper parts, anterior parts or the deep lobes of the parotid gland had statistically higher incidences of TFND compared with tumors located in the lower parts, posterior parts or the superficial lobe (P < 0.001, <0.001, <0.01, respectively). The odds ratio for the risk of TFND was significantly high if tumors were located in the upper parts, the anterior parts or the deep lobes with stepwise multivariate regression analysis. The other factors, including patient's age, tumor size, histopathology of the tumor, and inadequate surgeon's experience, were not apparent risks for TFND.

Conclusions

Parotid gland tumors located in the upper parts, the anterior parts or the deep lobes had a higher risk of TFND. The two hypothetical lines we used were shown to be useful to define the tumor location, eventually the risk of TFND.     

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy

IntroductionFine 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.ObjectiveWe aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors.MethodsPatients 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.Results217 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%.ConclusionFine 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.     

显微镜下功能性腮腺切除术治疗腮腺良性肿瘤42例

目的 评价显微镜下功能性腮腺切除术治疗腮腺良性肿瘤的临床疗效。方法 采用显微镜下功能性腮腺切除术,治疗腮腺浅叶良性肿瘤患者42例。该术式较传统术式改良之处主要有：全程显微镜下手术直观准确;切口改良、美容;腮腺嚼肌筋膜下翻瓣;解剖保留耳大神经后支和腮腺导管;只解剖暴露面神经的部分分支;包括肿瘤在内的腮腺浅叶部分切除;胸锁乳突肌肌瓣填塞术腔等。结果 42例术后出现面神经损伤3例(7.1%),损伤均为暂时性;出现Frey综合征者1例(2.4%);发生涎瘘者0例;5例(11.9%)患者术后出现不同程度的耳垂和耳郭背部皮肤感觉减弱;术后局部凹陷不明显,患者对颜面部外观满意。术后随访1～5年,未见肿瘤复发。结论 显微镜下功能性腮腺切除术治疗腮腺良性肿瘤,既降低手术并发症发生率,又可取得良好美容效果。     

Basal cell adenoma of the salivary glands

Basal cell adenoma is an unusual type of salivary gland tumor which has only recently been classified as a separate entity. Four cases are presented. Three were discovered by reviewing a series of adenoid cystic carcinomas and mixed tumors, and one was diagnosed originally. Three cases involved the parotid; one, the submaxillary gland. There was no facial nerve involvement in any case. Treatment was local excision. Follow-up from two to nine years revealed no recurrence. The lesions typically are slow growing, firm, non-tender, asymptomatic masses present for several years before treatment. The average age of the patients is generally older than those with mixed tumors. They are most often found in the parotid gland, but have been reported from the submaxillary and minor salivary glands of the upper lip, cheek, and palate. Microscopically the tumor consists of monomorphic basaloid cells with an absence of myoepithelial cells. Myoepithelial cells play an important role in salivary gland tumors. Their range of activity and products determine to a certain degree the morphology of adenoid-cystic and mixed tumors. They resemble muscle cells as demonstrated by electron microscopy studies and also by functioning as contractile elements. The cell of origin is unknown. The tumors may closely resemble adenoid cystic carcinoma and mixed tumors; therefore, diagnostic and therapeutic questions may arise. The tumors are benign. No malignancy has been reported. The lesions can be unencapsulated; therefore, the best treatment is adequate local excision rather than enucleation, tumor may contribute more knowledge concerning the histogenesis of certain salivary gland tumors. With increased awareness and acceptance of this lesion as a separate entity by pathologists, we perhaps can expect an increase in its diagnosis. As otolaryngologists we should have a thorough knowledge of its clinicopathology in terms of clinical presentation, pathology, treatment, and prognosis.     

Surgical procedure for Warthin's tumor in the parotid gland

Warthin's tumor is benign and exclusively involves the parotid gland but may, however, often show multifocal and/or bilateral growth. The aim of this study was to evaluate the surgical procedure for removal of this tumor. Sixty patients with Warthin's tumor in the parotid gland who presented at the Kansai Medical University Hospital from 1990 to 1999 were the subjects of the present study. The surgical procedures were as follows. We performed enucleation for tumors in the deep lobe. Tumors in the superficial lobe were resected with partial parotidectomy, and an enucleative procedure was also performed at the bottom of the tumor where the tumor capsule directly touched the facial nerve. No recurrence was observed in all sixty cases including cases of rupture of the capsule before or during surgery. Therefore, we recommend that enucleation is a useful choice as a surgical procedure for the removal of Warthin's tumor after accurate detection of the tumors using MRI. The overall incidences of temporary and permanent facial nerve palsy were 19.7% and 0%, respectively. The incidence of palsy increased after surgery for multiple tumors or deep lobe tumors. These findings indicate that more careful consideration for preservation of the facial nerve should be given in such cases and that simultaneous surgery for such tumors in the bilateral parotid glands should be avoided to prevent bilateral facial nerve palsy.     

'Medial maxillectomy' for lateral nasal wall neoplasms

Lateral rhinotomy and "medial maxillectomy," an en bloc resection of the medial maxillary sinus, ethmoid sinus with the lamina papyracea, medial orbital floor, and lacrimal fossa-duct, have been advocated for lateral nasal wall neoplasma. Experience with 35 (of 41) patients followed up at least 30 months (median, 57 months) postoperatively is reported. There was a 9% recurrence for benign tumors and 15% for malignant neoplasms, the latter only in the patients with nonmelanoma malignant neoplasms not receiving postoperative radiotherapy. The most frequent complications were cavity crusting, epicanthal scarring, and epiphora.     

Basal cell adenoma of the sublingual gland

Salivary gland tumors constitute about 3% to 4% of all head and neck neoplasms. Approximately 80% originate in the parotid gland, and they rarely present in the sublingual gland; however, a disproportionately large majority of sublingual gland tumors are malignant. Basal cell adenoma is a benign epithelial salivary gland tumor that appears to have unique histologic characteristics, different from those of mixed tumors, and has a predilection for development in the parotid and minor salivary glands. No case has ever been reported as arising from the sublingual gland in the otolaryngology literature. We report here a case of a middle-aged woman with basal cell adenoma of the sublingual gland. The clinical presentation, pathological features, differential diagnosis, and treatment options for this relatively rare tumor are discussed.     

Selective deep lobe parotid surgery for benign tumors

Conclusions: Deep-lobe tumor parotidectomy decreases the incidence of parotidectomy post-surgical complications, preserves parotid function, and has a good esthetic appearance. Objective: The existing surgical technique in the parotidectomy of deep-lobe benign tumors can be improved. Methods: Fourteen surgical operations were performed (2004–2015) for selective deep lobe parotidectomy for patients with primary benign parotid tumors. The patients with deep-lobe benign tumors were operated on with the method of superficial lobe preservation, which included methylene blue staining of the gland and intra-operative facial nerve detection. Results: During follow-up, no cases of tumor recurrence, permanent facial nerve injury, postparotidectomy depression, or Frey’s syndrome was found.     

Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patients

ObjectiveWe analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors.Patients and methodsA total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9 %) and malignant parotid gland tumors (n = 180, 18.1 %).ResultsPleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3 %, diagnostic specificity of 98.7 %, a positive predictive value of 89.5 %, a negative predictive value of 89.9 %, and accuracy of 89.9 % for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4 % of the patients with malignant parotid gland tumors compared to 5.4 % of those with benign tumors.ConclusionThe clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy.     

腮腺肿瘤的治疗经验及远期疗效观察

目的手术治疗腮腺肿瘤的多种方法及其远期疗效评定。方法回顾性分析我科自1997～2004年所收治的腮腺肿瘤手术患者病历资料86例,男性53例,女性33例,年龄23～84岁,中间年龄57岁。所有患者都作腮腺浅叶切除术或浅叶扩大切除术或腮腺全切除术,必要时作颈清扫术。常规术中快速冰冻和术后病理检查。术后面神经功能评定。恶性肿瘤患者辅助性根治放疗(50 Gy～70 Gy)。有效随访期36～120个月不等。结果86例腮腺肿瘤患者中良性肿瘤73例(85%),恶性肿瘤13例(15%)。8例腮腺深叶肿瘤中5例为恶性肿瘤。随访中良性肿瘤1例局部复发,局部控制率为98.6%(72/73);恶性肿瘤3年生存率为69.2% (9/13),3年原发灶局部控制率为84.6%(11/13),术后颈淋巴结转移率为23.1%(3/13)。术中快速冰冻与术后常规病理符合率为86%,腮腺良性肿瘤的面神经完好保存率为97.3%(71/73),恶性肿瘤面神经完好保存率为69.2%(9/13),总体面神经完好保存率为93%。结论腮腺浅叶切除术是常规基本术式,根据肿瘤具体情况可改变为腮腺浅叶扩大切除术或全腮腺切除术。术中应尽可能保存面神经主干及各分支,特别是颞面干。快速冰冻是腮腺手术中的有效诊断方法。腮腺深叶肿瘤恶变率高。     

Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.     

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.     

Benign myoepithelioma of the lacrimal gland: report of a case

Myoepithelioma of the lacrimal gland is an extremely rare monomorphic adenoma, with only six previously reported cases in the literature. We herein report the radiological, clinical and histopathological evaluation of a 46-year-old patient with a history of right eye proptosis and progressive diplopia. A mass in the right lacrimal fossa was detected at MRI and turned out to be benign myoepithelioma of the lacrimal gland at the histopathological examination. The patient underwent excision of the mass by means of a coronal bitemporal approach and lateral orbitotomy. The lesion was entirely removed en-bloc with the lacrimal gland. MRI did not show any evidence of recurrent disease 12 months after surgery. The patient was clinically free of disease after 22 months. Surgery is the treatment of choice for this kind of lesion. The coronal bi-temporal approach herein reported offered good exposure of the entire lesion and a satisfactory aesthetic result. Periodic postoperative radiological evaluations with MRI are mandatory.