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.     

Salivary gland tumors. Fine-needle aspiration vs frozen-section diagnosis

We examined the relative accuracy of fine-needle aspiration biopsy (FNAB) and frozen section (FS) in the diagnosis of salivary gland tumors; FNAB completely and accurately diagnosed 35 (88%) of 40 cases, including ten (100%) of ten nonneoplastic lesions, 20 (87%) of 23 benign, and five (71%) of seven malignant tumors. No complications were encountered with this procedure. These results compare favorably with previously published reports. Twenty-one of 40 tumors diagnosed by FNAB and FS at surgery. Sixteen (76%) of 21 of these were correctly diagnosed by FNAB, and 15 (71%) of 21 by FS. Cystic lesions gave the most diagnostic difficulties both on FNAB and FS. Worldwide, FNAB has been demonstrated to be a cost-effective, accurate, and safe procedure. Furthermore, the use of FNAB allows for better preoperative management and overall treatment planning.     

术中快速冰冻切片在136例腮腺肿瘤中的诊断价值

目的通过分析和比较腮腺肿瘤术中快速冰冻切片和术后最终病理诊断结果,评估术中快速冰冻切片在腮腺肿瘤诊断中的意义。方法对136例腮腺肿瘤行术中快速冰冻切片诊断肿瘤的性质与最终病理诊断进行对比分析。结果 136例腮腺肿瘤中经最终病理诊断,良性肿瘤97例,恶性39例;快速冰冻切片诊断鉴别出恶性肿瘤的准确率为95.6%。39例恶性肿瘤中最终病理诊断为恶性程度较高类型肿瘤12例,经快速冰冻切片诊断的准确率为76.9%。结论快速冰冻切片在腮腺手术中可提供一种快速准确诊断良、恶性肿瘤的的手段,并为临床判断腮腺恶性肿瘤恶性程度提供一定的参考,应作为腮腺手术术中的常规检查手段。     

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.     

Fine-needle aspiration biopsy of salivary gland lesions in a selected patient population

OBJECTIVE: To report the role of selective use of preoperative fine-needle aspiration biopsy (FNAB) in patients with major salivary gland lesions at a tertiary care cancer center. DESIGN: Retrospective review of FNAB results compared with final histologic diagnosis as the criterion standard. SETTING: An academic tertiary care cancer center. PATIENTS: A consecutive series of 258 patients who underwent FNAB of major salivary gland lesions between 1996 and 2000, of whom 169 had surgical resection. MAIN OUTCOME MEASURES: Predictive value, sensitivity, specificity, and accuracy. RESULTS: FNAB was performed in 169 (37%) of 463 salivary gland lesions undergoing surgical procedures. A total of 126 lesions were in the parotid gland and 44 in the submandibular gland. Seventy-nine lesions (46%) were malignant. There were 150 FNAB specimens (89%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesion had positive and negative predictive values of 84% and 77%, respectively. Ten of 20 false-negative FNAB results were low-grade lymphoma on final histologic assessment. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 83% and 88%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 47% of cases. Fifteen (47%) of 32 lymphocyte-predominant FNAB specimens were lymphoma on final histologic assessment. Ten (20%) of 49 patients with history of a solid, non-head and neck malignancy had evidence of distant metastasis to the salivary gland by histologic and/or cytopathologic assessment. CONCLUSIONS: An FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of final histologic diagnosis. The predictive value of a negative FNAB finding is low, and should not supersede clinical suspicion. Cytologic findings of a lymphocyte-predominant lesion should prompt further workup to rule out lymphoma.     

Basal cell adenoma of the parotid gland: a clinicopathological study of nine cases—basal cell adenoma versus pleomorphic adenoma and Warthin’s tumor

The aim of this study is to investigate the clinical and pathological characteristics of basal cell adenoma (BCA) and to compare the diagnosis/treatment of BCA with those of Warthin’s tumor (WT) and pleomorphic adenoma (PA). Among 192 patients with benign tumors of the parotid gland who underwent surgery, 9 had BCA. All of these tumors showed a benign pattern on computed tomography and magnetic resonance imaging. The accuracy of fine needle aspiration biopsy (FNAB) for diagnosis of BCA was slightly lower than for PA and WT. Most PA and BCA lesions developed in the upper part of the parotid gland. Considering the gender difference, tumor site, and age, it is necessary to differentiate BCA from PA rather than from WT. There were no significant differences in the duration of surgery, the blood loss, and the incidence of transient facial paralysis between surgical resection of BCA and surgery for PA or WT. BCA is the third most common of the benign parotid tumors, following WT and PA, although its incidence is low. When PA and WT are ruled out by FNAB after a tentative diagnosis of benign tumor has been based on imaging findings, BCA should be considered.     

Value of ultrasound in preoperative exploration of parotid tumors

Ultrasound image were compared with operative findings and gross pathology and histology appearances in 28 patients with parotid gland tumors (24 benign and 4 malignant). Ultrasound exploration provides precise data on localization, shape, size, outline, homogenicity of tumor contents and position of lesion in relation to pharyngeal wall. Clearly defined ultrasound images were detected in all benign but few malignant tumors, which presented mainly diffuse images. Non-homogeneous density of images, showing presence of intratumoral necrotic zones, was identified in all cases of malignant tumors but very few cases of benign lesions. Ultrasound imaging defines probable nature of a parotid tumor, probability enhanced by combining other exploratory investigations, but provides precise data on physical nature of tumor, of value during surgery.     

Wertigkeit der Feinnadelpunktionszytologie bei Neoplasien der Glandula parotis

BACKGROUND: In many parts of Germany fine-needle aspiration biopsy (FNAB) is still not part of the routine preoperative diagnostic evaluation of salivary gland neoplasms. Most opponents consider the study unnecessary and recommend that all salivary gland neoplasms should be excised. OBJECTIVE: Because of this an evaluated the ability of FNAB to provide an accurate diagnosis of parotid gland neoplasms. PATIENTS AND METHOD: Between January 1992 and October 1995, 336 patients referred for operative therapy of salivary gland neoplasms underwent retrospective analysis of preoperative FNAB compared with the excised tumor histology. RESULTS: Results showed that the FNAB had a sensitivity of 93.1%, a specificity of 99.2%, a positive predictive value of 93.1%, a negative predictive value of 99.2% and an accuracy of 98.6%. Complications were observed in less than 1%. DISCUSSION: Our findings demonstrated that the FNAB is a safe diagnostic tool that has a reliable sensitivity and high specificity for the assessment of salivary gland pathology. Since many malignant salivary gland neoplasms present with a virtual lack of symptoms indicating actual malignancy we believe that there is need for FNAB in routine preoperative diagnostic testing.     

New diagnostic markers in salivary gland tumors

Parotid gland tumors are a rare and heterogeneous entity. Molecular markers are sparse. The aim of the study was to identify new diagnostic markers in benign and malignant salivary tumors. A tissue microarray was constructed with 158 tumor samples. Expression of 21 tumor antigens involved in tumor cell survival and known for prognostic potential was assessed immunohistochemically in all parotid gland samples. CEA, Cox-1, Cox-2, Sigma, beta-Catenin, WISP-1 and PDGF-beta were differently regulated in benign and malignant parotid tumors. Subsequently, these seven proteins entered the step-wise logistic regression analysis. As a second step, we defined a score for differentiating benign versus malignant parotid lesions: 4*CEA+15*Cox-1+4*Cox-2+4*Sigma+3*PDGF-beta+10*beta-Catenin+14*Wisp1. Sensitivity and specificity of 94 and 83 % were reached. Besides routine hematoxylin and eosin staining, definition of new diagnostic markers and subsequently a new diagnostic score are an attempt to create an additional tool for the diagnosis of parotid gland tumors.     

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.     

Tumors of the parapharyngeal space

We retrospectively studied tumors of the parapharyngeal space treated at the Baylor College of Medicine Affiliated Hospital System, Houston, from 1972 to 1985. Of the 42 lesions, 30 (71.4%) were benign and 12 (28.6%) were malignant. Tumors of neurogenic origin were present in 17 (40.5%). Tumors of salivary gland origin were present in 16 (38.1%): ten were benign, six were malignant. Nine (21.4%) of the patients presented with miscellaneous lesions, six of which proved to be malignant. We have found that a preoperative arteriogram is no longer routinely indicated. High-resolution computed tomography is now the best initial diagnostic study because it helps determine the size and extent of the tumor, differentiate tumors of parotid and extraparotid origin, demonstrate degree of tumor vascularity, and separate benign from malignant lesions.     

Value of Fine‐Needle Aspiration Cytology of Parotid Gland Masses

Objective To evaluate the usefulness and accuracy of fine‐needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses. Study Design Retrospective chart review of patients undergoing FNAC. Methods Between January 1990 and December 1998, 410 parotid glands were resected at the Department of Otorhinolaryngology–Head and Neck Surgery at the University of Berne, Inselpital (Berne, Switzerland). Included in the study were 228 cases with preoperative FNAC. In a retrospective study the results of FNAC were analyzed and compared with the corresponding histopathological diagnosis. Results Histological evaluation revealed 65 malignant tumors and 163 benign lesions (150 neoplasms and 13 nonneoplastic lesions). The cytological findings were nondiagnostic in 13 (5.7%), true‐negative in 146 (64%), true‐positive in 39 (17%), false‐negative in 22 (9.8%) and false‐positive in 8 (4.5%) cases in detecting malignant tumors. Nineteen of 39 (49%) malignant tumors (true‐positive) and 123 of 146 (84%) benign lesions (true‐negative) were classified accurately. The accuracy, sensitivity, and specificity were 86%, 64%, and 95% respectively. Conclusions Fine‐needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure.     

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.     

Diagnosis management of Warthin tumour: clinical presentation, fine needle cytology and MRI

OBJECTIVES: Warthin tumour is the second most frequent benign tumour of the parotid gland after pleomorphic adenoma. The aim of this retrospective study was to define clinical, cytological and MRI characteristics in order to work out a therapeutic strategy. MATERIAL AND METHOD: During the period May 1991-January 2003, 53 patients with Warthin tumors were treated in our institution. Clinical data were reported from medical records reviewing. Histological diagnoses were compared with FNAB and MRI results. RESULTS: Warthin tumours represented 13% of all parotid lesions of our series. Mean age of patients was 58 year-old. Sex ratio was 3.8 men and 1 woman. Sensitivity of FNAB for Warthin tumour diagnosis was 75% while positive predictive value was 71%. Six cases of false positive patients were reported: 2 acinic cells carcinomas, 2 pleomorphic adenomas, 1 dermoid cyst, 1 branchial cyst. CONCLUSIONS: Surgical management is based on partial parotidectomy that may be adapted to the tumour location. Because of elderly patients, benign nature and low risk of malignant transformation of Warthin tumours, one might prompt to adopt a conservative strategy, avoiding surgery in some cases. Despite diagnosis of Whartin tumour on FNAB and MRI, one must be cautious in recommending conservative treatment in order to avoid ignoring a surgical tumour.     

Evaluation of frozen section diagnosis of parotid gland tumors

A retrospective study is presented comparing the results of 167 frozen section diagnoses of surgical extirpated parotid gland tumors with permanent-section diagnoses. Percentages of correct diagnosis for malignancy (cases correctly classified as benign or malignant tumors) and of correct diagnosis for histopathology (cases in which frozen section diagnosis and permanent-section diagnosis were identical) were calculated. Percentages of correct diagnosis for malignancy in all cases, benign cases, and malignant cases were 98.8%, 99.3%, and 95.8%, respectively. Percentages of correct diagnosis for histopathology in all cases, benign cases, and malignant cases were 94.0%, 97.2%, and 75.0%, respectively. These results are superior to the previous reports both of frozen section diagnosis and of fine-needle aspiration biopsy diagnosis although the data for histopathological diagnosis in malignant tumors are average compared to previous reports. We conclude that diagnoses of most parotid gland tumors based on frozen section examination are reliable and accurate, but caution should be exercised in malignant tumors diagnosis.     

Accuracy of fine-needle aspiration biopsy for Warthin's tumours

BACKGROUND: Although the overall accuracy of fine-needle aspiration biopsy (FNAB) for salivary gland neoplasms has been well established, definitive results for Warthin's tumour (WT) are lacking. For most salivary gland tumours, surgery is recommended because of progressive enlargement and the risk of malignant transformation. This behaviour is unusual with WT, and surgery is usually advocated for pathologic confirmation. A highly accurate diagnosis of WT by FNAB may justify conservative management for the asymptomatic patient. However, if the reliability of this diagnostic procedure is questionable, there should be little hesitation in recommending parotidectomy. METHODS: A retrospective study design was used to evaluate the accuracy of FNAB for parotid WTs. All consecutive parotid FNABs and parotidectomy specimens from 1992 to 2000 were reviewed, and cases suggestive of WT were identified. The fine-needle cytology and histopathology results were then correlated. The true-positive, false-positive, and false-negative rates were tabulated to determine the sensitivity and positive predictive value (PPV) of FNAB for WT. RESULTS: A total of 41 patients were included in the study. Of these, 33 patients had FNABs suggestive or diagnostic of WT that were confirmed following parotidectomy (true positives = 33). In 4 patients, the FNAB incorrectly suggested WT, with the surgical histopathology confirming different diagnoses (false positives = 4) (3 acinic cell carcinomas and 1 pleomorphic adenoma). Four patients had surgically confirmed WTs with FNABs suggestive of other diagnoses (false negatives = 4) (1 cystic squamous cell carcinoma, 1 simple cyst, 1 "inflammatory process," and 1 "negative for malignant cells"). The sensitivity and PPV were 89.2% and 89.2%, respectively. CONCLUSION: Although the sensitivity and PPV in this study are high, the false-positive rate is clinically significant given the type of lesions missed. Three acinic cell carcinomas and one pleomorphic adenoma were misdiagnosed as WT on FNAB. One must be cautious in recommending conservative management for parotid tumours even when a WT is suggested by FNAB.     

Primary sub-mandibular gland tumours: experience based on 68 cases

Sub-mandibulary gland tumours are less common than tumours of the parotid and pose many clinical and therapeutic challengers. OBJECTIVE: We report our experience of sub-mandibular tumours and review the literature. PATIENTS AND METHODS: Retrospective studies of sub-mandibular gland tumours presenting to our department between 1986 and 2000. RESULTS: 68 cases were reviewed comprising 37 benign and 31 malignant tumours (15 females and 33 males). Average age of patient was 46 years and all presented with a sub-mandibular swelling. Clinical suspicion of malignancy was associated with symptom of pain, cervical adenopathy, nerve palsy, skin and/or bone invasion. CAT Scans were performedd to assess tumour extent / invasion. Definitive diagnosis was by complete excision and pathological examination. Pleomorphic adenoma (n= 32) were the most frequent benign tumours. For malignant lesions (n= 31) the most frequent were: Adenoid cystic carcinoma (n= 10), epidermoid carcinoma (n= 5), adenocarcinoma (n= 5), mucoepidermoid carcinoma (n= 3), malignant non Hodgkinien lymphoma (n= 5). Treatment was by total surgical excision of the submandibular gland for the begnin tumours. For the malignant lesions it was associated acording to their extension with other anatomical region or in case of adenopathy with neck dissection. Radiotherapy was performed in 24 cases and chemotherapy in 10 cases. CONCLUSION: Malignity in sub-mandibular gland tumours is more frequent than in the parotid gland. Any delay in diagnosis or inappropriate management may result in a poor prognosis for the patient.     

Clinical significance of fine-needle aspiration biopsy in major salivary gland tumors

We compared preoperative evaluations of 93 fine-needle aspiration biopsies (FNAB) of major salivary gland tumors done over a 5 year period with pathologic diagnoses of surgically resected specimens. The overall accuracy was 88.5%. Eight of 15 aspirates from malignant tumors were correctly diagnosed by FNAB, for a sensitivity of 53.3%, while 69 of 72 aspirates from benign tumors were correctly diagnosed by FNAB, for a specificity of 95.8%. Five malignant tumors diagnosed as benign by FNAB were squamous cell carcinoma, carcinoma in pleiomorphic adenoma, malignant lymphoma, low-grade mucoepidermoid carcinoma, and acinic cell carcinoma. The false negatives in the first 2 cases appeared to be due to inaccurate placement of the aspiration site. The other 3 cases showed lack of atypia, leading to a benign diagnosis. Malignant lymphoma is difficult to diagnose as malignant, even in properly aspirated specimens, so we recommend open biopsy when malignant lymphoma is suspected from physical and radiological examinations. A case confirmed pathologically as benign myoepithelioma was diagnosed as adenoid cystic carcinoma preoperatively, based on the finding of a cribriform pattern containing mucin. It should be borne in mind that myoepithelioma and adenoid cystic carcinoma are difficult to distinguish by FNAB. Although FNAB is useful in diagnosing major salivary gland tumors, its low sensitivity (high percentage of false negatives) is undesirable. It may thus be helpful in intraoperative decision-making when combined with frozen sectioning.     

Computed tomography--guided needle biopsy of head and neck lesions

OBJECTIVE: To evaluate the diagnostic efficacy of computed tomography (CT)-guided needle biopsies of head and neck lesions. DESIGN: All CT-guided needle biopsies of head and neck lesions performed between September 1994 and February 1999 were included. Cytopathologic and histologic records, along with patient clinical records, were reviewed. SETTING: A tertiary care medical center. PATIENTS: Patients referred for evaluation of lesions inaccessible to routine methods of needle biopsy. RESULTS: Thirty-seven patients underwent 42 CT-guided biopsies. There were included 12 lesions in or adjacent to the skull base and 9 lesions around the pharyngoesophageal or laryngotracheal complex; the other lesions were located in the deep lobe of the parotid gland (n = 7), deep neck area (n = 12), and thyroid gland (n = 2). Diagnostic cytologic biopsy specimens were obtained in 38 (91%) of 42 needle biopsy procedures. The results were supported histologically and/or clinically in 36 cases (95%). Eighteen patients underwent open surgical procedures. Histologic confirmation was found in 86% of cases. Nineteen patients (51%) avoided an open surgical procedure: 11 with benign disease and 8 with recurrent malignancy. There were no false-positive or false-negative results, and no complications were identified. CONCLUSIONS: Computed tomography-guided needle biopsy is a safe and reliable minimally invasive technique for the diagnosis of poorly accessible or deep-seated lesions of the head and neck. Diagnostic needle biopsies allow improved preoperative planning and patient counseling in surgical patients and avoidance of open surgical procedures in patients with benign disease or recurrent malignant neoplasms.     

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.