The role of postoperative radiation therapy in carcinoma ex pleomorphic adenoma of the parotid gland

PURPOSE: To evaluate the impact of postoperative radiation therapy on the clinical course of patients with carcinoma ex pleomorphic adenoma of the parotid gland. METHODS AND MATERIALS: Between 1960 and 2004, 63 patients were treated with definitive surgery for carcinoma ex pleomorphic adenoma of the parotid gland. Forty patients (63%) received postoperative radiation therapy to a median dose of 60 Gy (range, 45-71 Gy). Adenocarcinoma (29 patients), salivary duct carcinoma (16 patients), and adenoid cystic carcinoma (9 patients) were the most common malignant subtypes. Pathologic T -stage was: 16% T1, 33% T2, 32% T3, and 19% T4. Twenty-one patients (33%) had microscopically positive margins and 39 (62%) had perineural invasion. Median follow-up was 50 months (range, 2-96 months). RESULTS: The use of postoperative therapy significantly improved 5-year local control from 49% to 75% (p = 0.005) and was associated with an improvement in survival among patients without evidence of cervical lymph node metastasis (p = 0.01). A Cox proportional hazard model identified pathologic involvement of cervical lymph nodes as an independent predictor of overall survival. Overall survival was 16% for patients with pathologic N-positive disease compared with 67% for those whose lymph node status was negative or unknown (p = 0.001). CONCLUSION: Surgery followed by postoperative radiation should be considered the standard of care for patients with carcinoma ex pleomorphic adenoma.     

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.     

Recurrent pleomorphic adenoma of the parotid gland: long-term outcome of patients treated with radiation therapy

PURPOSE: To evaluate the role of radiation therapy in the management of recurrent pleomorphic adenoma of the parotid gland. METHODS AND MATERIALS: Between 1960 and 2004, 34 patients were treated with postoperative radiation therapy for recurrent pleomorphic adenoma of the parotid gland to a median dose of 5000 cGy (range, 4,500-6,000 cGy). Median age was 48 years (range, 24-72 years). Gross total resection at the time of surgery before radiation was achieved in 30 patients (88%), and histologic analysis demonstrated multifocal disease in 16 patients (47%). Radiation was delivered for a first, second, third, fourth, fifth, and sixth local recurrence in 24%, 21%, 24%, 24%, 6%, and 3% of patients, respectively. RESULTS: With a median follow-up of 17.4 years (range, 2.3-28.9 years), 2 patients had local recurrences at a median of 3.4 years after completion of radiation. The 20-year actuarial local control rate was 94%. One patient developed a second malignancy at approximately 14 years after completion of therapy. CONCLUSION: The use of postoperative radiation therapy leads to excellent long-term local control for the treatment of recurrent pleomorphic adenoma with acceptable late toxicity. Although the incidence of second malignancy was low in this population, continued follow-up is warranted.     

Huge pleomorphic adenoma of nasal cavity

Pleomorphic adenoma is a common benign tumour of the salivary gland that has elements of both epithelial and mesenchymal tissue. It is commonly seen in major salivary glands, parotid being the most common site followed by submandibular gland. However it can sometimes arise from minor salivary glands that are distributed throughout the upper aerodigestive tract and paranasal sinuses. We report a case of a 45 yrs. Old male patient, who presented with progressive nasal blockage and intermittent minor episodes of epistaxis from left nostril for 1 ½ years. Lateral Rhinotomy revealed a well encapsulated lesion attached to the nasal septum, which was excised completely. Histopathology revealed it to be Pleomorphic Adenoma without any features of malignancy. Lesion is a rare one hence reported.     

Preauricular malignant lymphoma masqurading as benign pleomorphic adenoma — A rare tricky presentation

Lymphoma in the head neck area most commonly present as cervical lymph node swelling followed by tonsillar enlargement but the presentation as sole preauricular swelling without systemic involvement is a very rare finding. Here we present a case of malignant lymphoma Grade I, presenting as a single prauricular swelling masquerading as a benign pleomorphic adenoma, in a 24 year old girl.     

No-glucose strategy influences posterior cranial fossa tumors' postoperative course: introducing the Glycemic Stress Index

In a selected patient population, we evaluated the glycemic response to different infusional policies in the management of posterior cranial fossa tumor (PFT) removal. We analyzed the perioperative course, prospectically collected, of 137 children undergoing 150 surgical procedures. Patients were divided in two groups according to different intraoperative fluids (group A, 2.5% glucose; group B, crystalloids). In group B glycemia remained below 125 mg dl⁻¹, while group A showed persistently supranormal glycemic plasma values, reaching statistical significance at the end of surgery (P < 0.018). As no perioperative mortality occurred and no differences were found between groups regarding PICU respiratory or infectious complications, PICU length of stay (LOS) was assumed as the main outcome indicator. LOS was not influenced by group A or B inclusion, while a new indicator, namely the Glycemic Stress Index (GSI), representing both glycemic intraoperative change and procedure length, showed significantly different results in the study groups (P = 0.004). Our clinical experience suggests that both intraoperative glucose-free solutions are safe, and GSI can be a useful tool to identify prolonged PICU stay patients.     

后颅凹肿瘤术后发热的原因及治疗

目的：总结并分析后颅凹肿瘤术后发热的治疗经验。方法：收集并分析西北医院2001年9月至2010年7月后颅凹肿瘤开颅术后发热23例病例的临床资料。结果：20例患者预后良好,痊愈出院。2例死亡,1例放弃治疗出院。结论：后颅凹肿瘤术后发热是常见并发症,处理棘手,根据不同情况采取针对性治疗可取得满意效果。     

后颅凹肿瘤术后发热的原因及治疗

目的:总结并分析后颅凹肿瘤术后发热的治疗经验。方法:收集并分析西北医院2001年9月至2010年7月后颅凹肿瘤开颅术后发热23例病例的临床资料。结果:20例患者预后良好,痊愈出院。2例死亡,1例放弃治疗出院。结论:后颅凹肿瘤术后发热是常见并发症,处理棘手,根据不同情况采取针对性治疗可取得满意效果。     

原发性肺多形性腺瘤一例

多形性腺瘤是一种好发于涎腺组织的具有恶性潜能的肿瘤，但原发性肺多形性腺瘤在临床上较为少见，国内外也仅有少数病例报道。2017年4月中国医科大学附属第四医院胸外科收治了1例原发性肺多形性腺瘤患者，经单孔胸腔镜手术治疗后，痊愈出院。为提高对肺多形性腺瘤的认识，该研究结合患者的临床资料及相关文献，分析肺多形性腺瘤的诊断与治疗。     

Long-term results of local excision and radiotherapy in pleomorphic adenoma of the parotid

Three hundred and eleven patients with primary pleomorphic salivary adenoma of the parotid gland seen between 1950 and 1971 are reviewed. All were managed by a combination of surgery, usually local excision, and irradiation. The minimum follow-up is 10 years. Recurrence rates at 0-5 years and 5-10 years were 1 and 1.5%, respectively, and all recurrences in this period were histologically or clinically benign. This recurrence rate is similar to those reported after superficial parotidectomy. After 10 years, however, the recurrence rate rose, becoming maximal at 15-20 years (4%) and yielding a cumulative risk of recurrence of 8.0% at 20 years. The late recurrences were predominantly malignant tumors. One tumor was probably radiation-induced; the remainder were compatible with spontaneous malignant transformation of benign pleomorphic adenoma, although radiation may have increased the incidence. In the absence of a comparable purely surgical series, this cannot be determined. The recommendation is made that the management of these tumors should be primarily surgical with irradiation reserved for patients presenting surgical difficulties. In addition, prolonged follow-up is necessary since there is a significant incidence of late recurrence and such recurrence may be more likely to be malignant regardless of the primary form of management.     

Oncocytic pleomorphic adenoma of the parotid gland

A rare case of salivary gland pleomorphic adenoma, in which the majority of cells were oncocytic, is reported. The patient, a 53-year-old man, presented with a parotid gland mass that was otherwise asymptomatic. Surgical treatment consisted of a superficial parotid lobectomy. The specimen was prepared in standard fashion and studied by light and electron microscopy. The microscopic features were characteristic of salivary gland pleomorphic adenomas, however, both epithelial and "mesenchymal" elements were oncocytic. Such changes may occur focally in pleomorphic adenomas, but we were unable to find documentation of a wholly oncocytic variant in a review of the medical literature. From our clinical data and previous reports of pleomorphic adenomas with focal oncocytosis, it is concluded that such changes likely do not alter prognosis in affected patients. The possible significance of this lesion in regard to the histogenesis of salivary gland pleomorphic adenomas is discussed.     

The microscopic surgical treatment for tumor of posterior cranial fossa in children

OBJECTIVE To analyze and discuss about the clinical characteristics, pathological types, surgical modalities and techniques, and postoperative complications in children with tumor of posterior cranial fossa.
METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa, admitted and treated in our hospital during the period of January 1996 to January 2007. All patients underwent microscopic surgical treatment. Fiftyeight were male and 44 cases were female. The age ranged from 9 months to 14 years old, with an average of 6.1 ± 0.5 of age. Cranial CT or MRI examination was conducted before and after the surgery on all patients. RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia. Postoperative pathological diagnoses showed： 46 cases of medulloblastoma, 43 cases of astrocytoma, 11 cases of ependymoma （including 1 case of degenerative ependymoma）, 1 case of dermoid cyst, and 1 case of teratoma. In this group of the patients, radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases, while surgical removal of large section was performed on 3 cases. There were no deaths from surgery reported. Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions, while 11 cases showed either no improvement or more severely affected afterward. For 6 cases, postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery. Sixty-three patients gained follow-up for 3 to 60 months in duration. Thirty-nine patients regained normal life and were able to learn well, while there were 7 patients who could not live normally on their own. During the follow-up period, there were 17 cases of recurrence and 7 cases of death. In 23 cases of medulloblastoma in children with age of 3 years old or above, 2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord. Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of Carmustine.
CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa, right followed by ependymoma, and dermoid cysts and teratomas were rare. Early correct diagnosis, proper selection of appropriate surgical modality and the surgical margin, proper treatment of postoperative complications, and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with tumor of posterior cranial fossa.     

Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children

Background Swallowing impairment (dysphagia) has been reported as a possible sequela following surgical removal of posterior fossa tumours (PFT). Dysphagia may result in aspiration of food/fluid leading to respiratory tract infection, placing the patient at considerable health risk. No prospective studies have investigated dysphagia pre and post-surgical removal of PFT. The present study aimed to document the presence, severity and characteristics of dysphagia pre and post-surgical resection of PFT, and to determine whether children were managing a normal oral diet (i.e. a measure of functional swallowing ability) at two months post-surgery. Methods Dysphagia was assessed using a clinical bedside evaluation in 11 participants (8 M; aged 3 years 6 months to 13 years 5 months) pre (within 3–5 days) and post-surgery (within 1–2 weeks). Return to normal oral feeding was documented at two months post-surgery via a parent telephone interview. Results and conclusion No participant had dysphagia pre-surgically. Seventy three percent (8/11) had dysphagia at 1–2 weeks post-surgery, primarily characterized by impaired lip closure (8/8), poor mastication (8/8), and inefficient oral transit (8/8). Whilst dysphagia severity was largely mild (6/8) in presentation, data suggest that assessment and monitoring of this disorder may be required in the acute phase post-surgery. Overall however, prognosis appeared positive, with 75% (6/8) of participants managing a full oral diet at 2 months post-surgery.     

Treatment implications ofposterior fossa ependymoma subgroups

Posterior fossa ependymoma comprises two distinct molecular entities, ependymoma_posterior fossa A (EPN_PFA) and ependymoma_posterior fossa B (EPN_PFB), with differentiable gene expression proifles. As yet, the response of the two entities to treatment is unclear. To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment, we studied a cohort of 820 patients with molecularly proifled, clini-cally annotated posterior fossa ependymomas. We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA, which was recently reported in the paper entitled “Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era: a retrospective multicohort analysis” in theJournal of Clinical Oncology. Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy, whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.     

Transient mutism following posterior fossa surgery in children

We report 3 patients, ages 5, 9 and 13 years, with mutism following posterior fossa surgery (PFS). All presented with headache of 10–180 days duration, excellent premorbid learning performance and paucity of neurologic signs. Radiographic studies demonstrated large posterior fossa tumor occupying the fourth ventricle, and hydrocephalus, leading to gross total resection of the tumor. Within 24–48 hr, all patients were mute. None had problems with swallowing and coughing. AH were able to nod “yes or no,” follow commands, point to body parts, and make their wants known by gestures. Jaw, gag, snout and palmomental reflexes were normal. CT scan and MRI Brain showed no cerebral hemispheric lesions. All children regained speech although dysarthric, within 5–12 weeks. Twenty-two previously reported cases are similar to ours. We conclude that this post-surgical mutism syndrome is unique and must be differentiated from aphemia, Broca's aphasia, hysterical mutism and elective mutism. The cerebellum, in a way not yet understood, does play a role in speech production. © Wiley-Liss, Inc.     

Scale for assessing quality of life of children survivors of cranial posterior fossa tumors

Background Evaluation of quality of life of survivors of brain tumors is an important aspect of outcome that must be included in clinical studies.Methods We have developed a new scale for assessing quality of life (QL) of pediatric long-term survivors of posterior fossa tumors based on their physical, psychointellectual, and endocrine/growth status. We have studied 39 patients, with a median follow-up of 9 years. Twenty-five had cerebellar astrocytoma (CA), 6 medulloblastoma (MDB), 5 brain-stem glioma (BSG) and 3 ependymoma of IV ventricle (EPD).Results Sixty-six percent of children showed neurologic and/or visual sequelae. Little or no significant disability (Bloom's levels I–II) were present in 66%. Psychointellectual dysfunction was present in 44%, with an IQ < 90 in 39%. Endocrine and growth disorders were found in 26%, mostly stature anomalies. According to our scale, QL scores were high in 19 patients (49%), intermediate in 8 (20%), and low in the remaining 12 (31%). Unfavourable outcomes were related to age of less than 4 years, tumors other than CA (MDB, BSG, EPD), incomplete tumoral resection, and employment of radiotherapy and chemotherapy.     

涎腺良性多形性腺瘤和恶性多形性腺瘤中c-erbB-2和bcl-2蛋白产物的表达及其意义

目的：为了探讨细胞增殖和细胞凋亡的调控基因在涎腺肿瘤的发生发展及恶性转化中的作用。方法：采用免疫组化方法对５例瘤旁腺体，２１例良性多形性腺瘤和２４例恶性多形性腺瘤中ｃ－ｅｒｂＢ－２和ｂｃｌ－２蛋白产物的表达进行形态学观察。结果：ｃ－ｅｒｂＢ－２和ｂｃｌ－２在良性多形性腺瘤中均有过度表达，表达率分别为２９％和１９％，主要分布于腺管样结构的腺上皮细胞的胞浆中。在恶性多形性肿瘤中ｃ－ｅｒｂＢ－２的表达率为５８％，主要分布于腺癌细胞的胞膜；ｂｃｌ－２表达率为４６％，主要分布于腺癌细胞的核膜及部分胞浆中。５例瘤旁腺体内导管上皮细胞也存在ｃ－ｅｒｂＢ－２和ｂｃｌ－２的过度表达。结论：ｃ－ｅｒｂＢ－２蛋白产物的过度表达在涎腺多形性腺瘤的发生发展中起着重要作用，同时也表明细胞凋亡基因的调控失常也是其重要的发病因素之一     

24例涎腺恶性多形性腺瘤的临床分析

目的 了解涎腺恶性多形性腺瘤的临床特征、治疗和预后。方法 24例经病理证实的涎腺恶性多形性腺瘤,对其诊断、治疗以及生存率进行分析。结果 恶性多形性腺瘤患者总的5年生存率为66．7％,其中发生于大涎腺者5年生存率为63．6％,发生于小涎腺2例均存活5年以上。结论 治疗首选手术,提倡首治行规范切除,位于领下腺者建议行预防性颈清扫;术后补充放疗不提高局部控制率。     

腮腺混合瘤的超声诊断及其价值

目的：探讨腮腺混合瘤的声像图特征及其临床价值。方法：应用彩色多普勒超声对22例经病理证实的腮腺混合瘤进行观察。结果：实性不均匀12例，实性4例，囊实性5例，囊性1例。彩色多普勒显示：8例表现为0级血流信号，14例表现为Ⅰ级--Ⅲ级血流信号。结论：腮腺混合瘤有显著的声像图特点，彩色多普勒超声有助于提高诊断的正确性。