Current evidence on diagnosis and treatment of parotid gland lymphomas: a systematic review.

BACKGROUND AND PURPOSE: Parotid gland lymphoma (PGL) is a rare and challenging diagnosis. Different lymphomas can develop in the parotid gland, with the most common being the mucosa-associated lymphoid tissue (MALT) lymphoma, which originates directly from the glandular parenchyma. Other histologic subtypes arise from both intraglandular and extraglandular parotid lymph nodes. A consensus on diagnosis and treatment of PGL is still lacking, and published data is scarce and heterogeneous. METHODS: We performed a systematic review of the literature, including studies published after 2001, when the WHO classification of lymphoid tumours was introduced. RESULTS: Twenty retrospective studies were included in the analyses, eight of which focused exclusively on MALT lymphomas. Final analysis included 612 cases of PGL, with a 1.68:1 F/M ratio. MALT lymphoma was the most common histology, followed by follicular and diffuse large B-cell lymphoma. Most cases were low stages (IE/IIE acc. Ann Arbour, 76.5%) and only 10% of patients presented with symptoms, most commonly pain (4.8%) and B symptoms (2.2%). A high prevalence of associated autoimmune diseases was found, particularly Sjögren's syndrome, that affected up to 70% of patients with MALT lymphoma. In most cases diagnosis was achieved through parotidectomy (57.5%), or open biopsy (31.2%). Treatment strategies were either surgical, non-surgical or a combination of modalities. Surgery as a single-modality treatment was reported in about 20% of patients, supposing it might be a valuable option for selected patients. CONCLUSIONS: Our review showed that the diagnosis and treatment of PGLs is far from being standardized and needs further, more homogeneous reports to reach consensus.

Chronic atypical first bite syndrome and primary squamous cell carcinoma of the parotid.

BACKGROUND: First bite syndrome is a well-recognized complication of parapharyngeal space surgery. There are no reported cases of protracted first bite syndrome and subsequent diagnosis of a primary squamous cell carcinoma (SCC) of the parotid. METHODS: We present the case of a 73-year-old man with no surgical history and 9 years of first bite syndrome who was ultimately diagnosed with a primary SCC of the parotid. Diagnostic workup, including MRI and biopsy, along with oncologic treatment, were performed. RESULTS: Surgical treatment confirmed malignancy and also resulted in complete resolution of the first bite syndrome. CONCLUSION: First bite syndrome without prior surgery may warrant further diagnostic workup with imaging to evaluate for salivary gland pathology. When no radiographic mass lesion is detected but the patient displays protracted symptoms unresponsive to conservative therapy, one should maintain an index of suspicion for malignancy, especially in the presence of symptom escalation.

[Cat-scratch disease localisation in the parotid gland]. / Localisation parotidienne d'une maladie des griffes du chat.

INTRODUCTION: Cat scratch disease is an infection due to Bartonella henselae. It is one of the principal causes of benign chronic adenopathy in children or young adults. CASE REPORT: A 36-year-old woman presented with a left parotid pre-auricular swelling suggesting a pleiomorphic adenoma. The history and complementary tests (ultra sonography, MRI, cytopuncture, B. henselae serology) led to a diagnosis of cat scratch disease. Doxycilline was efficient within 15 days. DISCUSSION: The parotid localization of cat scratch disease is very rare. When a patient presents with parotid swelling, the distinction between a tumor and lymph node is not easy. Performing complementary tests can be in balance with a quicker but sometimes inappropriate surgical indication. The diagnosis is made even more difficult because of delayed specific serologic tests as for B. henselae.

Parotid gland metastasis of a breast cancer.

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.

Drenaje linfático manual en el linfedema facial / Manual lymph drainage in facial lymphedema

Presentamos la evolución de una paciente de 19 años de edad con un adenoma pleomorfo de parótida que tras varios tratamientos, incluyendo vaciamiento ganglionar cervical y radioterapia, desarrolló linfedema facial. Debido a la repercusión de tipo emocional que originó en la paciente, se planificó tratamiento físico rehabilitador con drenaje linfático manual con el que mejoró tanto subjetiva como objetivamente (AU)

[Treatment and clinicopathologic analysis of mucosa-associated lymphoid tissue lymphoma of the salivary glands].

OBJECTIVE: To further understanding of lymphoma of salivary gland through clinicopathologic analysis. METHODS: Clinical findings, pathologic features, clinical staging, therapy and prognosis of 4 cases were reviewed and clinically analysed. RESULTS: Different treatment were received by the 4 patients, one had stage IIIA disease and three had stage IE disease. All patients got their illness completely remitted. CONCLUSION: Mucosa-associated lymphoid tissue lymphoma of the salivary glands is an indolent disease. Different treatments can all result in prolonged remission, and it has better outcome than other NHL.

[Mucoepidermoid carcinoma of the salivary glands after high dosage radiotherapy]. / Mukoepidermoid-Karzinom der Speicheldrüsen nach hochdosierter Radioiodtherapie.

BACKGROUND: High-dose radioiodine therapy following total thyroidectomy is standard for patients suffering from differentiated thyroid carcinoma and contributes significantly to their favourable prognosis. Due to active iodine accumulation, high focal radiation doses are received by the salivary glands. PATIENTS/RESULT: Report on two patients, who received multiple high-dose radioiodine treatments because of a differentiated metastatic thyroid carcinoma. A few years later, they developed a mucoepidermoid carcinoma of the salivary glands. Due to the high cumulative radiation dose, radiation-induced secondary malignancies following radiation-induced sialadenitis appears likely, although no causal connection could be proven. CONCLUSION: Consistent protection of the salivary glands during radioiodine therapy as well as the follow-up of the many long-term survivors of differentiated thyroid carcinomas is desirable to further lower the salivary gland-related side effects and to detect secondary malignancies as early as possible.

Malignant oncocytoma of major salivary glands. Report of a post-irradiation case.

The fourth case of malignant oncocytoma arising in the submandibular gland is here reported. This tumor arose in a 48-year-old man after radiation exposure, a finding never described before for malignant oncocytoma. In addition, several regional metastatic lymph nodes were found. The diagnosis was confirmed by histochemical and ultrastructural findings. The tumor cells showed easily recognizable mucus production and, ultrastructurally, abundant mitochondria, intracytoplasmic lumina lined by microvilli and lipid droplets. These last features have only seldom been described in malignant oncocytoma. Furthermore, the neoplastic cells were alpha-1-antitrypsin positive and S100, thyroglobulin, carcinoembryonic antigen, and smooth muscle actin negative. A thorough review of the literature is also presented.

Cáncer de la glándula parótida / Parotid gland neoplasms

Se presentan 30 casos de cánceres de la parótida, representando el 80 por ciento de todos los carcinomas de las glándulas salivales. Estos 30 casos han sido vistos y tratados en el Servicio de Cirugía de Cabeza y Cuello del Hospital Nacional Guillermo Almenara Irigoyen, correspondiente a un periodo de 25 años (1960-1985). Todos los casos fueron debidamente tipificados por la variedad histológica y clasificados de acuerdo a T-N-M. La mayoría fueron tumores T2 y T3, y la variedad más frecuente fue el carcinoma muco-epidermoide. La totalidad fue tratada mediante la cirugía la Parotidectomía total con o sin disección radical del cuello y la gran mayoría recibió tratamiento complementario con cobaltoterapia. Se realizó en la tercera parte de los casos la cirugía reconstructiva facial por la consecuente parálisis facial irrecuperable. La sobrevida fue del 56.6 por ciento entre 5, 10 y más años.

[Recurrent infectious parotiditis in the child (author's transl)]. / Les parotidites infectieuses récidivantes de l'enfant.

On the basis of 18 cases of recurrent parotiditis in the child, the authors offer the current review of this condition: clinical features, radiological features, bacteriological features, course. They emphasize the importance of precise technique during sialography, which must include straight and lateral films. The progress of this condition is characterised by recurrences. These may be avoided by prolonged and appropriate antibiotic therapy. The improvement which takes place at puberty is of etiopathogenic significance. Bucco-dental septis, constantly present, is one of the causes favourising infectious parotiditis in child.

Sialography with continuous measurement of pressure outside and inside the gland.

In almost any method of sialography the results depend on a sign given by the patient. In order to eliminate this very uncertain factor or to limit its effect, a procedure was established to determine the pressure in the gland after the injection of contrast medium, as well as the injection pressure during injection. The difference between injection pressure and gland pressure was minimized through the use of special cannulas. A special syringe was used. Pressure was recorded by a membrane transducer connected to electronic equipment. It appears that the pressures are below or about the same as the diastolic blood pressure. Pressure values do not correlate with the volumes injected. The standard deviation of the pressure is too large to make entirely superfluous the sign given by the patient; nevertheless, the method improves the quality and reliability of sialogram readings and extends the field of application to patients unable to give reliable subjective information.