Risk of Carcinoma in Pleomorphic Adenomas of the Parotid.

Importance: Surgery is the mainstay of treatment for pleomorphic adenomas (PAs) of the parotid to prevent further growth and potential future malignant transformation. While historical case series have reported transformation rates as high as 10%, there is a lack of contemporary methodologically sound data. Objective: To examine the rate of carcinoma ex pleomorphic adenoma (CXPA) detection in untreated PAs and investigate factors associated with malignant neoplasm. Design, Setting, and Participants: This cohort study reviewed all cases of primary PAs managed at a quaternary referral center between December 1990 and January 2015. Patients whose clinical presentation was compatible with a primary benign PA and whose history indicated tumor duration of over 1 year were included. Data were analyzed from January to April 2023. Exposure: Untreated PA. Main Outcomes and Measures: Rate of CXPA detection among untreated PAs and association of tumor duration with rates of CXPA detection. Pathology slides of patients who underwent surgery were reviewed by a single expert pathologist for the presence of CXPA. Univariable logistic regression was performed to evaluate possible factors associated with CXPA. Results: A total of 260 patients (median age, 47 years [IQR, 38-60 years]; 174 [66.9%] female) had a median tumor duration of 3.2 years (range, 1-30 years; mean [SD], 5.7 [5.5] years). Patients were divided into 4 groups by tumor duration: 1 to 4 years (158 [60.7%]), 5 to 9 years (47 [18.1%]), 10 to 14 years (27 [10.4%]), and 15 to 30 years (28 [10.8%]). In 156 of 170 patients who underwent preoperative fine-needle aspiration (91.8%), a benign tumor was diagnosed; 5 of these patients (3.2%; 95% CI, 1.4%-7.3%) were later diagnosed with CXPA on pathology after eventual excision, and the rate of high grade CXPA was 1.3%. None of the patients had permanent facial nerve paralysis. Tumor size at presentation (odds ratio [OR], 1.66; 95% CI, 1.22-2.24) and incremental (per year) increase in age (OR, 1.04; 95% CI, 1.01-1.08) were found to be associated with CXPA, whereas tumor duration was not (OR, 1.00; 95% CI, 1.00-1.01). Conclusions and Relevance: In this study, the rate of malignant neoplasm detection among initially untreated PA was 3.2%. The results suggest that tumor size and older age are associated with the development of CXPA, while tumor duration is not. Observation of PA for longer periods was not associated with serious permanent complications.

Primary B-cell non-Hodgkin lymphoma of the parotid gland: An analysis based on the SEER database.

Primary malignant lymphoma of the parotid gland is a rare entity. The disease is often misdiagnosed, and its survival factors remain unclear. This study included patients diagnosed with primary B-cell non-Hodgkin lymphoma of the parotid gland from 1987 to 2016 in the surveillance, epidemiology, and end results program. Univariate survival analysis was conducted using the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazards regression model. A competing risks regression model was applied to estimate the specific risks associated with parotid lymphoma mortality. A total of 1443 patients were identified. The overall survival of indolent primary B-cell lymphoma of the parotid gland was higher than that of aggressive lymphoma (hazard ratio 0.53, 95% confidence interval 0.44-0.64, P < .001), and older patients (≥70 years) exhibited inferior overall survival. Histological subtype and age are important prognostic factors in patients with primary B-cell non-Hodgkin lymphoma of the parotid gland.

Metastatic parotid gland malignancy: A preliminary study in an eastern Chinese population.

OBJECTIVE: This study aimed to determine the incidence and clinicopathological patterns of metastatic carcinoma of the parotid gland. METHOD: Ninety patients with parotid gland metastases admitted to our hospital between January 2003 and December 2018 were included in this study. Clinical and pathological data were obtained from the medical records and follow-ups. Kaplan-Meier analysis was used to assess overall survival of patients. RESULTS: Among the 90 patients, parotid gland metastases originated from the head and neck in 86 (95.6%), from non-head and neck in 4 (4.4%), from the oral cavity in 30(33.3%), and from the eyelid in 21 (23.3%). Among the 85 cases with parotid gland lymph node metastasis, 45 (52.9%) were diagnosed with extra-lymph node metastasis. The capsule of the parotid lymph nodes was thinner than that of the cervical lymph nodes (P < 0.05). Hematogenous metastases to the parotid gland (only five cases) were rare, mainly from the non-head and neck malignancies. Patients with oral squamous cell carcinoma and meibomian adenocarcinoma with parotid metastatic disease had poorer overall survival (P < 0.05). CONCLUSION: Eastern China population analysis showed that parotid gland metastases usually arise from oral squamous cell carcinoma and eyelid, but rarely from cutaneous squamous cell carcinoma. Most cases metastasize to the parotid lymph nodes via the lymphatic system and are prone to extranodal extension with little or no facial nerve involvement. These findings have important implications for the treatment of metastatic parotid malignancies.

Clinico-Epidemiological Analysis of Most Prevalent Parotid Gland Carcinomas in Poland over a 20-Year Period.

(1) Background: Malignant tumours of the salivary glands have different clinical and histopathological characteristics. They most commonly involve the parotid gland. Histopathologically, the most common are mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (AcCC), adenocarcinoma, carcinoma in pleomorphic adenoma (CPA), and squamous cell carcinoma (SCC). (2) Methods: We analysed 2318 patients with malignant parotid gland tumours reported to the National Cancer Registry (NCR) in Poland over 20 years (1999-2018). The demographic characteristics of patients, clinical factors, and overall survival (OS) were analysed. (3) Results: The average age was 61.33 ± 16.1 years. The majority were males (55%) and urban citizens (64%). High percentage of carcinomas was diagnosed in locoregional (33.7%) and systemic (10.4%) stadium. The most prevalent diagnoses were SCC (33.3%) and adenocarcinoma (19.6%). Surgical resection with adjuvant RT (42.1%) was the most common treatment. The OS analysis showed a median survival time of 5.6 years. The most favorable median OS was found in patients with AcCC (18.30 years), the worst for SCC (1.58 years). (4) Conclusion: AcCC has the best prognosis and SCC the worst. Tumour stadium, treatment, and demographic factors affect prognosis. Improvements in diagnosis and re-evaluation of treatment standards are necessary to enhance the outcome of patients with parotid gland cancers in Poland.

Parotid incidentalomas: a systematic review.

OBJECTIVE: Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management. METHODS: A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion. RESULTS: Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy. CONCLUSION: If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.

Competing-risks nomograms for predicting cause-specific mortality in parotid-gland carcinoma: A population-based analysis.

INTRODUCTION: Parotid-gland carcinoma (PGC) is a relatively rare tumor that comprises a group of heterogeneous histologic subtypes. We used the Surveillance, Epidemiology, and End Results (SEER) program database to apply a competing-risks analysis to PGC patients, and then established and validated predictive nomograms for PGC. METHODS: Specific screening criteria were applied to identify PGC patients and extract their clinical and other characteristics from the SEER database. We used the cumulative incidence function to estimate the cumulative incidence rates of PGC-specific death (GCD) and other cause-specific death (OCD), and tested for differences between groups using Gray's test. We then identified independent prognostic factors by applying the Fine-Gray proportional subdistribution hazard approach, and constructed predictive nomograms based on the results. Calibration curves and the concordance index (C-index) were employed to validate the nomograms. RESULTS: We finally identified 4,075 eligible PGC patients who had been added to the SEER database from 2004 to 2015. Their 1-, 3-, and 5-year cumulative incidence rates of GCD were 10.1%, 21.6%, and 25.7%, respectively, while those of OCD were 2.9%, 6.6%, and 9.0%. Age, race, World Health Organization histologic risk classification, differentiation grade, American Joint Committee on Cancer (AJCC) T stage, AJCC N stage, AJCC M stage, and RS (radiotherapy and surgery status) were independent predictors of GCD, while those of OCD were age, sex, marital status, AJCC T stage, AJCC M stage, and RS. These factors were integrated for constructing predictive nomograms. The results for calibration curves and the C-index suggested that the nomograms were well calibrated and had good discrimination ability. CONCLUSION: We have used the SEER database to establish-to the best of our knowledge-the first competing-risks nomograms for predicting the 1-, 3-, and 5-year cause-specific mortality in PGC. The nomograms showed relatively good performance and can be used in clinical practice to assist clinicians in individualized treatment decision-making.

Mobile phone use and trends in the incidence of cancers of the parotid and other salivary glands.

BACKGROUND: There has been a significant increase in the use of mobile phones over the last three decades and a possible association with head cancers has been suggested, including cancers of the parotic and other salivary glands. We examined the incidence time trends of parotid and other salivary gland cancers in Australia to ascertain the influence of increased mobile phone use. METHODS: Analyses of incidence time trends were carried out using Poisson regression to estimate the annual percentage change (APC) in the incidence of salivary gland cancers of all available national registration data from 1982 to 2016, as well as specific time periods (1982-1993, 1994-2005, 2006-2016) representing changes in the prevalence of mobile phone use. RESULTS: The incidence of parotid gland cancer was stable for the periods 1982-1993 and 1994-2005. During 2006-2016 there was a large decrease in parotid gland cancer for males (APC: -3.71, 95 %CI: -6.66 to -0.67) and a large increase in females (4.80, 1.77-7.91) for adults aged 20-59 years. The incidence for other salivary gland cancers was stable during all the periods. CONCLUSIONS: The results do not indicate that mobile phone use increased the incidence of parotid or other salivary gland cancers. An increase in parotid gland cancer in females since 2006 may be attributed to other possible risk factors specific to this gender.

Symptoms and signs of parotid tumors and their value for diagnosis and prognosis: a 20-year review at a single institution.

BACKGROUND: Detailed clinical features other than parotid mass have not been investigated in detail for parotid tumors. Symptoms and signs are useful for the differentiation of benign versus malignant, and may also be of value to determine the grade of malignancy and histological type as well as the assessment of prognosis. METHODS: We reviewed symptoms and signs of 965 patients with benign tumors and 200 patients with malignant tumors. Symptoms and signs included pain/tenderness, adhesion to surrounding tissues, and facial nerve palsy. We reviewed the incidence in benign and malignant tumors, in histological type of benign tumors, and in grade and histology of malignant tumors. For each symptom or sign, covariates were analyzed, and their correlation with the prognosis was investigated. RESULTS: The incidence of symptoms and signs was significantly higher in malignant than benign tumors, and more frequent in higher grade of malignancy. Facial nerve palsy was observed in 18.0% of malignant tumor cases, while none occurred in benign tumor cases. Pain/tenderness was more commonly observed in adenoid cystic carcinoma, while adhesion to surrounding tissues and facial nerve palsy were most frequently noted in salivary duct carcinoma. The prognosis of patients with these symptoms and signs was significantly poor. CONCLUSION: A detailed investigation of symptoms and signs in parotid gland tumors is the first step that leads to the diagnosis of malignant tumors. Symptoms and signs are also useful for estimating the grade of malignancy and histological type, and they are important information for predicting prognosis.

Clinicopathological features of incidental parotid lesions.

BACKGROUND: The purpose of this study is to determine the histopathological spectrum and risk of primary malignancy of asymptomatic parotid lesions incidentally discovered on cross-sectional imaging. METHODS: Over a 10-year period, 154 patients underwent 163 ultrasound-guided parotid lesion biopsies at our institution. This retrospective chart review included 89 lesions in 87 patients with asymptomatic parotid lesions discovered on cross-sectional imaging studies performed for unrelated clinical indications. The histopathologic findings of all sampled lesions were reviewed. We evaluated the patient demographics and pathological diagnoses of sampled parotid lesions to determine the histopathological spectrum and risk of malignancy. RESULTS: The average age was 67.5 years and 92 % were males. 25 % of patients had bilateral lesions. The average size of the parotid lesions was 1.5 cm and 91 % were located in the superficial lobe. 92.1 % of lesions were benign with Warthin tumor being the most common diagnosis followed by pleomorphic adenoma. 2.3 % of lesions were primary parotid malignant neoplasms, while 5.6 % were metastatic lesions in patients with known malignancy. CONCLUSIONS: The incidence of primary parotid malignant neoplasm in asymptomatic incidentally discovered parotid lesions is low. Imaging or clinical follow-up may be considered in patients with incidental parotid lesions who prefer to avoid biopsy.

An audit of parotid gland surgeries in Kano, Nigeria: A review of 34 cases.

BACKGROUND: Neoplasms both benign and malignant are the most common indications for parotidectomy. About 70%-80% of all salivary gland tumours are located in the parotid gland with up to 80% being benign. Parotidectomy is a common surgical procedure performed by the otorhinolaryngologist and oral and maxillofacial surgeons. AIMS: This study aimed to document our experience on parotid gland surgeries, and occurrence of facial nerve palsy. MATERIALS AND METHODS: The records of all patients that had parotidectomy between January 2014 and December 2018 were evaluated. Demographic, clinical and operative data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). RESULTS: A total of 34 cases were reviewed and there were 12 (35.3%) males and 22 (64.7%) females with a male-to-female ratio of 1:1.8 and mean age ± standard deviation of 39.3 ± 18.4 years. Patients with primary disease constituted the majority 29 (85.3%) in this series. Most of them (26, 76.5%) had superficial parotidectomy. Cervicomastoidfacial incision was the most preferred incision employed among 33 (97.1%) of our patients. Complication following surgery was observed in 12 (35.3%) patients. Majority, 7 (63.6%), had temporary facial nerve paresis. Pleomorphic adenoma was the most common histological diagnosis noted in 19 (55.9%) patients postoperatively. There is a statistically significant association between fine-needle aspiration cytology (FNAC) findings and final histological diagnosis. CONCLUSION: Pre-operative FNAC could be a reliable tool in the evaluation of our patients being prepared for parotidectomy even in our resource-poor setting.

A retrospective study of 30 basal cell adenomas of the salivary gland in a Brazilian population and literature review.

PURPOSE: The present study aimed to provide the clinicopathological data of Brazilian patients with basal cell adenoma (BCA). METHODS: Records of BCA cases were retrospectively gathered from the Brazilian National Cancer Institute database between 1996 and 2006. All cases were histopathologically reviewed, and the clinicopathological data were collected from the patients' medical files. In addition, an English literature review about this tumor is also presented. RESULTS: Of 1127 salivary gland tumors identified, 30 were BCAs (2.7%). Women were more affected than men (70.0% vs. 30.0%), and the majority (60.0%) were elderly (> 65 years old). The parotid gland was the most frequent location affected (93.3%), followed by the upper lip (3.3%) and submandibular gland (3.3%). Fine-needle aspiration was the main procedure applied to establish a preoperative diagnosis of tumor; however, the results were not always consistent. Histopathologically, the trabecular pattern was the most common type seen (50.0%) among our BCA samples. Most patients underwent superficial or partial parotidectomy. Frey's syndrome was reported only in one case during the follow-up. No recurrence was noted in the present series. The literature review revealed a total of 213 reported cases of BCA in the period investigated. CONCLUSIONS: This is the first case series of BCA reported in Brazil. As occurred in other previously reported series, the clinicopathological data of BCAs are similar and confirm that this type of tumor is rare, develops predominantly in the parotid gland, frequently affects older women, has an indolent behavior, and the affected patients have an excellent prognosis.

Trends in parotidectomy over 30 years in an Australian tertiary care center.

BACKGROUND: Nomenclature, classification, and management of parotid tumors are constantly evolving; this study was performed to identify temporal trends in histology and facial nerve sacrifice in parotidectomy during a 30-year period (1987-2018). METHODS: Retrospective analysis of patients treated in a single tertiary-care institution during this time period was performed with analysis of temporal trends. RESULTS: Two thousand eight hundred and fifty-seven parotidectomies were performed; pleomorphic adenoma was the most common histology (34.3%), followed by skin cancer metastases (32.3%). Significant trends noted were increasing age (P < .001), fewer parotidectomies for inflammatory lesions (P < .001), reduced incidence of mucoepidermoid carcinoma (P = .048), increasing incidence of parotidectomy for cutaneous malignancies (P < .001), and reduced facial nerve sacrifice (P = .034). CONCLUSION: In this contemporary series of parotid pathology, metastatic cutaneous malignancies accounted for a third of cases. Despite reducing facial nerve sacrifice in parotid disease, it is still required in approximately 15% of malignancy and needs to be discussed with all patients preoperatively.

Change in Warthin's tumor incidence: a 20-year joinpoint trend analysis.

PURPOSE: The incidence of Warthin's tumor (WT) has increased worldwide. In this study, we aimed to evaluate the incidence of WT in our hospital, which provides health care for an extremely large population. METHODS: We retrospectively evaluated 573 patients, comprising 345 males and 228 females, who all experienced parotid tumor for the past 20 years. Patients with WT that were operated in the last 20 years were evaluated according to the number of patients per year to determine the annual WT increase trend. RESULTS: In the distribution of WT over the years of surgery, the ratio of WT to all tumors irregularly changed. Furthermore, the total number of parotidectomies per year increased in time. We investigated whether WT had any increasing trend over the years. The annual percentage change (APC) of WT was calculated, and according to the segmented regression analysis, the APC was insignificant (APC = 4.3, 95% CI = - 3.6-12.9, P = 0.300). CONCLUSION: The incidence of WT has increased across the world. However, in our study, no significant APC was observed according to the segmented regression analysis.

Incidence and survival trends of parotid malignancies over 42 years.

BACKGROUND: There is a paucity of information regarding the incidence and survival of parotid malignancies over time. METHODS: The Surveillance, Epidemiology, and End Results population-based cancer registry was queried for parotid malignancies from 1973 to 2015. RESULTS: The age-adjusted incidence of parotid malignancies has increased by 58.1% (7.87-12.44 per 1 000 000). Analysis of histologic type revealed an increased annual percent change (APC) of acinar cell carcinoma (1.38) and squamous cell carcinoma (1.58), but decreased APC of adenoid cystic carcinoma (-1.63) and adenocarcinoma NOS (-0.86) (P < .05). The disease-specific survival of mucoepidermoid carcinoma, adenocarcinoma NOS, and squamous cell carcinoma significantly improved (P < .05) over time. CONCLUSION: The incidence of parotid cancer is rising steadily since 1973, while the incidence of overall head and neck cancer has decreased. Further research is necessary to understand the etiology, risk factors, and pathophysiology of parotid cancer to curb its rising incidence. LEVEL OF EVIDENCE: 4.

Warthin's tumour seems to be the most common benign neoplasm of the parotid gland in Germany.

PURPOSE: Recent reports indicate an increase in the prevalence of Warthin's tumours (adenolymphoma) with percentages which exceed that of pleomorphic adenomas (PA) in the same registries. The purpose of this study is to analyse a large cohort of benign parotid tumours in relation to various demographic and other patients' characteristics that might affect their incidence. METHODS: A retrospective review of prospective collected data was performed on all patients who have been operated for a parotid mass in the last 5 years. A total of 474 patients with benign lesion were included in the study. Age, gender, smoking status, histological diagnosis, site of lesion, and size of tumour were recorded. RESULTS: Warthin's tumours were the most common benign lesions, found in 201 (42.4%) parotic glands followed by pleomorphic adenomas found in 138 (29.1%) of these surgical cases. Patients with WT had a mean age of 61.6 years instead of 52 years for PA patients (t = 6.589, p < 0.001). The vast majority (93%) of patients with WT had a current or previous history of smoking compared with 47% of PA patients (p = 0.001). There was a male predominance regarding WT with a male:female (M:F) ratio of 2.3:1, whereas the corresponding ratio of PA was 1:1.4. CONCLUSIONS: This study confirms the increased regional prevalence of WT reported in studies mainly carried out in central Europe. This could affect future management of WT, which remains largely controversial due to the extremely low malignant potential reported, concurrently with its higher rates of multiplicity and recurrence, as well as the moderately accurate results of FNA biopsies.

Clinicopathological analysis of parotid masses: six-year experience of a tertiary center.

OBJECTIVE: To analyse the clinical and histopathological characteristics of parotid gland masses at a tertiary referral centre and to compare the results with those cited in literature. METHODS: The retrospective study was conducted at Adana Numune Training and Research Hospital, Adana, Turkey, and comprised data of patients undergoing parotid surgery between January 2011 and December 2016. They were evaluated in terms of age, gender, surgery method, fine-needle aspiration biopsy results, specimen reports and complications after the surgery for one year. SPSS 20 was used for data analysis. RESULTS: Of 170 parotidectomies, 97(57.1%) had been performed on males and 73(42.9%) on females. There were 145(85.3%) benign and 25(14.7%) malignant tumours. Pleomorphic adenoma 67(39.4%) and Warthin's tumour 56(32.9%) were the two most common benign tumours. Mucoepidermoid carcinoma 7(4.1%) and adenoid cystic carcinoma 6(3.5%) were the two most prevalent malignant tumours. Superficial parotidectomy 133(78.2%) was the main type of surgical intervention. The sensitivity of fine needle aspiration cytology for identifying malignant tumours was 64.71%, the specificity was 100% and overall accuracy of the procedure was 94.92%. CONCLUSIONS: Repeated aspirations for sampling different parts of the lesion should be performed on suspicion of malignancy, especially if fine needle aspiration cytology reported pleomorphic adenoma.

Review and characteristics of 585 salivary gland neoplasms from a tertiary hospital registered in the Polish National Major Salivary Gland Benign Tumors Registry over a period of 5 years: a prospective study.

<b>Introduction:</b> A Polish National Major Salivary Gland Benign Tumors Registry (SGR) is a report of benign salivary gland neoplasms (SGNs) from 26 different centres in Poland, introduced in 2014. The aim of this study is to analyze demographic characteristics and clinico-pathological factors of benign SGNs treated in large tertiary institutions and to determine possible correlations between selected variables. <br><b>Material and method:</b> Analysis of 585 patients recorded in SGR and operated on for SGNs in the Department of Otolaryngology and Laryngological Surgery, University of Medical Sciences, Poznan, Poland, over a 5-year period. Patient age, sex, occupation, place of residence, tumor location, size, histology, recurrence, facial nerve function after surgery, wound healing, surgery procedure, availability of pre-operative imaging examinations, fine-needle aspiration cytology (FNAC) results were analyzed. <br><b>Results:</b> 338 females and 247 males with a mean age of 53 years were operated on. In total, 96.2% of tumors originated from the parotid and 3.8% from the submandibular gland. The most frequent primary tumor diameter was 2-4 cm (59.5%) followed by <2 cm (29.2%) and >4 cm (8.4%). Tumors of over 4 cm were frequently removed by partial superficial parotidectomy, while those under 2 cm - by extracapsullar dissection (ECD). Pleomorphic adenomas (PA) were predominant (58.8%), followed by Warthin's tumor (WT) - 37.1%. Patients with WT were on average 13.3 years older than patients with PA. <br><b>Discussion:</b> This research can be helpful to better understand the clinico-pathological features of SGNs. Long-termin hospital-based analysis is important for subsequent metaanalyses and comparisons with other centers. The reasons why not all patients' data are reported to the national SGR should be further precisely analyzed.

Parotid Gland Tumors in Northern Greece: A 7-year Retrospective Study of 207 Patients.

<b>Introduction:</b> Parotid gland neoplasms represent a heterogenous group of tumors, either benign or malignant. The diagnosis and management of parotid gland tumors is complicated by their relative infrequency and their diverse biologic behavior. <br><b>Aim:</b> The aim of this study is to investigate the epidemiological characteristics, the recurrence rates and the surgical approach employed for parotid gland tumors in Northern Greece. <br><b>Material and methods:</b> This is a single-center retrospective study. All patients admitted to the ENT department of "G. Papanikolaou" General Hospital of Thessaloniki from January 2012 to June 2019 with the diagnosis of parotid gland tumor were included in the study. Patients with incomplete charts and patients that underwent revision surgeries were excluded. Chi-squared tests were used to assess the associations between variables. <br><b>Results:</b> A total of 207 patients with a mean age of 54.97 (range 16-91) were included in the study. Benign neoplasms accounted for 87.9% of the cases. Warthin's tumor was the most common neoplasm encountered, with an incidence of 46.8%, followed by pleomorphic adenoma (31.9%). There was a higher incidence of parotid gland tumors in males and smokers (P = 0.025, P = 0.001 respectively). The majority of the patients were treated with an extracapsular resection (60.4%) or with a partial superficial parotidectomy (22.6%). In 12 cases (5.7%), there was a recurrence of the lesion. The most common complications encountered were facial nerve injury, Frey's syndrome and hematoma formation. <br><b>Conclusions:</b> Parotid gland tumors are typically benign, non-aggressive tumors, more frequently seen in men than women. There is a positive association between smoking and parotid gland tumor development. Comprehensive information regarding recurrence and complication rates is presented.

Understanding primary parotid squamous cell carcinoma - A systematic review.

INTRODUCTION: The true incidence of primary parotid squamous cell carcinoma (SCC) is unknown and likely overestimated in the literature. The aim of this systematic review is to examine the diagnosis, aetiology and incidence of parotid SCC by analysing studies evaluating primary parotid SCC. METHODS: A systematic search of Medline, EMBASE and Cochrane library was performed. A narrative synthesis was done. RESULTS: A total of 14 observational retrospective studies on primary parotid SCC were included. There are currently no standard criteria for ascertainment of primary parotid SCC. Primary parotid SCC is thought to be due to squamous metaplasia within the ductal epithelium and subsequent invasive squamous carcinoma. Histological features that favour primary disease includes SCC confined to parotid parenchyma with no direct communication to the skin and the absence of mucin. Incidence of primary parotid SCC varied from 1.54 to 2.8 cases per million person-years. Around 30%-86% of patients recorded to have primary parotid SCC on clinical records, when scrutinised, were in fact secondary to parotid lymph node involvement following regional advancement from skin or upper aerodigestive tract SCC. CONCLUSION: Primary parotid SCC is rare and it is currently a diagnosis of exclusion. Thorough clinical assessment including endoscopy, preoperative imaging and the scrutiny of histopathological findings allow for differentiation between primary and secondary SCC within the parotid. This thus affects both initial treatment and subsequent follow-up.

Clinically Node-Negative Parotid Gland Cancers: Prognostic Factors of Survival and Surgical Extent.

OBJECTIVE: Conservative parotidectomy is known to reduce morbidity, but has been rarely examined in patients with clinically node-negative (cN0) parotid cancers. We evaluated the clinicopathological variables influencing the outcomes of these patients and the efficacy of conservative parotidectomy. METHODS: We reviewed the clinical and pathological data of 256 patients with cN0 parotid carcinomas who underwent curative surgery at our institution. Of these, 110 and 146 underwent conservative and total parotidectomy, respectively, with 83 undergoing elective neck dissection and 135 receiving postoperative radiotherapy. Univariate and multivariate analyses of variables predicting recurrence-free survival (RFS) and overall survival (OS) were performed. Morbidity, survival, and recurrence rates were compared between the conservative and total parotidectomy groups. RESULTS: The 5-year RFS and OS rates in all patients were 85.7 and 91.4%, respectively. Multivariate analysis showed that advanced T classification, positive resection margin, and high-histologic grade were independent prognostic factors for both RFS and OS. Among the 201 patients with low- or intermediate-grade parotid cancers, those who underwent total parotidectomy had a greater chance of facial nerve paralysis than those who underwent conservative parotidectomy (p < 0.001). The 5-year RFS and OS after conservative parotidectomy (93.7 and 100%, respectively) were not worse than those after total parotidectomy (85.5 and 90.9%, respectively). CONCLUSION: Patients with cN0 parotid cancers may be stratified by histological grade and T classification. Conservative parotidectomy may be suitable for early T1-2 low- or intermediate-grade tumors if a resection margin is secured.