The diagnostic value of Superb Microvascular Imaging in identifying benign tumors of parotid gland.

BACKGROUND: We compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin's tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland. METHODS: The vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed. RESULTS: The internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P < 0.05). By SMI, the vascular distribution and vascular grade in PA were mainly peripheral (33.1%) and avascular (25.7%), Grade 1 (27.8%) and Grade 0 (25.7%). WT were mainly central (31.3%) and mixed distribution (34.9%), in Grade 3 (37.3%) and Grade 2 (36.2%). BCA was mainly peripheral (33.3%) and mixed distribution (33.3%), in Grade 2 (33.3%) and Grade 3 (33.3%). The overall detection rate of SMI for vascular Grade 2 and 3 was significantly higher than that of CDFI (P < 0.05). Both VI and MVD were lowest in PA, highest in WT (P < 0.001). The VI by SMI was correlated with MVD (P < 0.001). The correlation index between vascular distribution and grade by SMI and MVD were significantly higher than CDFI. CONCLUSION: SMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.

Carcinoma ex pleomorphic adenoma: a case report and review of literature.

BACKGROUND: Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CAex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma. OBJECTIVE: Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor. CASE REPORT: 54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion. CONCLUSION: Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.

Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland.

PURPOSE: This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function. MATERIALS AND METHODS: Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ2 and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study. RESULTS: Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/minute, respectively (P = .05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group. CONCLUSION: ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors.

[Laryngeal pleomorphic adenoma]. / Pleomorfnaia adenoma gortani.

Pleomorphic adenomas are the most widespread epithelial tumours originating from the salivary glands. In almost 90% of the cases, they are localized in the parotid salivary glands. Pleomorphic adenomas only rarely affect the larynx. To the best of our knowledge, as many as 27 cases of laryngeal pleomorphic adenoma have thus far been described in the special literature. The present article was designed to report a case of pleomorphic adenoma in the larynx of a 76 year-old male patient. The surgical treatment of this condition proved beneficial for the patient whose condition remains uncomplicated by the relapse of the tumour during the 5 year-long postoperative follow-up.

Chondroid Syringoma of a Cheek.

Chondroid syringoma is an unusual, benign skin appendageal tumor originating from the eccrine and apocrine sweat glands resembling mixed tumors of the salivary glands. It develops as a slow-enlarging, small, cutaneous nodule or mass. The lesions are usually seen in older men on head and neck. This is a clinical report of a 46-year-old lady who presented with a slowly growing nodular protruding mass in a cheek. The clinical and histologic findings of the tumor are demonstrated. The clinician and the pathologist should take into account the tumor among differential diagnosis not to overlook the lesion. Total surgical excision is needed with a long-term follow-up.

Síndrome del primer mordisco: presentación de 2 casos / First bite syndrome: report of two cases

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Risk factors for recurrence of pleomorphic adenoma.

Pleomorphic adenoma is the most frequent benign tumor of the salivary glands. It is characterized by a tendency to recur, which is determined by the biological characteristics of the tumor as well as the mode of its treatment. Recurrence of the tumor is associated with a high risk of postoperative facial palsy, risk of subsequent recurrence after revision surgery, and an increased risk of malignant transformation. Knowledge of the recurrence risk factors could allow selection of treatments that minimize the risk. Among the factors in this study the most important are: incomplete excision, intraoperative capsule rupture, myxoid subtype, presence of the satellite nodules and tumor extensions (pseudopodia), lack of the glandular tissue margin and the experience of the surgeon. The possible factors are: the female sex, young age, location and size of the tumor, and the duration of the tumor growth. The technique of tumor enucleation of pleomorphic adenoma carries a high risk of recurrence and should be replaced by parotidectomy. In cases of recurrence the treatment is individually tailored and may: further follow up, limited resection of the tumor, lateral parotidectomy or extended radical parotidectomy with concurrent reconstruction of the facial nerve. The role of radiotherapy is discussed.

Aneurisma intraparotídeo de vena comunicante posterior / Intraparotid aneurysm of the posterior communicating vein

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Siringoma condroide con matriz rica en hialina: una lesión infrecuente en el canal auditivo externo / Hyaline matrix rich chondroid syringoma: a rare lesion of the external auditory canal

El siringoma condroide, o tumor mixto cutáneo, es un tumor benigno infrecuente de las glándulas sudoríparas. Es el homólogo cutáneo del adenoma pleomórfico de las glándulas salivares. La presentación clínica es inespecífica y su diagnóstico histopatológico resulta difícil. Característicamente, el tumor se compone de una proliferación de células epiteliales en una matriz condromixoide. Presentamos un caso de siringoma condroide originado en un pólipo del canal auditivo externo en un varón de 25 años, con un cuadro clínico de sensación de obstrucción del oído e hipoacusia. El propósito de esta presentación es ayudar tanto al clínico como al patólogo a reconocer este tumor benigno infrecuente(AU)

Chondroid syringoma, or mixed tumour of the skin, is an uncommon benign sweat gland tumour. It is the cutaneous counterpart of pleomorphic adenoma of the salivary glands. The clinical presentation of chondroid syringoma is non-specific and its histological diagnosis can prove difficult. Characteristically, it is composed of a proliferation of epithelial cells set in a chondromyxoid matrix. We report a case of chondroid syringoma arising from a polyp in the external auditory canal in a 25 year old male who presented with a sensation of blockage of the ear and impaired hearing. The aim of this report is to help both the clinician and the pathologist recognize this uncommon benign neoplasm(AU)

Adenoma pleomorfo de lóbulo profundo de parótida. Diagnóstico diferencial de masas en el espacio parafaríngeo / No disponible

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Carcinoma ductal sobre adenoma pleomorfo de parótida / Duct carcinoma over the pleomorphic adenoma of the parotid gland

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Case studies in the surgical management of nasal airway obstruction.

Nasal obstruction is one of the most common complaints evaluated by the otolaryngologist. The differential diagnosis is broad, ranging from benign reversible causes to life-threatening diseases. In addition, patients may suffer from a combination of etiologies, further confusing the diagnosis. Surgical management is directed at the underlying origin of obstruction. The clinician therefore must use a careful history and physical examination as well as appropriate sinonasal imaging in accurately identifying the causes of nasal obstruction. To further illustrate these principles, we present two interesting cases of patients presenting with nasal obstruction.

Diagnosis of pleomorphic adenoma in a heterotopic salivary gland: a case report.

BACKGROUND: The histologic diversity encountered in pleomorphic adenoma may cause diagnostic difficulty in fine needle aspiration cytology (FNA) due to limited and selective sampling. CASE: A 40-year-old woman presented with a mass in the anterior aspect of the neck along the sternocleidomastoid muscle. FNA revealed a cellular tumor with a chondrimyxoid background and epithelial cells intermingled with a few mesenchymal cells. The diagnosis of pleomorphic adenoma was confirmed on histopathology. CONCLUSION: Primary ectopic pleomorphic adenoma can confidently be diagnosed by FNA. This technique is a useful tool in the initial assessment of the tumor.

Schwannomalike mixed tumor of the parotid gland: a case report.

BACKGROUND: Schwannomalike mixed tumor is a rare benign tumor of the parotid glands. CASE: A 75-year-old woman presented with a tumor 3 cm in diameter localized in her left parotid gland. Fine needle aspiration (FNA) of the lesion revealed 2 types of cells: 1 with elongated, wavy, hyperchromatic nuclei and a scant cytoplasmic border and 1 with larger, weakly staining nuclei and more abundant cytoplasm. Morphologic examinations were performed. CONCLUSION: FNA cytology was very useful in the diagnosis of this rare tumor of the parotid gland.

[The relationship of abnormal expression of cell glucoprotein with recurrence of pleomorphic adenoma in salivary gland].

OBJECTIVE: To study the relationship of expression of mucin 1 and E-cadherin with recurrence of pleomorphic adenoma in salivary gland, and to investigate the signal to predict the recurrence potential of the tumor. METHODS: ; The capsule of tumor was observed by microscope. The expression of mucin 1 and E-cadherin in 33 cases of primary adenoma, 12 cases of recurrent pleomorphic adenomas and 7 cases of malignant pleomorphic adenomas were detected by immunohistochemistry. RESULTS: There was no significant difference about the status of capsule and the positive rate of mucin 1 expression between primary and recurrent pleomorphic adenoma (P > 0.05). The abnormal distribution of mucin 1 expression was observed in recurrent pleomorphic adenoma (6/8), which was characterized by the positive staining of the whole cytomembrane. On the other hand, positive staining of the primary pleomorphic adenoma was observed on the top of the membrane (19/21). The difference was statistically significant (P < 0.05). The staining pattern in malignant pleomorphic adenoma was similar with the recurrent ones except higher ratio of positive expression. No significant different was observed among the three kind of tumors on the expression rate of E-cadherin (P > 0.05). CONCLUSION: The status of capsule didn't have much actual usage in predicting the recurrence of pleomorphic adenoma. There was no significant relationship between the expression of E-cd and the recurrence of the tumor. The abnormal distribution of mucin 1 expression contributes to the invasiveness of the tumor and can be used as the predictive signal for recurrence of pleomorphic adenoma.

Pleomorphic adenoma of the nasal septum: a case report.

Pleomorphic adenomas arise most commonly in the major salivary glands; the minor salivary glands are affected in only 8% of the cases. Intranasal pleomorphic adenoma being extremely rare originates most commonly from the nasal septum. We present a case of a 55-year-old man who presented with complaints of right-sided nasal obstruction and occasional nasal bleed for the last 6 months. Examination showed a mucosa-covered, fleshy 2 x 2 x 1.5 cm mass in the right nasal cavity. Computed tomogram showed right-sided polypoidal mass with attachment to the cartilaginous nasal septum without any erosion of the surrounding structures. The clinical presentation, gross and microscopic appearance, and treatment of intranasal pleomorphic adenoma is briefly discussed.

Tumor mixto maligno en conducto auditivo externo (CAE). Presentacion de un caso y revision de la Literatura / Maling mixed tumor in external ear canal (EAC). Case presentation and literature review

Se presenta un caso de siringoma condroide maligno en una paciente con una masa a nivel de CAE izquierdo y cuyo cuadro clínico se caracterizó por una oclusión total del lumen del conducto asociado a secreción purulenta y líquido serohemático. La escisión es la forma de tratamiento. Este tipo de expresión tumoral es infrecuente y corresponde a un tumor mixto de la piel que incluye elementos glandulares sudoríparos (siringoma) y tejido conectivo tipo cartilaginoso (condroide), por lo tanto es un tumor epitelial derivado de glándulas cerinas o apocrinas con cambios secundarios en el estroma, presentando además una similitud histológica con el adenoma pleomorfo en glándulas salivales.