Locoregional metastatic behavior in a complex mosaic of primary malignant tumors of the parotid gland.

BACKGROUND: The aim of the study was to investigate primary locoregional metastatic behavior in a large sample of various malignant tumors of the parotid gland with varying grades following surgical treatment consisting of complete parotidectomy and neck dissection. METHODS: The records of all patients treated for primary malignant tumors of the parotid gland by means of complete parotidectomy and neck dissection between 2007 and 2022 were studied retrospectively. RESULTS: 196 patients formed our study sample (98 females, 98 males). The mean age was 65.7 years (22-101 years). 92 cases presented with low-grade subtypes, 19 with intermediate-grade, and 85 with high-grade carcinomas. The locoregional lymphatic network had been invaded in a total of 66/196 cases (33.6 %). The intraparotid lymph nodes were positive in 54/196 cases (27.5 %) and the cervical lymph nodes in 41/196 cases (20.9 %). In 12 out of the 66 cases with a pN+ status, the neck had been invaded without involvement of the intraparotideal lymph nodes (18.2 %). Male patients tended to suffer from more aggressive carcinomas, and high-grade subtypes presented significantly more frequently as locally advanced tumors. Higher grading was significantly associated with the involvement of the parotid (p < 0.001) and cervical (p < 0.001) lymph nodes. Intermediate and low-grade cases presented similar behavior concerning tumorous invasion of the lymphatic network of the parotid gland (p = 0.522) and the neck (p = 0.467). CONCLUSION: The locoregional metastatic potential of parotid malignant tumors depends upon a variety of histopathologic factors, which have to be considered in the decision-making process concerning the management of locoregional lymph nodes.

[The influence of the capsular defect as a risk factor for recurrence in pleomorphic adenoma]. / Der Einfluss des Kapseldefektes als Risikofaktor für die Rezidivbildung beim pleomorphen Adenom der Glandula parotidea.

OBJECTIVE: Aim of this study was to enlighten various aspects of the capsular defect of a pleomorphic adenoma and to analyze its influence on recurrence rate with the help of our data and the relevant literature. MATERIAL AND METHODS: The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2005 and 2020 were evaluated retrospectively. The histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. The records of the cases with a capsular defect were examined for information on age, gender, type of surgery and surgical outcome. RESULTS: A total of 845 patients were included in the primary group. 7 (0.8 %) recurrences were detected, all of these were resected without a capsular rupture. Positive margins were found in 37 cases (4.4 %). In 13/37 cases the capsular defect was detected intraoperatively, whereas the defect was only identified histopathologically in 24 of the 37 cases. In the group of the intraoperative capsular opening, with a median follow-up of 62 months, the sonographic examination suspected a unilocular recurrence of the pleomorphic adenoma in two cases. CONCLUSION: The intraoperative capsule opening does not inevitably seem to lead to a pre-programmed recurrence.

Histopathology of Parotid Pleomorphic Adenomas: A "Pleomorphic Approach" to a Demanding Lesion.

OBJECTIVES/HYPOTHESIS: The aim of this study was to identify potential associations between epidemiologic, morphologic, and histopathologic features in pleomorphic adenomas (PAs) of the parotid gland in order to extract information about the natural course and biologic behavior of these lesions on the basis of a single-center series of 845 cases within a period of 15 years. STUDY DESIGN: Retrospective study in a tertiary academic center. METHODS: For this study, an experienced head and neck pathologist critically re-evaluated the histological slides of the pathological specimens of all patients who underwent a parotidectomy for PA of the parotid gland between 2006 and 2020. RESULTS: A total of 845 cases made up our study sample. Our analysis showed a statistically significant association of the histologic subtype with younger age (P = .001) and maximal diameter (P = .044), with the hypocellular type being encountered more often in younger patients and in smaller lesions. The same subtype was significantly associated with an incomplete capsule (P = .001), pseudopodia (P = .006), and satellite nodules (P = .001). An incomplete capsule was associated with the presence of pseudopodia (P = .001) and satellite nodules (P = .001). CONCLUSION: It seems that various histologic subtypes have different capsule-producing properties. Apparently, over the course of time, tumor material builds a finger-like projection still inside the capsule, separates itself from the parenchyma with fibrous tissue still remaining enclosed within the capsule (pseudopodium), slowly penetrates the capsule (incomplete capsule), and leaves the main lesion taking a part of the capsule with it (satellite nodules). Laryngoscope, 132:73-77, 2022.

Histopathological comparison of pleomorphic adenomas of the parotid and submandibular gland.

OBJECTIVE: The aim of this study was to investigate and compare the histopathological findings in pleomorphic adenomas (PA) of the parotid and submandibular gland with emphasis on the histological subtype and capsular characteristics. MATERIALS AND METHODS: The histopathological specimens of all patients with PAs of the parotid and submandibular gland between 2000 and 2020 were re-examined by an experienced head and neck pathologist. Patients without representative slides allowing evaluation of the whole periphery of the PA were excluded from our study sample. RESULTS: Nine hundred and thirty-four patients formed our study sample (327 men, 607 women, male-to-female ratio: 0.53:1). Eight hundred and forty-four cases had a PA in the parotid gland and the remaining 90 in the submandibular gland. Our comparative analysis showed that submandibular PAs are characterized by the consistent presence of an intact anatomical capsule, infrequent occurrence of pseudopodia and satellite nodules, and a low proportion of the high-risk myxoid subtype. CONCLUSION: Our study highlights significant differences between PAs of the parotid and submandibular glands in their histopathological characteristics. Their differences likely underlie the favorable surgical outcome observed in PAs of the submandibular glands and may explain the propensity of PAs of the parotid glands for local recurrences.

Satellite nodules in pleomorphic adenomas of the parotid gland: A nightmare for less invasive parotid surgery?

OBJECTIVES: The aim of this study was to thoroughly investigate the incidence of satellite nodules (SN) and some of their characteristics (number, distance to main lesion) in a large series of pleomorphic adenomas (PA) and to compare several surgical modalities regarding their efficacy in addressing this critical morphological feature. MATERIALS AND METHODS: The records of all patients treated for primary PA of the parotid gland between 2006 and 2020 were studied retrospectively. All the histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. RESULTS: 845 cases made up our initial study sample. SNs were detected in 68/845 cases (8%). No statistically significant difference could be detected in the incidence of SNs in the surgical specimens between the patient groups managed by extracapsular dissection (46/577, 7.9%) and facial nerve dissecting surgery (22/268, 8.2%, p = 0.502). In the group of cases with SNs, no recurrences were detected (mean follow-up time: 71.4 months). The mean distance from the main lesion to the most distant SN was 1.1 mm (0.08-6.3 mm). The mean size of the SN was 1.9 mm (0.1-9.7 mm). Altogether, the mean distance from the main lesion to the outer periphery of the most distant SN was 3.1 mm (0.4-10.5 mm). CONCLUSION: Our analysis could not award SNs the title of an "extracapsular dissection's nightmare". In the majority of cases, their favourable histological patterns offer the ideal circumstances for their surgical inclusion in a tumour specimen.

Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas.

BACKGROUND: Traditional surgical philosophy condemns extracapsular dissection for pleomorphic adenoma as a euphemism for the enucleation of this lesion. OBJECTIVES: The aims of the study were to trace the development of surgical treatment by pleomorphic adenomas of the parotid gland over the last 15 years and explore its effects on the histopathology specimen. MATERIALS AND METHODS: The medical records of all cases with pleomorphic adenomas of the parotid gland between 2006 and 2020 were examined for information on age, gender, and type of surgery. An experienced head and neck pathologist re-evaluated the histology slides from all the cases. RESULTS: The study included 844 patients. Our analysis showed an increase in the performance of extracapsular dissection from 52.8% (2006) to 63.3% (2020), and an increase in histopathology specimens with tumours completely covered by healthy tissue from 27.7% (2006) to 50% (2020). CONCLUSIONS: Our decision-making process reached its peak in the last study years, in terms of reduced surgical invasiveness and quality of the pathology specimen. SIGNIFICANCE: Extracapsular dissection has gained a firm hold as an indispensable tool for the experienced parotid surgeon. Proper indication is based on careful selection of cases and the correct interpretation of preoperative features on palpation and imaging.