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Journal of Personalized Medicine Jan 2024The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of...
BACKGROUND
The treatment of choice for tumors located in the parotid gland is surgery. Nevertheless, postoperative complications are not infrequent. Regardless of the type of surgical procedure, the most common complication is Frey's syndrome (FS). Traditionally, FS includes unilateral gustatory sweating and flushing of the facial skin lining the parotid compartment. Recent research describes atypical discomfort associated with FS. The aim of this study was to assess the late prevalence and severity of both usual and atypical symptoms after parotidectomy for benign tumors.
METHODS
We conducted a cross-sectional study involving 86 subjects who underwent superficial parotidectomy at least one year before the study. The questionnaire included the sweating-flushing-itch-paresthesia-pain (SFIPP) Frey scale supplemented by specific questions about symptoms.
RESULTS
Sixty-seven out of eighty-six (77.9%) cases reported almost one symptom. The most frequent symptom was itch (36/67-53.7%), followed by pain (35/67-52.2%), while 28/67 (41.8%) subjects complained of atypical symptoms without flushing or sweating. A desire to treat the discomfort was reported by 50/67 (74.6%) subjects.
CONCLUSIONS
Late postparotidectomy local discomfort is not infrequent and includes both usual and "unusual" symptoms almost equally. Our results suggest the importance of informing patients about the occurrence of the syndrome and the available treatment options during pre- and postoperative counseling.
PubMed: 38248797
DOI: 10.3390/jpm14010096 -
Radiology Case Reports Aug 2024The primary malignant melanoma of the parotid is a rare and complex clinical entity, posing numerous diagnostic challenges due to the absence of melanin in the tumor and...
The primary malignant melanoma of the parotid is a rare and complex clinical entity, posing numerous diagnostic challenges due to the absence of melanin in the tumor and its histological similarities with other poorly differentiated lesions. Accurate diagnosis often requires advanced imaging techniques and immunohistochemical procedures to identify specific melanoma markers. Therapeutically, total parotidectomy with simultaneous cervical dissection is frequently recommended, although approaches combining surgery, chemotherapy, radiotherapy, or even immunotherapy are also being explored. Despite these advancements, malignant parotid melanoma continues to be associated with a grim prognosis, emphasizing the importance of ongoing research to improve therapeutic options and understanding of this rare pathology.
PubMed: 38872741
DOI: 10.1016/j.radcr.2024.05.005 -
Case Reports in Oncology 2023Solitary fibrous tumors (SFTs) are soft tumors (mesenchymal origin) that most likely develop from adult mesenchymal stem cells. SFTs are not common in the head and neck...
Solitary fibrous tumors (SFTs) are soft tumors (mesenchymal origin) that most likely develop from adult mesenchymal stem cells. SFTs are not common in the head and neck region, and the characteristics of tumors in this location are unclear. The present study describes the clinicopathological findings of 2 cases of SFTs arising in the parotid gland and buccal space, presenting as salivary gland tumors. The first case is a 76-year-old man presenting with a painless tumor on the right parotid gland who subsequently underwent partial superficial parotidectomy. According to the results of histopathological analysis, the tumor consisted of stellate and spindle-shaped cells proliferating on a mucous-like substrate. Immunohistochemical staining revealed that neoplastic cells were positive for CD34, vimentin, Bcl2, and STAT6. The second case is of a 64-year-old man presenting with a painless lump on his right cheek. Based on the findings of fine needle aspiration cytology, a tumor derived from myoepithelial cells of the minor salivary gland or a nonepithelial tumor was suspected. The patient underwent surgical resection via an intraoral approach. Histopathologically, the tumor consisted of spindle-shaped cells with rod-shaped or irregular nuclei. Immunohistochemical staining revealed that the neoplastic cells were positive for CD34, CD99, Bcl2, and STAT6. Briefly, SFT should be considered in the differential diagnosis of a well-marginalized lesion in the salivary gland and oral cavity. STAT6 immunohistochemistry is the most specific and sensitive method of diagnosing SFT. A thorough understanding of the morphological changes associated with SFT and their correlation with clinical, immunohistochemical, and molecular characteristics is important to avoid misdiagnosis.
PubMed: 37485015
DOI: 10.1159/000531067 -
Journal of Maxillofacial and Oral... Apr 2024Frey's syndrome, described by Lucy Frey in 1923, is a unique condition characterized by sweating, flushing, and reddening as a direct response to mastication. This...
INTRODUCTION
Frey's syndrome, described by Lucy Frey in 1923, is a unique condition characterized by sweating, flushing, and reddening as a direct response to mastication. This phenomenon results from the aberrant regeneration of postganglionic parasympathetic neurons originating from the auriculotemporal nerve and the subsequent acetylcholine secretion induced by masticatory stimuli. Although rare, this syndrome can have multiple underlying causes and is frequently observed, occurring in up to 65% of cases following lateral parotid resections. Additionally, it can less commonly manifest after neck dissection, facelift procedures, or be associated with diabetes mellitus.
METHOD
This article outlines a comprehensive diagnostic algorithm for Frey's syndrome, which includes the utilization of the Minor-Starch-Iodine Test. This test is a key component in diagnosing the syndrome and is discussed in detail, providing insights into its procedure and interpretation. Additionally, the gold standard of treatment for established Frey's syndrome, botulinum toxin A, is thoroughly described, including its mechanism of action, administration, and potential side effects.
DISCUSSION
Finally, the article underscores the need for further research to enhance our understanding of Frey's syndrome, leading to better diagnostic methods and more tailored treatment options for patients.
PubMed: 38601257
DOI: 10.1007/s12663-023-02029-9 -
Cureus Jul 2023Carcinosarcoma ex pleomorphic adenoma is a rare malignant neoplasm, with most cases reported in the parotid gland. We herein report a case of a 75-year-old male referred...
Carcinosarcoma ex pleomorphic adenoma is a rare malignant neoplasm, with most cases reported in the parotid gland. We herein report a case of a 75-year-old male referred to our hospital with a long-standing right parotid lesion that was treated in an outside hospital by a superficial parotidectomy. The patient reported a painful, rapidly enlarging mass following the excision. Histopathological examination showed the proliferation of malignant epithelial and mesenchymal elements with a solid sheet of Langerhans cells admixed with eosinophils. The Langerhans cells were reactive to CD1a and BRAF; hence, a diagnosis of carcinosarcoma ex pleomorphic adenoma with Langerhans cell histiocytosis was given. Complete clinical and radiographic workup showed no other organ involvement. The patient underwent total parotidectomy with adjuvant chemoradiation; however, the tumor progressed and showed lung metastasis. We herein report the first case of a concurrent Langerhans cell histiocytosis with associated carcinosarcoma ex pleomorphic adenoma.
PubMed: 37621779
DOI: 10.7759/cureus.42351 -
Biomedical Papers of the Medical... Jun 2024Pleomorphic adenoma (PA), the most common benign tumour of the parotid gland, requires accurate preoperative diagnosis owing to its capacity for malignant...
PURPOSE
Pleomorphic adenoma (PA), the most common benign tumour of the parotid gland, requires accurate preoperative diagnosis owing to its capacity for malignant transformation. The aim of this study was to evaluate our experience with ultrasound-guided fine-needle aspiration biopsy (FNAB) in the diagnostic algorithm for patients with PA and to assess clinical outcomes for those with different surgical approaches.
MATERIAL AND METHODS
We carried out a retrospective analysis of patients treated for parotid gland mass between 2010 and 2016. These had had preoperative FNAB and had undergone subsequent surgery.
RESULTS
165 patients had FNAB with the result of PA and the definitive histology confirmed PA in 159 cases (96.4%). On the other hand, in 179 patients, the definitive histology showed PA and the preoperative FNAB result corresponded in 159 cases (88.9%). The measured sensitivity, specificity and accuracy of ultrasound-guided FNAB in the diagnosis of PA were, respectively, 88.83%, 96.23% and 92.31%. Most of the patients underwent superficial or partial superficial parotidectomy, followed by extracapsular dissection which was associated with statistically lower risk of facial nerve injury (P=0.04).
CONCLUSION
Ultrasound-guided FNAB is simple, accurate and valuable in the diagnosis of PA and provides results that can lead to the choice of less invasive operative treatment.
Topics: Humans; Adenoma, Pleomorphic; Parotid Neoplasms; Male; Female; Retrospective Studies; Middle Aged; Adult; Biopsy, Fine-Needle; Aged; Aged, 80 and over; Sensitivity and Specificity; Young Adult; Adolescent; Parotid Gland; Image-Guided Biopsy; Ultrasonography, Interventional
PubMed: 37431621
DOI: 10.5507/bp.2023.027 -
Journal of the West African College of... 2024Reconstruction of large facial defects is quite a challenging and difficult task. Various surgical options are available, each with its challenges and complications....
Reconstruction of large facial defects is quite a challenging and difficult task. Various surgical options are available, each with its challenges and complications. Galeo-pericranial flap has provided a suitable technique for reconstruction of radical parotidectomy defects with satisfactory outcomes. A 50-year-old farmer with a histologically diagnosed mucoepidermoid carcinoma of the right parotid gland of 15 years duration had radical parotidectomy and reconstruction of the defect with galeo-pericranial flap. The patient was followed up for 2 years, and the flap was completely taken with no donor site morbidity.
PubMed: 38486657
DOI: 10.4103/jwas.jwas_78_23 -
Rare Tumors 2024Mucoepidermoid carcinoma (MEC) is a common malignancy arising in the parotid gland. The diagnosis of MEC is typically based on its morphological features alone,...
Mucoepidermoid carcinoma (MEC) is a common malignancy arising in the parotid gland. The diagnosis of MEC is typically based on its morphological features alone, characteristically containing mucocytes, intermediate cells and epidermoid cells. However, when cystic degeneration is diffuse, it is challenging to distinguish MEC from other benign cystic tumors. This is a case report of a 58-year-old Caucasian man who presented with a parotid mass. H&E sections of the mass reveal multiloculated cysts lined by bland-looking epithelium with only rare papillary architectures. The papillary proliferation contains mucocytes, and epidermoid cells highlighted by the p63 immunohistochemistry study. The diagnosis was confirmed by FISH result of positive MAML2 (11q21) rearrangement. Patient underwent parotidectomy and is disease-free 6 months post-surgery. MEC with cystic degeneration is a common diagnostic pitfall which can mimic many benign lesions in the salivary gland. We present a rare case with MEC with extensive cystic change, its molecular and pathologic findings and review the diagnostic features of MEC, its benign mimickers and useful tools for distinguishing these entities.
PubMed: 38525087
DOI: 10.1177/20363613241242397 -
Journal of Clinical Medicine Jun 2024This study aims to retrospectively investigate the prognostic significance of the tumor microenvironment, with a focus on TILs (tumor-infiltrating lymphocytes), in...
Role of Tumor-Infiltrating Lymphocytes and the Tumor Microenvironment in the Survival of Malignant Parotid Gland Tumors: A Two-Centre Retrospective Analysis of 107 Patients.
This study aims to retrospectively investigate the prognostic significance of the tumor microenvironment, with a focus on TILs (tumor-infiltrating lymphocytes), in relation to survival in a large cohort of patients with parotid gland cancer, and it uses the method proposed by the International TILs Working Group in breast cancer. We included a cohort of consecutive patients with biopsy-proven parotid cancer who underwent surgery between January 2010 and September 2023. A retrospective review of medical records, including surgical, pathological and follow-up reports, was performed. The density of TILs was determined according to the recommendations of the International TILs Working Group for breast cancer. A weak negative correlation ( = 0.3) between TILs and time of survival and a weak positive correlation ( = 0.05) between TILs and months of survival (high TILs were correlated with longer survival in months) were identified. High TILs were weakly negatively, but not statistically significantly (0.7), correlated with the grading of tumor; this means that high TILs were associated with low-grade tumors. Contrary to previous preliminary reports, this retrospective work found no statistically significant prognostic role of TILs in parotid gland malignancies. This case series represents the largest cohort ever reported in the literature and includes all malignant histological types. Future larger molecular studies may be useful in this regard.
PubMed: 38930103
DOI: 10.3390/jcm13123574 -
Cureus Sep 2023Multifocal cystadenomatous oncocytic hyperplasia of the parotid gland is an extremely rare non-neoplastic lesion. We present a case involving a 73-year-old female with a...
Multifocal cystadenomatous oncocytic hyperplasia of the parotid gland is an extremely rare non-neoplastic lesion. We present a case involving a 73-year-old female with a painless, small mass in her right preauricular region for the past two months. Fine needle aspiration suggested a diagnosis of mucoepidermoid carcinoma. Following further investigations, the patient underwent an uneventful right superficial parotidectomy without neck dissection. Histopathological examination of the excised superficial parotid tissue revealed multifocal cystadenomatous oncocytic hyperplasia with negative surrounding margins. The patient's subsequent follow-ups in the outpatient department were satisfactory, with no reported issues, concerns, or evidence of recurrence.
PubMed: 37868548
DOI: 10.7759/cureus.45614