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Radiotherapy and Oncology : Journal of... Jul 2024Recently, a comprehensive xerostomia prediction model was published, based on baseline xerostomia, mean dose to parotid glands (PG) and submandibular glands (SMG)....
BACKGROUND AND PURPOSE
Recently, a comprehensive xerostomia prediction model was published, based on baseline xerostomia, mean dose to parotid glands (PG) and submandibular glands (SMG). Previously, PET imaging biomarkers (IBMs) of PG were shown to improve xerostomia prediction. Therefore, this study aimed to explore the potential improvement of the additional PET-IBMs from both PG and SMG to the recent comprehensive xerostomia prediction model (i.e., the reference model).
MATERIALS AND METHODS
Totally, 540 head and neck cancer patients were split into training and validation cohorts. PET-IBMs from the PG and SMG, were selected using bootstrapped forward selection based on the reference model. The IBMs from both the PG and SMG with the highest selection frequency were added to the reference model, resulting in a PG-IBM model and a SMG-IBM model which were combined into a composite model. Model performance was assessed using the area under the curve (AUC). Likelihood ratio test compared the predictive performance between the reference model and models including IBMs.
RESULTS
The final selected PET-IBMs were 90 percentile of the PG SUV and total energy of the SMG SUV. The additional two PET-IBMs in the composite model improved the predictive performance of the reference model significantly. The AUC of the reference model and the composite model were 0.67 and 0.69 in the training cohort, and 0.71 and 0.73 in the validation cohort, respectively.
CONCLUSION
The composite model including two additional PET-IBMs from PG and SMG improved the predictive performance of the reference xerostomia model significantly, facilitating a more personalized prediction approach.
Topics: Humans; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Female; Male; Middle Aged; Xerostomia; Positron-Emission Tomography; Radiopharmaceuticals; Aged; Adult; Submandibular Gland; Parotid Gland; Salivary Glands
PubMed: 38702014
DOI: 10.1016/j.radonc.2024.110319 -
Journal of Medical Case Reports May 2024Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have... (Review)
Review
BACKGROUND
Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting.
CASE PRESENTATION
A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma.
CONCLUSIONS
Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.
Topics: Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Magnetic Resonance Imaging; Lymphoma
PubMed: 38698413
DOI: 10.1186/s13256-024-04553-9 -
National Journal of Maxillofacial... 2024Distant metastasis to salivary glands is a very rare event. Renal cell carcinoma (RCC) has been known for its high propensity of metastasis to unusual locations and... (Review)
Review
Distant metastasis to salivary glands is a very rare event. Renal cell carcinoma (RCC) has been known for its high propensity of metastasis to unusual locations and salivary glands are one among those sites. Approximately 0.1% of all salivary gland metastatic neoplasms originate from renal malignancies Literature has reported several studies analysing the metastatic tumors to the oral region. However, very little research work has been published to date to analyse solely the RCC metastasizing to the salivary glands. Thus, this review was conducted to examine the published cases of RCC metastasizing to salivary glands in the literature to date and to learn about their characteristics. An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ('Renal cancer', OR 'Renal carcinoma' OR 'Renal cell cancer' OR 'Renal cell carcinoma'), AND ('Metastasis' OR 'Metastases'), And ('Salivary glands' OR 'Parotid gland' OR 'Submandibular gland' OR 'Sublingual gland'). We also searched all related journals manually. The reference list of all articles was also checked. Our research revealed a total of 83 relevant papers (1965-2022) with 100 patients. Parotid was the most predominant gland affected. 8% of patients died with a mean survival time of 1.3 yr. From this research, it can be concluded that RCC metastasizing to salivary glands is a rare occurrence. Careful evaluation of these cases is needed in order to raise awareness of these lesions and gain a better understanding of their characteristics for clinical as well as global implications.
PubMed: 38690239
DOI: 10.4103/njms.njms_79_23 -
In Vivo (Athens, Greece) 2024First bite syndrome (FBS) is a symptom of severe pain at the beginning of a meal that lessens as the meal progresses. It is a common postoperative complication of...
BACKGROUND/AIM
First bite syndrome (FBS) is a symptom of severe pain at the beginning of a meal that lessens as the meal progresses. It is a common postoperative complication of parapharyngeal space tumors and is rarely reported as the first symptom of parotid carcinoma. The parapharyngeal space is considered a difficult area for approach; hence, preoperative histopathology is often challenging. However, there are hardly any reports on the approach of performing biopsies under computerized tomography (CT) guidance.
CASE REPORT
A 28-year-old woman presented to our hospital with the chief complaint of pain in the left parotid region since the past year. Contrast-enhanced magnetic resonance imaging of the parotid gland revealed a 10-mm high-signal area on T2-weighted images extending from the deep lobe of the left parotid gland to the parapharyngeal space, which could not be visualized on ultrasound. She was suspected to have a malignant tumor because of the presence of a parotid tumor with FBS. Therefore, she underwent CT-guided fine-needle aspiration cytology (FNAC) and was diagnosed with adenoid cystic carcinoma. The patient underwent left parotid tumor resection and left cervical dissection, and her pain during feeding improved postoperatively.
CONCLUSION
In a patient with parotid tumor extending into the parapharyngeal space with FBS as the initial symptom, CT-guided FNAC was successfully used to diagnose parotid carcinoma. Symptoms of pain, including FBS, should be considered in cases of malignancy. CT-guided FNAC is effective for lesions that cannot be visualized by ultrasound, such as those in the parapharyngeal space.
Topics: Humans; Female; Parotid Neoplasms; Adult; Tomography, X-Ray Computed; Biopsy, Fine-Needle; Image-Guided Biopsy; Parotid Gland; Magnetic Resonance Imaging; Cytology
PubMed: 38688641
DOI: 10.21873/invivo.13590 -
In Vivo (Athens, Greece) 2024Warthin's tumor, the second most frequent neoplasia of the parotid gland, is characterized by a proliferation of both epithelial and lymphoid components. In addition to...
BACKGROUND/AIM
Warthin's tumor, the second most frequent neoplasia of the parotid gland, is characterized by a proliferation of both epithelial and lymphoid components. In addition to epithelial and lymphoid cells, various other cell types are implicated to varying degrees in the immune response. Notably, mast cells have long been recognized as a consistent cell population within this tumor. Despite the historical acknowledgment of mast cell presence, their true distribution and significance within Warthin's tumor remain unclear. In this study, we aimed to elucidate the distribution and significance of mast cells in Warthin's tumor.
MATERIALS AND METHODS
Histochemical and immunohistochemical methods were employed for the evaluation of mast cells within tumor specimens.
RESULTS
Our study revealed a notable concentration of mast cells in the epithelial component of Warthin's tumor. Microscopic examination showed predominant lymphoid and epithelial elements with occasional cystic formations. Immunohistochemical analysis identified mast cells in both components, emphasizing their role in the tumor microenvironment. Double immunostaining (mast cell tryptase and CD34) revealed no significant correlation between mast cells and blood vessels. Intraepithelial mast cells (IEMCs) had a significantly higher density in the epithelial component, suggesting a potential association with the tumor's benign nature. The relationship between IEMCs and epithelial cells, especially in the presence of cystic structures, offers valuable insights into the unique features of Warthin's tumor.
CONCLUSION
Our study contributes to the understanding of mast cells in Warthin's tumor, highlighting a substantial concentration within the epithelial component. This knowledge may pave the way for further investigations into the roles of mast cells in the pathogenesis and treatment of Warthin's tumor.
Topics: Mast Cells; Adenolymphoma; Humans; Male; Female; Immunohistochemistry; Middle Aged; Aged; Tumor Microenvironment; Cell Count; Parotid Neoplasms; Adult; Epithelial Cells
PubMed: 38688595
DOI: 10.21873/invivo.13544 -
POCUS Journal 2024A pseudoaneurysm results from a tear in a vessel wall. This leads to extravasation of blood into adjacent tissue and eventual formation of a fibrous sac that maintains...
A pseudoaneurysm results from a tear in a vessel wall. This leads to extravasation of blood into adjacent tissue and eventual formation of a fibrous sac that maintains continuity with the lumen. These vascular injuries very rarely occur in deeper vessels of the face (e.g. maxillary artery) due to protection from structures like the bony mandible and parotid gland. If left untreated, these pseudoaneurysms can lead to infection, thromboembolism, hemorrhage, and compression of surrounding structures such as facial nerve branches. Pseudoaneurysms are typically diagnosed by advanced imaging techniques including computed tomography angiography and magnetic resonance angiography. However, these tests require time to perform and interpret, are costly, and take place outside the patient care area. Computed tomography also confers ionizing radiation. Fortunately, point of care ultrasound (POCUS) is a readily available, dynamic imaging tool that can be performed at the bedside. Here we present the first known case report of a maxillary artery pseudoaneurysm diagnosed by POCUS in the emergency department. Early differentiation from a typical hematoma led to rapid management in the form of a compression bandage, as well as expedited consultation to the appropriate services.
PubMed: 38681166
DOI: 10.24908/pocus.v9i1.16831 -
Current Oncology (Toronto, Ont.) Apr 2024Castleman disease (CD) is an uncommon benign lymphoproliferative disease characterized by hypervascular lymphoid hyperplasia. We present a unique case of unicentric CD...
BACKGROUND
Castleman disease (CD) is an uncommon benign lymphoproliferative disease characterized by hypervascular lymphoid hyperplasia. We present a unique case of unicentric CD of the parotid gland treated by preoperative direct puncture embolization.
CASE PRESENTATION
A 27-year-old female patient was admitted for a right neck mass. Ultrasound examination and MRI scan documented a hypervascular mass within the right parotid gland. Preoperative embolization was performed by direct puncture technique: a needle was inserted into the core of the mass under both ultrasound and fluoroscopic guidance and SQUID 12 was injected into the mass under fluoroscopic control, achieving a total devascularization.
CONCLUSION
Preoperative direct puncture embolization was safe and effective and provides excellent hemostatic control during the surgical operation, limiting the amount of intraoperative bleeding.
Topics: Humans; Female; Adult; Castleman Disease; Embolization, Therapeutic; Parotid Gland; Preoperative Care; Punctures; Magnetic Resonance Imaging
PubMed: 38668054
DOI: 10.3390/curroncol31040151 -
BMC Surgery Apr 2024We primarily aimed to evaluate whether parotid incidental lesion (PIL) in F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for...
Incidentally found parotid gland lesion in F-FDG PET/CT for staging evaluation of patients with hepatocellular carcinoma: remote possibility of metastatic tumor or second primary salivary gland malignancy.
OBJECTIVES
We primarily aimed to evaluate whether parotid incidental lesion (PIL) in F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for staging evaluation of patients with hepatocellular carcinoma (HCC) would represent a possibility of extrahepatic metastasis or second primary malignancy (SPM). Additionally, we explored the incidence of PIL in HCC patients and examined any associated risk factors.
METHODS
We retrospectively analyzed patients with HCC who underwent F-FDG PET/CT at our institution from 2010 to 2022. The pathological findings of PILs in HCC patients were investigated for confirmatory identification of the risk of HCC metastasis or SPM in parotid gland. Healthy controls received F-FDG PET/CT for health screening were also enrolled to compare the incidence of PILs with HCC patients. Various parameters associated with patient demographics and characteristics of HCC were analyzed to find the related factors of PILs.
RESULTS
A total of 17,674 patients with HCC and 2,090 healthy individuals who had undergone F-FDG PET/CT scans were enrolled in the analyses. Among the 54 HCC patients who underwent pathological confirmation for PILs, benign primary parotid tumor was most commonly observed (n = 43 [79.6%]); however, no malignant lesions were detected, including HCC metastasis. The incidence of PILs was higher in patients diagnosed with HCC compared with the control group (485 [2.7%] vs. 23 [1.1%], p = 0.002). Analysis for the risk factors for PILs revealed that patient age, sex, and positive viral markers were significantly associated with the incidence of PILs in patients with HCC (all p < 0.001).
CONCLUSIONS
Our study demonstrates that PILs are more frequently identified in patients with HCC on F-FDG PET/CT. However, no malignant PIL, including extrahepatic metastasis of HCC, was identified. Therefore, the presence of PIL should not impede or delay the treatment process for patients with HCC. Additionally, we suggested that for future swift and straightforward differential diagnoses of PIL, the development of additional protocols within the PET/CT imaging could be beneficial.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Male; Liver Neoplasms; Female; Middle Aged; Carcinoma, Hepatocellular; Retrospective Studies; Incidental Findings; Aged; Parotid Neoplasms; Radiopharmaceuticals; Neoplasms, Second Primary; Adult; Neoplasm Staging; Salivary Gland Neoplasms; Incidence
PubMed: 38658868
DOI: 10.1186/s12893-024-02422-2 -
Physica Medica : PM : An International... May 2024The purpose of this investigation is to quantify the spatial heterogeneity of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) uptake within...
UNLABELLED
The purpose of this investigation is to quantify the spatial heterogeneity of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) uptake within parotid glands. We aim to quantify patterns in well-defined regions to facilitate further investigations. Furthermore, we investigate whether uptake is correlated with computed tomography (CT) texture features.
METHODS
Parotid glands from [18F]DCFPyL PSMA PET/CT images of 30 prostate cancer patients were analyzed. Uptake patterns were assessed with various segmentation schemes. Spearman's rank correlation coefficient was calculated between PSMA PET uptake and feature values of a Grey Level Run Length Matrix using a long and short run length emphasis (GLRLML and GLRLMS) in subregions of the parotid gland.
RESULTS
PSMA PET uptake was significantly higher (p < 0.001) in lateral/posterior regions of the glands than anterior/medial regions. Maximum uptake was found in the lateral half of parotid glands in 50 out of 60 glands. The difference in SUV between parotid halves is greatest when parotids are divided by a plane separating the anterior/medial and posterior/lateral halves symmetrically (out of 120 bisections tested). PSMA PET uptake was significantly correlated with CT GLRLML (p < 0.001), and anti-correlated with CT GLRLMS (p < 0.001).
CONCLUSION
Uptake of PSMA PET is heterogeneous within parotid glands, with uptake biased towards lateral/posterior regions. Uptake within parotid glands was strongly correlated with CT texture feature maps.
Topics: Humans; Parotid Gland; Positron Emission Tomography Computed Tomography; Glutamate Carboxypeptidase II; Male; Ligands; Antigens, Surface; Prostatic Neoplasms; Biological Transport; Aged; Middle Aged; Lysine; Urea
PubMed: 38657425
DOI: 10.1016/j.ejmp.2024.103366 -
Ear, Nose, & Throat Journal Apr 2024Warthin's tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on... (Review)
Review
Warthin's tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on Warthin's tumors of the parotid gland can be complicated in patients who wish to avoid risks of surgery and general anesthesia. This systematic review explores the potential of radiofrequency ablation (RFA) as a minimally invasive alternative. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model was used to collect 3 relevant studies that focused on RFA treatment for Warthin's tumors. The cumulative averages for tumor size and cosmetic scores were then quantified for patients with Warthin's tumors who underwent RFA therapy. The PRISMA systematic review method was employed to the PubMed and EMBASE databases. The comprehensive search term "Warthin Tumor Treatment" yielded 1299 articles from the years 1955 to 2023, 3 of which met inclusion criteria and were then selected. The 3 quantitative studies collectively assessed 37 patients with Warthin's tumors treated with RFA. Patients experienced an average tumor size reduction of 85.03% at 12 months post-RFA. There were minimal complications associated with RFA in these patients. This study suggests that RFA is an alternative to parotidectomy for the symptomatic treatment of Warthin's tumors. RFA procedures demonstrated substantial tumor size reduction with few complications. However, further meta-analysis and comparison with alternative treatments is warranted to establish RFA's role in treatment of Warthin's tumors. The study is limited by its reliance on only 2 databases and a lack of comprehensive examination of different RFA settings.
PubMed: 38647239
DOI: 10.1177/01455613241248119