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National Journal of Maxillofacial... 2023The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome.
AIM OF THE STUDY
The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome.
MATERIAL AND METHODS
Data of 102 patients assessed from hospital records who underwent parotid surgery between the years 2013 and 2018 were obtained. Parameters included age, sex, socio-demographic profile, presenting complaints, examination findings, and cytopathology. Surgical techniques, post-operative complications such as a facial scar, retro-mandibular and pre-auricular depression, facial palsy, Frey's syndrome, and numbness over the ear lobule were analyzed.
RESULT
Out of a total of 102 patients, 54.0% of patients were male, and 45.1% were female. The mean age of patients was 33.30 ± 13.87 years ranging from 7 to 65 years. The most common clinical presentation was swelling in the parotid region (95.1%), and associated symptoms with swelling were pain (17.5%), facial palsy (4.9%), discharging sinus (4.9%), and ulcerative lesions (1%) at the time of presentation. Pleomorphic adenoma was the most common benign neoplasm (76.5%), followed by Warthin's tumors (2.9%). Mucoepidermoid carcinoma was the most common malignant neoplasm (3.9%). After parotid surgery, 35% of patients had a sensory impairment or hypoesthesia of the ear lobule, and 23.28% had temporary facial nerve weakness. 5.0% of patients had permanent facial weakness, and 2.06% of patients had weakness of the marginal mandibular nerve.
CONCLUSION
Pleomorphic adenoma and mucoepidermoid carcinoma are the most common benign and malignant tumors, respectively, and parotidectomy is the treatment of choice, depending on the tumor location. Successful treatment depends on early diagnosis and histopathological and radiological investigations. Sensory impairment and temporary facial nerve paralysis are the most common post-operative complications, which are minimized by proper knowledge of anatomy and meticulous dissection of the facial nerve during parotid surgery.
PubMed: 38273931
DOI: 10.4103/njms.njms_111_22 -
Medical Ultrasonography Mar 2024We presented the case of a patient with a slowly developing right parotid tumor over the course of several years. Multimodal ultrasonography proved relevant for...
We presented the case of a patient with a slowly developing right parotid tumor over the course of several years. Multimodal ultrasonography proved relevant for malignancy. Subsequent imaging identified tumors in numerous organs, considered metastases. Ultrasonography consolidated all identified aspects. Biopsy from an adrenal mass and histological examination evidenced the presence of a malignant, metastatic melanoma with cutaneous origin. Considerations are made regarding the role of ultrasonography in such cases.
Topics: Humans; Melanoma; Parotid Neoplasms; Skin Neoplasms; Parotid Gland; Ultrasonography
PubMed: 38266228
DOI: 10.11152/mu-4322 -
Journal of Radiation Research Mar 2024The present study aimed to evaluate whether an adapted plan with Ethos™ could be used for pharyngeal cancer. Ten patients with pharyngeal cancer who underwent...
Cone-beam computed tomography-guided online adaptive radiotherapy for pharyngeal cancer with whole neck irradiation: dose-volume histogram analysis between adapted and scheduled plans.
The present study aimed to evaluate whether an adapted plan with Ethos™ could be used for pharyngeal cancer. Ten patients with pharyngeal cancer who underwent chemoradiotherapy with available daily cone-beam computed tomography (CBCT) data were included. Simulated treatments were generated on the Ethos™ treatment emulator using CBCTs every four to five fractions for two plans: adapted and scheduled. The simulated treatments were divided into three groups: early (first-second week), middle (third-fourth week), and late (fifth-seventh week) periods. Dose-volume histogram parameters were compared for each period between the adapted and scheduled plans in terms of the planning target volume (PTV) (D98%, D95%, D50% and D2%), spinal cord (Dmax and D1cc), brainstem (Dmax) and ipsilateral and contralateral parotid glands (Dmedian and Dmean). The PTV D98%, D95% and D2% of the adapted plan were significantly higher than those of the scheduled plans in all periods, except for D98% in the late period. The adapted plan significantly reduced the spinal cord Dmax and D1cc compared with the scheduled plan in all periods. Ipsilateral and contralateral parotid glands Dmean of the adapted plan were lower than those of scheduled plan in the late period. In conclusion, the present study revealed that the adapted plans could maintain PTV coverage while reducing the doses to organs at risk in each period compared with scheduled plans.
Topics: Humans; Radiotherapy, Intensity-Modulated; Organs at Risk; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Pharyngeal Neoplasms; Cone-Beam Computed Tomography
PubMed: 38264828
DOI: 10.1093/jrr/rrad103 -
Journal of Applied Clinical Medical... Jun 2024Artificial intelligence (AI) based commercial software can be used to automatically delineate organs at risk (OAR), with potential for efficiency savings in the...
PURPOSE
Artificial intelligence (AI) based commercial software can be used to automatically delineate organs at risk (OAR), with potential for efficiency savings in the radiotherapy treatment planning pathway, and reduction of inter- and intra-observer variability. There has been little research investigating gross failure rates and failure modes of such systems.
METHOD
50 head and neck (H&N) patient data sets with "gold standard" contours were compared to AI-generated contours to produce expected mean and standard deviation values for the Dice Similarity Coefficient (DSC), for four common H&N OARs (brainstem, mandible, left and right parotid). An AI-based commercial system was applied to 500 H&N patients. AI-generated contours were compared to manual contours, outlined by an expert human, and a gross failure was set at three standard deviations below the expected mean DSC. Failures were inspected to assess reason for failure of the AI-based system with failures relating to suboptimal manual contouring censored. True failures were classified into 4 sub-types (setup position, anatomy, image artefacts and unknown).
RESULTS
There were 24 true failures of the AI-based commercial software, a gross failure rate of 1.2%. Fifteen failures were due to patient anatomy, four were due to dental image artefacts, three were due to patient position and two were unknown. True failure rates by OAR were 0.4% (brainstem), 2.2% (mandible), 1.4% (left parotid) and 0.8% (right parotid).
CONCLUSION
True failures of the AI-based system were predominantly associated with a non-standard element within the CT scan. It is likely that these non-standard elements were the reason for the gross failure, and suggests that patient datasets used to train the AI model did not contain sufficient heterogeneity of data. Regardless of the reasons for failure, the true failure rate for the AI-based system in the H&N region for the OARs investigated was low (∼1%).
Topics: Humans; Head and Neck Neoplasms; Radiotherapy Planning, Computer-Assisted; Algorithms; Organs at Risk; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Artificial Intelligence; Software; Image Processing, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 38263866
DOI: 10.1002/acm2.14273 -
Journal of Medical Case Reports Jan 2024Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic... (Review)
Review
BACKGROUND
Carcinosarcoma of the parotid gland is an extremely rare malignancy comprising of 0.04-0.16% of all salivary gland tumors. This is the first case of an adenoid cystic carcinoma with chondrosarcoma to the best of our knowledge. They consist of distinct carcinomatous and sarcomatous components and may arise de novo or from a preexisting pleomorphic adenoma.
CASE PRESENTATION
Herein we present a case of an 80-year-old white female who presented with progressively increasing left facial swelling over 6 weeks. Magnetic Resonance Imagining revealed a mass (3.4 cm) in the parotid gland with a predominant cystic/necrotic component. The cytology was atypical (Milan3) and a total parotidectomy and selective lymph node dissection was done. The resection showed extensive necrosis with high grade sarcomatous (chondrosarcoma) areas. The epithelial component was adenoid cystic carcinoma with perineural invasion. The patient is currently undergoing radiotherapy of the tumor bed and skull base due to propensity of perineural invasion of the adenoid cystic component. The most common carcinomas in carcinosarcomas of salivary glands are adenocarcinoma and squamous cell carcinoma.
CONCLUSION
Carcinosarcoma is a high-grade aggressive lesion with a poor prognosis and should be treated aggressively. More studies are needed to understand the origin of these tumors.
Topics: Humans; Female; Aged, 80 and over; Parotid Gland; Parotid Neoplasms; Carcinoma, Adenoid Cystic; Carcinosarcoma; Chondrosarcoma; Bone Neoplasms
PubMed: 38243328
DOI: 10.1186/s13256-023-04280-7 -
BMC Oral Health Jan 2024This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap...
OBJECTIVE
This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects.
MATERIALS AND METHODS
A retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data.
RESULTS
Among the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases.
CONCLUSION
Immediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.
Topics: Humans; Skin Transplantation; Parotid Region; Neoplasm Recurrence, Local; Carcinoma, Squamous Cell; Algorithms
PubMed: 38238723
DOI: 10.1186/s12903-024-03872-z -
International Journal of Surgery Case... Feb 2024Lipomatous neoplasms of the parotid gland represent an exceptionally rare and often underdiagnosed category of tumors, accounting for an incidence ranging from 0.6 % to...
INTRODUCTION AND IMPORTANCE
Lipomatous neoplasms of the parotid gland represent an exceptionally rare and often underdiagnosed category of tumors, accounting for an incidence ranging from 0.6 % to 4.4 % of all neoplasms detected within the parotid gland. Sialolipoma is defined as an uncommon variant of lipoma, characterized by a well-defined proliferation of mature adipocytes with secondary entrapment of salivary gland elements, including serous acini, ducts, and myoepithelial cells.
CASE PRESENTATION
The current case pertains to a 17-year-old female who presented with a one-year history of enlargement in the left preauricular region.
CLINICAL DISCUSSION
The case we present poses a complex diagnostic challenge due to two distinct characteristics. The diagnostic challenge lies in its remarkably low incidence and the propensity for confusion with pleomorphic adenoma, which is the most common tumor of the parotid gland. It is a benign disease entity characterized by the absence of dysplasia, in marked contrast to pleomorphic adenoma.
CONCLUSIONS
The infrequency in the manifestation of these tumor types, coupled with their prolonged asymptomatic course, can pose a diagnostic challenge. Enhancing our knowledge to comprehensively delineate these entities is imperative to effectively address the diagnostic complexities from both clinical and histopathological standpoints.
PubMed: 38227981
DOI: 10.1016/j.ijscr.2024.109264 -
Clinical Epigenetics Jan 2024As an oncovirus, EBV is associated with multiple cancers, including solid tumors and hematological malignancies. EBV methylation plays an important role in regulating...
BACKGROUND
As an oncovirus, EBV is associated with multiple cancers, including solid tumors and hematological malignancies. EBV methylation plays an important role in regulating tumor occurrence. However, the EBV methylation profiles in EBV-associated tumor tissues are poorly understood.
RESULTS
In this study, EBV methylation capture sequencing was conducted in several different tumor tissue samples, including NPC, EBVaGC, lung LELC and parotid LELC. Besides, EBV capture sequencing and following qMSP were performed on nasopharyngeal brushing samples from NPC and nasal NKTCL patients. Our results showed that the EBV genome among different types of tumors displayed specific methylation patterns. Among the four types of tumors from epithelial origin (NPC, EBVaGC, lung LELC and parotid LELC), the most significant differences were found between EBVaGC and the others. For example, in EBVaGC, all CpG sites within 1,44,189-1,45,136 bp of the EBV genome sequence on gene RPMS1 were hyper-methylated compared to the others. Differently, significant differences of EBV CpG sites, particularly those located on gene BILF2, were observed between NPC and nasal NKTCL patients in nasopharyngeal brushing samples. Further, the methylated level of BILF2 was further detected using qMSP, and a diagnostic model distinguishing NPC and nasal NKTCL was established. The AUC of the model was 0.9801 (95% CI 0.9524-1.0000), with the sensitivity and specificity of 98.81% (95% CI 93.63-99.94%) and 76.92% (95% CI 49.74-91.82%), respectively.
CONCLUSIONS
Our study reveals more clues for further understanding the pathogenesis of EBV, and provides a possibility for distinguishing EBV-related tumor by detecting specific EBV CpG sites.
Topics: Humans; Nasopharyngeal Carcinoma; Herpesvirus 4, Human; DNA Methylation; Carcinoma; Nasopharyngeal Neoplasms; Lymphoma, T-Cell
PubMed: 38212818
DOI: 10.1186/s13148-024-01624-y -
Current Opinion in Otolaryngology &... Apr 2024This review critically assesses the current literature and guidelines, aiming to clarify some of the most important factors that impact surgical strategies of head and... (Review)
Review
PURPOSE OF REVIEW
This review critically assesses the current literature and guidelines, aiming to clarify some of the most important factors that impact surgical strategies of head and neck nonmelanoma skin cancers (NMSCs), focusing on squamous, basal, and Merkel cell carcinomas.
RECENT FINDINGS
Recent developments underscore the complexity of treatment for NMSC, particularly in the head and neck region. There is a lack of high-level evidence for the management of these tumors, especially in advanced stages. The need to tailor the extent of surgical margins and parotid/neck management to different histotypes, considering the varying risk factors for recurrence, is beginning to emerge in the literature. Moreover, the role of immunotherapy and targeted therapies for locally advanced disease, alongside traditional treatment options, is progressively growing.
SUMMARY
NMSCs represent a heterogeneous group of malignancies with varying treatment complexities and prognoses. Management of NMSC is evolving towards an increasingly personalized strategy within a multidisciplinary therapeutic framework.
Topics: Humans; Carcinoma, Basal Cell; Skin Neoplasms; Prognosis; Head and Neck Neoplasms; Immunotherapy
PubMed: 38193646
DOI: 10.1097/MOO.0000000000000960 -
Radiation Oncology (London, England) Jan 2024The aim of the present study is to examine the impact of kV-CBCT-based online adaptive radiation therapy (ART) on dosimetric parameters in comparison to...
BACKGROUND
The aim of the present study is to examine the impact of kV-CBCT-based online adaptive radiation therapy (ART) on dosimetric parameters in comparison to image-guided-radiotherapy (IGRT) in consecutive patients with tumors in the head and neck region from a prospective registry.
METHODS
The study comprises all consecutive patients with tumors in the head and neck area who were treated with kV-CBCT-based online ART or IGRT-modus at the linear-accelerator ETHOS™. As a measure of effectiveness, the equivalent-uniform-dose was calculated for the CTV (EUD) and organs-at-risk (EUD) and normalized to the prescribed dose. As an important determinant for the need of ART the interfractional shifts of anatomic landmarks related to the tongue were analyzed and compared to the intrafractional shifts. The latter determine the performance of the adapted dose distribution on the verification CBCT2 postadaptation.
RESULTS
Altogether 59 consecutive patients with tumors in the head-and-neck-area were treated from 01.12.2021 to 31.01.2023. Ten of all 59 patients (10/59; 16.9%) received at least one phase within a treatment course with ART. Of 46 fractions in the adaptive mode, irradiation was conducted in 65.2% of fractions with the adaptive-plan, the scheduled-plan in the remaining. The dispersion of the distributions of EUD-values from the 46 dose fractions differed significantly between the scheduled and adaptive plans (Ansari-Bradley-Test, p = 0.0158). Thus, the 2.5th percentile of the EUD-values by the adaptive plans amounted 97.1% (95% CI 96.6-99.5%) and by the scheduled plans 78.1% (95% CI 61.8-88.7%). While the EUD for the accumulated dose distributions stayed above 95% at PTV-margins of ≥ 3 mm for all 8 analyzed treatment phases the scheduled plans did for margins ≥ 5 mm. The intrafractional anatomic shifts of all 8 measured anatomic landmarks were smaller than the interfractional with overall median values of 8.5 mm and 5.5 mm (p < 0.0001 for five and p < 0.05 for all parameters, pairwise comparisons, signed-rank-test). The EUD-values for the larynx and the parotid gland were significantly lower for the adaptive compared with the scheduled plans (Wilcoxon-test, p < 0.001).
CONCLUSIONS
The mobile tongue and tongue base showed considerable interfractional variations. While PTV-margins of 5 mm were sufficient for IGRT, ART showed the potential of decreasing PTV-margins and spare dose to the organs-at-risk.
Topics: Humans; Radiotherapy Planning, Computer-Assisted; Head and Neck Neoplasms; Radiotherapy, Image-Guided; Head; Neck
PubMed: 38191400
DOI: 10.1186/s13014-023-02390-6