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The Journal of Investigative Dermatology Jul 2019Cutaneous squamous cell carcinoma from the head and neck typically metastasize to the lymph nodes of the neck and parotid glands. When a primary is not identified, they...
Cutaneous squamous cell carcinoma from the head and neck typically metastasize to the lymph nodes of the neck and parotid glands. When a primary is not identified, they are difficult to distinguish from metastases of mucosal origin and primary salivary gland squamous cell carcinoma. UV radiation causes a mutation pattern that predominantly features cytosine to thymine transitions at dipyrimidine sites and has been associated with cutaneous squamous cell carcinoma. In this study, we used whole genome sequencing data from 15 cutaneous squamous cell carcinoma metastases and show that a UV mutation signature is pervasive across the cohort and distinct from mucosal squamous cell carcinoma. The mutational burden was exceptionally high and concentrated in some regions of the genome, especially insulator elements (mean 162 mutations/megabase). We therefore evaluated the likely impact of UV-induced mutations on the dipyrimidine-rich binding site of the main human insulator protein, CCCTC-binding factor, and the possible implications on CCCTC-binding factor function and the spatial organization of the genome. Our findings suggest that mutation signature analysis may be useful in determining the origin of metastases in the neck and the parotid gland. Furthermore, UV-induced DNA damage to insulator binding sites may play a role in the carcinogenesis and progression of cutaneous squamous cell carcinoma.
Topics: Adult; Aged; CCCTC-Binding Factor; Carcinoma, Squamous Cell; Cohort Studies; DNA Mutational Analysis; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Mutation; Neoplasm Metastasis; Parotid Neoplasms; Skin Neoplasms; Ultraviolet Rays; Whole Genome Sequencing
PubMed: 30684551
DOI: 10.1016/j.jid.2019.01.008 -
Head and Neck Pathology Dec 2021Low-grade intraductal carcinoma is a rare neoplasia with an excellent prognosis, previously classified as low-grade cribriform cystadenocarcinoma and low-grade salivary... (Review)
Review
Low-grade intraductal carcinoma is a rare neoplasia with an excellent prognosis, previously classified as low-grade cribriform cystadenocarcinoma and low-grade salivary duct carcinoma. The tumor mainly occurs in the parotid gland and presents a ductal phenotype and an intraductal/intracystic growth pattern. It resembles intraductal breast lesions such as atypical ductal hyperplasia, papillary and cribriform ductal carcinoma in situ. Despite its infrequency, discriminating low-grade intraductal carcinoma from other salivary gland tumors is crucial, especially because of its favorable prognosis. A 74-year-old woman with a history of neurofibromatosis underwent a superficial parotidectomy to remove a sharply demarcated multi-cystic mass, diagnosed as category 4 at FNAC. The histological examination revealed a demarcated but unencapsulated lesion composed of a bigger cyst surrounded by several smaller cysts, lined by a monolayer or bilayer epithelium alternated with a cribriform proliferation, characterized by "Roman-bridges", with occasional micro-papillae. A myoepithelial component, with a basal disposition, was present, confirmed by intense staining for protein p63 and SMA. Immunohistochemical stains showed intense, strong uniform positivity for pan-cytokeratin, protein S100, and SOX10. The Ki67 proliferation index was low (< 10%). A diagnosis of Low-grade Intraductal Carcinoma (LGIC) of the parotid was made. We performed a literature search in PUBMED for "Intraductal carcinoma", "Low-grade Intraductal Carcinoma", "Cribriform Cystadenocarcinoma", "Salivary Duct Carcinoma", and "Low-Grade Salivary Duct Carcinoma". We selected 17 papers published between 1983 and 2020; the most affected anatomical site was the parotid gland (77/90), followed by minor salivary glands (6/90), the intraparotid lymph nodes (3/90) and the submandibular gland (4/90). Their main histopathological features are reported in the paper. Here we present a case report and a review of scientific literature on this topic to provide some essential diagnostic tools to discriminate this rare entity.
Topics: Aged; Biomarkers, Tumor; Biopsy, Fine-Needle; Carcinoma, Ductal; Diagnosis, Differential; Female; Humans; Neoplasm Grading; Parotid Neoplasms; Tomography, X-Ray Computed
PubMed: 33501556
DOI: 10.1007/s12105-021-01290-z -
Journal of Global Oncology Sep 2018This meta-analysis aimed to review the published outcomes of parotid non-Hodgkin lymphoma (NHL) pertaining to different treatment modalities. (Meta-Analysis)
Meta-Analysis
PURPOSE
This meta-analysis aimed to review the published outcomes of parotid non-Hodgkin lymphoma (NHL) pertaining to different treatment modalities.
MATERIALS AND METHODS
A total of 48 journal articles published between 1993 and 2015, comprising 742 cases of parotid NHL, were initially evaluated. In total, 108 patients from 12 studies who had sufficient data for analysis, including age, tumor histopathology, treatment modality, and outcome at final follow-up, were included. Patients were randomly assigned to different categories on the basis of histopathology and treatment modality. Groups were compared using Kaplan-Meier survival curve analysis and the Mann-Whitney U test.
RESULTS
Log-rank tests demonstrated that for early-stage (I and II) parotid NHL of all histopathology variants, radiation therapy significantly improved the survival rate versus chemotherapy ( P = .043), as well as combined treatment with chemotherapy and radiation therapy ( P = .023). For early-stage diffuse large B-cell lymphoma, combined treatment significantly improved survival versus single treatment ( P = .028). No treatment was received by seven patients with early-stage mucosa-associated lymphoid tissue lymphoma after undergoing parotidectomy. When the clinical outcomes of these patients were compared with those of other patients with the same histology who underwent further treatment, no significant differences were noted in survival outcomes.
CONCLUSION
Radiation therapy seems to be a valid treatment of early-stage parotid NHL. However, for diffuse large B-cell lymphoma, survival was higher with combined treatment versus single treatment. For early-stage parotid mucosa-associated lymphoid tissue lymphoma, complete excision of the tumor through superficial parotidectomy may have similar survival outcome.
Topics: Female; Humans; Lymphoma, Non-Hodgkin; Middle Aged; Parotid Neoplasms; Survival Analysis
PubMed: 30241143
DOI: 10.1200/JGO.17.00071 -
Journal of Otolaryngology - Head & Neck... Nov 2019Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction...
BACKGROUND
Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.
METHODS
A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.
RESULTS
There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.
CONCLUSIONS
There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.
Topics: Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Parotid Neoplasms; Patient Readmission; Postoperative Complications; Plastic Surgery Procedures; Reoperation; Retrospective Studies; United States
PubMed: 31744535
DOI: 10.1186/s40463-019-0387-y -
Oral and Maxillofacial Surgery Sep 2021Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous cell...
PURPOSE
Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous cell carcinomas (CSCC) of the head and neck area. The aim of this study was to analyse and compare the clinical behaviour of primary as well as CSCC metastatic parotid cancers with special emphasis on therapy and oncologic outcome.
METHODS
Clinical and histopathological data of 342 patients with parotid gland malignomas surgically treated in a tertiary referral centre between 1987 and 2015 were retrospectively assessed. Oncologic outcomes of all cases with CSCC metastasis of the parotid gland (n = 49) were compared to those of primary parotid gland carcinomas (n = 293).
RESULTS
Mean age at diagnosis was 72.3 years for CSCC patients versus 56.8 years in patients with primary parotid carcinoma. A total of 83.7% of CSCC patients were male, compared to 48.8% in the group of primary carcinomas. Forty-five out of 49 CSCC patients underwent total parotidectomy and neck dissection (91.8%). A total of 93.9% out of all CSCC patients received adjuvant radiotherapy. Five-year overall survival (OS) was 32.6% in CSCC patients versus 77.2% in primary parotid carcinoma patients.
CONCLUSION
As compared to primary parotid cancers, we could show that patients suffering from CSCC metastases to the parotid gland presented with significantly higher age and worse survival.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Male; Neoplasm Staging; Parotid Gland; Parotid Neoplasms; Retrospective Studies; Skin Neoplasms; Squamous Cell Carcinoma of Head and Neck
PubMed: 33400041
DOI: 10.1007/s10006-020-00934-8 -
International Journal of Molecular... Jul 2021Salivary gland cancers are rare but aggressive tumors that have poor prognosis and lack effective cure. Of those, parotid tumors constitute the majority. Functioning as...
Salivary gland cancers are rare but aggressive tumors that have poor prognosis and lack effective cure. Of those, parotid tumors constitute the majority. Functioning as metabolic machinery contributing to cellular redox balance, peroxisomes have emerged as crucial players in tumorigenesis. Studies on murine and human cells have examined the role of peroxisomes in carcinogenesis with conflicting results. These studies either examined the consequences of altered peroxisomal proliferators or compared their expression in healthy and neoplastic tissues. None, however, examined such differences exclusively in human parotid tissue or extended comparison to peroxisomal proteins and their associated gene expressions. Therefore, we examined differences in peroxisomal dynamics in parotid tumors of different morphologies. Using immunofluorescence and quantitative PCR, we compared the expression levels of key peroxisomal enzymes and proliferators in healthy and neoplastic parotid tissue samples. Three parotid tumor subtypes were examined: pleomorphic adenoma, mucoepidermoid carcinoma and acinic cell carcinoma. We observed higher expression of peroxisomal matrix proteins in neoplastic samples with exceptional down regulation of certain enzymes; however, the degree of expression varied between tumor subtypes. Our findings confirm previous experimental results on other organ tissues and suggest peroxisomes as possible therapeutic targets or markers in all or certain subtypes of parotid neoplasms.
Topics: Adenoma, Pleomorphic; Carcinoma, Acinar Cell; Carcinoma, Mucoepidermoid; Case-Control Studies; Humans; Neoplasm Proteins; Parotid Gland; Parotid Neoplasms; Peroxisome Proliferator-Activated Receptors; Peroxisomes
PubMed: 34360635
DOI: 10.3390/ijms22157872 -
Head & Neck Sep 2021Resection of parotid carcinomas involving the parapharyngeal space is challenging. How this affects tumor margin control, recurrence, and survival is unclear.
BACKGROUND
Resection of parotid carcinomas involving the parapharyngeal space is challenging. How this affects tumor margin control, recurrence, and survival is unclear.
METHODS
Patients who underwent resection of parotid carcinomas between 1985 and 2015 at Memorial Sloan Kettering Cancer Center were evaluated for the impact of parapharyngeal extension (PPE) on margin status, local recurrence-free probability (LRFP), and disease-specific survival (DSS).
RESULTS
Out of 214 patients in whom preoperative imaging was available for review, 22 (10.3%) had PPE. Matched by histotypes, carcinomas with PPE had comparable margin positivity (p = 0.479), T classification (p = 0.316), pathologic risk (p = 0.936), and adjuvant therapy (p = 0.617) to those without PPE. The 3-year LRFP was 88.9% versus 95.4% (hazard ratio [HR] 2.23 after adjusting for pT classification, p = 0.342) and the 5-year DSS was 74.2% versus 69.5% (adjusted HR 0.45, p = 0.232) in patients with and without PPE.
CONCLUSION
PPE does not appear to worsen oncologic outcomes in the resection of parotid carcinomas.
Topics: Carcinoma; Humans; Margins of Excision; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Neoplasms; Retrospective Studies
PubMed: 33931905
DOI: 10.1002/hed.26730 -
Medicine Jun 2018To analyze the superiority of wait-and-see policy and elective neck dissection in treating cN0 patients with facial cutaneous cell carcinoma (cSCC).Patients with... (Comparative Study)
Comparative Study Observational Study
To analyze the superiority of wait-and-see policy and elective neck dissection in treating cN0 patients with facial cutaneous cell carcinoma (cSCC).Patients with clinically negative parotid and neck metastasis disease were prospectively enrolled. Three groups were divided based on whether the patient received an operation of superficial parotidectomy or/and elective dissection, and regional control and disease-specific survival rates were compared.The occult parotid and neck metastasis rate was 20% and 16%, respectively. There was neck node metastasis without parotid metastasis in only 1 patient. All the node metastasis occurred in level II. Regional recurrence was noted in 16 (16%) patients, and 6 patients died of the disease. In the group undergoing superficial parotidectomy and elective neck dissection, 2 patients had neck node metastasis, and there was no disease-related death, further survival analysis indicated it had better regional control and disease-specific survival rates compared with the other 2 groups.Superficial parotidectomy and elective neck dissection are suggested for patients with T3-4 facial cutaneous squamous cell carcinoma.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Elective Surgical Procedures; Facial Neoplasms; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Gland; Parotid Neoplasms; Prospective Studies; Radiotherapy, Adjuvant; Retrospective Studies; Skin Neoplasms; Survival Analysis
PubMed: 29851784
DOI: 10.1097/MD.0000000000010782 -
Ear, Nose, & Throat Journal Aug 2022A case of primary first bite syndrome (FBS), diagnosed in a patient with nonspecific adenocarcinoma of the deep lobe of the parotid gland. (Review)
Review
OBJECTIVE
A case of primary first bite syndrome (FBS), diagnosed in a patient with nonspecific adenocarcinoma of the deep lobe of the parotid gland.
DATA SOURCES
A Medline literature search was conducted on PubMed, using the keywords "first bite syndrome."
REVIEW METHODS
Using primary FBS and existence of a definite etiology as inclusion criteria.
RESULTS
We report on an unusual case of primary FBS, which had no surgical history. After multiple examinations, the pain was localized to a mass in the deep lobe of the parotid gland. After tumorectomy, the FBS pain was significantly relieved. The postoperative pathological examination determined that the excised mass was a nonspecific adenocarcinoma. Reviewing the literature, we found that primary FBS was mostly caused by malignant tumors in the inferior temporal fossa, the deep lobe of the parotid gland, and (or) the parapharyngeal space. Surgery was reported to be an effective treatment.
CONCLUSION
The case highlights the critical importance of identifying the etiology of primary FBS. When manifested with a primary FBS, malignant tumors must be high on the differential diagnosis list, especially those in the region of the inferior temporal fossa, the deep lobe of the parotid gland, and the parapharyngeal space.
Topics: Adenocarcinoma; Humans; Mastication; Pain; Parotid Gland; Parotid Neoplasms; Syndrome
PubMed: 33023340
DOI: 10.1177/0145561320962584 -
The Laryngoscope Feb 2023To design a deep learning model based on multimodal magnetic resonance image (MRI) sequences for automatic parotid neoplasm classification, and to improve the diagnostic...
OBJECTIVE
To design a deep learning model based on multimodal magnetic resonance image (MRI) sequences for automatic parotid neoplasm classification, and to improve the diagnostic decision-making in clinical settings.
METHODS
First, multimodal MRI sequences were collected from 266 patients with parotid neoplasms, and an artificial intelligence (AI)-based deep learning model was designed from scratch, combining the image classification network of Resnet and the Transformer network of Natural language processing. Second, the effectiveness of the deep learning model was improved through the multi-modality fusion of MRI sequences, and the fusion strategy of various MRI sequences was optimized. In addition, we compared the effectiveness of the model in the parotid neoplasm classification with experienced radiologists.
RESULTS
The deep learning model delivered reliable outcomes in differentiating benign and malignant parotid neoplasms. The model, which was trained by the fusion of T2-weighted, postcontrast T1-weighted, and diffusion-weighted imaging (b = 1000 s/mm ), produced the best result, with an accuracy score of 0.85, an area under the receiver operator characteristic (ROC) curve of 0.96, a sensitivity score of 0.90, and a specificity score of 0.84. In addition, the multi-modal paradigm exhibited reliable outcomes in diagnosing the pleomorphic adenoma and the Warthin tumor, but not in the identification of the basal cell adenoma.
CONCLUSION
An accurate and efficient AI based classification model was produced to classify parotid neoplasms, resulting from the fusion of multimodal MRI sequences. The effectiveness certainly outperformed the model with single MRI images or single MRI sequences as input, and potentially, experienced radiologists.
LEVEL OF EVIDENCE
3 Laryngoscope, 133:327-335, 2023.
Topics: Humans; Parotid Neoplasms; Artificial Intelligence; Deep Learning; Sensitivity and Specificity; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 35575610
DOI: 10.1002/lary.30154