Numerous types of malignant parotid tumors are seen, the most common being adenoid cystic carcinoma, mucoepidermoid carcinoma, squamous cell carcinoma, and acinic cell carcinoma. A growing mass is the main symptom, sometimes accompanied by facial nerve palsy and associated pain, but in the majority of cases, an asymptomatic course is observed until the tumor reaches an advanced stage. The initial diagnosis is made through a physical examination, whereas imaging studies, and a histopathological exam (either preoperative or postoperative) are recommended for confirming the exact etiology.
Tumors of the parotid gland constitute about 80% of all salivary gland tumors, which are rarely encountered in clinical practice  . Approximately 20% of all tumors are malignant in nature, with numerous subtypes are described in the literature  . Adenoid cyst carcinoma, squamous cell carcinoma, mucoepidermoid carcinoma, acinic cell carcinoma, as well as lymphomas and mixed tumors are the main types of primary malignant parotid tumors   . In addition, recurrences of previously resected tumors constitute a small, but significant proportion of malignant parotid tumors . These malignancies are encountered at the end of the sixth and the beginning of the seventh decade (mean onset around 60 years of age), with no gender predilection   . Several risk factors have been attributed to the pathogenesis, such as cigarette smoking and alcohol, but the exposure to high doses of ionizing radiation is the only definite risk factor . Malignant parotid tumors are generally described as slow-growing lesions, (which may result in an insidious clinical course) , and a small, well-defined, and mobile lump can be identified as the only finding . In more aggressive forms, the mass grows rapidly and produces symptoms such as pain, facial paralysis (due to facial nerve palsy), and proximal lymphadenopathy   . Because metastatic spread of tumors, particularly into the lungs , are a known complication of malignant parotid tumors, their early recognition is vital.
Entire Body System
Jaw & Teeth
- Parotid Mass
FNAC of palpable lymph node is mandatory for parotid mass where FNAC of parotid is inconclusive. [jhrr.org]
In the second report, a 60-year-old female patient presented a 5 cm parotid mass with four microscopic patterns: undifferentiated carcinoma, undifferentiated sarcoma, osteosarcoma and malignant giant cell tumor (8). [scielo.br]
Parotid Mass Removal Here the parotid mass is about to be completely removed (being held up by the clamp). This part of the procedure takes about 5-10 minutes to perform. [fauquierent.net]
Approximately 25% of parotid masses are nonneoplastic; the remaining 75% are neoplastic. [emedicine.medscape.com]
- Parotid Swelling
A 10-year-old boy visited our hospital with a parotid swelling on the right side. [jstage.jst.go.jp]
There is an increased incidence of development of carcinomas and malignant lymphomas following benign lymphoepithelial lesion.  If the parotid swelling is diagnosed as chronic sialadenitis based on FNAC report, Doppler scan with USG-guided FNAC has [jhrr.org]
The reason for consultation is conventional: It is at the beginning of a painless parotid swelling, progressively extensive. In our observation, the swelling was ulceronercotic and surinfected due to delayed diagnosis. [omicsonline.org]
A 43 year-old woman was referred to our Department presenting with a 4 years history of right parotid swelling. The tumor was solid in consistency, had slowly increased in size until 2 cm in its greatest dimension and was mildly painful. [bjorl.org]
From a clinical point of view, it is easier to consider the presentation of either diffuse parotid swelling or a mass within the region of the parotid. [surgwiki.com]
Face, Head & Neck
- Neck Mass
Most tumours present as a painless neck mass. [surgwiki.com]
During hospitalization, the neck mass rapidly increased in size with ulceration and severe bleeding. The patient evolved with anemia, hypoalbuminemia and renal failure, and eventually died four months after surgery. [scielo.br]
Our patient had no sudden painful increase in neck mass size or any signs of facial weakness. [tmj.ro]
The physician plays a crucial role in identifying malignant parotid tumors in its early stages, which could lead to a very good prognosis (5-year survival rates of tumors in stages I and II are 96% and 77%, respectively) . For this reason, a thorough patient history that evaluates the presence of associated complaints and their duration, together with a meticulous physical exam that includes palpation of the parotid glands, are essential steps for raising clinical suspicion. After a nondisclosed mass is observed in the parotid gland, imaging studies should be ordered as soon as possible. Ultrasonography (US) is a reliable first-line method that can detect a mass and determine its basic characteristics, particularly if the mass is located in the superior lobe of the parotid gland   . If inconclusive findings are obtained during the US, computed tomography (CT) or magnetic resonance imaging (MRI) might be employed for a better delineation of the lesion   . The use of a preoperative biopsy is still a matter of debate when it comes to malignant parotid tumors. Some authors advocate the use of a fine-needle aspiration biopsy (FNAB), or even an open biopsy, but both procedures carry a high risk of tumor seeding into the adjacent tissues   . Thus, a post-operative examination of the tumor through a histopathological evaluation is considered to be a definite diagnostic measure .
- Bussu F, Parrilla C, Rizzo D, Almadori G, Paludetti G, Galli J. Clinical approach and treatment of benign and malignant parotid masses, personal experience. Acta Otorhinolaryngologica Italica. 2011;31(3):135-143.
- Ho K, Lin H, Ann DK, Chu PG, Yen Y. An overview of the rare parotid gland cancer. Head Neck Oncol. 2011;3:40.
- Godge P, Sharma S, Yadav M. Adenoid cystic carcinoma of the parotid gland. Contemp Clin Dent. 2012;3(2):223-226.
- Huang CC, Tseng FY, Chen ZC, et al. Malignant parotid tumor and facial palsy. Otolaryngol Head Neck Surg. 2007;136(5):778-782.
- Mlika M, Kourda N, Zidi Y, et al. Salivary duct carcinoma of the parotid gland. J Oral Maxillofac Pathol. 2012;16(1):134-136.
- Sood S, McGurk M, Vaz F. Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(Suppl 2): S142-S149.
- Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol 2008;66:419–436.