Tumors of the parotid gland constitute about 80% of all salivary gland tumors, which are rarely encountered in clinical practice [1] [2]. Approximately 20% of all tumors are malignant in nature, with numerous subtypes are described in the literature [1] [2]. 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 [1] [3] [4]. In addition, recurrences of previously resected tumors constitute a small, but significant proportion of malignant parotid tumors [1]. 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 [1] [4] [5]. 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 [2]. Malignant parotid tumors are generally described as slow-growing lesions, (which may result in an insidious clinical course) [2], and a small, well-defined, and mobile lump can be identified as the only finding [6]. In more aggressive forms, the mass grows rapidly and produces symptoms such as pain, facial paralysis (due to facial nerve palsy), and proximal lymphadenopathy [3] [5] [6]. Because metastatic spread of tumors, particularly into the lungs [2], are a known complication of malignant parotid tumors, their early recognition is vital.

• Rigor

  2016 Number of Print Pages: 12 Number of Figures: 4 Number of Tables: 0 ISBN: 978-3-318-05801-7 (Print) eISBN: 978-3-318-05802-4 (Online) Abstract The successful treatment of salivary gland malignancies originating in the parotid gland begins with rigorous [karger.com]

• Vascular Disease

  Nonneoplastic causes of parotid enlargement include cysts, parotitis, lymphoepithelial lesions associated with AIDS, collagen vascular diseases, and benign hypertrophy. [emedicine.medscape.com]

• 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. [7] 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]

• 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) [2]. 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 [1] [6] [7]. 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 [1] [6] [7]. 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 [1] [6] [7]. Thus, a post-operative examination of the tumor through a histopathological evaluation is considered to be a definite diagnostic measure [1].

• Multiple Pulmonary Nodules

  On further workup, a chest CT scan revealed multiple pulmonary nodules ranging from 3 to 44 mm, compatible with metastatic disease; these are biopsied, showing similar morphology and immunophenotype to the parotid lesion. [elsevier.es]

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2. Ho K, Lin H, Ann DK, Chu PG, Yen Y. An overview of the rare parotid gland cancer. Head Neck Oncol. 2011;3:40.
3. Godge P, Sharma S, Yadav M. Adenoid cystic carcinoma of the parotid gland. Contemp Clin Dent. 2012;3(2):223-226.
4. Huang CC, Tseng FY, Chen ZC, et al. Malignant parotid tumor and facial palsy. Otolaryngol Head Neck Surg. 2007;136(5):778-782.
5. Mlika M, Kourda N, Zidi Y, et al. Salivary duct carcinoma of the parotid gland. J Oral Maxillofac Pathol. 2012;16(1):134-136.
6. 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.
7. Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol 2008;66:419–436.