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Malignant Parotid Tumor

Cancer of the Parotid Gland

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.


Presentation

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.

Asymptomatic
  • ., director of Johns Hopkins Department of Otolaryngology-Head and Neck Surgery discusses a case of a parotid tumor that presented as an asymptomatic mass and was confirmed as a malignant neoplasm (T1 NO tumor) with a fine needle aspiration biopsy.[clinicalconnection.hopkinsmedicine.org]
  • 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.[symptoma.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]
  • Saw D, Ho JH, Lau WH, Chan J (1986) Parotid swelling as the first manifestation of nasopharyngeal carcinoma: a report of two cases. Eur J Surg Oncol 12:71–75 PubMed Google Scholar 129.[link.springer.com]
Parotid Mass
  • FNAC of palpable lymph node is mandatory for parotid mass where FNAC of parotid is inconclusive.[jhrr.org]
  • Location parotid gland : 70% minor salivary glands (including sublingual): 22% with the palate being most frequent (see: minor salivary gland tumors ) submandibular gland : 8% Overall 80% of all parotid masses are benign and the majority of these are[radiopaedia.org]
  • A head and neck CT scan showed a 39 29 mm 2 parotid mass, extending to the deep lobe without associated adenopathies.[elsevier.es]
  • Tumor distribution (Perez 5th edition): Parotid gland 70% Submandibular gland 8% Minor salivary glands 22% Histology [ edit ] 75% of parotid masses are benign Low grade tumors of the parotid: acinic cell, low grade mucoepidermoid High grade tumors of[en.wikibooks.org]
Dry Eyes
  • No history of fever, excessive salivation, or dry eyes. On examination, a single nontender, firm-to-hard swelling present in the right parotid region. Clinically, there was no evidence of cervical lymphadenopathy.[jhrr.org]
Meningism
  • A clinicopathologic review of 18 cases and comparison to meningeal hemangiopericytomas [11] M. Fusconi, A. Ciofalo, A. Greco, G. Pulice, M. Macci, M.[elsevier.es]

Workup

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]

Treatment

  • , guidelines, discoveries in your fields of interest; be notified You are informed about innovative treatments, techniques and innovations in medicine This video is limited to doctors and other health professionals.[medtube.net]
  • Armstrong JG, Harrison LB, Thaler HT, Friedlander-Klar H, Fass DE, Zelefsky MJ, et al: The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer 1992;69:615-619.[karger.com]
  • When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial.[medicinenet.com]
  • A search for spread to regional nodes or distant metastases in the lung, liver, bone, or brain may be indicated before treatment is selected. Surgery, sometimes plus radiation therapy Treatment of benign tumors is surgery.[merckmanuals.com]
  • […] decisions challenging for the treatment team.[enttoday.org]

Prognosis

  • Patients with high-grade tumors frequently experienced distant metastases and prognosis was poor. KEYWORDS: Malignant parotid tumor; Postoperative radiotherapy; Surgery; WHO classification[ncbi.nlm.nih.gov]
  • 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).[symptoma.com]
  • Conley J, Hamaker RC (1975) Prognosis of malignant tumors of the parotid gland with facial paralysis. Arch Otolaryngol 101: 39–41 Google Scholar 4. Eneroth CM (1972) Facial nerve paralysis: a criterion of malignancy in parotid tumors.[link.springer.com]
  • The news has left many people with questions about this type of cancer, its actual location, and, of course, its prognosis.[everydayhealth.com]
  • Adenoid cystic carcinoma (ACC) is slow-growing but persistent, leading to relatively favorable short-term prognosis but a poor prognosis beyond 10 years due to common late recurrences. ACC tumors tend to metastasize to the lungs.[enttoday.org]

Etiology

  • 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.[symptoma.com]

Epidemiology

  • They utilized the Surveillance, Epidemiology and End Results (SEER) database from 1973–2009 to get a sufficient pediatric cohort. The SEER database includes data on patients …[aapgrandrounds.aappublications.org]
  • Through this observation and review of the literature, we discuss the epidemiological, clinical and histological aspects of malignant tumors of the parotid gland.[omicsonline.org]
  • A 1999 epidemiologic study from Alabama found mucoepidermoid carcinomas to be the most frequent malignancy. 5 These tumors develop most often in the parotid glands, and can vary from low- to high-grade.[enttoday.org]
  • Scholar Li N, Xu L, Zhao H, El-Naggar AK, Sturgis EM (2011) A comparison of the demographics, clinical features, and survival of patients with adenoid cystic carcinoma of major and minor salivary glands versus less common sites within the Surveillance, Epidemiology[link.springer.com]
  • Next, among suspected non-PA cases, WT and non-WT cases were distinguished by evaluation of epidemiology and subsequent 99m Tc pertechnetate scintigraphy.[journals.plos.org]
Sex distribution
Age distribution

Prevention

  • The parotid gland was removed totally with prevention of injury to the facial nerve. Postoperative permanent sections of the tumor showed well-differentiated squamous cell carcinoma.[jstage.jst.go.jp]
  • They acknowledge that this prevents them from reaching a "definitive conclusion about the effect of cellular phone usage." A second anomaly is that rural residents had a lower risk than those in the city, the opposite of what Sadetzki reported.[microwavenews.com]
  • Prevention If you’re playing any contact sports, wearing a mouthguard can help protect your teeth from injury and trauma.[colgate.com]
  • Thus, parotid gland removal of the tumor, or parotid surgery, and close monitoring is absolutely necessary in order to prevent a more serious problem from developing.[parotidsurgerymd.com]
  • Saliva also helps to defend against bacteria and prevent cavities. Diseases of the Parotid Gland There are several types of medical conditions which can affect the salivary gland, from stones to tumors. Let's look at each of these separately.[verywell.com]

References

Article

  1. 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.
  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.

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Last updated: 2019-06-28 10:32