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R E S E A R C H
SUMMARY:
Salivary gland tumors are rare, generally benign and affect mainly the parotid gland. Their
diagnosis and management is complicated by their relative infrequency, the limited amount
of pre-treatment information available and the wide range of biologic behavior seen with the
different pathologic lesions. The purpose of this study was to retrospectively analyze all
cases of parotid tumors treated in ENT Department Timioara from 2002 to 2009. 104 cases
of parotid tumors were selected; 78 were benign and 26 were malignant. Pleomorphic
adenoma was the most common benign tumor. The most frequent malignant tumors were
the mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma, in the same
proportion. Therapy in most cases consisted of parotidectomy. Adjuvant therapy mainly
radiotherapy was used in some cases with malignancies and in one patient was the only
therapy that the patient received. Parotid gland tumor pathology represent an important
chapter of ENT surgical pathology. The parotid gland give rise to a surprising variety of
benign and malign tumors, the pathologic diagnosis is the key for these lesions
management. Treatment often includes surgical resection as the primary modality for
benign and malignant lesions.
Key Words: parotid gland, benign tumor, malignant tumor, parotidectomy
TUMORILE GLANDEI PAROTIDE - EXPERIENA CLINICII ORL TIMIOARA
Rezumat:
Tumorile glandelor salivare sunt rare, n general benigne i afecteaz n special glanda
parotid. Diagnosticul i tratamentul lor este complicat datorit frecvenei lor sczute,
informaiilor preoperatorii limitate i modificrilor biologice foarte variate ntlnite n
diversele leziuni histopatologice. Scopul acestui studiu a fost o analiz retrospectiv a
tuturor cazurilor cu tumori parotidiene tratate n Clinica ORL Timioara ntre anii 2002-2009.
Au fost selectate 104 cazuri cu tumori parotidiene; 78 de cazuri au fost benigne i 26 de
cazuri au fost maligne. Cea mai frecvent tumor benign a fost adenomul pleomorf. Cele
mai frecvente tumori maligne au fost carcinomul mucoepidermoid i carcinomul ex adenom
pleomorf, ntlnite n aceeai msur. Tratamentul n cele mai multe cazuri a fost
parotidectomia. Tratamentul adjuvant, n special radioterapia s-a folosit la unele cazuri cu
tumori maligne, iar la un pacient a reprezentat singura terapie pe care acesta a urmat-o.
Patologia tumoral a glandei parotide reprezint un capitol important n patologia
chirurgical ORL. Glanda parotid poate genera o varietate mare de tumori benigne i
maligne, unde diagnosticul histopatologic este cheia pentru managementul acestor leziuni.
Cuvinte-cheie: glanda parotid, tumor benign, tumor malign, parotidectomie
Correspondence to: Dr. Anamaria Mag, Clinica ORL Timioara, Bd. Revoluiei No. 6, Telefon: 0740 43 47 40,
Email: anamariamag@yahoo.com
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INTRODUCTION
The salivary glands neoplasms are rare and represent
a variable group of benign and malign tumors with
different behavioral characteristics. Classification of
salivary gland tumors is based on morphology, and these
tumors represent the most histologically heterogeneous
group of tumors of any tissue in the body, which adds to
the complexity of diagnosis and treatment planning (1,2).
The salivary glands neoplasms represents approximately
1-3% of the head and neck tumors (3). Despite the
incidences vary according to the literature, 67,7% to 84%
of the neoplasms start in the parotid gland (4,5,6).
In the evaluation of parotid gland tumors, the
importance of a thorough history and comprehensive
examination of the head and neck is critical. Parotid gland
tumors shows a high histologic heterogenity and
diversity, and this is the reason it requires a pathologist
with experience to obtain a histopathological diagnosis of
confidence for optimal treatment of the patient.
In the parotid gland, the most common histological
subtype is the pleomorphic adenoma (53,3%), followed
by the Warthins tumor (28,3%) and by the
mucoepidermoid carcinoma (9%) (7).
Surgical treatment is the treatment of choice in parotid
gland tumors (2).
RESULTS
Clinical features
Number
Hard consistency
72
Rapid growth
48
Deep fixation
32
Pain
19
Palpable nodes
Skin involvement
260
Histopathological diagnosis
Nr. of
cases
Pleomorphic adenoma
53
Warthins tumor
22
Hemangioendotelioma
Mucoepidermoid carcinoma
Carcinoma
adenoma
Surgical intervention
No.
Pts.
Limited excision
15
Superficial parotidectomy
58
24
Total
parotidectomy
submaxillectomy
with
4
3
Extensive
parotidectomy
sacrification of facial nerve
Adenocarcinoma NOS
Squamocell carcinoma
Total
ex
pleomorphic
with
103
Postoperative complications
No. Pts.
11
Freysyndrome
Seroma
Salivary fistula
Wound dehiscence
DISCUSSIONS
Salivary gland tumors consist of a group of
heterogeneous lesions with complex clinicopathological
characteristics and distinct biological behaviors (9).
These tumors represents about 3% of all neoplasms of the
head and neck (10). Diagnosis and management is
complicated by the relative infrequency, the limited
amount of pre-treatment information available and the
wide range of biologic behavior seen with the different
pathologic lesions (11).
About 64 to 80% of all salivary gland epithelial tumors
involve the parotid gland, mostly located in the superficial
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lobe (3). Most studies show that the mean age is higher
in malignant tumors (about 55 years) compared to benign
tumors (about 45 years) (4,12). Our results confirm these
findings; the mean age in our study was 47,12 years for
benign tumors and 58,30 years for malignancies. There
was a slight overall female predominance, with a male to
female ratio of 1:1.12. This finding is different from other
reports (13,14). But the reports of our study is similar to
others as far as an association between the male sex and
malignant neoplasms and the female sex and benign
neoplasms is concerned (15).
Pathology of the parotid gland has been reviewed
extensively due to the high cost of the surgical morbidity
of facial nerve paresis or paralysis. Proper diagnostic
evaluation should always include a thorough history and
physical examination with consideration of facial nerve
function, onset of disease and identification of associated
lymph node metastasis. The main complaint of patients
with parotid tumor was a lump in the parotid area. In six
cases when parotid tumor arised from the deep lobe of
the gland, the tumor was bulging the lateral wall of the
oropharynx. 72% of patients with malignant tumors
manifested signs of malignancy, such as pain, facial
nerve damage, no mobility, involvement of skin,
increased parotid volume and lymphadenopathy.
In establishing an accurate diagnosis are useful
imaging and laboratory examinations such as:
sonography and Color Doppler ultrasound; contrast
enhanced CT and MRI; fine needle aspiration biopsy
FNA; frozen section; examination slide in paraffin (from
excised piece). Ultrasonography can be used to aid in
core needle biopsy in the diagnosis of parotid tumors
(16). King et al. advocate the use of proton magnetic
resonance (MR) spectroscopy for evaluation of salivary
gland tumors. They noted a significant difference in MR
spectroscopy of benign and malignant lesions (17). FNA
remains the most common preoperative intervention to
distinguish histologic pathology. In a recent article from
New Zeeland, sensitivity and specificity of benign lesions
were noted to be 85% and 97%, respectively. However,
the specificity of malignant lesions was only 85% (18).
Cohen et al. report a slightly lower sensitivity of 73% for
malignant lesions and a similar specificity of 87% (19).
Correct diagnosis is confirmed only by histopathology in
paraffin, sometimes there need for additional
immunohistochemical investigation for a final diagnosis
of certainty.
The pleomorphic adenoma and Warthins tumor are
the most common benign tumors (4). Our data show that
the pleomorphic adenoma and Warthins tumor
comprised 67,94% and 28,20% of cases each. The
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CONCLUSIONS
Parotid gland tumor pathology represents an important
chapter of ENT surgical pathology.
A deep knowledge of the anatomy and physiology of
parotid gland is required for a suitable clinical and
surgical approach.
The parotid gland give rice to a surprising variety of
benign and malign tumors, where the pathologic
diagnosis is the key for these lesions management.
Treatment often includes surgical resection as the
primary modality for benign and malignant lesions.
Treatment of the neck, including neck dissection and
radiotherapy, should be considered in all high-grade
malignancies or malignancies with clinical nodal disease.
Postoperative radiation therapy is indicated in patients
with advanced, recurrent or high-risk disease and in
patients with high-grade tumors. Chemotherapy plays a
limited role, but it may be indicated in patients with
distant metastases or inoperable malignancies.
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