Parotid metastasis of rare lung adenocarcinoma:A case report

BACKGROUND Lung cancer(LC)is the leading cause of malignancy-related deaths worldwide.The most common sites of metastasis include the nervous system,bone,liver,respiratory system,and adrenal glands.LC metastasis in the parotid gland is very rare,and its diagnosis presents a challenge.Here,we report a case of parotid metastasis in primary LC.CASE SUMMARY The patient was a 74-year-old male who was discovered to have bilateral facial asymmetry inadvertently two years ago.The right earlobe was slightly swollen and without pain or numbness.Computed tomography(CT)examination showed bilateral lung space-occupying lesions.Pulmonary biopsy was performed and revealed adenocarcinoma(right-upper-lung nodule tissue).Positron emission tomography-CT examination showed:(1)Two hypermetabolic nodules in the right upper lobe of the lung,enlarged hy-permetabolic lymph nodes in the right hilar and mediastinum,and malignant space-occupying lesion in the right upper lobe of the lung and possible metastasis to the right hilar and mediastinal lymph nodes;and(2)multiple hypermetabolic nodules in bilateral parotid glands.Parotid puncture biopsy was performed considering lung adenocarcinoma metastasis.Gene detection of lung biopsy specimens revealed an EGFR gene 21 exon L858R mutation.CONCLUSION This case report highlights the challenging diagnosis of parotid metastasis in LC given its rare nature.Such lesions should be differentiated from primary tumors of the parotid gland.Simple radiological imaging is unreliable,and puncture biopsy is needed for final diagnosis of this condition.

Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix

BACKGROUND Frey syndrome,also known as ototemporal nerve syndrome or gustatory sweating syndrome,is one of the most common complications of parotid gland surgery.This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes,visual stimuli,or eating.AIM To investigate the preventive effect of acellular dermal matrix(ADM)on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.METHODS Retrospective data from 82 patients were analyzed to assess the correlation between sex,age,resection sample size,operation time,operation mode,ADM usage,and occurrence of postoperative Frey syndrome.RESULTS Among the 82 patients,the incidence of Frey syndrome was 56.1%.There were no significant differences in sex,age,or operation time between the two groups(P>0.05).However,there was a significant difference between ADM implantation and occurrence of Frey syndrome(P<0.05).ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.CONCLUSION ADM can effectively prevent Frey syndrome and delay its onset.

Benign lymphoepithelial cyst of parotid gland without human immunodeficiency virus infection:A case report

BACKGROUND Benign lymphoepithelial cyst(BLEC)of the parotid gland is a rare benign embryonic-dysplastic cystic tumor in the anterolateral neck that occurs most commonly in human immunodeficiency virus(HIV)-positive adults and rarely in non-acquired immune deficiency syndrome patients.The main presentation is a slow-growing,painless mass,and secondary infection may cause acute inflammatory symptoms.CASE SUMMARY A 44-year-old Chinese male patient presented with a 1-year history of a mass in the left side of the neck.On physical examination,a mass similar in size and shape to a quail egg was found in the left parotid gland.The mass was tough,without tenderness,and easily moveable.The results of HIV tests,including antibody and nucleic acid tests and CD4+T cell examination,were negative.Imaging examination revealed a left parotid gland mass.The patient underwent surgical treatment,and BLEC was diagnosed based on postoperative pathology.After 2years of follow-up,the patient survived well without related discomfort.CONCLUSION The detailed characteristics of a BLEC in a patient without HIV infection contribute to an improved understanding of this rare disease.

Removal of unexpected schwannoma with superficial parotidectomy using modified-Blair incision and superficial musculoaponeurotic system folding: A case report

BACKGROUND When a firm facial mass in the cheek region is associated with a high index of clinical suspicion of its being of parotid gland origin,preventive parotidectomy is invariably performed.We report a rare case of a schwannoma that was suspected to be of parotid gland origin in a patient,who underwent successful surgical management using a modified-Blair incision and superficial musculoaponeurotic system(SMAS)layer folding method.CASE SUMMARY A 27-year-old woman presented to the hospital for evaluation of a firm,fixed,non-tender mass(2.5 cm×3.5 cm),located anterior to the right ear,of 1 year’s duration.Contrast-enhanced facial computed tomography revealed a wellencapsulated,low-density mass adherent to the superficial lobe of the right parotid gland,with a high index of clinical suspicion of an accessory parotid gland mass.The patient was scheduled to undergo resection of the mass and superficial parotidectomy.She underwent surgery using a modified-Blair incision,and the SMAS layer was folded posteriorly to reconstruct the defect.Histopathological examination confirmed the diagnosis of a schwannoma.,and we observed no postoperative complications such as hematoma,infection,or abnormal facial expressions.The incision scar was unnoticeable 2 mo postoperatively,and the facial contour was maintained without any differences between the affected and unaffected sides.CONCLUSION We used a modified-Blair incision and SMAS layer folding method to achieve aesthetically good results following resection of a rare schwannoma with superficial parotidectomy in the cheek region.

Indications and Results of Parotidectomies in the Orl Department of the Idrissa Pouye General Hospital in Dakar. Concerning 31 Cases

Introduction: The parotid tumors are benign or malignant, primary or secondary neoformations developed at the expense of the parotid gland. The aim of the present study was to describe the indications and results of parotidectomies in the ENT department of the Idrissa Pouye General Hospital in Dakar. Patients & Methods: We conducted a retrospective study between January 1, 2004 and December 31, 2012, including all patients who had been consulted for a parotid tumor with or without histological evidence collected in the otolaryngology and anatomy-pathology department of the Idrissa Pouye General Hospital in Dakar. Results: We collected 31 patient files. The mean age was 47.45 years, with extremes of 16 and 74 years. Females predominated, with a sex ratio of 0.82. Swelling of the parotid region was the main reason for consultation in 100% of cases. Parotidectomy was the most frequently performed procedure, accounting for 41.93%. Benign tumors accounted for 72% of cases, the majority being pleomorphic adenomas (50%). The outcome was favorable in 67.74% of cases. Conclusion: Management of parotid tumors at HOGIP would be improved by informing and educating patients to consult early, and by upgrading the technical platform.

Multiple clear-cell sarcomas of small intestine with parotid gland metastasis: A case report

Clear-cell sarcoma is a rare, malignant soft tissue tumor that displays melanocytic differentiation with a distinct molecular profile. It is rarely localized in the gastrointestinal tract. Herein we reported a case of multiple synchronous clear-cell sarcomas of the gastrointestinal tract with parotid gland metastasis. A 51-year-old male patient presented with a growing painless mass under the right ear. A preoperative positron emission tomography/computed tomography showed multiple intestinal masses and a mass in the right parotid with increased glucose uptake, and he underwent operative treatment with resection of three tumors in the jejunum and ileum and then received a right parotidectomy. Postoperative pathological examination showed that cells in the intestinal tumor were consistent with clear-cell sarcoma of the gastrointestinal tract, and the malignant cells in the parotid gland were similar to the intestinal tumor. Immunohistochemical studies revealed positive expression of HMB-45, Melan-A, and S-100. EWSR1 gene fusion transcripts were undetectable by fluorescence in situ hybridization.

Sebaceous lymphadenocarcinoma of the parotid gland:A case report

BACKGROUND Sebaceous lymphadenoma is a benign tumor that occurs rarely in the salivary glands,most commonly in the parotid glands or periparotid lymph nodes,and even more rarely undergoes malignant transformation into a sebaceous lymphadenocarcinoma.CASE SUMMARY We report an 82-year-old woman who presented with a painless mass in the right parotid region.We performed extended surgical resection of the parotid gland mass.Intraoperative pathology revealed a sebaceous lymphadenocarcinoma with metastasis into the periparotid cervical lymph nodes,so we also performed neck dissection and lymph node resection.Postoperative pathology confirmed the diagnosis.The literature review revealed that this was the seventh reported case of sebaceous lymphadenocarcinoma and the second reported case of cervical lymph node metastasis and infiltration of the skin of the parotid gland.CONCLUSION Treatment of sebaceous lymphadenocarcinoma depends on the typing and clinical staging of the cancer.Extensive resection is the first choice,and adjuvant radiotherapy should be given to patients with high-grade tumors or those at an advanced clinical stage.

Cystic teratoma of the parotid gland:A case report

BACKGROUND Teratoma is a common tumor,but rarely occurs in the parotid region.Only nine cases have been reported in the current literature.Although it is generally detected in infancy or childhood,it is commonly asymptomatic.Computed tomography(CT)and magnetic resonance imaging(MRI)have important roles in the diagnosis of teratoma.CASE SUMMARY A 36-year-old man developed a lump located below the left auricular lobule 3 years ago.Physical examination revealed a nearly-circular tumor in the left parotid gland region with a defined border,firm texture,and significant movement.Calcification,fat,keratinized substances,and typical fat-liquid levels was observed on CT and MRI.A diagnosis of cystic teratoma of the parotid gland was established preoperatively and confirmed by postoperative pathology.Following surgery,the patient developed temporary facial paralysis.There was no recurrence of teratoma during the 15-mo follow-up period.CONCLUSION When an asymptomatic mass in the parotid region is identified,parotid gland teratoma should be included in the differential diagnosis.Imaging examinations are helpful in the diagnosis.

Histological Features of Parotid Gland of Albino Rats Exposed to. Smokeless Tobacco

Smokeless tobacco is very common personal habit of people living in various areas of Asia which is an alarming sign for the development of different oral diseases in such people. The aim of present study was to investigate effects of smokeless tobacco on parofid glands of the Aalbano rats by using various percentages of the smokeless tobacco. The rats were divided into three different groups, control group （A） no smokeless tobacco, experimental group （B） 5% smokeless tobacco and experimental group （C） 10% of smokeless tobacco with different feeds required according parameters. Weekly weight gain and partid gland were analyzed through student P test and histological structures were recorded through HE stain and Retculin stain. The results showed that as compared to control group body, weight of the rats was decreased in groups B and C having smokeless tobacco percentage in the diet. Weight of parotid gland as compared to control group was decreased in groups B and C with diet of smokeless tobacco. Further, histological observation under HE stain showed that parofid gland of group B showed mild narrowing of ductal lumen, collapse of vessels and stromal was also increased, in group C parenchyrnal tissues with loss of acini found damaged and glandular dystrop and lymphatic infiltration were determined moderate to severe. Meanwhile, reticulin stain showed that vascular collapses were shown because of increasing in stromal glandular atrophy in group C as compared to control group. In conclusion, this study showed that smokeless tobacco caused serious injuries in the tissue level in parotid gland with high percentage of smokeless tobacco which highlight health hazards on its consumption.

Hybrid intercalated duct lesion of the parotid:A case report

BACKGROUND Intercalated duct lesions(IDLs)are considered relatively benign and rare tumors of salivary glands,that were only described recently.Their histopathological appearance may range from ductal hyperplasia to encapsulated adenoma with hybrid patterns of both variants.It is thought that IDLs may be the precursor for malignant proliferations,therefore their correct diagnosis remains crucial for proper lesion management.It is the first reported IDL case arising from the accessory parotid gland(APG),which stands for less frequent but higher malignancy rate tumor developmental area.CASE SUMMARY A 24-years-old male with no accompanying diseases was referred to the hospital with a painless nodule on the right cheek.On physical examination,the stiff,immobile,and painless mass was palpable in the anterior portion of the right parotideomasseteric region,just superior to the parotid duct.Ultrasound examination demonstrated 1.5 cm×1.0 cm hypoechogenic mass on the anterior part of the right parotid gland.Ultrasound-guided fine needle aspiration cytology,followed by liquid-based fine needle aspiration biopsy were performed.However,the results were uninformative.A contrast-enhanced magnetic res-onance imaging(MRI)of the parotid was obtained,demonstrating a 1.5 cm×1.0 cm×0.5 cm tumor with high intensity capsule together with low intensity core in the very anterior part of right superficial lobe,situated in the APG.An MRI features were uncharacteristic to common parotid tumors,therefore surgical resection followed up.After histopathological examination,the final diagnosis of hybrid IDL was confirmed.CONCLUSION Fine needle aspiration biopsy might not always be diagnostic,and given the malignant potential,the surgical resection of such lesion remains the treatment of choice.

Predictors of distant metastasis in acinic cell carcinoma of the parotid gland

BACKGROUND AiCC is a primarily indolent disease process.Our aim with this study is to determine characteristics consistent with rapidly progressive AiCC of the parotid gland.AIM To report on patients with metastatic lung disease from AiCC and potential correlative factors.METHODS Single-institution retrospective review of patients treated at the University of Michigan between 2000 and 2017.Univariate analyses were performed.RESULTS A total of 55 patients were identified.There were 6 patients(10.9%)with primary AiCC of the parotid gland who developed lung metastases.The mean age at diagnosis for patients with lung metastases was 57.8 years of age,in comparison to 40.2 years for those without metastases(P=0.064).All 6 of the patients with lung metastases demonstrated gross perineural invasion intraoperatively,in comparison to none of those in the non-lung metastases cohort.Worse diseasefree and overall survival were significantly associated with gross perineural invasion,high-grade differentiation,and T4 classification(P<0.001).CONCLUSION AiCC of the parotid gland is viewed as a low-grade neoplasm with good curative outcomes and low likelihood of metastasis.With metastasis,however,it does exhibit a tendency to spread to the lungs.These patients thereby comprise a unique and understudied patient population.In this retrospective study,factors that have been shown to be statistically significant in association with worse disease-free survival and overall survival include presence of gross facial nerve invasion,higher T-classification,and high-grade disease.

Delayed Management of Parotid Sialocele:Role for Two-week Intraoral Drainage

Iatrogenic injury or trauma to the salivary gland duct is one of the most common causes of parotid sialoceles,which are usually superficial,soft,and filled with saliva.The enrolled 7 patients with parotid sialocele were divided into two groups:trauma group(4 cases)and iatrogenic group(3 cases).No evidence of recurrence or cranial nerve injuries were observed.With persisted parotid sialocele,intraoral drainage for two weeks as a safe and inexpensive method is recommended.

Parotid mammary analogue secretory carcinoma:A case report and review of literature

BACKGROUND Mammary analogue secretory carcinoma(MASC)is a rare low-grade malignant salivary gland tumor.The morphological and immunohistochemical features of MASC closely resemble those of breast secretory carcinoma.The key characteristics of the lesion are a lack of pain and slow growth.There is no obvious specificity in the clinical manifestations and imaging features.The diagnosis of the disease mainly depends on the detection of the MASC-specific ETV6-NTRK3 fusion gene.CASE SUMMARY This report describes a rare case of a 32-year-old male patient who presented with a gradually growing lesion that was initially diagnosed as breast-like secretory carcinoma of the right parotid gland.Imaging and histological investigations were used to overcome the diagnostic difficulties.The lesion was managed with right parotidectomy,facial nerve preservation,biological patch implantation to restore the resulting defect,and postoperative radiotherapy.On postoperative follow-up,the patient reported a mild facial deformity with no complications,signs of facial paralysis,or Frey’s syndrome.CONCLUSION The imaging and histological diagnostic challenges for MASC are discussed.

Drainless Day Case Superficial Parotidectomy with ARTISS [Solutions for Sealant]

Aims: Superficial parotidectomy (SP) is a commonly performed procedure which traditionally requires a drain and overnight hospital stay. This series aimed to show the safety and efficacy of drainless day case parotidectomy using ARTISS [Solution for Sealant] fibrin glue. Materials and Methods: Patients with a superficial parotid lump with benign preoperative sampling underwent an SP. We initially used both ARTISS and a drain, which was removed when output was <40 mls. ARTISS without drain was then introduced and once confident patients were sent home the same day. Objectives: We prospectively collected data and divided groups into ARTISS alone and ARTISS with a drain to compare patients’ length of stay and complication rates. Results: 88 patients were included;52 ARTISS alone, 22 as a day case. 42.3% of patients where ARTISS alone was used were discharged within 24 hours, with the remainder between 24 - 48 hours. Comparatively, no ARTISS and drain patients were discharged within 24 hours and 86.1% were discharged between 24 - 48 hours with the remainder over 48 hours. There were 3 postoperative haematomas and none in the drainless group;a statistically significant difference (p = 0.034). Of the 6 recorded salivary leaks, 4 were in the drain group and 2 in the ARTISS alone group (p > 0.05). Conclusions: Comparable complication rates and reduced length of stay suggest that ARTISS in SP is safe and effective. These findings stand to benefit both patients and the NHS by improving the patient journey and reducing overall costs.

左侧耳廓转移性分泌性癌1例

1临床资料患者,女,76岁,因“发现左耳垂肿物1年”于2022-04-19收入我科。1年前患者发现左耳垂出现0.5 cm×0.5 cm大小肿块,不伴疼痛、发热、张口受限、口角歪斜等症状。近1个月来患者自觉肿块增长较快,伴红肿、疼痛,无张口受限、口角歪斜,遂来我院就诊。增强CT示左侧耳垂可见类圆形软组织密度灶,约2.7 cm×2.0 cm,呈不均匀环形强化,周围肿大的淋巴结呈环形强(图1A)。

Synchronous carcinoma of head and neck: 2 cases report

Multiple primary cancers are becoming an increasingly frequent situation and are often the source of many diagnostic and therapeutic difficulties. We report the case of two patients diagnosed with head and neck synchronous carcinomas. The first case is a 33-yearold man with a history of a keratinizing squamous cell carcinoma of the eye lid and who was operated 4 mo later from a mucoepidermoid carcinoma of thesubmandibular salivary gland. The second case is a 71-year-old woman who underwent a total parotidectomy for a mucoepidermod carcinoma of the left parotid gland and who consulted 2 mo later for epistaxis. The explorations concluded to a squamous cell carcinoma of the nasopharynx. The patient had a complementary radiotherapy. No local neither distant recurrence of the two tumors has been detected after a follow-up of 36 mo in the first case and 24 mo in the second one.

Facial nerve monitoring in parotid gland surgery:Design and feasibility assessment of a potential standardized technique

Background:Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve,it surely offers some advantages over the traditional approach.Different from thyroid surgery,where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve,in parotid gland surgery,a formal guideline to follow while dissecting the facial nerve has yet to be described.Methods:A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring.The operative findings regarding the neuromonitoring process,particularly in regard to the amplitude of two main branches,were revised.A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered.Results:Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System(Medtronic);31 were female patients,and 47 patients had benign lesions.Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation.There were only three articles discussing the term loss of signal during parotid gland surgery.Conclusion:Today,no sufficient attention has been given to the facial nerve monitoring process during parotidectomy.This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.

Parotid gland carcinosarcoma with follicular dendritic cell sarcoma as mesenchymal component: a case report

The WHO has classified malignant mixed tumours of salivary glands into noninvasive carcinoma in pleomorphic adenoma, invasive carcinoma in pleomorphic adenoma, carcino-sarcoma and metastasizing mixed tumour.~1 Carcinosarcoma, or true malignant mixed tumour, is a tumour composed of both carcinomatous and sarcomatous elements. It is an exceedingly rare tumour of the salivary glands and only about 60 cases have been reported.~2 In this report we describe a case of carcinosarcoma of a parotid gland that contained an unusual mesenchymal component (follicular dendritic cell sarcoma, FDCS) in a 55-year-old man with cytological, histological and immunohistochemical findings. To our knowledge, this histological pattern has not been reported previously in the English literature.

Clinical observation on prevention and treatment of radiation-induced parotid-gland injury in patients with nasopharyngeal carcinoma by Compound Sarcandra Glabra

Objective:To investigate the protective effect of the Compound Sarcandra Glabra on radiation injury of parotid glands in patients with nasopharyngeal carcinoma.Methods:Sixty patients with primary nasopharyngeal carcinoma in the First Affiliated Hospital of Guangxi Medical University from June 2018 to January 2019 were collected,which were divided into treatment group and control group using a random number table.All patients were treated by a combination of 9-field intense-modulated radiotherapy and chemotherapy.The treatment group was given the Compound Sarcandra Glabra orally every day from 3 days before radiotherapy to the end.The degree of xerostomia(dry mouth)of patients was compared between the two groups at the end of radiotherapy and 3 months after radiotherapy by the chi-square test.The maximal adsorption and secretion rates of the parotid glands were compared between groups before radiotherapy,at the end of radiotherapy and 3 months after radiotherapy by the independent sample t-test.Results:The symptoms of dry mouth were alleviated in the treatment group,and the degree of dry mouth significantly differed between groups at the end of radiotherapy and 3 months after radiotherapy(χ2=6.696 and 10.977,P<0.05).There were no significant differences in the maximal adsorption and secretion rates of the parotid glands between groups before radiotherapy(t=0.974 and4.646,P>0.05);however,both variables were significantly higher in the treatment group at the end of radiotherapy and 3 months after radiotherapy(t=2.920 and 5.037;t=2.820 and 2.213,P<0.05).Patients presented no liver and kidney injury after radiotherapy.Conclusions:Oral administration of the Compound Sarcandra Glabra can effectively prevent radiation injury of the parotid glands in patients with nasopharyngeal carcinoma,thereby alleviating the degree of dry mouth after radiotherapy.

Retrospective review of 190 patients treated for parotid tumors： a single institute experience

Salivary gland neoplasms account for 3%-6% of all head and neck neoplasms, and the incidence was estimated to range from 0.4 to 13.5 cases per 100 000 inhabitants annually. Histologically, salivary gland tumors are a diverse group of neoplasms, making it difficult to establish a common standard for diagnosis and treatment. Most of the current studies concerning salivary gland tumors investigated the histological features and clinical manifestations including both major and minor salivary gland tumors, making it difficult to evaluate their real frequency and site distribution. Parotid tumor is the most frequently occurring salivary neoplasms, comprising 60%-80% of all salivary gland tumors. Clinical experience led us to suspect that our epidemiology of parotid tumors in south China may be different from that of other areas in the world. Here, we retrospectively reviewed parotid tumor cases and aimed to summarize the clinical presentation, histological feature, and surgical complications of parotid tumors.