Oncocytic sialolipoma of parotid gland: Case report and literature review

Neoplastic lipomatous lesions of the salivary glands constitute ?0.5% of all the salivary gland tumors. Oncocytic sialolipoma of the parotid glands is extremely uncommon. We report a case of oncocytic sialolipoma of the parotid gland in a 59-year-old male who presented with a gradually increasing swelling of the right parotid. Excisional parotid biopsy performed in view of possible pleomorphic adenoma as suggested on ultrasonography showed histological features consistent with oncocytic sialolipoma. We also described the characteristics of 24 previously reported cases of oncocytic sialolipoma of the parotid gland. The median age of the patients including the present case was 56 years (range 7–89), and 14 were male. The largest and the least reported sizes of the tumor were 7.0 and 1.4 cm, respectively. The left-sided parotid gland was more commonly involved (14/23). Despite its rarity, oncocytic sialolipoma should be considered in lipomatous parotid lesions showing epithelial components with oncocytic changes.

Reporte de caso: poliquistosis parotídea (Adenosis poliquística esclerosante asociada a Enfermedad poliquística disgenética)

Introducción: La adenosis/adenoma poliquistico esclerosante (SPA) es aceptada como una nueva entidad neoplásica benigna muy poco frecuente de las glándulas salivales que compromete por lo general la glándula parótida. La enfermedad poliquística disgenética es otra entidad poco común con histología similar a la SPA y que también afecta a la gládula parótida con mayor frecuencia. Reporte de caso: Se presenta el caso de una mujer 28 de años con aumento de volumen de la glándula parótida derecha de aproximadamente 3 años de evolución cuyo análisis histopatológico sugirió el diagnostico de Adenosis/adenoma Poliquístico Esclerosante asociado a Enfermedad Poliquística Disgenética de la glándula parótida derecha. La paciente recibió tratamiento quirúrgico de parotidectomía total con preservación del nervio facial. Al momento con remisión de la enfermedad.

Introduction: Polycystic sclerosing adenosis / adenoma (SPA) is accepted as a very rare new benign neoplastic entity of the salivary glands that generally involves the parotid gland. Dysgenetic polycystic disease is another rare entity with histology similar to SPA and that also affects the parotid gland more frequently. Case report: The case of a 28-year-old woman with increased volume of the right parotid gland of approximately 3 years of evolution is presented, whose histopathological analysis suggested the diagnosis of Polycystic Sclerosing Adenosis / adenoma associated with Polycystic Dysgenetic Disease of the right parotid gland. The patient received surgical treatment of total parotidectomy with preservation of the facial nerve. At the moment with remission of the disease.

Refractory pneumoparotid in children: a case report and literature review / 口腔疾病防治

Objective @#To discuss the treatment of pneumoparotid and to provide a reference for clinical practice. @*Methods@# A case of refractory pneumoparotid was reported, and the diagnosis and treatment of parotid emphysema were reviewed and analyzed in combination with the literature.@*Results @#This child had parotid gland enlargement without any obvious cause for more than 1 month. Conservative treatment, such as anti-inflammatory agents, psychological interventions and physical compression were ineffective. The patient had a history of cerebral palsy with epilepsy and involuntary cheek bulging behavior. Therefore, we considered it a refractory case. It was cured after parotid duct ligation and partial parotidectomy of the superficial lobe. A literature review showed that a pneumoparotid is a rare parotid enlargement. Most of the clinical cases were considered to be caused by the return of air into the parotid gland through the parotid duct due to an increase in oral pressure. The diagnosis of pneumoparotid mainly depends on intermittent parotid gland swelling and other clinical manifestations and imaging examination methods, such as ultrasound, CT, MRI and angiography. Its treatment mainly includes conservative anti-inflammatory treatment, physical therapy and psychological intervention. Surgical treatment is indicated for refractory parotid emphysema.@*Conclusion@# Pneumoparotid cases may further develop into parotid inflammation, which is generally treated conservatively. For some severe, recurrent and poor compliance cases, surgical treatment is sometimes needed.

Recent progress in the treatment of intractable sialolithiasis / 北京大学学报(医学版)

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.

Extracapsular dissection and minimally invasive procedures of primary benign parotid tumours: Case series

Extracapsular dissection is an old technique use for the removal of benign parotid tumours, which is not generally chosen as the first treatment option due to the association of recurrences in the past but is currently considered again accord to the aesthetic requirements of the patients. The general trend in the last decade is to return to minimally invasive procedures for this type of lesions, which are mainly conditioned by the pleomorphic adenoma and its positive margins in its capsule. By this, the purpose of this case series study is to analyze those patients diagnosed with benign parotid tumors and treated by extracapsular dissection in a tertiary hospital in Chile between 2018-2020.

Carcinoma de células acinares de parótida: reporte de un caso y revisión de literatura / Acinic cell carcinoma of parotid: A case report and review of literature

Resumen Los tumores malignos de glándulas salivales (TMGS) constituyen un grupo infrecuente de cánceres de una gran variedad histológica. Dentro de las neoplasias de estirpe epitelial encontramos al carcinoma de células acinares (CCA), que representa entre un 6%-10% de todos los TMGS. No posee patrones clínicos ni radiológicos específicos, pero comparte características comunes con otros TMGS que serán discutidas a lo largo del reporte. Cabe destacar que en términos generales es un cáncer de bajo grado y poco recidivante, por lo que un tratamiento oportuno y un seguimiento estricto mejoran el pronóstico para este tipo de pacientes. Su diagnóstico se establece con evidencia histopatológica que confirme la presencia de diferenciación epitelial de tipo acinar. El tratamiento consiste en la exéresis tumoral con márgenes libres por parotidectomía suprafacial o total, asociado a vaciamiento cervical si se detecta compromiso nodal. Adicionalmente, se debe sugerir terapia adyuvante ante la presencia de un factor de mal pronóstico. Se presenta un caso y se realiza revisión de literatura.

Abstract Malignant salivary gland tumors (TMGS) constitute an infrequent group of cancers of a wide histological variety. Within the epithelial lineage neoplasms, we find acinar cell carcinoma that represent between 6%-10% of all TMGS. It does not have specific clinical or radiological patterns, but it shares common characteristics with other TMGS that will be discussed throughout the report. It should be noted that in general terms it is a low-grade cancer with low recurrence rates, so timely treatment and strict follow-up improve the prognosis for this type of patient. Its diagnosis is established with histopathological evidence that confirms the presence of acinar-type epithelial differentiation. Treatment consists of tumor excision with free margins by suprafacial or total parotidectomy, associated with cervical lymph node dissection if nodal locoregional metastasis is detected. Additionally, adjuvant therapy should be suggested in the presence of a poor prognostic factor. A case is presented and a literature review is carried out.

Clinical analysis of 21 cases of IgG4-related diseases / 口腔疾病防治

Objective@# To summarize the clinical manifestations of IgG4-related diseases in the head and neck, explore treatment methods.@*Methods @#The clinical data of 21 patients diagnosed with IgG4-related diseases were retrospectively analyzed. The clinical data and the results of glucocorticoid and immunosuppressive therapy were studied retrospectively.@* Results@#All patients had swollen sclerotic masses, and CT showed irregular high-density masses with uniform enhancement in the enlarged glands. Some patients had mucosal thickening and mass-like changes in theoral cavity, nose, sinuses, throat and other tissues, and most of the patients had cervical lymphadenopathy and elevated serum IgG4 levels (≥ 1.35 g/L). Histopathological examination of affected exosine glands and affected mucosa and lymph nodes in all patients showed infiltration of lymphocytes, plasma cells and IgG4+ plasma cells. In 21 patients, the mass in the affected glands and mucosa (including head, neck and other tissues) disappeared, and the clinical symptoms were relieved after the application of glucocorticoids. However, with a reduction in glucocorticoids, the mass recurred or even worsened.@*Conclusion @#For patients with a single mass in the submandibular gland, parotid gland and other salivary glands, as well as lymph node enlargement, CT is the first choice to identify the nature of gland neoplasms. Combined with pathological examination, related auxiliary examination and peripheral blood examination are also needed to obtain a definitive diagnosis. Glucocorticoid therapy is used to achieve a good prognosis, and long-term follow-up and timely adjustment of medication regimens are required.

Diagnosis and surgical approach of parotid gland benign tumors and treatment of common complications / 口腔疾病防治

@#Benign tumors of the parotid gland are common tumors of the head and neck. Surgical resection is considered the main treatment. For the treatment of benign parotid tumors, different surgical approaches can be applied based on many factors, such as tumor type, size, location, depth of tumor and patient requirements, such as improved periauricular incision and improved facial wrinkle removal incision, to achieve the best therapeutic effect. In parotidectomy, the facial nerve, great auricular nerve and parotid duct should be protected as much as possible to preserve the function of the nerve and gland and reduce postoperative complications. In addition, complications after parotidectomy, such as facial nerve injury, salivary fistula, Frey syndrome, postoperative facial depression, abnormal ear sensation and recurrence, should be actively prevented and treated early after the operation, consequently minimizing the impact on patients' postoperative life and improving patients' satisfaction with the operation.

Effects of acid stimulation on saliva flow rate and compositions of human parotid and submandibular glands / 北京大学学报(医学版)

OBJECTIVE@#To investigate the effect of acid stimulation on salivary flow rate and compositions of human parotid and submandibular glands, so as to provide basis for comprehensive evaluation of salivary gland function in both health and disease status.@*METHODS@#In the study, 210 healthy participants' whole saliva samples were collected under passive drooling, and their parotid gland and submandibular gland secretions were collected by negative pressure suction. 2% citric acid was dropped on the tip of tongue every 1 min for acid stimulation for a total of 5 times to collect stimulated whole saliva, parotid and submandibular gland saliva. The collected saliva was weighed and saliva flow rate was calculated. The K+, Na+, Cl-, Ca2+, total protein, total phosphorus and α-amylase in saliva samples were detected by biochemical analyzer, and the changing features of flow rate and compositions of different kinds of saliva were compared and analyzed.@*RESULTS@#After acid stimulation, saliva flow rate significantly increased. The increase proportion of parotid gland saliva (10.7 folds) was much higher than that of submandibular gland saliva (2.9 folds). The concentrations of Na+, Cl-, Ca2+, total protein and α-amylase in parotid gland saliva increased significantly (P < 0.05), but there was no significant difference in total phosphorus and K+ (P=0.89, P=0.34). The concentration of Na+ and Ca2+ in saliva of submandibular gland increased significantly(P < 0.05), the concentration of total phosphorus decreased significantly(P < 0.05), and the concentration of Cl- increased, but the difference was not significant(P=0.068). There was no significant difference in total protein, K+ and α-amylase (P=0.85, P=0.07, P=0.95). The compound secretion rate of total phosphorus in saliva of submandibular gland remained unchanged(P=0.066), while the secretion rate of K+, Na+, Cl-, Ca2+, total protein and α-amylase significantly increased(P < 0.01). The compound secretion rate of K+, Na+, Cl-, Ca2+, total protein and total phosphorus and α-amylase in parotid gland saliva increased(P < 0.01). The concentrations of Na+, Cl-, K+, total phosphorus, total protein and α-amylase in parotid were higher than those in submandibular gland (P < 0.01), and the concentration of Ca2+ in submandibular gland saliva was significantly higher than that in parotid (P < 0.001).@*CONCLUSION@#The response of parotid to acid stimulation is stronger, and the secretion of submandibular gland is more stable. Acid stimulation significantly influences the concentrations of electrolytes in saliva, and the composited secretion rate is an evaluation index to reflect both flow rate and composition concentration of saliva. The parotid gland plays an important role in the secretion of total protein, total phosphorus and α-amylase in saliva, and the submandibular gland is the main source of Ca2+ in saliva.

Studies on newly recognized chronic sialadenitis / 北京大学学报(医学版)

Some kinds of chronic sialadenitis were recognized during the recent years. They have specific pathogenesis, clinical and histopathologic appearances, and require specific treatment. IgG4-related sialadenitis (IgG4-RS) is one of the immune-mediated diseases, characterized by tumefactive lesions. The incidence of IgG4-RS obviously increased during the past 30 years. The study on the potential relationship between occupational exposure to chemical substances and the incidence of IgG4-RS showed that subjects with occupational exposure to agents known to cause IgG4-RD had an increased risk for IgG4-RS. Surgical excision of involved SMG could not control the disease progression, which is not recommended for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents is effective for treating IgG4-RS, and restores salivary gland function. Radioiodine induced sialadenitis (RAIS) is one of the common complications of postoperative adjuvant treatment of differentiated thyroid cancer by 131I. The incidence of the disease is related to radiation dosage. Clinically, the patients suffered from swelling and tenderness in the buccal or submandibular regions, especially during the mealtime. Imaging appearances are similar to those of chronic obstructive sialadenitis. Conservative managements, such as gland massage, sialagogues, are the mainstream methods in the treatment of RAIS. Sialendoscopy is feasible for RAIS, but not as effective as conventional obstructive sialadenitis (COS). Therefore the prevention of RAIS is crucial. Eosinophilic sialodochitis (ES) is a new type of chronic inflammatory disease of the salivary gland related to allergy. It has characteristics of swelling of multiple major salivary glands, strip-like gelatinous plugs discharged from the duct orifice of the gland, elevated level of serum IgE and eosinophils in peripheral blood, infiltration of eosinophils and IgE positive plasma cells in the tissues, allergic history, increased expression of allergy-related cytokines, such as IL-4, IL-5, IL-13, and eotaxin, which suggest allergic reactions as a potential pathogenesis of the disease. The clinical, laboratory, histological, and immunohistochemical characteristics of ES are significantly different from conventional obstructive sialadenitis (COS). Therefore, it is suitable to separate ES from COS. Conservative managements, such as self-maintenance therapy and anti- allergic modality are the choices of treatment for ES. Based on the results of our comprehensive studies a new classification of chronic sialadenitis is suggested.

Masa parotídea de rápido crecimiento, representando un dilema diagnóstico / Rapidly growing parotid gland mass, posing a diagnostic dilemma

La toxoplasmosis es una infección parasitaria con distribución mundial, cuyo huésped definitivo son los felinos. Se presenta con un cuadro clínico sintomático difuso solo en el 20 % de los pacientes inmunocompetentes. Además del malestar general, fiebre y adinamia, el hallazgo más importante lo constituye la presencia de adenopatías a nivel cervical. Describimos un caso poco común de un paciente masculino con masa parotídea izquierda de crecimiento rápido, en quien se practicó parotidectomía, a fin de descartar la enfermedad linfoproliferativa. Se comprobó compromiso por Toxoplasma gondii luego de múltiples análisis.

Toxoplasmosis is a parasitic infection with worldwide distribution, whose definitive host is felines. It is only symptomatic in less than 20% of immunocompetent patients. Symptoms may vary from general malaise, fever, weakness and the presence of cervical lymphadenopathy. A description of an uncommon presentation of this disease in a male patient with progressively growing left-sided parotid mass, in whom a parotidectomy was performed to rule out lymphoproliferative disease. Infection by Toxoplasma gondii was diagnosed after a series of exams

Caracterización de pacientes con neoplasias de glándulas salivales mayores tratadas quirúrgicamente en un hospital universitario cubano / Characterization of patients with major salivary gland neoplasms treated surgically in a Cuban university hospital

Introducción: Las neoplasias de las glándulas salivales representan el grupo más heterogéneo y complejo de los procesos tumorales de la cabeza y el cuello. Objetivo: Caracterizar a los pacientes con neoplasias de glándulas salivales mayores que recibieron tratamiento quirúrgico en un hospital universitario cubano. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes diagnosticados histológicamente con neoplasias de glándulas salivales mayores. Las variables evaluadas fueron: edad, sexo, tipo de neoplasia, sitio primario, diagnóstico histológico y técnicas quirúrgicas. Resultados: Se estudiaron 55 pacientes con neoplasias, de las cuales 45 (81,82 por ciento) fueron benignas, con mayor frecuencia en los hombres (n = 28; 62,22 por ciento). La edad media de presentación de las neoplasias fue 55,11 ± 16,04 años, y el grupo de edad más afectado fue el de 40-59 años (n = 26; 47,27 por ciento). La parótida fue la glándula más afectada (n = 48), fundamentalmente por adenomas pleomorfos (n = 28; 58,33 por ciento). La parotidectomía subtotal fue la cirugía mayormente realizada (n = 38; 79,17 por ciento). Conclusiones: Las neoplasias parotídeas benignas presentadas en pacientes adultos del sexo masculino fueron las más frecuentes(AU)

Introduction: Salivary gland neoplasms are the most heterogeneous and complex group of head and neck tumoral processes. Objective: Characterize patients with major salivary gland neoplasms undergoing surgical treatment in a Cuban university hospital. Methods: A cross-sectional observational descriptive study was conducted of patients histologically diagnosed with major salivary gland neoplasms. The variables evaluated were age, sex, type of neoplasm, primary site, histological diagnosis and surgical techniques. Results: A total 55 neoplasms were studied, of which 45 (81.82 percent) were benign, with a higher frequency in men (n = 28; 62.22 percent). Mean age at neoplasm presentation was 55.11 ± 16.04 years, and the most affected age group was 40-59 years (n = 26; 47.27 percent). The parotid was the most frequently affected gland (n = 48), mainly by pleomorphic adenomas (n = 28; 58.33 percent). Subtotal parotidectomy was the most common surgical procedure (n = 38; 79.17 percent). Conclusions: Benign parotid gland neoplasms presenting in male adult patients were the most frequent type(AU)

Tratamento cirúrgico de sialólito no ducto da parótida: relato de caso / Surgical treatment of sialolite in the duct of the parotid: case report / Tratamiento quirúrgico de sialolito en el conducto del parótido: reporte de caso

Introdução: Os sialólitos são lesões mineralizadas nas glândulas salivares que causam obstrução total ou parcial do ducto, acometendo comumente a glândula submandibular. Sua abordagem varia de pouco invasiva à cirúrgicas, a depender do número, localização e dimensões dos cálculos. Objetivo: Esse estudo teve como objetivo relatar um caso clínico raro de sialólito no ducto da glândula parótida tratado através da remoção cirúrgica. Relato De Caso: Paciente compareceu ao ambulatório com história de dor e edema em face com 2 meses de evolução, referindo piora da sintomatologia após alimentação. Ao exame físico apresentou edema endurecido em região pré-auricular esquerda e ausência de drenagem no ducto da parótida ipsilateral. Foi realizado uma radiografia de tecidos moles com filme periapical, que revelou imagem radiopaca circunscrita sugestiva de um sialólito no ducto da glândula parótida esquerda. Assim, foi realizada excisão cirúrgica do cálculo seguida do reestabelecimento da patência ductal através da instalação de cateter venoso. Paciente evoluiu bem e segue em acompanhamento sem recidiva dos sinais e sintomas. Considerações Finais: O presente estudo revela que o diagnóstico precoce da sialolitíase e a escolha do plano de tratamento adequado estão associados a um bom prognóstico, e o reestabelecimento da patência ductal, quando danificado, é imprescindível para o sucesso do tratamento(AU)

Introduction: Sialoliths are mineralized lesions in the salivary glands that cause total or partial obstruction of the duct, commonly affecting the submandibular gland. It ranges from less invasive to surgical approach, depending on the number, location and dimension of the calculi. Objective: This study aimed to report a rare clinical case of a sialolith in the parotid gland's duct treated by surgical removal. Case Report: The patient attended the outpatient clinic with a history of pain and edema in the face with 2 months of evolution, reporting worsening symptoms after feeding. On physical examination, he had hardened edema in the left preauricular region and no drainage in the ipsilateral parotid duct. Soft tissue radiography with a periapical film was performed, which revealed a circumscribed radiopaque image suggestive of a sialolith in the left parotid gland's duct. Thus, the calculus's surgical excision was performed, followed by the reestablishment of the ductal patency through the installation of a venous catheter. The patient evolved well and is being followed up without recurrence of signs and symptoms. Final Considerations: The present study reveals that the early diagnosis of sialolithiasis and the choice of the appropriate treatment plan are associated with a good prognosis, and the reestablishment of ductal patency, when damaged, is essential for the success of the treatment(AU)

Introducción: Os sialolitos son lesiones mineralizadas en las glándulas salivales que causan obstrucción total o parcial del conducto, afectando comúnmente a la glándula submandibular. Su abordaje varía desde poco invasivo hasta quirúrgico, dependiendo del número, ubicación y dimensiones de los cálculos. Objetivo: Este estudio tuvo como objetivo reportar un caso clínico raro de sialolito en el conducto de la glándula parótida tratado mediante extirpación quirúrgica. Reporte de Caso: Paciente acudió a consulta externa con antecedente de dolor y edema en el rostro de 2 meses de evolución, refiriendo empeoramiento de la sintomatología tras la alimentación. A la exploración física presentaba edema endurecido en región preauricular izquierda y ausencia de drenaje en conducto parotídeo ipsilateral. Se realizó una radiografía de partes blandas con placa periapical, que reveló una imagen radiopaca circunscrita sugestiva de un sialolito en el conducto de la glándula parótida izquierda. Así, se realizó la escisión quirúrgica del cálculo seguida del restablecimiento de la permeabilidad ductal mediante la instalación de un catéter venoso. El paciente evolucionó bien y se le está dando seguimiento sin recurrencia de signos y síntomas. Consideraciones Finales: El presente estudio revela que el diagnóstico precoz de la sialolitiasis y la elección del plan de tratamiento adecuado se asocian a un buen pronóstico, y el restablecimiento de la permeabilidad ductal, en caso de daño, es fundamental para el éxito del tratamiento(AU)

Re-cognition of chronic obstructive diseases of the parotid gland / 口腔疾病防治

@#Chronic obstructive diseases of the parotid gland are common clinically, with repeated swelling and a prolonged course and poor treatment outcomes. Based on the summarization of clinical practice and related literature, from the viewpoint of etiology, parotid obstructive diseases can be classified as mechanical obstructions, specific obstructions and non-specific obstructions. The principles of fluid mechanics are introduced to explain the formation of parotid obstructions. According to the different causes, the methods of changing the flow pattern of saliva in the parotid to reduce the resistance and relieve the obstruction, are proposed, such as mechanical factors removals, application of drugs that promote saliva secretion and lower saliva viscosity, ductal expansion under endoscopy and stent placement, and embolization of collateral ducts. These managements can effectively increase the salivary flow rate, reduce the occurrence of the saliva stranded and parotid gland obstructions.

Clinical analysis of 22 cases of lymphoepithelial carcinoma of parotid gland / 口腔疾病防治

Objective @# To investigate the diagnosis, treatment and prognosis of lymphoepithelial carcinoma of the parotid gland. @*Methods@#Data from 22 patients with parotid lymphoepithelial carcinoma from 2012 to 2019 were collected, and their clinical manifestations, imaging examinations, treatment methods and follow-up results were retrospectively analyzed.@*Results@# Among the 22 patients, 8 were males and 14 were females. The patients ranged from 26 to 61 years old, with a complaint duration ranging from 3 days to 18 years. One patient had multiple unilateral lumps in the parotid gland, and the other 21 patients had single unilateral lumps in the parotid gland. All patients underwent preoperative spiral CT examination. CT showed a soft tissue lump in the parotid tissue, the internal density shadow was not uniform, the CT value ranged from 26 to 81 Hu, and 15 patients presented elliptical lesions with clear boundaries. Seven patients presented nodular lesions, and the boundary was not clear. The diagnosis of all cases was ultimately based on pathological examination. Hematoxylin-eosin (HE) staining images showed active epithelial cell growth with atypia, mitotic figures could be seen, and abundant lymphocyte and plasma cell infiltration could be seen in the tumor stroma. All 22 patients received surgical treatment; 9 patients did not undergo cervical lymph node dissection. Twenty patients received adjuvant radiotherapy after surgery, and 10 of them received adjuvant chemotherapy at the same time. One patient only received chemotherapy after surgery, and one patient did not receive any other adjuvant therapy after surgery. All patients received follow-up visits. One patient died of liver metastasis 16 months after the operation, and the remaining patients survived without tumors for periods of 13 months to 8 years until the present. @*Conclusion @#Parotid lymphoepithelial carcinoma is a rare malignant tumor clinically. Pathology is still the gold standard for the diagnosis of lymphoepithelial carcinoma of the parotid gland. Radical resection of the tumor is the first choice of treatment. Selective neck lymph node dissection and postoperative adjuvant radiotherapy and chemotherapy can obtain better therapeutic effects according to clinical examination, imaging examination and neck conditions.

Análisis clínico y terapéutico ante la patología obstructiva crónica de las glándulas salivales / Clinical and therapeutic analysis to the chronic obstructive pathology of the salivary glands

Introducción: gran parte de la población sufre procesos relacionados con las glándulas salivales, que, con los avances técnicos, se tiende cada vez más a tratar de una manera mínimamente invasiva. Objetivos: remarcar las indicaciones y las diferencias entre los abordajes comunes y los mínimamente invasivos, guiados por el sialoendoscopio. Además, describir la presentación clínica y el estudio de dichos pacientes. Diseño: realizamos un estudio descriptivo, observacional, longitudinal y retrospectivo sobre un grupo de 67 pacientes diagnosticados con patología obstructiva crónica no tumoral de las glándulas. Material y métodos: revisamos los datos referentes a la edad, sexo, hábitos tóxicos, enfermedades sistémicas o autoinmunes asociadas, radioterapia o tratamiento con yodo radiactivo (I131), síntomas asociados y resultados del examen físico y radiológico efectuados, así como el tratamiento efectuado. En mayo de 2019 incorporamos la técnica de sialoendoscopia al manejo de esta patología. Resultados: desde la incorporación de la sialoendoscopia, los casos de patología litiásica a nivel del tercio distal del conducto de Wharton se abordaron mediante exéresis de la litiasis sobre el suelo de la boca con ayuda del sialoendoscopio. Realizamos una sialoendoscopia diagnóstico-terapéutica en pacientes con clínica obstructiva crónica no litiásica. Discusión: el abordaje mínimamente invasivo permite una recuperación más temprana con una adecuada función glandular tras la cirugía. No solo es útil en la patología litiásica, sino que también presenta buenos resultados en patología autoinmune. Conclusión: las técnicas mínimamente invasivas han hecho que el manejo haya cambiado, limitando la realización de resecciones glandulares.

Introduction: A large part of the population suffers from processes related to the salivary glands, which with new advances in technology tends to be treated in a minimally invasive way. Goals: To highlight the indications and differences between common and minimally invasive approaches, guided by the sialoendoscope. In addition, to describe the clinical presentation and the study of these patients. Design: We carried out a descriptive, observational, longitudinal and retrospective study on a group of 67 patients diagnosed with non-tumorous chronic obstructive pathology of the glands. Material and methods: We review the data regarding age, sex, toxic habits, associated systemic or autoimmune diseases, radiotherapy or treatment with I131 (radioactive iodine), associated symptoms and results of the physical and radiological examination carried out. As well as the given treatment. In May 2019 we incorporated the sialoendoscopy to the management of this pathology. Results: Since the incorporation of sialoendoscopy, cases of lithiasic pathology at the distal 1/3 of Wharton's duct were approached by excision of the stone on the floor of the mouth using sialoendoscopy. We perform diagnostic-therapeutic sialoendoscopy in patients with non-lithiasic chronic obstructive symptoms. Discussion: The minimally invasive approach allows an earlier recovery with adequate glandular function after surgery. It is not only useful in lithiasic pathology, but it also has good results in autoimmune pathology. Conclusion: Minimally invasive techniques have changed management, limiting the neck open surgeries.

Brain-derived Neurotropic factor (BDNF) mediates the protective effect of Cucurbita pepo L. on salivary glands of rats exposed to chronic stress evident by structural, biochemical and molecular study

Abstract Acute and chronic stresses affect the salivary glands, representing the source of plasma BDNF during stressful conditions. Pumpkin is a medicinal plant with an evident antioxidant, anti-inflammatory and potential antidepressant effects. Objective To assess the structural and biochemical effects induced by exposure to chronic unpredictable mild stress (CUMS) on salivary glands of albino rats, and to evaluate the role of pumpkin extract (Pump) in ameliorating this effect. Methodology Four groups (n=10 each) of male albino rats were included in this study: the control, CUMS, Fluoxetine-treated and Pump-treated. The corticosterone, the pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), and the oxidant/antioxidant profile were all assessed in the serum. The level of BDNF mRNA was measured in the salivary glands using qRT-PCR. Histopathological changes of the salivary glands were also assessed. Results The depressive-like status was confirmed behaviorally and biochemically. Exposure to CUMS significantly up-regulated (p<0.001) the level of serum corticosterone. CUMS induced degenerative changes in the secretory and ductal elements of the salivary glands evident by increased apoptosis. Both Fluoxetine and Pumpkin significantly up-regulated (p<0.001) BDNF expression in the salivary glands and ameliorated the CUMS-induced histopathological and biochemical alterations in the salivary glands. Pumpkin significantly (p<0.001) increased the serum levels of antioxidant enzymes SOD, GPX and CAT, and reduced the serum levels of the pro-inflammatory cytokines TNF-α, IL-6. Conclusion Pumpkin ameliorates the depressive-like status induced in rats following exposure to chronic stress through exerting a promising anti-inflammatory, antioxidant and anti-depressant-like effects. The pumpkin, subsequently, improved stress-induced structural changes in the salivary glands that might be due to up-regulation of BDNF expression in the glands.

Target delineation and dosimetry analysis of 125I interstitial brachytherapy for recurrent adenoid cystic carcinoma in the parotid gland / 中华放射医学与防护杂志

Objective:To analyze the target design and dosimetric parameters of patients with recurrent adenoid cystic carcinoma (ACC) in the parotid gland who were treated with 125I interstitial brachytherapy alone. Methods:A retrospective analysis was conducted for 25 patients with recurrent adenoid cystic carcinoma in parotid gland who were histopathologically diagnosed between January 2015 and October 2019. These patients were treated with 125I interstitial brachytherapy alone, with prescribed doses of 100-120 Gy. The target volume was designed according to the pathological characteristics of ACC and recurrence sites. The pre- and post-operation dosimetric parameters (i.e., local control rates) were calculated using the treatment planning system. Results:In this study, the local recurrence sites included the superficial lobe (10/25) and deep lobe (7/25) of the parotid gland primarily and the skull base region (four patients) and mastoid posterior region (four patients) secondarily. The number of 125I seeds ranged from 16 to 111, with a median number of 59. The activity of radioactive particles was 18.5-25.9 MBq. The 3- and 5-year local control rates were 81.5% and 61.5%, respectively. No significant differences were found between pre- and post-operative dosimetric parameters such as D90, V100, and V150. There was no significant difference in local control rates among the four different recurrence sites. Conclusions:125I interstitial brachytherapy is proven to be an effective approach in the treatment of recurrent adenoid cystic carcinoma in the parotid gland. Satisfying local control rates can be achieved through target delineation performed according to recurrence sites and perineural invasion characteristics of ACC.

The value of multi-echo Dixon technique and T 2 mapping for evaluating early parotid gland changes in primary Sj?gren′s syndrome / 中华放射学杂志

Objective:To assess the value of the parotid fat fraction (FF) and T 2 relaxation time (T 2 value) in the evaluation of early parotid involvment in patients with primary Sj?gren′s syndrome (pSS) using multi-echo Dixon technique and T 2 mapping imaging. Methods:From December 2018 to December 2019, 26 early pSS patients (pSS group) and 20 healthy controls (control group), matched to age and gender, were enrolled at the First Affiliated Hospital of Zhengzhou University in this prospectively study. All subjects underwent conventional MRI, DWI, multi-echo Dixon and T 2 mapping sequences before treatment. The ADC, FF and T 2 value of bilateral parotid parenchyma in pSS group and control group were measured respectively. Paired sample t test was used to compare the differences of ADC, FF and T 2 values between left and right parotid glands for pSS group and control group, while independent sample t test was used to compare the differences of ADC, FF and T 2 values between pSS group and control group. The ROC curves were drawn to evaluate diagnostic performance of ADC, FF and T 2 values to distinguish early pSS, and the difference of diagnostic efficacy of each parameter was compared by Delong test. Binary logistic regression analysis and ROC curve were used to evaluate the diagnostic performance of the combination of the 3 parameters in early pSS. Results:There were no significant differences of ADC, FF and T 2 values between left and right parotid glands for pSS group and control group (all P>0.05). The parotid ADC values were significantly lower in pSS group than control group ( t=4.641, P=0.006), while the FF and T 2 values of pSS group were significantly higher than those of control group ( t=-2.910, -6.411, both P<0.001). The areas under the ROC curve of ADC, FF and T 2 values to distinguish early pSS were 0.666, 0.750 and 0.862, respectively. The area under ROC curve of the combination of ADC, FF and T 2 values was 0.930, with a sensitivity of 73.1% and a specificity of 97.5%. T 2 values showed a better diagnostic efficacy than ADC values ( Z=2.626, P=0.009) and FF values ( Z=2.112, P=0.035) when distinguishing pSS group from control group. The area under ROC curve of the combination of ADC, FF and T 2 values showed a better diagnostic efficacy than each parameter alone ( Z=4.869, P<0.001, Z=3.628, P<0.001, Z=2.162, P=0.031). Conclusions:Multi-echo Dixon technique and T 2 mapping can quantitatively evaluate the parotid gland fat deposition and inflammatory response in the early stage of pSS. T 2 value has great potential in evaluating early parotid gland injury of pSS, and the combination of ADC, FF and T 2 values can further improve the diagnostic efficiency.