Accuracy of frozen-section diagnosis in salivary gland neoplasms.

A retrospective review of 100 patients with major or minor salivary gland neoplasms was conducted to ascertain the accuracy and effect on therapy of frozen-section diagnosis. Of these patients, 23% had malignant and 77% benign neoplasms. Twelve patients benefited by further surgery during the initial operation, and no treatment delay occurred as a result of frozen-section diagnosis. There were four incorrect diagnoses of clinical significance, two false positives (benign tumor called malignant on frozen section) and two false negatives (malignant tumor called benign on frozen section). The accuracy of frozen section for specific pathologic diagnosis was 92%. No unnecessary radical surgery was performed. Frozen-section diagnosis of salivary gland neoplasms in our institution was found to be accurate and useful.

An unusual cause of cervical adenopathy. Extramedullary hematopoiesis.

A painless lateral neck mass in an otherwise healthy 58-year-old man is a frequent diagnostic problem. We have recently seen such a patient with a cervical neck mass whose preoperative evaluation findings were normal. Excisional biopsy revealed a lymph node exhibiting changes compatible with extramedullary hematopoiesis. This becomes an additional unusual cause of enlarged lateral neck nodes.

Renal cell carcinoma presenting as a primary parotid gland tumor.

A 62-year-old Caucasian man presented with a slow-growing 3 by 3 cm. mass in the left preauricular region. The pathologist's report on the surgical specimen favored a diagnosis of acinic cell carcinoma but recommended evaluation of the patient for possible metastatic renal cell carcinoma. A subsequent intravenous pyelogram and arteriogram revealed the presence of a mass in the right kidney. The lesion proved to be a renal cell carcinoma which was microscopically indistinguishable from the parotid tumor.

Granulomatous laryngitis of unknown etiology.

A 21-year-old man was admitted for odynophagia and hoarseness of four months duration. He smoked one and a half packs of cigarettes a day and occasionally inhaled marijuana. Indirect laryngoscopy revealed a massive swelling of the entire epiglottis, aryepiglottic folds, and arytenoids. The histopathologic diagnosis of chronic but active nonspecific inflammation was made. Combined antibiotics and steroid therapy gave temporary relief. He was readmitted several months later with progressive shortness of breath, dysphagia, and hoarseness. Biopsy of the epiglottic tissues showed multiple noncaseating epithelioid granulomatous lesions consistent with sarcoidosis. All pertinent laboratory tests failed to establish a definitive diagnosis. The patient eventually underwent supraglottic laryngectomy. He has been symptom-free for 20 months following surgery.

Chondroblastic osteosarcoma of the larynx.

Osteosarcoma of the larynx is a rare lesion. Acceptable cases in the literature are difficult to find. We report a case in which total laryngectomy was carried out for a large, obstructing mass that arose from the cricoid cartilage. We present the histologic criteria for the diagnosis of chondroblastic osteosarcoma.