The diagnostic value of Superb Microvascular Imaging in identifying benign tumors of parotid gland.

BACKGROUND: We compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin's tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland. METHODS: The vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed. RESULTS: The internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P < 0.05). By SMI, the vascular distribution and vascular grade in PA were mainly peripheral (33.1%) and avascular (25.7%), Grade 1 (27.8%) and Grade 0 (25.7%). WT were mainly central (31.3%) and mixed distribution (34.9%), in Grade 3 (37.3%) and Grade 2 (36.2%). BCA was mainly peripheral (33.3%) and mixed distribution (33.3%), in Grade 2 (33.3%) and Grade 3 (33.3%). The overall detection rate of SMI for vascular Grade 2 and 3 was significantly higher than that of CDFI (P < 0.05). Both VI and MVD were lowest in PA, highest in WT (P < 0.001). The VI by SMI was correlated with MVD (P < 0.001). The correlation index between vascular distribution and grade by SMI and MVD were significantly higher than CDFI. CONCLUSION: SMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.

Preservation of Salivary Function Following Extracapsular Dissection for Tumors of the Parotid Gland.

PURPOSE: This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function. MATERIALS AND METHODS: Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ2 and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study. RESULTS: Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/minute, respectively (P = .05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group. CONCLUSION: ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors.

Risk interrelationship among multiple primary tumors: A case report and review of literature.

RATIONALE: Along with advanced management in oncology, great progress has been recently achieved in the studies of multiple primary tumors. Several reports have studied the coexistence between lymphoma and either renal cell carcinoma (RCC) or Warthin tumor. However, the level of coexistence between these cases remains unclear due to the absence of a distinct link between them. PATIENT CONCERNS: We present a unique case of multiple primary tumors (lymphoma, RCC, and Warthin tumor) in an 80-year-old man and a review of the literature on the coexistence of RCC with lymphoma and lymphoma with Warthin tumor. DIAGNOSIS: With a history of RCC, the patient had a freely movable lump under his left ear, and the pathological report indicated Hodgkin lymphoma and Warthin tumor. INTERVENTION: RCC and Warthin tumor of the patient were surgically treated, followed by 2 cycles (14 days per cycle) of Epirubicin 40 mg day 1, Bleomycin 8 mg day 1, Vincristine 2 mg day 1, and Dacarbazine 500 mg day 1. The chemotherapy protocol was then changed to Epirubicin 40 mg day 1, Vincristine 2 mg day 1, and Dacarbazine 500 mg day 1 for 7 cycles. OUTCOMES: After the last day of chemotherapy, the patient showed a complete response. LESSONS: To the best of our knowledge, this paper is the first to report a case of multiple primary tumors with a complete response. For their early detection, favorable prognosis, and correlation identification, we suggest a transitive relation between these coexisting tumors. Therefore, similar studies should be conducted.

Sebaceous lymphadenoma identified by fine needle aspiration biopsy: a case report.

BACKGROUND: Sebaceous lymphadenoma of the parotid gland is a rare benign neoplasm. This is the first reported case of fine needle aspiration biopsy (FNAB) findings for sebaceous lymphadenoma of the parotid gland. CASE: A 60-year-old male presented with painless, bilateral parotid swelling noted for 5 months. The swelling was more pronounced on the right. Examination revealed bilaterally prominent parotid glands with diffuse firmness but no discrete masses. There was no evidence of facial nerve dysfunction. Laboratory evaluation was negative for infectious and autoimmune etiologies. Magnetic resonance imaging revealed bilateral cystic parotid masses. FNAB of the right parotid was obtained to assist with preoperative counseling. It revealed lymphoid and salivary gland parenchymal cells. The patient underwent a right superficial parotidectomy. The surgical specimen of the parotid mass confirmed the diagnosis of sebaceous lymphadenoma on the tissue section. The contralateral parotid mass had not been excised at this writing. CONCLUSION: This report is the first to describe the FNAB findings of the unusual benign parotid neoplasm sebaceous lymphadenoma. Though the definitive diagnosis of any parotid mass requires tissue, generally obtained via parotidectomy, an FNAB diagnosis can be useful in counseling a patient prior to definitive biopsy.

Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography.

To establish criteria for the differentiation of benign and malignant tumors of the parotid gland using color Doppler sonography (CDS) and pulsed Doppler sonography (PDS) we examined 37 patients with parotid tumors by gray-scale ultrasound, CDS, and PDS. Tumor vascularization displayed by CDS was graded subjectively on a 4-point scale (0 = no vascularization, 3 = high vascularization). From the Doppler spectrum, the highest systolic peak flow velocity, the resistive index (RI), and the pulsatility index (PI) were calculated. There were 11 malignant and 26 benign tumors. Tumor vascularization by CDS was grade 0 or 1 in 88.5% of benign lesions, whereas it was grade 2 or 3 in 82% of malignant lesions (P < 0.0001). The highest systolic peak flow velocity was statistically significantly higher in malignant lesions than in benign lesions. Using a threshold systolic peak flow velocity of 25 cm/s, sensitivity was 72% and specificity was 88% for the detection of a malignant tumor. Evaluation of tumor vascularization by CDS and PDS cannot differentiate between benign and malignant parotid tumors with certainty. However, high vascularization and high systolic peak flow velocity in tumor vessels should raise the suspicion of malignancy, even if tumor morphology on gray-scale sonography indicates a benign lesion.

Familial occurrence of Warthin's tumour.

A rare occurrence of Warthin's tumour in the parotid glands of three brothers is presented. The only two reports of familial Warthin's tumour are mentioned and pathophysiologic mechanisms are suggested.

[Warthin's tumor. Review of the literature and personal experience]. / Il tumore di Warthin. Revisione della letteratura ed esperienza personale.

Warthin's tumour is a much debated clinical case-characterised by the presence of epithelial proliferation and lymphoreticular stroma. Numerous controversies concern this type of tumour so much so that recently is was even denied that it can be considered a real tumour. The present paper aims to review the state of the art and report the authors' personal experience.