Extended and treatment-oriented classification of parotid duct stenosis.

OBJECTIVES/HYPOTHESIS: To provide an extended and treatment-oriented classification of parotid duct stenosis that might be useful in the management of this condition. STUDY DESIGN: Retrospective study in a tertiary referral center. METHODS: A total of 550 symptomatic stenoses of the parotid gland excretory duct in 445 patients were analyzed. Sialendoscopy was performed with semirigid endoscopes. The tissue quality, location, grade of luminal narrowing, and length and number of the stenoses were assessed. RESULTS: Inflammation-dominant stenosis (type 1) was found in 8.9% of the patients, web-associated fibrous stenosis (type 2) in 19.5%, and fibrous (type 3) in 71.6%. Multiple stenoses (≥3) were found in 2.8% of patients, and bilateral stenoses in 11.9%. Type 1 stenoses differed significantly from type 3 stenoses, with lower grades. Type 3 stenoses showed significantly higher grades of luminal narrowing than the other two types (P = .0001). Type 2 stenoses were significantly shorter in comparison with the other two types (P = .0001). Multiple stenoses were observed significantly more often in type 2 than in type 3 stenoses (P = .0001). Due to these differences, the type of stenosis appears to be the most important criterion in the treatment-oriented classification. CONCLUSIONS: Significant differences between the different stenoses were observed. Type 1 stenosis may be considered as a precursor of type 3 stenosis, but type 2 stenosis showed significantly different characteristics. The differences prescribed in this classification may be helpful in the management of parotid duct stenoses. LEVEL OF EVIDENCE: 4. Laryngoscope, 2016 127:366-371, 2017.

Feasibility of a novel classification for parotid gland cytology: A retrospective review of 512 cytology reports taken from 4 United Kingdom general hospitals.

BACKGROUND: A novel classification for parotid cytology has been previously proposed. The purpose of this study was to assess the feasibility and clinical relevance of this classification. METHOD: Between 2010 and 2013, cytology reports from 4 United Kingdom general hospitals were retrospectively classified and compared to histological and clinical outcomes. RESULTS: Based on the cytology reports of 512 patients, we revised our previous "P" system to a "Sal" (salivary) classification to encompass all cytologic outcomes. The percentage of patients with a final diagnosis of malignancy according to each category heading were: Sal 1 (inadequate) 7.9%; Sal 2I (nonneoplastic) 10%; Sal 2N (benign neoplastic) 1.4%; Sal 3 (atypical) 20.4%; Sal 4 (suspicious) 52.6%; Sal 5P (primary salivary gland malignancy) 71.4%; Sal 5NOS (malignancy not otherwise specified) 100%; and Sal 5M (metastasis) 91.7%. CONCLUSION: By stratifying the probability of encountering a malignant neoplasm, the classification could guide clinical management decisions. A future prospective study is warranted. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Rare Parotid Gland Diseases.

The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and pathologic analysis and molecular technology. This article reviews rare parotid diseases, discussing the respective disease's clinical presentation, diagnosis, imaging, pathogenesis, treatment, and prognosis.

The Oral HIV/AIDS Research Alliance: updated case definitions of oral disease endpoints.

The Oral HIV/AIDS Research Alliance (OHARA) is part of the AIDS Clinical Trials Group (ACTG), the largest HIV clinical trials organization in the world. Its main objective is to investigate oral complications associated with HIV/AIDS as the epidemic is evolving, in particular, the effects of antiretrovirals on oral mucosal lesion development and associated fungal and viral pathogens. The OHARA infrastructure comprises: the Epidemiologic Research Unit (at the University of California San Francisco), the Medical Mycology Unit (at Case Western Reserve University) and the Virology/Specimen Banking Unit (at the University of North Carolina). The team includes dentists, physicians, virologists, mycologists, immunologists, epidemiologists and statisticians. Observational studies and clinical trials are being implemented at ACTG-affiliated sites in the US and resource-poor countries. Many studies have shared end-points, which include oral diseases known to be associated with HIV/AIDS measured by trained and calibrated ACTG study nurses. In preparation for future protocols, we have updated existing diagnostic criteria of the oral manifestations of HIV published in 1992 and 1993. The proposed case definitions are designed to be used in large-scale epidemiologic studies and clinical trials, in both US and resource-poor settings, where diagnoses may be made by non-dental healthcare providers. The objective of this article is to present updated case definitions for HIV-related oral diseases that will be used to measure standardized clinical end-points in OHARA studies, and that can be used by any investigator outside of OHARA/ACTG conducting clinical research that pertains to these end-points.

Sjögren's syndrome of the parotid gland: value of diffusion-weighted echo-planar MRI for diagnosis at an early stage based on MR sialography grading in comparison with healthy volunteers.

PURPOSE: To investigate the value of diffusion-weighted echo-planar imaging (DW-EPI) for quantifying functional changes of the parotid gland in Sjögren's disease and to evaluate whether ADC mapping allows for early diagnosis based on MR sialography grading. MATERIALS AND METHODS: Using a DW-EPI sequence at 1.5 T (b-factors: 0, 500 and 1000 sec/mm (2)), the parotid glands of 52 healthy volunteers and 13 patients with histologically verified affection of Sjögren's disease were examined. All scans were performed prior to and following gustatory stimulation with 5 ml of lemon juice. ADC maps were evaluated by placing an inordinate region-of-interest (ROI) enclosing the entire parotid gland. Sjögren's disease was graded based on MR sialography findings using a 4-point grading-scale. Statistics included student t-test and kappa-analysis. RESULTS: In healthy volunteers mean ADCs of 1.14 x 10 (-3 )mm (2) /sec before and 1.2 x 10 (-3) mm (2) /sec after stimulation were observed. Higher ADCs were determined for early-stage Sjögren's disease, averaging 1.22 x 10 (-3) mm (2) /sec before and 1.29 x 10 (-3) mm (2) /sec after stimulation. Advanced disease revealed significantly lower ADCs (0.97 x 10 (-3) mm (2) /sec (p = 0.002) before and 1.01 x 10 (-3) mm (2) /sec (p < 0.001) after stimulation). CONCLUSION: DW-EPI seems to display functional changes of the parotid gland affected by Sjögren's disease. Combined with MR sialography, it might be a useful tool for discriminating healthy from affected glands and seems to allow differentiation between the early and advanced disease.

The benign lymphoepithelial cyst and a classification system for lymphocytic parotid gland enlargement in the pediatric HIV population.

OBJECTIVES/HYPOTHESIS: The objectives of this study are to present a series of parotid gland benign lymphoepithelial cysts (BLEC) in HIV-positive children and to propose a three-tiered classification system for HIV-associated lymphocytic parotid gland enlargement. STUDY DESIGN: The authors conducted a retrospective case series and literature review. METHODS: The authors conducted a retrospective chart review of four pediatric patients with HIV-associated parotid gland BLEC who presented to a tertiary care university medical center. RESULTS: Four pediatric HIV-positive patients (four girls; age range, 7-17 years [mean age, 12.8 years]) were diagnosed with parotid gland BLEC. Two patients presented with acute parotitis and the others presented with asymptomatic enlargement of the parotid glands. Three patients had bilateral parotid gland BLEC. The other patient demonstrated persistent generalized lymphadenopathy (PGL) of the intraparotid and cervical lymph nodes and early BLEC limited to the left parotid gland. One patient also displayed parotid gland microcalcifications and cystic changes in the adenoids, neither of which have been described previously in the setting of HIV-associated BLEC. Computed tomography was performed on all patients, and one patient underwent fine needle aspiration to confirm the diagnosis. All patients opted for observation and antiretroviral medication therapy as long-term treatment. Based on these findings and a review of the literature, we propose a three-tiered classification system for lymphocytic parotid gland enlargement in the HIV population: 1) PGL, 2) benign lymphoepithelial lesions (BLEL), and 3) BLEC. CONCLUSIONS: This series equals the largest pediatric series of HIV-associated parotid gland BLEC in the English literature. One patient in our series also demonstrated PGL; there were no cases of BLEL. A classification system based on morphology is proposed to help resolve the confusion in terminology used to describe this entity. Most pediatric HIV-infected patients with parotid gland BLEC can be treated with observation and antiretroviral medication therapy. For others, who are symptomatic or more concerned about their cosmetic appearance, sclerotherapy may offer a reasonable option. Radiation therapy and surgery should be reserved for select cases.

Some unusual oral lesions in HIV infection: comments on the current classification.

Of the numerous oral lesions reported in HIV-infected patients, four entities will be discussed in this paper: linear gingival erythema; cystic lymphoid hyperplasia of the parotid gland; oral non-Hodgkin's lymphoma; and oral squamous cell carcinoma. Based on the literature and the author's personal experience, it appears that linear gingival erythema is perhaps a specific HIV-associated periodontal lesion, but that insufficient data are available in the literature yet to classify this periodontal lesion as a lesion that is strongly associated with HIV infection. On the other hand, cystic lymphoid hyperplasia of the parotid gland has been rather widely reported and has characteristic histopathological features that would justify consideration of this lesion as highly indicative of an underlying HIV infection. Oral non-Hodgkin's lymphoma, at present regarded as a lesion 'strongly associated with HIV infection', is less characteristic in this respect and should merely be classified as 'a lesion seen in HIV infection'. Oral squamous cell carcinomas, not included in the most recent International Classification of Oral Manifestations of HIV infection, should be listed in Group 3 of that classification, representing 'lesions seen in HIV infection'. Further criteria should be developed that will enable distinctions to be made between lesions 'strongly associated with', 'less commonly associated with', and 'seen in' HIV infection.

[Sclerosing polycystic sialadenopathy. A rare non-tumorous disease]. / Sklerosierende polyzystische Sialadenopathie. Eine seltene nichttumoröse Erkrankung.

Tumour-like lesions of the salivary glands are diseases which, in accordance with the new WHO classification of salivary gland tumours, can simulate a true tumour by swelling or induration of the salivary gland tissue. An additional rare entity, only recently not described in the new WHO classification, is "sclerosing polycystic sialadenopathy" (s.p.s.) which, especially in younger patients, results in nodular, incompletely encapsulated, tumour-like masses mainly of the parotid gland. Histologically, it is comparable to fibrocystic mastopathy and is characterized by distinct hyalinized, centrally accentuated sclerosing collageneous tissue with inclusion of cystically ectatic ducts and focal epithelial hyperplasia. In the hyperplastic ducts, trans-luminal bridges and cribriform patterns can develop, sometimes also apocrine secretion and eosinophilic globules. The s.p.s. must be distinguished mainly from cystadenoma, mucoepidermoid carcinoma and also from dysgenetic cystic parotid gland. Based on four of our own observations the differential diagnosis is analysed.

Benign parotid diseases of childhood.

A 25-year retrospective study of 63 pediatric surgical cases of benign parotid disease was done. Inflammatory disorders accounted for 34 of the cases. The remaining 29 non-inflammatory conditions included vasoformative, solid, and cystic lesions and were nearly always asymptomatic.

Parotid cysts. An analysis of 16 cases and suggested classification.

Cystic lesions, greater than 8 mm in diameter, were found in 16 of 183 surgically excised parotid glands over an 8 yr period. Of these 16 cysts, 9 had developed in parotid neoplasms, usually of Warthin type. The remaining 7 were not associated with neoplasms and 5 were unilocular. The epithelial lining of non-neoplastic cysts was squamous in all but one case, and there was lymphoid tissue in the walls of 3 cysts. On the basis of these findings and a review of the literature, a morphological classification of parotid cysts is proposed. To the surgical pathologist, the major problems in dealing with parotid cysts are the recognition of associated neoplasms and of those cysts likely to have accompanying congenital abnormalities.