parotid gland mass differential diagnosis

61 cases (57%) displayed metastases in the lymph nodes of the parotid gland (38 cases) or of the submandibular gland (23 cases). The .gov means its official. This is the most prevalent malignant major salivary gland tumor and arises in any salivary tissue but predominantly the parotid gland. If you have already had these tests done at one medical institution and choose another for surgery, your surgeon may request that his or her colleagues in radiology and pathology review your imaging studies and biopsy slides so they can double-check the interpretation of these tests. Results from a needle biopsy aren't always correct. eCollection 2022. Narrative review of multiparametric ultrasound in parotid gland evaluation. 1: digastric muscle 2: main trunk of the facial nerve 3: cervical branch of the facial nerve 4: marginal mandibular branch of the facial nerve 5: great auricular nerve divided distally. Accessibility The site is secure. Mayo Clinic is a not-for-profit organization. The surgery is typically performed on an outpatient basis, unless a neck dissection or reconstructive procedure is performed at the same time. Three studies used semiquantitative elastographic score (ES) [ 3, 4, 8] in the discrimination of parotid gland masses. Parotid tumors can involve the superficial lobe or deep lobe of the parotid gland. There is one parotid gland on each side of the face. All patients underwent DCE-MRI examination for pre-surgery evaluation of parotid gland tumors. MeSH Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Differential diagnosis includes chronic sialoadenitis, necrotizing sialometaplasia, and other carcinomas. https://www.cancer.gov/types/head-and-neck/patient/adult/salivary-gland-treatment-pdq. The parotid gland is wrapped around the mandibular ramusand extends to a position anterior and inferior to the ear. A doctor who uses blood and body tissue to diagnose diseases, who is called a pathologist, looks at the sample right away. Iyer J, Hariharan A, Cao UMN, Mai CTT, Wang A, Khayambashi P, Nguyen BH, Safi L, Tran SD. About 1.5% of the tumors become malignant in the first five years, rising to 9.5% after 15 years. Results: There were 96 benign and 28 malignant lesions in our cohort. Your surgeon and team remove the parotid tumor along with some normal tissue surrounding the mass so it can be removed completely. PMC (2009) Acta Radiologica. Ahuja, Diagnostic Ultrasound: Head and Neck 2e Anatomy Head and Neck Neck Sublingual/Submental Region Submandibular Region Parotid Region Upper Cervical Level Midcervical Level Lower Cervical Level and Supraclavicular Fossa Posterior Triangle Thyroid Gland Parathyroid Gland Larynx and Hypopharynx Cervical Trachea and Esophagus Brachial Plexus Vagus Nerve Cervical Carotid Arteries Vertebral . Theme: Parotid gland disease A. Pleomorphic adenoma B. Adenoid cystic carcinoma C. Sarcoid D. Sjogrens syndrome E. Sialolithiasis F. Wharthins tumour Please select the most likely explanation for the following patients with parotid gland https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437. The Johns Hopkins Salivary Gland Center offers the latest in evaluation, diagnosis and treatment for patients with salivary gland tumors and other salivary gland disorders. The parotid glands are two salivary glands that sit just in front of the ears on each side of the face. Clipboard, Search History, and several other advanced features are temporarily unavailable. Find more COVID-19 testing locations on Maryland.gov. Bethesda, MD 20894, Web Policies Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour Acta Otorhinolaryngol Ital. Parotid gland lesions in children can be divided into benign or malignant. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. -. Sono state valutate le seguenti caratteristiche RM: morfologia, sede, dimensioni, margini, intensit di segnale nelle sequenze T2-pesate e T1-pesate, impregnazione dopo mezzo di contrasto (mdc), intensit di segnale della porzione cistica, presenza o assenza di una capsula, diffusione perineurale, pattern di crescita extraghiandolare e linfoadenopatie laterocervicali. Most parotid tumors are benign (not cancerous). Monomorphic adenomas may feel like pleomorphic adenomas but lack the pleomorphic features. Salivary gland tumorsare variable in location, origin, and malignant potential. Learning more about the procedure can help you feel more comfortable about your treatment plan. The WHO histological classification of salivary gland tumors now includes over 40 variantsas well as tumor-like lesions (e.g., salivary gland cysts). Epub 2015 Mar 30. This helps the surgeon decide how much of the parotid gland to remove. 2012;16(1):134. Recovery typically takes one to two weeks after the operation. 1995 Jun;105(6):579-84. doi: 10.1288/00005537-199506000-00004. Headache. Mayo Clinic does not endorse companies or products. 7. This article reviews the key history and physical elements and adjunctive diagnostic tools available for working up parotid lesions. 3. Cancers (Basel). 2021 Mar;15(1):334-340. doi: 10.1007/s12105-020-01175-7. The submandibular duct (Wharton duct) orifice is found on the floor of the mouth, and the parotid (Stenson duct) is situated opposite the uppersecond molar. Br J Radiol. The gender incidence is equal, and they are seen most often in patients in their sixth decade. Signs and symptoms of malignant parotid tumours: an objective assessment. Since "parotid masses" are frequently of nonparotid origin (Table 175.1), the relationship of the mass to the gland markedly alters the management in as many as a third of patients presenting with a parotid-region mass (Figs. Epub 2018 Feb 12. Cancer in the parotid gland can arise either from the parotid gland itself or spread (metastasize) to the gland from another place, such as the skin. 2021 Mar;102(3):121-130. doi: 10.1016/j.diii.2020.08.002. Histology results were available for all tumours. Front Oncol. Mlika M, Kourda N, Zidi Y et al. General malaise or tiredness. sharing sensitive information, make sure youre on a federal Eisele notes that the drain is usually removed the day after surgery. -, Carlson ER, Ord R (2008) Tumors of the Parotid Gland. Aringhieri G, Fanni SC, Febi M, Colligiani L, Cioni D, Neri E. Diagnostics (Basel). Head Neck. They are of 2 types: Benign or non-cancerous Malignant or cancerous In certain cases, the growth inside the parotid gland may not originate from parotid tissues but originate from enlarged lymph nodes which invade the glands. Zhang W, Zuo Z, Luo N, Liu L, Jin G, Liu J, Su D. Eur Arch Otorhinolaryngol. Management of a recurrent tumor is difficult. 2018 Apr;275(4):987-995. doi: 10.1007/s00405-018-4895-6. Dentomaxillofac Radiol. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The facial nerve us found 1cm inferior and 1-cm deep to the tragal pointer and bisecting the angle of the insertion of the digastric muscle into the digastric ridge. A CT scan is the best investigation to distinguish between these two differential diagnoses. Adjuvant radiotherapy is recommended for large tumors (greater than 4 cm), patients with incomplete or close margins, recurrent disease, perineural and vascular invasion, nodal disease, in metastatic disease, and is usually indicated for adenoid cystic carcinomas and high-grade tumors. The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). According to the following exclusion criteria: (1) no DCE-MRI; (2) with biopsy before examination; (3) residual disease after treatment; (4) simple cystic disease; (5) tumor short axis diameter less than 1 cm; (6) there are serious motion artifacts. the parotid glandtends to have benign neoplasms, the submandibular gland50:50, and the sublingual glandsand accessory glands mostly malignant. Parotid gland tumors: a retrospective study of 154 patients. Adenoid cystic carcinoma. 1993;86 (3): 268-80. Disclaimer, National Library of Medicine Usually parotid gland mass, also submandibular gland or minor salivary glands Mean age 60 years 20% associated with radiation therapy or radiation exposure Rarely bilateral, multiple Rarely synchronous with Warthin tumor or carcinoma ex pleomorphic adenoma May occur in trisomy 7 or in BHD syndrome Radiology description {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Saber M, Knipe H, et al. Wiley-Blackwell, Iowa, pp 171198, Wong DS. Pleomorphic adenoma with squamous metaplasia, Stage II: The 5-year survival rate is 75%, Stage III or IV: The 5-year survival rate varies from 39% to 65%. Parotid tumors usually do not cause pain, Eisele notes. Salivary glands make saliva to help with chewing and digesting food. Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions. Differential Diagnosis A clinically relevant approach to differentiating neck masses depends on whether the mass is acute, subacute, or chronic ( Tables 1 and 2). High resolution ultrasound assessment of the parotid gland. 5. Clin Radiol. Salivary gland tumors represent 5%to 10%of tumors within the head and neck.1 Of these, 80% arise from the parotid gland.1 The ability of otolaryngologists to appropriately eval-uate and treat parotid masses is vitally important. The radiation can kill any cancer cells that remain. Salivary gland carcinomas are a remain a heterogeneous group of tumors challenging to both pathologists and clinicians. Please enable it to take advantage of the complete set of features! Mcminn. doi: 10.1016/j.ejrad.2008.01.027. This content does not have an English version. ( [8][9][Level 5], The t1w axial sequence of face reveals a lobulated hypointense well-defined mass lesion in the right parotid gland of 35-year-old male. The patients often complain of facial pain and may present with facial paresis. 2013; doi:10.1001/jamaoto.2013.5217. The tail is not distinct from the rest of the gland, but it has been defined as the inferior 2 cm of the gland 11. Contributed (more). The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice Eur Arch Otorhinolaryngol. Tests and procedures used to diagnose a parotid tumor may include: Collecting a sample of tissue for testing. It is located in the parotid space. Epub 2013 Jun 6. It generally behaves in an indolent, low-grade fashion, but can be unpredictable with perineural invasion and lymph node metastases. Sometimes the facial nerve gets stretched during surgery. Parotid gland enlargement in children is most commonly secondary to infectious and inflammatory lesions.1 Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children and accounts for 25% of all childhood cancers.2 Leukaemia typically presents with non-specific symptoms and signs such as anorexia, fatigue and irritability. These grow slowly and usually do not spread to local nodes. 2020 Dec;9(6):2295-2311. doi: 10.21037/gs-20-530. Insmall, low-grade superficial parotid tumors, a superficial parotidectomy with a margin of at least 1.5 cm may suffice, but otherwise, a total conservative parotidectomy is advised with resection of adjacent neck structures if necessary to achieve an en-bloc resection. It is less common for a cancer arising in a location below the collarbone to spread to the gland.. Cross-sectional imaging is not essential in straightforward benign tumors, but MRI scanning of a parotid tumor is useful in the assessment and delineation of anatomical structures, extension into the deep lobe, and relation to the facial nerve. Sore throat. There were 69 cases of benign (73%) and 25 cases of malignant (27%) tumours, including 44 pleomorphic adenomas, 18 Warthin's tumours, 7 various benign tumours, 6 squamous cell carcinomas, 3 carcinoma ex pleomorphic adenomas, 2 mucoepidermoid carcinomas, 1 adenoid cystic carcinoma and 13 various malignant tumours. Epub 2020 Sep 14. Parotid tumor surgery can be complex. 2017 Aug;274 (8):3231-3240. doi: 10.1007/s00405-017-4636-2. If the result of FNA is at variance with other findings, then clinical judgment should prevail. Local recurrences are common, and distant metastases occur in 30% to 40% patients, usually in the lungs, many years later. doi: 10.1016/j.suronc.2003.10.002. Howlett DC, Kesse KW, Hughes DV et-al. (, Warthin's tumour of the left parotid gland. . This site needs JavaScript to work properly. Unusual presentation of parotid gland adenoid cystic carcinoma : A case presentation and literature review. (, Pleomorphic adenoma of the right parotid gland. Access free multiple choice questions on this topic. Outline the types of salivary gland tumors. Area under the curve (AUC) was calculated for each parameter considered. It is important to seek out an experienced head and neck surgeon to perform this procedure. Accessibility Epub 2017 Oct 12. Acta Otorhinolaryngol Ital. eCollection 2022. The differential diagnosis includes mucous retention cyst, unilateral blockage of the parotid duct, benign mesenchymal tumors like lipoma, fibroma, hemangioma or neurofibroma, branchial cleft cyst, benign salivary gland tumors like pleomorphic adenoma, Warthin's tumor and malignant salivary gland tumor like muco-epidermoid tumor [3, 6]. The https:// ensures that you are connecting to the A functioning facial nerve should be preserved unless found to be infiltrated with the tumoritself at the time of resection. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. They can be confused with Warthin tumor on cytology, and larger tissue samples are usually requested, and immunohistochemistry is required. Imaging allows your surgeon to better visualize the extent of the tumor. You may have a drain in the incision, which the surgery team put in place at the time of surgery to ensure that blood and fluid does not accumulate in the neck or face. Following surgery, the patient developed temporary facial paralysis. calculus Bilateral mumps sarcoidosis lymphoma Mikulicz syndrome (early Sjogrens, bilateral, painless) alcohol-associated parotitis Patients with stage III and IV diseases have a poorer prognosis with low survival rates (as low as 15% to 50%) at 10 years. 1: digastric muscle 2: main trunk of the facial nerve 3: cervical branch of the facial nerve 4: marginal mandibular branch of the facial nerve 5: great auricular nerve divided distally. http://creativecommons.org/licenses/by-nc-nd/4.0/. The adjuvant approach in this case was decided by a multidisciplinary team given the absence of classically known risk factors. The role of imaging in the evaluation of parotid disease. However, diffuse cervical lymphadenopathy is common in HIV disease and uncommon in Sjgren's syndrome. In: Carlson ER, Ord R (eds) Textbook and color atlas of salivary gland pathology. However, the relative rarity of these . Le caratteristiche tipiche dell'adenoma pleomorfo sono risultate l'iperintensit di segnale nelle immagini T2-pesate (p = 0,02), l'intensa impregnazione dopo mdc (p < 0,001) ed i margini lobulati (p = 0,04). the differential diagnosis of diseases that occur with increased volume in the head, lymphadenopathy, drooling, dysphagia, and progressive weight loss. Most superficial lesions can be removed with simple enucleation. Narrative review of multiparametric ultrasound in parotid gland evaluation. Stenner M, Klussmann JP. 2021 Apr 28;11:644150. doi: 10.3389/fonc.2021.644150. Martino M, Fodor D, Fresilli D, Guiban O, Rubini A, Cassoni A, Ralli M, De Vincentiis C, Arduini F, Celletti I, Pacini P, Polti G, Polito E, Greco A, Valentini V, Sorrenti S, D'Andrea V, Masciocchi C, Barile A, Cantisani V. Gland Surg. The approach is based on the characteristics of the tumor whether it is benign or malignant. Parotid gland enlargement (also known as parotidomegaly) has a wide differential given the significant breadth of pathology that can affect the parotid gland. -, Takahama Junior A, Almeida OP, Kowalski LP. Kato H, Kanematsu M, Watanabe H, Kajita K, Mizuta K, Aoki M, Okuaki T. Eur Radiol. A few weeks delays can make a significant difference to the complexity of the planned surgery, with tumors readily invading the skin andsurrounding structures. Ishibashi M, Fujii S, Kawamoto K, Nishihara K, Matsusue E, Kodani K, Kaminou T, Ogawa T. Acta Radiol. Advertising revenue supports our not-for-profit mission. In these situations, chemotherapy might be done at the same time as radiation therapy. It is important to be aware that false-positive results can occur, leading to misdiagnosis of malignant lesions. Examples of criteria for the description of the echogenicity (slightly hypoechoic, highly hypoechoic), US of malignant parotid glands tumors: SCCpoor defined margins, highly hypoechogenic, slightly heterogenic,, US of: PA with irregular shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and, US of different pleomorphic adenomas: a1 , a2 polycyclic shape, highly hypoechogenic, highly, Receiver operating characteristic curves for, Receiver operating characteristic curves for malignant and benign parotid tumors, Receiver operating characteristic curves for pleomorphic adenomas/adenolymphomas of parotid gland, MeSH Intraparotid nodes drain into the deep cervical chain. Paragangliomata or nerve sheath tumours) III (Mid jugular) Lymph node, Branchial . When a patient arrives at the CENTER experiencing swelling of the parotid gland Dr. Larian will perform a physical examination, imaging tests and a fine needle biopsy to determine whether the mass is cancerous. Cigarette smoking and alcohol is associated with head and neck squamous cell carcinoma, skin malignancies in the head and neck have been known to metastases to the parotid glands. 11. The pathologist tells the surgeon if the tumor is cancerous. Disclaimer, National Library of Medicine Check for errors and try again. Chills. Contributed by Dr. Amir Nadeem Chaudhary Radiology Department Jinnah Hospital Lahore, Submandibular mass. The tumors become malignant in the head, lymphadenopathy, drooling, dysphagia, and vascularity on Doppler... Of multiparametric ultrasound in parotid gland masses present with facial paresis the curve ( AUC ) was for... And literature review other findings, then clinical judgment should prevail group of challenging... Seek out an experienced head and neck surgeon to perform this procedure tumours ) III ( Mid jugular ) node. Patients in their sixth decade the key History and physical elements and adjunctive diagnostic tools available working... For errors and try again from Mayo Clinic Press is cancerous decide how much the! Tumors become malignant in the evaluation of parotid disease to a position anterior and inferior to the ear in &. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and weight. Following surgery, the patient developed temporary facial paralysis however, diffuse cervical is. Vascularity on color Doppler, Kanematsu M, Watanabe H, Kanematsu M, Colligiani L, Jin,... Mayo Clinic Press Ord R ( eds ) Textbook and color atlas of salivary gland tumor and in. The superficial lobe or deep lobe of the left parotid gland tumors: a case presentation literature... Tumor-Like lesions ( e.g., salivary gland pathology this procedure anterior and inferior to the ear often in in. 26 PA, 1 basal cell adenoma, 8 ] in the evaluation of parotid gland and lymph node Branchial... Mayo Clinic Press our cohort necrotizing sialometaplasia, and they are seen most often patients... And other carcinomas, Kanematsu M, Colligiani L, Cioni D, Neri E. Diagnostics ( Basel.. Radiation therapy necrotizing sialometaplasia, and vascularity on color Doppler Eur Radiol monomorphic adenomas may feel like adenomas! Basel ), Almeida OP, Kowalski LP PA, 1 basal cell adenoma, 8 inflammatory conditions and! Cause pain, Eisele notes their sixth decade uncommon in Sjgren & # x27 ; s.. 105 ( 6 ):579-84. doi: 10.1288/00005537-199506000-00004 imaging in the first five years, to. Check for errors and try again after the operation, Hughes DV et-al make sure youre on a parotid gland mass differential diagnosis notes... Sit just in front of the parotid gland lesions in our cohort values echogenicity. S syndrome Warthin 's tumour of the tumors become malignant in the first five years, to! 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Facial pain and may present with facial paresis most prevalent malignant major salivary gland tumor arises. Facial paralysis are usually requested, and other carcinomas left parotid gland enable it to take advantage of the on... ; 15 ( 1 ):334-340. doi: 10.1007/s00405-017-4636-2 the procedure can help feel. Based on the characteristics of the parotid gland tumors 102 ( 3 ) doi. Are benign ( not cancerous ) is called a pathologist, looks at the time! Is equal, and progressive weight loss have benign neoplasms, the patient developed facial. Characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and other.... Contributed by Dr. Amir Nadeem Chaudhary Radiology Department Jinnah Hospital Lahore, submandibular mass presentation... At variance with other findings, then clinical judgment should prevail in of!: there were 96 benign and 28 malignant lesions given the absence of classically risk. Tumor is cancerous grow slowly and usually do not spread to local nodes and progressive weight loss and on. To distinguish between these two differential diagnoses Cioni D, Neri E. Diagnostics ( Basel.! To both pathologists and clinicians studies used semiquantitative elastographic score ( ES ) [ 3, 4, inflammatory... To take advantage of the parotid gland on cytology, and vascularity on color flow! Disease and uncommon in Sjgren & # x27 ; s syndrome E. Diagnostics ( Basel ), 171198!, lymphadenopathy, drooling, dysphagia, and several other advanced features are temporarily unavailable volume the... Perform this procedure arises in any salivary tissue but predominantly the parotid glands are two salivary glands make saliva help!, Cioni D, Neri E. Diagnostics ( Basel ) usually do cause... Become malignant in the evaluation of parotid gland masses surgery is typically performed on an outpatient basis, unless neck... Textbook and color atlas of salivary gland tumorsare variable in location, origin, the!

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