Acinic cell carcinoma (ACC) is an uncommon malignant tumor of the salivary glands that is difficult to diagnose. It grows slowly and shows distant metastasis rarely. We experienced a case of recurrent ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy. The 29-year-old man had been suffering from severe multiple bones and joints pain for 2 months. Ten years earlier, he underwent superficial parotidectomy due to a right subauricular mass. The mass was diagnosed with ACC. After surgery, the tumor recurred twice. Then the patient was diagnosed with cardiac metastasis via positron emission tomography-computed tomography and trans-thoracic echocardiography. He also had hypertrophic osteoarthropathy with multiple bone metastasis. He was given palliative radiotherapy and conservative treatment. ACC in the parotid gland with cardiac metastasis and hypertrophic osteoarthropathy has not yet been reported in literature. From this case, it is recommended to evaluate multiple distant metastasis in the ACC of the parotid gland when joint and bone pain are present.
Adult ; Carcinoma, Acinar Cell* ; Echocardiography ; Electrons ; Humans ; Joints ; Neoplasm Metastasis* ; Parotid Gland* ; Parotid Neoplasms ; Radiotherapy ; Salivary Glands

Aged ; Epiglottis ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; secondary ; Neoplasm Metastasis ; Neoplasm Staging ; Parotid Neoplasms ; pathology

Cutaneous squamous cell carcinoma has a high incidence. However, regional metastasis occurs infrequently because skin cancer is usually recognized and treated early. We report the case of squamous cell carcinoma around the earlobe in a 74-year-old male patient. The cutaneous squamous cell carcinoma invaded ipsilateral parotid gland directly without lymphatic spreading. Wide excision was made with 1.5 cm margin and immediate reconstruction was performed with radial forearm fasciocutaneous free flap. During operation facial nerve was preserved. No recurrence was noted for 5 years and the patient was satisfied with good aesthetic result. Cutaneous squamous cell carcinoma spreads to the parotid gland usually through lymph nodes and there are few reports of invasive organ damage by direct invasion. We experienced a case of direct invasion to parotid gland without lymph node involvement of cutaneous squamous cell carcinoma and treated the cancer adequately with wide excision and free flap coverage.
Aged ; Carcinoma, Squamous Cell* ; Facial Nerve ; Forearm ; Free Tissue Flaps ; Humans ; Incidence ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Parotid Gland* ; Parotid Neoplasms ; Recurrence ; Skin Neoplasms

OBJECTIVE: To study our experiences in anatomy of marginal mandibular branch of facial never in partial parotidectomy. METHOD: Thirty-eight cases receiving partial parotidectomy were analyzed retrospectively, and marginal mandibular branch of facial nerve were separated in all cases. RESULT: Temporary facial paralysis appeared in 2 cases and Frey's syndrome appeared in 2 cases. There was no patient appeared the recurrence in the 1-3 years followed up time. CONCLUSION Partial parotidectomy with anatomy of marginal mandibular branch of facial nerve is a safe, effective and minimally invasive therapeutic method for benign tumor on parotid gland (<5 cm).
Face ; Facial Nerve ; anatomy & histology ; Facial Paralysis ; Humans ; Mandible ; Neoplasm Recurrence, Local ; Parotid Gland ; Parotid Neoplasms ; surgery ; Postoperative Complications ; Retrospective Studies ; Sweating, Gustatory

OBJECTIVE: To study our experiences on deep lobe tumor parotidectomy with preservation of the superficial lobe of the parotid gland. METHOD: Eleven cases of benign tumor in the deep lobe of the parotid gland were analyzed restrospectively. Tumour recurrence, Frey's syndrome, paralysis of facial nerve, salivary fistula, dry mouth and feeling around the auricular lobule were evaluated. RESULT: Numbness around the auricular lobule appeared in 2 cases and salivary fistula appeared in 1 case, transient facial paralysis in 1 case. There were no patients appeared Frey's syndrome, dry mouth, permanent facial paralysis and recurrence in the 1-3 years followed up time. CONCLUSION Deep lobe tumor parotidectomy with preservation of the superficial lobe improves the cosmetics and the feeling around the auricular lobule, reduces the incidence rate of Frey's syndrome, facial paralysis and dry mouth.
Ear Auricle ; Face ; Facial Paralysis ; Humans ; Neoplasm Recurrence, Local ; Organ Sparing Treatments ; Parotid Gland ; surgery ; Parotid Neoplasms ; surgery ; Postoperative Complications ; pathology ; Retrospective Studies ; Sweating, Gustatory ; Xerostomia

BACKGROUND AND OBJECTIVES: Management of the clinically negative neck remains a controvertial issue in patients with carcinoma of the parotid gland. In order to assist in selecting appropriate patients of elective neck dissection, we sought to determine how regional nodal metastasis affects survival in patients with parotid carcinomas and to identify clinical predictors for nodal disease. MATERIALS AND METHOD: We retrospectively evaluated 124 patients with parotid carcinoma who received their definitive treatment at the Severance hospital between 1988 and 2003. A total of 84 neck dissections (ND) were performed. 24 of 84 patients who underwent neck dissection had pN(+)-staged stage. Seventy patients had an elective ND (subdigastric ND in 50 and supraomohyoid ND in 20), usually because of ominous histology or high T stage. Kaplan-Meier survival analysis was conducted to compare patients with and without histopathologic evidence of nodal disease. Univariate and multivariate analyses were carried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. RESULTS: Patients with no evidence of nodal disease had significantly improved survival over patients with pathologically positive nodes (p<0.00001). The following variables were significantly associated to the risk of lymph node metastasis by univariate analysis: sex (p=0.0093), facial palsy (p=0.0001), T stage (p=0.0003), tumor location (p=0.01) and histologic type (p=0.0009). By multivariate analysis, only facial palsy had the highest correlation with lymph node metastasis. CONCLUSION: Nodal disease significantly decrease survival in patients with parotid carcinoma. Tumor histopathologic type and facial nerve involvement are the most important predictors of nodal disease. Therefore, even in cN0, we should consider elective neck dissection in parotid carcinomas in case of high-grade malignancy and/or facial nerve paralysis.
Facial Nerve ; Facial Paralysis ; Humans ; Logistic Models ; Lymph Nodes* ; Lymphatic Metastasis ; Multivariate Analysis ; Neck ; Neck Dissection ; Neoplasm Metastasis* ; Paralysis ; Parotid Gland ; Parotid Neoplasms ; Prognosis* ; Retrospective Studies ; Risk Factors*

Large cell neuroendocrine carcinoma is a rare malignant tumor of the parotid gland and has poor prognosis due to its aggressive and rapid growth and easy metastasis. Large cell neuroendocrine carcinoma usually occurs in the lung and intestine. However, a few cases of large cell neuroendocrine carcinoma have been reported in other sites such as the uterine cervix, thymus, urinary bladder, ovary and the ampulla of vater. In large cell neuroendocrine carcinoma of the parotid gland, radical parotidectomy is the first therapeutic step and can be followed by local radiation therapy. We report one case of primary large cell neuroendocrine carcinoma occurring in the parotid gland, and discuss the literature.
Ampulla of Vater ; Carcinoma, Large Cell ; Carcinoma, Neuroendocrine ; Cervix Uteri ; Female ; Intestines ; Lung ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Ovary ; Parotid Gland ; Parotid Neoplasms ; Prognosis ; Thymus Gland ; Urinary Bladder

Approximately 3% of all head and neck neoplasms originate in the parotid gland and less than 1% are oncocytic. We present the rare case of a 63-year-old woman with oncocytic carcinoma of the parotid gland with facial nerve invasion and discuss the characteristics of this rare entity. Based on the results of medical history, physical examination, computed tomography and postoperative histopathological diagnosis, oncocytic carcinoma of the parotid gland was diagnosed. Treatment involved complete parotid gland removal and right neck dissection. Adjuvant radiotherapy and chemotherapy were followed by operation. As of 9 months following surgery, no recurrence has been identified, but long-term results are undefined.
Adenocarcinoma ; pathology ; therapy ; Facial Nerve ; Female ; Humans ; Middle Aged ; Neck Dissection ; Neoplasm Recurrence, Local ; Parotid Gland ; pathology ; Parotid Neoplasms ; pathology ; therapy ; Radiotherapy, Adjuvant ; Tomography, X-Ray Computed

A total of 38 patients with frozen section slides who underwent parotidectomy from January 1980 to December 1993 were retrieved from the Department of Pathology. The permanent section slides of the resected specimens were used as the gold standard. The frozen section and permanent section slides were reviewed by two independent pathologists and were labeled either as benign or malignant. If malignant, the tumor grade was determined as either high grade or low grade. Kappas correlation of agreement was used to determine inter-observer variability. Of the 38 slides, 16 were correctly labeled as malignant and 20 as benign. One slide was incorrectly labeled as malignant and 1 as benign. Sensitivity was 94.1 and specificity was 95.2 percent. The prevalence of malignant parotid tumors was 44.7 per cent, with a positive predictive value of 94.1 per cent and a negative predictive value of 95.2 per cent. Kappa statistic for the permanent section was 100 per cent, and 85 per cent for the frozen section. Tumor grading revealed that only 35.2 per cent were labeled correctly as high grade or low grade. This study showed that frozen section could reliably diagnose a malignant parotid tumor but could not reliably determine tumor grade. (Author)

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Frozen Sections ; Pathologists ; Prevalence ; Observer Variation ; Neoplasm Grading ; Parotid Neoplasms ; Sensitivity And Specificity

Myoepithelial carcinoma is a very rare malignant tumor accounting for less than one percent of the salivary gland neoplasms. This uncommom tumor, showing almost exclusively tumor cells with myoepithelial differentiation, is most commonly diagnosed in the parotid gland and in the minor silivary glands of the palate. We report a 77-year-old woman with myoepithelial carcinoma originating from maxillary sinus, one of the most unusual locations. The patient presented with progressive nasal obstruction and signs of a space-occupying lesion in the left maxillary sinus. A frozen biopsy identified a malignant tumor and a radical maxillectomy was performed. Histology confirmed the presence of a malignant myoepithelial carcinoma. Patient was followed up for one year without any recurrence or distant metastasis.
Accounting ; Aged ; Biopsy ; Female ; Humans ; Maxillary Sinus ; Myoepithelioma ; Nasal Obstruction ; Neoplasm Metastasis ; Palate ; Parotid Gland ; Recurrence ; Salivary Gland Neoplasms