Recurrent Multinodular Pleomorphic Adenoma of Parotid Gland- A Case Report

Vascular malformation of the parotid gland is an extremely rare condition with very few reported cases in the literature. Here we report a case of a 55 years old, female who presented with the complaint of swelling in the right parotid region for one year. Imaging revealed a vascular malformation involving the superficial lobe of the right parotid gland. Superficial Parotidectomy was done and histopathology was consistent with the diagnosis of vascular malformation of the parotid.

Lipomas are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. The parotid lipoma is a slowly growing, asymptomatic, freely movable, soft mass. Preoperative diagnosis is generally difficult. We present a case of a slowly enlarging mass of the parotid region in a 44-year-old man that proved to be a lipomatous tumor of the parotid gland. We also review 42 other cases from the literature. Our patient's huge tumor was located in the superficial lobe of the gland, and a parotidectomy with preservation of the facial nerve was performed. There was no complication or recurrence of the tumor after a follow-up of 1 year.

<p class="abstract"><strong>Background:</strong> The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system.  </p><p class="abstract"><strong>Results:</strong> Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size &lt;4 cm), 2 suffered facial paresis and out of 11 patients (size &gt;4 cm), 5 suffered same. Out of 59 patients with depth of tumor &lt;2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth &gt;2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).</p><p class="abstract"><strong>Conclusions:</strong> Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.</p>

Pleomorphic adenomas are benign salivary gland tumours, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumour can be explained on the basis of its epithelial and connective tissue origin. The tumour has a female predilection between 30-50 years of age. Slowly progressing asymptomatic swelling is the usual presentation of the tumour. Surgical excision of the tumour mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve. This case report aims to throw light on an interesting case of pleomorphic adenoma of the parotid gland in a 10 years old female patient. The patient presented with a slowly progressing asymptomatic swelling on the right side of the face, which was diagnosed to be pleomorphic adenoma of right parotid gland. The aim of the study is to discuss how to proceed regarding the further management.

A 59-year-old woman presented to an otolaryngology clinic with an 8-week history of a painless lump over her left parotid gland. Her medical history included an invasive ductal carcinoma (33 mm) and a ductal carcinoma in situ (70 mm) of the right breast, for which she had a mastectomy and various adjuvant therapies. The primary tumour presented 8 years prior to the metachronous metastasis. This patient was a non-smoker and had no significant family history. Post-superficial parotidectomy pathology revealed the parotid gland tumour to be oestrogen receptor-positive and HER2 receptor-positive, thus ruling out the initial differential diagnosis of a pleomorphic adenoma. A consequential total parotidectomy with a posterolateral neck dissection was performed with sparing of the facial nerve. The patient recovered well having only encountered a self-resolving salivary fistula. She portrayed no signs of facial nerve palsy and subsequent imaging scans showed no abnormalities.

Apocrine hidrocystoma is a cystic tumor originating from apocrine sweat glands. It is predominantly located in the eyelid margins. Here, we report a case of apocrine hidrocystoma of the parotid gland in a 19-year-old man who was referred to our outpatient clinic with a 5-year history of a gradual swelling in the left parotid region. The patient underwent left superficial parotidectomy. Histological examination confirmed the diagnosis of apocrine hidrocystoma. The case is original by the tumor’s location: to the best of our knowledge, this could be the first case in English and French literature reporting an apocrine hidrocystoma affecting the parotid gland. The purpose of this article is to report our case and discuss its clinical and anatomopathological features as well as its differential diagnoses.

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair’s incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

AbstractThe presentation of tuberculosis as an isolated parotid lump is rare. In this paper, six cases with tuberculous parotitis are reported which were evaluated as a benign parotid neoplasm in 216 specimens pre-operatively. All but one of them had no previous history of tuberculosis and all had a parotid lump as a sole symptom for at least one year. The diagnosis of tuberculosis was made, after superficial parotidectomy, by histopathology. Parenchymal involvement and intraparotid lymph node involvement with tuberculosis were seen in five and three patients, respectively. Two of the patients had lymph node involvement outside the parotid area. One of six patients had a coincidental Warthin tumour. A surgical approach is not only therapeutic but also diagnostic when other diagnostic tools fail.

Background: Pleomorphic adenoma being the most common benign tumor of the major salivary gland, parotid in particular, attracts attention. Facial nerve anatomically separates the superficial lobe from deeper lobe. Superficial Parotidectomy, commonly practiced surgical technique carries high risk of nerve injury causing long term functional and esthetic deficits. This prospective study was to designed to compare required time of  surgery and facial nerve injury in antegrade versus retrograde dissection.Methods: Total of 32 patients who underwent superficial parotidectomy between June 2010 to June 2013 included in this study in which 18 patients were in retrograde dissection group and 14 subjects were in antegrade facial nerve dissection group. Time from the incision till closure is noted along with post operative facial nerve palsy for statistical analysis.Results: This study shows that retrograde facial nerve dissection in superficial parotidectomy requires statistically significant lesser time duration with no difference in facial nerve injury when compared to antegrade nerve dissection.Conclusions: This study approves retrograde facial nerve dissection over antegrade nerve dissection in cases of superficial parotidectomy for betterment of the patient.

AbstractThere is continued controversy over the extent of parotidectomy required for removal of a benign pleomorphic adenoma from the parotid gland. Currently, consensus exists that the integrity of the facial nerve must be preserved when the tumour is totally removed.As a result of experience gained in the first half of the twentieth century, it was recommended that superficial parotidectomy with facial nerve dissection should be the minimal biopsy for pleomorphic adenoma. Since that time, however, research has indicated that partial parotidectomy or extracapsular dissection of benign pleomorphic adenoma can be accomplished with preservation of the facial nerve without an increase in tumour recurrence. Partial parotidectomy or extracapsular dissection results in impaired cosmetic results and a lower incidence of Frey's syndrome, and thus may be the preferred approach when undertaken by experienced surgeons.