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Pleomorphic adenoma of the parotid: extracapsular dissection compared with superficial parotidectomy--a 10-year retrospective cohort study.

ABSTRACT: The purpose of this study was to investigate the complication rates and effectiveness of extracapsular dissection compared with superficial parotidectomy for pleomorphic adenomas of the parotid gland from 2002 to 2012. The authors carried out a retrospective cohort study of 198 patients with pleomorphic adenomas of the parotid gland. Extracapsular dissection (ED) or superficial parotidectomy (SP) was performed. The recurrence rate and complications of the two surgical techniques were measured with a univariate analysis of each variable using the appropriate statistical analysis (chi-squared test or t-test). A total of 198 patients were enrolled between January 2003 and December 2012. The study included 97 females (48.99%) and 101 males (51.01%) whose mean age was 50.97 years (range 14-75). The type of surgery performed was ED in 153 patients (77.27%, 80 males and 73 females) and SP in 45 patients (22.73%, 21 males and 24 females). The mean follow-up time was 61.02 +/- 4.9 months for the patients treated with ED and 66.4 +/- 4.5 months for the patients treated with SP. Transient facial nerve injury and facial paralysis were significantly more frequent after SP than after ED (P = 0.001 and P = 0.065, resp.). No significant differences in capsular rupture, recurrence, and salivary fistula were observed after SP or ED: 2.2% versus 3.9%, 2.2% versus 3.3%, and 2.2% versus 0.65%, respectively. Extracapsular dissection may be considered the treatment of choice for pleomorphic adenomas located in the superficial portion of the parotid gland because this technique showed similar effectiveness and fewer side effects than superficial parotidectomy.

SUBMITTER: Cristofaro MG

PROVIDER: S-EPMC4221864 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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PRISMA-Extracapsular Dissection Versus Superficial Parotidectomy in Treatment of Benign Parotid Tumors: Evidence From 3194 Patients.

Project description:Benign parotid tumor is one of the most common neoplasms in head and neck region. Its therapeutic methods have been debatable topics over the past 100 years. Recently, some surgeons suggest that extracapsular dissection (ECD) instead of superficial parotidectomy (SP) for treatment of benign parotid tumor. This study aimed to compare ECD with SP in the treatment of benign parotid tumors by a meta-analysis.We searched Cochrane Library, PubMed, Embase, Ovid, and Web of Science databases on February 14, 2015 for studies that assessed clinical outcomes of SP and ECD as surgical techniques for the management of benign parotid tumors. Outcome data were evaluated by pooled risk ratio (RR) and corresponding 95% confidence interval (CI).After serious scrutiny, a total of 14 cohort studies with 3194 patients were included in this meta-analysis. The pooled RR revealed that there were no significant difference in tumor recurrence rate between ECD and SP (fixed-effect model: RR = 0.71, 95% CI = 0.40-1.27, P = 0.249; random-effect model: RR = 0.67, 95% CI = 0.38-1.23, P = 0.197). However, there were significantly lower incidences of transient facial nerve dysfunction (FND), permanent FND, and Frey's syndrome in patients of ECD group compared with SP group.ECD might be a good choice in treatment of the benign parotid tumor that were mobile, small, located in superficial lobe and without adhesion to facial nerve; ECD should be performed by the experienced surgeons with ability of dissection facial nerve, who should perform SP if tumor is found adhere to facial nerve during an operation; and a multicenter randomized control trial study is necessary to decide the optimal treatment of benign parotid tumor.

| S-EPMC4602923 | biostudies-literature

Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults.

Project description:ImportanceThere is no consensus regarding optimal management of pleomorphic adenoma in adults.ObjectivesTo compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.Design and settingThis decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results.Main outcomes and measuresModel outcomes were measured with quality-adjusted life-years (QALYs).ResultsIn the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years for patients with superficial lobe tumors (5.37 QALYs in favor of parotidectomy below this age, and 5.37 QALYs in favor of observation above this age) and 83.4 years for patients with deep lobe tumors (7.51 QALYs in favor of surgery below this age, and 7.51 QALYs in favor of observation above this age). There was no significant difference in outcomes between parotidectomy and observation among patients aged 70 to 80 years.Conclusions and relevanceThis study suggests that the outcomes associated with parotidectomy and observation are similar at 70 years or older among patients with pleomorphic adenoma and that observation may be the favorable treatment in that age group.

| S-EPMC7516813 | biostudies-literature

Parotid Quadrantectomy Is a Safe Management for Localized Pleomorphic Adenoma.

Project description:Aim:Pleomorphic adenoma is the most common benign tumor of the parotid gland and is classically treated with superficial or total parotidectomy. Less radical surgeries have been proposed to minimize the risk of facial nerve injury. The oncological safety of these procedures remains controversial. We conducted this study to evaluate the safety of superficial hemi-lobectomy (quadrantectomy). Patients and methods:Retrospective analysis was conducted on the paraffin sections of archived superficial parotidectomy specimens from 11 male and 6 female patients (median age 33?years). The microscopic extent of extra-capsular extension was determined on pathological revision. In addition, prospective evaluation of 12 quadrantectomy procedures (M/F?=?7/5, median age?=?36?years) compared to 24 radical surgeries (M?=?F, median age?=?40?years) regarding temporary and persistent facial nerve dysfunction on routine clinical assessment and recurrence rate. Results:On retrospective pathological revision, pleomorphic adenomata had a median microscopic spread of 3?mm beyond capsule in paraffin sections (SD?=?3.6). On prospective analysis with a median follow-up of 33?months (range?=?18-54?months), quadrantectomy had similar relative risk of temporary facial nerve dysfunction evaluated at the immediate postoperative period as well as persistent nerve dysfunction assessed at 3?months (P?=?0.701 and P?=?0.902, respectively). Of the whole study population, one case of recurrence after total parotidectomy was observed at mid-term follow-up (P?=?1.000). Conclusion:Parotid quadrantectomy is a safe management for smaller pleomorphic adenomata localized close to one of the two divisions of the facial nerve.

| S-EPMC5807666 | biostudies-literature

Increase in Chymase-Positive Mast Cells in Recurrent Pleomorphic Adenoma and Carcinoma Ex Pleomorphic Adenoma of the Parotid Gland.

Project description:Incomplete excision of pleomorphic adenoma (PA) may result in recurrent pleomorphic adenoma (RPA). Furthermore, long-term neglected PA may become carcinoma ex pleomorphic adenoma (CXPA). In the present study, the relationships between mast cell-derived chymase and these tumors were examined. The tumor tissues of PA consisted of either or both glandular and fibrotic structures. Histological features of RPA were almost similar to those of PA, except that they showed multinodular structures. CXPA is composed of a mixture of PA and carcinoma. The main stromal cells in PA were myofibroblasts, whereas fibroblasts constituted the main cellular portion in the stromal tissue of RPA. Cancer-associated fibroblasts (CAFs) were present abundantly in CXPA. With increased VEGF expression, neovascularization tended to increase in RPA or CXPA. Compared with PA, chymase-positive mast cells, as well as chymase gene expression, were increased in the tumor tissues from patients with RPA or CXPA. SCF, TGFβ1, and PCNA-positive staining was widely observed in these tumor tissues. The above results suggest that mast cell-derived chymase through its direct or cooperative effects with other mediators may participate in the pathophysiology of RPA and CXPA.

| S-EPMC8657626 | biostudies-literature

Massive transcranial parotid pleomorphic adenoma: recurrence after 30 years.

Project description:Pleomorphic adenoma, also known as benign mixed tumor, is the most common tumor affecting the parotid gland and can reach massive size; however, intracranial invasion is rare. Recurrence of pleomorphic adenoma after excision is a well-known phenomenon and can present decades after resection of the primary tumor. Here we present the case of a 53-year-old man who presented to our clinic with ear fullness, otalgia, and hearing loss 30 years after undergoing total parotidectomy and external beam radiotherapy for pleomorphic adenoma. Magnetic resonance imaging revealed a massive transcranial tumor invading the mastoid cavity, the dura of the posterior fossa, the fallopian and semicircular canals, the jugular foramen, the lateral infratemporal fossa skull base, the sigmoid and transverse sinuses, and the superior parapharyngeal region. Gross examination and histopathological studies confirmed that the mass was a recurrent pleomorphic adenoma. Here we discuss the features of recurrent pleomorphic adenoma and review the current literature.

| S-EPMC3658653 | biostudies-other

A case of lipomatous pleomorphic adenoma in the parotid gland: a case report.

Project description:IntroductionPleomorphic adenoma is the most common benign neoplasm of the salivary glands. Extensive lipomatous involvement of the tumor is, however, a very rare finding.Case reportHerein, a rare case of lipomatous pleomorphic adenoma arising in the parotid gland of a 14-year-old Japanese woman is presented.ConclusionThis is the sixth case of lipomatous pleomorphic adenoma in the English literature. Recognition of this rare subtype of pleomorphic adenoma is important for clinical diagnosis and management. On CT scan, it may not be detected possibly due to the extensive fatty component.

| S-EPMC2710317 | biostudies-literature

Remarkable Triple Pleomorphic Adenoma Affecting both Parotid and Submandibular Glands.

Project description:The objective of this article is to present the first case reported in the literature of metachronous pleomorphic adenoma of bilateral parotid glands and submaxillary gland. The authors report the case of a 27-year-old female with metachronous mixed tumors in her right parotid and submandibular glands. The patient has no history of previous radiotherapy. All three lesions were diagnosed by fine-needle aspiration. The histopathologic evaluation of all three major salivary gland masses demonstrated pleomorphic adenomas, with no occult malignancy observed on serial sections. The presentation of pleomorphic adenomas in the parotids and submandibular glands probably represents three unrelated primary sites of tumor, yet the possibility of metastasis from one gland to the other cannot be excluded.

| S-EPMC4428710 | biostudies-other

Comparison of Different Machine Models Based on Multi-Phase Computed Tomography Radiomic Analysis to Differentiate Parotid Basal Cell Adenoma From Pleomorphic Adenoma.

Project description:ObjectiveThis study explored the value of different radiomic models based on multiphase computed tomography in differentiating parotid pleomorphic adenoma (PA) and basal cell tumor (BCA) concerning the predominant phase and the optimal radiomic model.MethodsThis study enrolled 173 patients with pathologically confirmed parotid tumors (training cohort: n=121; testing cohort: n=52). Radiomic features were extracted from the nonenhanced, arterial, venous, and delayed phases CT images. After dimensionality reduction and screening, logistic regression (LR), K-nearest neighbor (KNN) and support vector machine (SVM) were applied to develop radiomic models. The optimal radiomic model was selected by using ROC curve analysis. Univariate and multivariable logistic regression was performed to analyze clinical-radiological characteristics and to identify variables for developing a clinical model. A combined model was constructed by integrating clinical and radiomic features. Model performances were assessed by ROC curve analysis.ResultsA total of 1036 radiomic features were extracted from each phase of CT images. Sixteen radiomic features were considered valuable by dimensionality reduction and screening. Among radiomic models, the SVM model of the arterial and delayed phases showed superior predictive efficiency and robustness (AUC, training cohort: 0.822, 0.838; testing cohort: 0.752, 0.751). The discriminatory capability of the combined model was the best (AUC, training cohort: 0.885; testing cohort: 0.834).ConclusionsThe diagnostic performance of the arterial and delayed phases contributed more than other phases. However, the combined model demonstrated excellent ability to distinguish BCA from PA, which may provide a non-invasive and efficient method for clinical decision-making.

| S-EPMC9315155 | biostudies-literature

Quantitative promoter methylation differentiates carcinoma ex pleomorphic adenoma from pleomorphic salivary adenoma.

Project description:BACKGROUND: potential epigenetic biomarkers for malignant transformation to carcinoma ex pleomorphic adenoma (Ca ex PSA) have been sought previously with and without specific comparison with the benign variant, pleomorphic salivary adenoma (PSA). Previous analysis has been limited by a non-quantitative approach. We sought to demonstrate quantitative promoter methylation across a panel of tumour suppressor genes (TSGs) in both Ca ex PSA and PSA. METHODS: quantitative methylation-specific real-time polymerase chain reaction (qMSP) analysis of p16(INK4A), CYGB, RASSF1, RAR?, human telomerase reverse transcriptase (hTERT), Wilms' tumour 1 (WT1) and TMEFF2 gene promoters was undertaken on bisulphite-converted DNA, previously extracted from archival fixed tissue specimens of 31 Ca ex PSA and an unrelated cohort of 28 PSA. All target regions examined had formerly been shown to be hypermethylated in salivary and/or mucosal head and neck malignancies. RESULTS: the qMSP demonstrated abnormal methylation of at least one target in 20 out of 31 (64.5%) Ca ex PSA and 2 out of 28 (7.1%) PSA samples (P<0.001). RASSF1 was the single gene promoter for which methylation is shown to be a statistically significant predictor of malignant disease (P<0.001) with a sensitivity of 51.6% and a specificity of 92.9%. RAR?, TMEFF2 and CYGB displayed no apparent methylation, while a combinatory epigenotype based on p16, hTERT, RASSF1 and WT1 was associated with a significantly higher chance of detecting malignancy in any positive sample (odds ratio: 24, 95% CI: 4.7-125, P<0.001). CONCLUSIONS: we demonstrate the successful application of qMSP to a large series of historical Ca ex PSA samples and report on a panel of TSGs with significant differences in their methylation profiles between benign and malignant variants of pleomorphic salivary adenoma. qMSP analysis could be developed as a useful clinical tool to differentiate between Ca ex PSA and its benign precursor.

| S-EPMC3008600 | biostudies-literature

Dysregulated long non‑coding RNAs in pleomorphic adenoma tissues of pleomorphic adenoma gene 1 transgenic mice.

Project description:Long non‑coding RNAs (lncRNAs) have been proven to serve vital roles in various human diseases. However, their involvement in the development of pleomorphic adenoma (PA) in the salivary gland has yet to be examined. In the present study, microarray analysis of the lncRNA and mRNA expression profiles in pleomorphic adenoma gene 1 (PLAG1) transgenic mice was performed. Next, bioinformatics tools were used to predict the differentially expressed genes associated with PA, including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and lncRNA‑mRNA co‑expression network analyses. Comparison of the transgenic and control mice demonstrated that a total of 9,110 lncRNAs and 7,750 mRNAs were significantly differentially expressed (fold change >2; P<0.05). Subsequently, six lncRNAs were randomly selected for further analysis, and five of these were validated as differentially expressed in PA by quantitative polymerase chain reaction, supporting the methodology employed in the current study. The GO and KEGG enrichment analysis of the differentially expressed mRNAs revealed that these mRNAs were closely associated with a number of processes involved in the development of PA. Furthermore, the lncRNA‑mRNA co‑expression network indicated that certain lncRNAs may serve vital roles in the pathogenesis of PA by interacting with a number of core genes. Taken together, these results indicated that lncRNAs and mRNAs were differentially expressed in PA tissues obtained from PLAG1 transgenic mice as compared with those from control mice. These differentially expressed lncRNAs may act as novel biomarkers and therapeutic targets for PA.

| S-EPMC6522809 | biostudies-literature

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