The objective of this study is to provide a comprehensive classification system for parotidectomy operations. Data sources include Medline publications, author’s experience, and consensus round table ...at the Third European Salivary Gland Society (ESGS) Meeting. The Medline database was searched with the term “parotidectomy” and “definition”. The various definitions of parotidectomy procedures and parotid gland subdivisions extracted. Previous classification systems re-examined and a new classification proposed by a consensus. The ESGS proposes to subdivide the parotid parenchyma in five levels: I (lateral superior), II (lateral inferior), III (deep inferior), IV (deep superior), V (accessory). A new classification is proposed where the type of resection is divided into formal parotidectomy with facial nerve dissection and extracapsular dissection. Parotidectomies are further classified according to the levels removed, as well as the extra-parotid structures ablated. A new classification of parotidectomy procedures is proposed.
Objective
A major characteristic of the autoimmune disease primary Sjögren's syndrome (SS) is salivary gland (SG) hypofunction. The inability of resident SG stem cells (SGSCs) to maintain homeostasis ...and saliva production has never been explained and limits our comprehension of mechanisms underlying primary SS. The present study was undertaken to investigate the role of salivary gland stem cells in hyposalivation in primary SS.
Methods
SGSCs were isolated from parotid biopsy samples from controls and patients classified as having primary SS or incomplete primary SS, according to the American College of Rheumatology/European League Against Rheumatism criteria. Self‐renewal and differentiation assays were used to determine SGSC regenerative potential, RNA was extracted for sequencing analysis, single telomere length analysis was conducted to determine telomere length, and frozen tissue samples were used for immunohistochemical analysis.
Results
SGSCs isolated from primary SS parotid gland biopsy samples were regeneratively inferior to healthy control specimens. We demonstrated that SGSCs from samples from patients with primary SS are not only lower in number and less able to differentiate, but are likely to be senescent, as revealed by telomere length analysis, RNA sequencing, and immunostaining. We further found that SGSCs exposed to primary SS–associated proinflammatory cytokines we induced to proliferate, express senescence‐associated genes, and subsequently differentiate into intercalated duct cells. We also localized p16+ senescent cells to the intercalated ducts in primary SS SG tissue, suggesting a block in SGSC differentiation into acinar cells.
Conclusion
This study represents the first characterization of SGSCs in primary SS, and also the first demonstration of a linkage between an autoimmune disease and a parenchymal premature‐aging phenotype. The knowledge garnered in this study indicates that disease‐modifying antirheumatic drugs used to treat primary SS are not likely to restore saliva production, and should be supplemented with fresh SGSCs to recover saliva production.
Abstract
Objective
Salivary gland (SG) progenitor cells (SGPCs) maintain SG homeostasis. We have previously shown that in primary Sjögren’s syndrome (pSS), SGPCs are likely to be senescent, and may ...underpin SG dysfunction. This study assessed the extent of senescence of cells in a SGPC niche in pSS patients’ SGs, and its correlation with functional and clinical parameters.
Methods
The expression of p16 and p21 as markers of senescence in both total SG epithelium and a SGPC niche (basal striated duct cells, BSD) was examined in SGs of pSS (n = 35), incomplete pSS (n = 13) (patients with some signs of pSS, but not fulfilling all classification criteria) and non-SS sicca control (n = 21) patients. This was correlated with functional and clinical parameters.
Results
pSS patient SGs contained significantly more p16+ cells both in the epithelium in general (P <0.01) and in the BSD layer (P <0.001), than non-SS SGs. Significant correlations were found in pSS patients between p16+ BSD cells and secretion of unstimulated whole saliva, stimulated whole saliva, stimulated parotid saliva, CD45+ infiltrate, ultrasound total score and ACR-EULAR classification score, but not with EULAR Sjögren’s syndrome disease activity index (ESSDAI) and EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) scores. Correlations with total epithelium p16+ cells were weaker. Incomplete pSS patients also had increased numbers of p16+ epithelial and BSD cells. Based on protein and mRNA expression, p21+ appears not to play a significant role in the SG in pSS.
Conclusion
These findings suggest SGPC senescence may be an early feature of primary Sjögren’s syndrome and may contribute to defective SG function in pSS but not to systemic disease activity.
Background
Enucleation has been reported as a minimally invasive surgery for Warthin's tumor (WT). However, the definite indications for enucleation have not been clarified.
Methods
Enucleation was ...indicated by the following findings: findings of WT, cystic fluid, or benign leukocytes by fine‐needle aspiration cytology; a well‐margined and homogeneous pattern on imaging; and a tumor location in the tail or preauricular area of the parotid gland. We reviewed 552 cases treated with parotid gland surgery in our hospital.
Results
A total of 108 tumors were treated with enucleation and included no malignant solid tumors or pleomorphic adenoma. Enucleation demonstrated low invasiveness and complication rates. Revision surgery for WT reappearance after enucleation was rare and showed minimal scarring, with a lower risk of facial weakness.
Conclusions
The indication criteria for enucleation were validated. Such enucleation is useful, as it is associated with minimal invasiveness, low complication rates, and safety in revision surgery.
Solitary plasmacytoma is a rare neoplasm of monoclonal plasma cells that falls along the spectrum of plasma cells dyscrasias. Unlike bone plasmacytomas, extramedullary plasmacytomas occur outside the ...bone marrow in any soft tissue. The aerodigestive tract is the most common site, but any organ, including the parotid gland, may be rarely involved. Extramedullary plasmacytoma lacks the defining features of multiple myeloma or medullary plasmacytoma. Here, we report a case of a 60-year-old man who presented with a mass in the retro-auricular area of 2 months’ duration. On physical examination, a 2-cm mass was palpated in the right parotid area with no palpable cervical lymph nodes. Fine-needle aspiration cytology showed atypical cells. MRI of the head and neck showed a 2x2-cm mass in the parotid tail with features suggestive of muco-epidermoid carcinoma and absence of lymphadenopathies. Total parotidectomy was performed. Histopathological evaluation revealed monoclonal plasma cells expressing kappa immunoglobulin light chains. To complete the workup, serum protein electrophoresis, immunofixation, quantitation of immunoglobulins and urine protein electrophoresis, and Bence-Jones were normal. A whole-body 18F-FDG PET/CT scan did not reveal any other lesions. Bone marrow aspirate and biopsy demonstrated less than 3% clonal plasma cells. A complete blood count showed a normal hemoglobin level. Chemistry screen revealed normal calcium and creatinine levels. A diagnosis of solitary plasmacytoma of the parotid gland was made, and the patient received post-operation radiation therapy to the right parotid area. Because less than 7% of patients with solitary medullary plasmacytoma will develop local recurrence and approximately 10–15% of patients will ultimately develop multiple myeloma, the patient was followed up by laboratory tests and imaging at periodic intervals; he is still in complete remission. Although patients with parotid masses are commonly observed in our practice, parotid plasmacytoma is rare. Despite its rarity, it should be considered in the differential diagnosis of parotid gland tumors. Biopsy, blood tests, and imaging are important in the accurate diagnosis and management of this neoplasm.
Background
The aim of the present study was to establish a competing risk nomogram to predict parotid gland cancer‐specific mortality (PGC‐SM).
Methods
Seven thousand nine hundred and sixty‐two ...patients extracted from SEER database were randomly categorized into training and validation sets. The competing risk model was used to identify factors associated with PGC‐SM. The nomogram was evaluated via concordance indexes (C‐indexes), calibration plots, and decision curve analysis (DCA).
Results
Male, elderly, white, widowed, larger tumor, no surgery, advanced tumor grade, lymph node (LN) metastasis, adenocarcinoma (ADC), and higher TNM stage were associated with higher incidence of PGC‐SM. Calibration plots showed that the nomogram was well calibrated. C‐indexes for nomogram were 0.84 (95% CI: 0.81–0.86) and 0.84 (95% CI: 0.82–0.86) in training and validation sets, respectively. DCA demonstrated the clinical usefulness of nomogram.
Conclusions
The competing risk nomogram shows high performance in predicting PGC‐SM, which might enable clinicians formulate suitable treatment protocols for patients with parotid gland carcinoma (PGC).
Parotid gland incidentalomas: A single-institution experience Moon, Peter K.; Tusty, Mahbuba; Megwalu, Uchechukwu C.
American journal of otolaryngology,
March-April 2022, 2022 Mar-Apr, 2022-03-00, 20220301, Letnik:
43, Številka:
2
Journal Article
Recenzirano
Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation, management, and outcomes of PGIs ...discovered on various imaging modalities.
This is a retrospective case series from a single academic institution. The study cohort included 34 patients with parotid gland incidentalomas discovered between January 2009 and December 2019.
Parotid gland incidentalomas were most frequently identified on magnetic resonance imaging (16 patients, 47.1%). Most patients (26 patients, 76.5%) underwent further evaluation with subsequent imaging, most often magnetic resonance imaging (18 patients, 69.2%), and fine needle aspiration biopsy (33 patients, 97.1%). Most tumors were benign on fine needle aspiration biopsy (19 patients, 57.6%). Most cases (21 patients, 61.8%) were managed with observation without parotidectomy. Malignant findings on fine needle aspiration cytology were associated with increased likelihood of undergoing parotidectomy (25% vs 0%; p = 0.04). Among the patients who received a parotidectomy, most (8 patients, 61.5%) had benign findings on final histopathology.
Parotid gland incidentalomas were discovered across a diverse set of imaging modalities in our institution. Magnetic resonance imaging and fine needle aspiration were often performed for further evaluation. Most cases were found to be benign on fine needle aspiration and were managed with observation. These findings highlight the necessity of appropriate work-up for these tumors, and the need for shared decision making between the patient and the physician in selecting the appropriate treatment strategy.
Although conventional ultrasound (CUS) allows for clear detection of parotid gland lesions (PGLs), it fails to accurately provide benign-malignant differentiation due to overlapping morphological ...features. Radiomics is capable of processing large-quantity volume of data hidden in CUS image undiscovered by naked eyes. The aim was to explore the potential of CUS-based radiomics score (Rad-score) in distinguishing benign (BPGLs) and malignant PGLs (MPGLs). A consecutive of 281 PGLs (197 in training set and 84 in test set) with definite pathological confirmation was retrospectively enrolled. 1465 radiomics features were extracted from CUS images and Rad-score was constructed by using Least Absolute Shrinkage and Selection Operator (LASSO) algorithm. Different nomogram models, including clinic-radiomics (Clin + Rad-score), CUS-clinic (CUS + Clin) and combined CUS-clinic-radiomics (CUS + Clin + Rad-score), were built using logistic regression. The diagnostic performance of different models were calculated and compared by area under receiver operating curve (AUC) and corresponding sensitivity and specificity. Finally, 26 radiomics features were independent signatures for predicting MPGLs, with MPGLs having higher Rad-scores in both cohorts (both P < 0.05). In the test population, CUS + Clin + Rad-score obtained an excellent diagnostic result, with significantly higher AUC value (AUC = 0.91) when compared to that of CUS + Clin (AUC = 0.84) and Clin + Rad-score (AUC = 0.74), respectively (both P < 0.05). In addition, the sensitivity of this combined model was higher than that of single Rad-score model (100.00% vs. 71.43%, P = 0.031) without compromising the specificity value (82.86% vs. 88.57%, P = 0.334). The calibration curve and decision curve analysis also indicated the clinical effectiveness of the proposed combined nomogram. The combined CUS-clinic-radiomics model may help improve the discrimination of BPGLs from MPGLs.
•For discriminating parotid lesions, the combined nomogram model using clinical information, conventional ultrasound feature and radiomics signature (CUS + Clin + Rad-score) obtained excellent diagnostic performance both in the trainingarea under the receiver operating characteristic curve(AUC) = 0.94 and test cohort (AUC = 0.91).
Synchronous pleomorphic adenoma in the parotid gland and parapharyngeal space are rare. We report a case of simultaneous pleomorphic adenoma in parotid gland and parapharyngeal space in a 65-year-old ...male presenting to the ENT outpatient department at Northwest General Hospital, Peshawar. The patient presented with a left parotid lump, intra oral examination of which revealed the left palatine tonsil to have been pushed medially. CT of the neck showed a completely separate lump in the left parapharyngeal space, and FNAC of the parotid lump was suggestive of mucoepidermoid carcinoma. The superficial parotid lump was excised first, and the parapharyngeal growth was accessed intraorally and excised. Histopathology revealed both the growths to be pleomorphic adenomas. It is important to raise awareness of synchronous salivary gland tumours, which are a rare occurrence, to highlight its optimal investigation to ensure complete surgical excision, and appropriate management.
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