Primary neoplasms of the parapharyngeal space: diagnostic and therapeutic pearls and pitfalls

Abstract Purpose Parapharyngeal space neoplasms (PSNs) are rare tumors of the head and neck region. In this study, we report our institutional experience with PSNs over a 27-years period. Methods Patients treated between 1992 and 2018 were identified through our tumor board database. Data concerning demographics, clinical presentation, disease features, treatment, complications and follow-up were obtained retrospectively. Results In total, 48 patients were identified. Most patients had benign tumors (67.5%), with pleomorphic adenoma and schwannoma being the most frequent entities. Malignant tumors represented the remaining 32.5% of neoplasms. Concerning tissue of origin, 67.5% of neoplasms originated from salivary glands and 17.5% were neurogenic. The vast majority of PSNs required open surgical approaches (77%). The most frequent reversible and irreversible complications included paralysis of facial, vagal, and hypoglossal nerves (transient 62.5%, permanent 31.3%). Tumor recurrences occurred in 16.7% of our patients. Conclusion Neoplasms of the parapharyngeal space (PPS) are rare. In our series, consistent with the literature, most patients had benign tumors. Fine-needle aspiration cytology (FNAC) and/or transoral biopsy in selected cases combined with radiographic imaging are helpful to plan the optimal approach (open/transoral) and extent of primary surgery. Close follow-up in malignant neoplasms is crucial to assess recurrence early. We present one of the largest recent studies on PPS tumors treated in a center. Given the low incidence of these tumors, our results contribute to the existing sparse evidence regarding the management and outcome of such tumors.

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Parapharyngeal space tumors: considerations in 26 cases

Sao Paulo Medical Journal ◽

10.1590/s1516-31801999000100006 ◽

1999 ◽

Vol 117 (1) ◽

pp. 34-37 ◽

Cited By ~ 8

Author(s):

Alfio José Tincani ◽

Antonio Santos Martins ◽

Albina Altemani ◽

Rui Carlos Scanavini Jr. ◽

Gilson Barreto ◽

...

Keyword(s):

Parapharyngeal Space ◽

Malignant Tumors ◽

Soft Tissue Sarcomas ◽

Needle Aspiration ◽

High Rate ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Surgical Morbidity ◽

Neurogenic Tumors ◽

Parapharyngeal Space Tumors

CONTEXT: Parapharyngeal space tumors comprise less than 0.5% of all head and neck neoplasms.1 The majority of these tumors are benign, but surgery is usually required to establish the diagnosis and treat the patients. We present 26 patients treated surgically for tumors arising in the parapharyngeal space (PPS) at the State University of Campinas Hospital – UNICAMP. CASES SERIE: Of these, 17 (65.5%) had benign and 9 (34.6%) malignant neoplasms. The surgical and pathological data relevant to these cases are highlighted, observing any local recurrence, surgical complications and the five-year survival. Neurogenic tumors and soft tissue sarcomas were, respectively, the most frequent benign (35.3%) and malignant neoplasms (44.5%). Benign tumors accounted for the majority of the cases and involved minimal surgical morbidity with no recurrence during a median follow-up of five years. Malignant tumors had a high rate of recurrence and mortality. Surgery is the treatment of choice for PPS tumors. A knowledge of the anatomy of this site is essential for the safe performance of surgical procedures. Malignant neoplasms have a poor prognosis. Fine needle aspiration was helpful in diagnosis of all tumors.

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A Clinical Approach to the Parapharyngeal Space

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1296 ◽

2017 ◽

Vol 8 (1) ◽

pp. 1-4

Author(s):

AM Shivakumar ◽

Praveen D Shivanandappa ◽

Veena P Doddamane ◽

KS Munish ◽

BS Yogeesha

Keyword(s):

Parapharyngeal Space ◽

Malignant Tumors ◽

Imaging Study ◽

Needle Aspiration ◽

Benign Tumors ◽

Clinical Approach ◽

Preoperative Diagnostic ◽

Clinicopathological Profile ◽

Needle Aspiration Cytology ◽

Clinical Records

ABSTRACT Aim To present the clinicopathological profile, surgical management, and the outcome of parapharyngeal space (PPS) neoplasms in 14 patients. Materials and methods This is a retrospective review of the clinical records of 14 patients treated for PPS tumors. The age of patients ranged from 24 to 54 years, with female to male ratio of 1.3:1. The commonest clinical presentation was a slowgrowing, painless neck swelling. The preoperative protocol was based on: (1) imaging study to establish site, size, and anatomical relationships. (2) Fine-needle aspiration cytology (FNAC) was performed to determine the nature of the mass. Details of the management, morbidity, and outcome of these patients are presented. Results A total of 85.7% of the PPS neoplasms were benign and 14.2% were malignant. Majority of the benign tumors were of neurogenic origin. The histocytopathology confirmed 12 (85.7%) of these diagnoses (2 patients were with “nondiagnostic” result). The positive predictive value of the FNAC was 83.3% for benign tumors and 100% for malignant tumors. In 6 patients (60%), a transcervical surgery was performed. Three patients (30%) underwent transparotid–transcervical surgery for a pleomorphic adenoma of the deep lobe of the parotid gland in the prestyloid space and transcervical–transmandibular approach was taken in 1 case (10%). Postoperative complications occurred in 3 out of 10 patients (33.3%). Conclusion The results of our study are in agreement with other studies reported in the literature and confirm the need to follow a careful preoperative diagnostic protocol that must take advantage of imaging studies (computed tomography, magnetic resonance imaging) and of cytology FNAC, in order to plan surgical treatment with a safe approach and that reduces complications, esthetic and functional damage, and the risk of recurrence. How to cite this article Shivanandappa PD, Doddamane VP, Munish KS, Yogeesha BS, Shivakumar AM. A Clinical Approach to the Parapharyngeal Space. Int J Head Neck Surg 2017;8(1):1-4.

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Metastatic adrenal lesions in cancer patients.

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2018-11-3-179-182 ◽

2018 ◽

Vol 11 (3) ◽

pp. 179-182

Author(s):

Ivan Petrovich Moshurov ◽

Olga Valerievna Andreeva

Keyword(s):

Cancer Patients ◽

Adrenal Glands ◽

Malignant Neoplasm ◽

Needle Aspiration ◽

Adrenal Tumors ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Fine Needle ◽

History Of

Relevance.The col lective concept of" incidence " of the adrenal glands includes a group of neoplasms of more than 1 cm in diameter, accidentally revealed by radiation methods of research. With the development of methods of instrumental diagnostics, the number of adrenal glands detected by the incident is steadily increasing, including in patients with a history of malignant neoplasm (ZNO). Objective.Study of the frequency of occurrence metastaties of adrenal tumors in cancer patients. Materials and methods. Made 137 fine-needle aspiration biopsies (TAB) of adrenal tumors in the patients in whom during follow-up were detected adrenal incidence. Results. According to the results of morphological verification in 44(32%) cases of adrenal tumors were metastatic. Conclusion. Adrenal tumors, detected in patients with malignant neoplasms of different localization, can be provided as metastatic and benign tumors. However, each revealed a tumor in the adrenal glands of patients undergoing treatment after testing shall be considered as potentially metastatic.

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Parapharyngeal space tumors: a serial case study

Journal of International Medical Research ◽

10.1177/0300060519862659 ◽

2019 ◽

Vol 47 (8) ◽

pp. 4004-4013

Author(s):

Kuang-Hsu Lien ◽

Chi-Kuang Young ◽

Shy-Chyi Chin ◽

Chun-Ta Liao ◽

Shiang-Fu Huang

Keyword(s):

Parapharyngeal Space ◽

Clinical Symptoms ◽

Malignant Tumors ◽

Neck Mass ◽

Surgical Approaches ◽

Common Symptom ◽

Neck Tumors ◽

The Mean

Objective Primary parapharyngeal space (PPS) tumors are one of the most challenging head and neck tumors to diagnose and treat. We analyzed our experience in patients with PPS tumors who were treated in our hospital over 13 years. Methods We retrospectively reviewed 16 patients with PPS tumors between 2006 and 2018. The study included clinical symptoms, histological types, surgical approaches, adjuvant therapies, postoperative complications, and prognosis. Results The mean age of the patients was 49.63 ± 17.03 years. A palpable neck mass (56.3%) was the most common symptom. In our series, 78.6% of the tumors were benign, and of these, schwannomas were the most common (6/14, 42.9%). Three surgical approaches were used in our patients, including transmandibular (57.1%), transcervical (21.4%) and transparotid (21.4%) approaches. Few complications were reported, including hoarseness and numbness. Adjuvant therapy was administered depending on pathological parameters of the tumors. No recurrence was observed during a mean follow-up of 60.6 months in patients with malignant tumors. Conclusions Radiological studies of PPS tumors are essential for diagnosis and surgical planning. Excision of PPS tumors using appropriate surgical approaches provides good outcomes.

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Parotid Tumors: Fine-Needle Aspiration and/or Frozen Section

Otolaryngology ◽

10.1016/j.otohns.2008.09.013 ◽

2008 ◽

Vol 139 (6) ◽

pp. 811-815 ◽

Cited By ~ 63

Author(s):

Peter Zbären ◽

Dominique Guélat ◽

Heinz Loosli ◽

Edouard Stauffer

Keyword(s):

Sensitivity And Specificity ◽

Fine Needle Aspiration ◽

Malignant Tumors ◽

Frozen Section ◽

Needle Aspiration ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Tumor Type ◽

Fine Needle ◽

Parotid Tumors

Objective The purpose of this study was to analyze and compare the value of fine-needle aspiration cytology (FNAC) and frozen section (FS) analysis in the assessment of parotid gland tumors. Study Design Chart review and cross-sectional analysis. Subjects and Methods FNAC and FS analysis of 110 parotid tumors, 68 malignancies and 42 benign tumors, were analyzed and compared with the final histopathologic diagnosis. Results The accuracy, sensitivity, and specificity of FNAC in detecting malignant tumors were 79 percent, 74 percent, and 88 percent, respectively. On FS analysis, the accuracy, sensitivity, and specificity in detecting malignant tumors were 94 percent, 93 percent, and 95 percent, respectively. The histologic tumor type was correctly diagnosed by FNAC and FS in 27 of 42 (64%) and 39 of 42 (93%) benign tumors, respectively, and in 24 of 68 (35%) and 49 of 68 (72%) malignant neoplasms, respectively. Conclusion The current analysis showed a superiority of FS compared with FNAC regarding the diagnosis of malignancy and tumor typing. FNAC alone is not prone to determine the surgical management of parotid malignancies.

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The Milan System for Reporting Salivary Gland Cytopathology: Assessment of Cytohistological Concordance and Risk of Malignancy

Acta Cytologica ◽

10.1159/000510720 ◽

2020 ◽

pp. 1-13

Author(s):

Shilpy Jha ◽

Suvradeep Mitra ◽

Suvendu Purkait ◽

Amit Kumar Adhya

Keyword(s):

Salivary Gland ◽

Predictive Value ◽

Malignant Tumors ◽

Minor Salivary Gland ◽

Treatment Protocol ◽

Needle Aspiration ◽

Histopathological Diagnosis ◽

Wide Range ◽

Risk Of Malignancy

Introduction: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was proposed by the American Society of Cytopathology and the International Academy of Cytology to bring uniformity in the reporting system and the treatment protocol. A wide range of risk of malignancy for each category has been reported by various authors by applying the system. Aim: We intend to study the cytohistological concordance and the ROM for each of the diagnostic categories of the Milan system. Materials and Methods: The study included 292 cases of fine-needle aspiration cytology (FNAC) of salivary gland lesions over a period of 3 years. The diagnosis of these cases was reclassified into the 6 categories of the Milan system. The cytohistological concordance and ROM for each category of the Milan system were calculated based on the clinical and histopathological follow-up. Results: The patients’ age ranged from 3 to 81 years with the mean of 42.65 ± 16.3 years. The cases included 189 (64.7%) parotid, 82 (28.1%) submandibular, and 21 (7.2%) cases of minor salivary gland swellings. Follow-up histopathological diagnosis for 102 cases was available. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated to be 64.28, 97.01, 90, 86.67, and 87.37%, respectively. After reclassification, the number of cases in each category was as follows: category I: 31 (10.62%), category II: 80 (27.4%), category III: 2 (0.68%), category IVA: 143 (48.97%), category IVB: 1 (0.34%), category V: 13 (4.45%), and category VI: 22 (7.53%). The calculated ROM was as follows: category I: 42.86%, category II: 26.67%, category III: 100% category IVA: 10.17%, category IVB: 0%, category V: 71.42%, category VI: 100%. Conclusion: FNAC is an excellent procedure to differentiate benign from malignant tumors, and MSRSGC is a useful system for risk assessment and deciding the further treatment protocol. Our findings also suggest that in addition to the surgical follow-up, inclusion of the clinical and radiological follow-up may be a better strategy for calculation of ROM, especially for categories I and II.

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Spontaneous Tumors and Non-Neoplastic Proliferative Lesions in Pet Degus (Octodon degus)

Veterinary Sciences ◽

10.3390/vetsci7010032 ◽

2020 ◽

Vol 7 (1) ◽

pp. 32

Author(s):

Tanja Švara ◽

Mitja Gombač ◽

Alessandro Poli ◽

Jožko Račnik ◽

Marko Zadravec

Keyword(s):

Malignant Tumors ◽

Single Case ◽

Case Reports ◽

Hepatocellular Adenoma ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Octodon Degus ◽

Hind Limbs ◽

Neoplastic Lesion ◽

Veterinary Faculty

In recent years, degus (Octodon degus), rodents native to South America, have been becoming increasingly popular as pet animals. Data about neoplastic diseases in this species are still sparse and mainly limited to single-case reports. The aim of this study was to present neoplastic and non-neoplastic proliferative changes in 16/100 pet degus examined at the Veterinary Faculty University of Ljubljana from 2010 to 2015 and to describe the clinic-pathological features of these lesions. Twenty different lesions of the integumentary, musculoskeletal, genitourinary and gastrointestinal systems were diagnosed: amongst these were 13 malignant tumors, six benign tumors, and one non-neoplastic lesion. Cutaneous fibrosarcoma was the most common tumor (7/16 degus). It was detected more often in females (6/7 degus) and lesions were located mainly in hind limbs. The gastrointestinal tract was frequently affected, namely with two malignant neoplasms - an intestinal lymphoma and a mesenteric mesothelioma, four benign tumors – two biliary cystadenomas, an oral squamous papilloma and a hepatocellular adenoma, and a single non-neoplastic proliferative lesion. In one animal, two organic systems were involved in neoplastic lesions.

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Well-differentiated liposarcoma arising in the parapharyngeal space: a case report and review of the literature

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002461 ◽

2015 ◽

Vol 129 (S2) ◽

pp. S86-S90 ◽

Cited By ~ 1

Author(s):

N Kikuchi ◽

T Nakashima ◽

J Fukushima ◽

K Nariyama ◽

S Komune

Keyword(s):

Case Report ◽

Parapharyngeal Space ◽

Case Reports ◽

Surgical Margin ◽

Neck Region ◽

Surgical Excision ◽

Curative Therapy ◽

Long Term Follow Up ◽

Well Differentiated

AbstractBackground:Liposarcomas rarely occur in the parapharyngeal space and only a few case reports exist. For curative therapy of liposarcoma, surgical excision remains the dominant modality. Although a wide surgical margin is important to prevent local recurrence, wide excision is often difficult in the head and neck region.Case report:We report a case of a 19-year-old female with a well-differentiated liposarcoma arising in the parapharyngeal space. We removed the tumour surgically utilising a cervical–parotid approach. The histological diagnosis was well-differentiated sclerosing liposarcoma. There is no recurrence after five years and nine months of follow up.Conclusion:The patient's age and the tumour site made it difficult for us to make a quantitative diagnosis before the operation. Well-differentiated liposarcoma rarely develop distant metastasis, but often recur locally. The benefit of adjuvant radiotherapy for well-differentiated liposarcoma is still not clear and careful and long-term follow up is necessary.

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Risk Factors of Malignant Neoplasms of Female Genital Organs (Review of Literature)

Journal of New Medical Technologies ◽

10.12737/3326 ◽

2014 ◽

Vol 21 (1) ◽

pp. 115-121 ◽

Cited By ~ 2

Author(s):

Сулейманова ◽

N. Suleymanova

Keyword(s):

Malignant Tumors ◽

Pathological Process ◽

The Body ◽

Morbidity Rate ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Scientific Review ◽

Papillomavirus Infection ◽

Hormone Homeostasis ◽

Female Genital

The scientific review discusses the correlation between the MN morbidity rate of the female genitalia and the factors of the external and internal environment of the body: genetic (hereditary) and environmental (exogenous and endogenous). The author notes that the significance of the factors in the development of oncological process is different depending on the form and localizations of malignant tumors. Identified genes are responsible for the appearance of hereditary ovarian cancer (however, the genes of predisposition to cancer of body and cervix of the uterus don’t identified so far). The role of human papillomavirus infection (in the genesis of pre-cancerous lesions and cervical cancer) in hormone homeostasis due to functional and anatomical changes in the hypothalamic-pituitary-ovarian system (in formation of cancer of the womb and ovaries) is proved, including the background processes and pre-cancerous changes in the occurrence of all forms of genital cancer. A number of researchers consider benign tumors as an intermediate in the pathological process changes that lead with time under the influence of certain factors to be precancerous and malignant transformation. Significant fluctuations in the frequency of malignant tumors of female genital organs in different ethnic groups of the population are scientifically confirmed. Correlation frequency of cancer of the genitalia in women with age, and state of the immune system are noted.

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Neurofibromatosis in Children: Actually and Perspectives

Children ◽

10.3390/children9010040 ◽

2022 ◽

Vol 9 (1) ◽

pp. 40

Author(s):

Maria Lucia Sur ◽

Ionel Armat ◽

Genel Sur ◽

Diana-Cristina Pop ◽

Gabriel Samasca ◽

...

Keyword(s):

Cellular Proliferation ◽

Malignant Tumors ◽

Correct Diagnosis ◽

Neurofibromatosis Type ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Nf1 Gene ◽

Clear Delineation ◽

Tumor Management

The three types of neurofibromatosis, namely type 1, type 2, and schwannomatosis, are generally associated with various benign tumors affecting the skin and the nervous system. On rare occasions, especially in patients with neurofibromatosis type 1 (NF1), malignant neoplasms may also be present, several of them possessing a more aggressive course than in individuals without this syndrome. As such, a clear delineation between the three variants of neurofibromatosis is crucial to establish the correct diagnosis and management, as well as predict the neoplasm-related outcomes. Neurofibromin, the principal product of the NF1 gene, is a potent inhibitor of cellular proliferation, having been linked to several key signaling pathways involved in tumor growth. Therefore, it may provide a useful therapeutic target for tumor management in these patients. In this article, we want to present the association between deficiency of neurofibromin and the consequences of the lack of this protein leading to different kinds of malignant tumors. The therapy is still uncertain and most therapeutic options are in development or clinical trials.

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