A Clinical Approach to the Parapharyngeal Space

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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Intracapsular Carcinoma Ex-Pleomorphic Adenoma of the Parapharyngeal Space: Report of Two Cases and Review of the Literature

Tumori Journal ◽

10.5301/tj.5000688 ◽

2017 ◽

Vol 103 (1_suppl) ◽

pp. S73-S77

Author(s):

Remo Accorona ◽

Diego Barbieri ◽

Davide Farina ◽

Davide Lombardi ◽

Mario Bussi ◽

...

Keyword(s):

Pleomorphic Adenoma ◽

Adjuvant Radiotherapy ◽

Parapharyngeal Space ◽

Correct Diagnosis ◽

Needle Aspiration ◽

Malignant Degeneration ◽

Carcinoma Ex Pleomorphic Adenoma ◽

Transcervical Approach ◽

Needle Aspiration Cytology ◽

Clinical Records

Background Carcinoma ex-pleomorphic adenoma of the parapharyngeal space is an exceedingly rare entity. Methods The clinical records of two patients with primary carcinoma ex-pleomorphic adenoma of the parapharyngeal space surgically treated at two different centers were retrospectively analyzed. Results Despite ultrasound-guided fine-needle aspiration cytology and magnetic resonance imaging, the correct diagnosis was preoperatively missed in both cases. Excision was obtained through a transcervical-transparotid approach in 1 case and a minimally-invasive endoscopic-assisted transcervical approach in the other. Definitive histology was consistent with intracapsular carcinoma ex-pleomorphic adenoma. Adjuvant radiotherapy was performed in the case with macroscopic malignant degeneration; both patients are alive and free from disease 36 months after surgery. Conclusions Carcinoma ex-pleomorphic adenoma of the parapharyngeal space is a rare disease, and definitive diagnosis may be challenging. Surgery is the mainstay of treatment, but adjuvant radiotherapy also may be required in the presence of specific risk factors.

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Giant Juvenile Fibroadenoma of the Breast: Report of 2 Cases

Faridpur Medical College Journal ◽

10.3329/fmcj.v7i1.10298 ◽

2012 ◽

Vol 7 (1) ◽

pp. 42-45

Author(s):

SK Biswas ◽

ASM Tanjihur Rahman ◽

AC Paul ◽

MSI Mollah ◽

V Chowdhury

Keyword(s):

Surgical Treatment ◽

Fine Needle Aspiration ◽

Rapid Growth ◽

Needle Aspiration ◽

Benign Tumors ◽

Clinical Approach ◽

Aspiration Cytology ◽

Fine Needle ◽

Large Size ◽

Needle Aspiration Cytology

Giant fibroadenomas are benign tumors, but their rapid growth and large size together with their rarity may determine difficulties in the clinical approach. The authors present 2 cases of giant juvenile fibroadenoma of the breast in girls aged 14 and 16 years, and the respective diagnostic workup and conservative surgical treatment. The diagnosis was made on fine needle aspiration cytology which was confirmed on histopathology. These tumours are almost always benign and should be treated with breast conserving surgery.DOI: http://dx.doi.org/10.3329/fmcj.v7i1.10298Faridpur Med. Coll. J. 2012;7(1): 42-45

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Parotid Tumors: How Rare are They?

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1197 ◽

2014 ◽

Vol 5 (3) ◽

pp. 126-129

Author(s):

Vadisha S Bhat ◽

Rajeshwary Aroor ◽

Satheesh Kumar Bhandary ◽

Anusha S Shetty ◽

KS Gangadhara Somayaji

Keyword(s):

Malignant Tumors ◽

Needle Aspiration ◽

Benign Tumors ◽

Aspiration Cytology ◽

Parotid Tumors ◽

Parotid Swelling ◽

Needle Aspiration Cytology ◽

And Behavior ◽

Malignant Parotid Tumors ◽

Head Neck

ABSTRACT Objectives Salivary gland neoplasms are uncommon, but they are of much interest and debate because of their remarkable variability in structure, clinical presentation, and behavior. We have studied 56 cases of parotid tumors and shared our views on the diagnosis and management of these rare tumors. Materials and methods Fifty-six patients with parotid swelling presented to us over a period of 5 years. Preoperatively, all these patients were evaluated with fine needle aspiration cytology (FNAC). Depending on the report, they were subjected to further treatment. Results Out of 56 cases, 44 (79%) were benign and 12 (21%) were malignant. Pleomorphic adenoma being the commonest benign tumor [32 cases (72%)] and among the malignant tumors, mucoepidermoid carcinoma was the commonest. Parotidectomy is the gold standard treatment for both the benign and malignant parotid tumors. Conclusion Parotid tumors are a rare entity. Among which benign tumors are more common than malignant. An accurate diagnosis preoperatively and timely surgical management would reduce the recurrence rate and risk of complications. How to cite this article Aroor R, Shetty AS, Bhandary SK, Bhat VS, Somayaji KSG. Parotid Tumors: How Rare are They? Int J Head Neck Surg 2014;5(3):126-129.

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Evaluation of salivary gland tumors- clinically radiologically and pathologically: prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211178 ◽

2021 ◽

Vol 7 (4) ◽

pp. 575

Author(s):

Namita Mishra ◽

Neeta Sharma

Keyword(s):

Salivary Gland ◽

Diagnostic Accuracy ◽

Clinical Presentation ◽

Malignant Tumors ◽

Needle Aspiration ◽

Salivary Gland Tumors ◽

Benign Tumors ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Background: Salivary gland tumors are difficult to differentiate based solely on clinical presentation or cytological findings due to their overlapping pictures. Often inadequate samples from cytology pose a challenge in preoperative diagnosis. Histopathology is considered the gold standard in diagnosing these tumors. The purpose of this study was to determine clinical, radiological, and cytological findings of these tumors and to assess the accuracy of these results with that of histopathological diagnosis.Methods: Prospectively 52 patients with salivary gland swellings were enrolled between 2007-2009. Cases with inflammatory swelling were excluded from the study. Demographic, clinical history, preoperatively ultrasonography, cytology, and histopathological data were collected and analyzed.Results: Most cases (65.38%) had parotid gland involvement. Benign tumors were common (80.76%) with pleomorphic adenoma as the most common one. Malignant tumors comprised 19.23%. Mucoepidermoid carcinoma and adenoid cystic carcinoma were common malignant tumors. Local swelling was the most common clinical presentation, and no facial nerve involvement was reported. The hard palate was the most common minor salivary gland affected predominantly by benign tumors. The diagnostic accuracy of fine-needle aspiration cytology was 96.15%, followed by clinical and radiological diagnostic accuracy of 92.31% and 86.54%, respectively. Using McNemar's test, a significant agreement was found between clinical and histological diagnosis (p=0.1336) and between FNAC and histological diagnosis (p=0.4975).Conclusions: Fine needle aspiration cytology is a highly accurate, sensitive, and specific screening technique. It is safe and reliable, though minimally invasive. Ultrasonography-guided cytology along with clinical, and radiological findings could enhance the pre-operative diagnostic accuracy in distinguishing salivary gland 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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Cytopathological study of salivary gland lesions by fine needle aspiration cytology

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195523 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4585

Author(s):

Priyanka Desai ◽

Bhavna Gamit ◽

Neha S. Shahu ◽

Bhavika Dholiya

Keyword(s):

Salivary Gland ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Malignant Tumors ◽

Malignant Lesion ◽

Needle Aspiration ◽

Benign Tumors ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Background: Fine needle aspiration cytology is an inexpensive, minimally invasive, outpatient diagnostic procedure. FNA of salivary gland is easier to perform as the site is superficial and repeat FNAC can be perform. As compared to biopsy methods, FNA is a very smooth, cheaper, outpatient procedure helping clinician to save his time for earlier diagnosis and treatment. Though anatomical structure of the gland is very simple, it is subjected to a diverse and heterogenous range of tumors.Methods: The present study on “Cytomorphological features of salivary gland lesion by FNAC” was carried out on department of pathology from June 2015 to June 2017. 65 patients with salivary gland lesions who were sent to pathology department for FNAC were aspirated and correlated histopathologically.Results: Benign salivary gland lesions contribute to majority of cases (54%). Pleomorphic Adenoma was the most common benign salivary gland lesions and Mucoepidermoid Carcinoma was most common malignant lesion. Parotid gland was the most commonly involved in benign tumors and submandibular gland was commonly involved by malignant tumors. Commonly affected age group by benign salivary gland lesion was 31-40 years and those with malignant salivary gland lesion was 41-50 years.Conclusions: FNA cytology provides useful information for the management of salivary gland lesions and prevents unnecessary surgery in cases of nonneoplastic lesions and identification of malignancy helps the surgeon in deciding type and extent of surgery.

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

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06718-4 ◽

2021 ◽

Author(s):

Olcay Cem Bulut ◽

Roland Giger ◽

Ashwag Alwagdani ◽

Nada Aldabal ◽

Albrecht Stenzinger ◽

...

Keyword(s):

Parapharyngeal Space ◽

Malignant Tumors ◽

Neck Region ◽

Needle Aspiration ◽

Tumor Board ◽

Surgical Approaches ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Optimal Approach

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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Role of fine needle aspiration cytology in the preoperative diagnosis of malignancy in parotid and submandibular gland neoplasm

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v19i2.17634 ◽

2014 ◽

Vol 19 (2) ◽

pp. 110-118

Author(s):

Mohammad Amzad Hossain ◽

Md Zahedul Alam ◽

Md Rojibul Haque ◽

Md Nazmul Haque ◽

KM Nurul Alam ◽

...

Keyword(s):

Submandibular Gland ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

False Negative ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Fine Needle ◽

Medical College ◽

Preoperative Diagnostic ◽

Needle Aspiration Cytology

Objective: To evaluate the role of Fine Needle Aspiration Cytology in the preoperative diagnosis of malignancy in parotid and submandibular gland neoplasm. Methods: This cross sectional study on 50 cases was conducted in the Department of Otolaryngology and Head-Neck Surgery of Sir Salimullah Medical College Mitford Hospital and Dhaka Medical College Hospital from January2009 to June 2010. Results: Fine needle aspiration cytology findings of our all 50 cases were compared with postoperative histopathological reports. Out of the 50 cases, in 36(72%) cases of benign neoplasm and 7(14%) cases of malignant neoplasm, pre-operative FNAC findings and post operative histopathological findings were same. In 7 cases, FNAC and post operative histopathological findings did not matched. These were 2 (4%) false positive and 5 (10%) false negative result.In our study sensitivity of FNAC for reporting malignancy was 58.33%, specificity to rule out malignancy was 94.73% and overall accuracy in detecting malignant tumour was 86%. Positive predictive value and negative value were 77.77% and 87.80% respectively. It can be concluded that fine needle aspiration cytology is a safe, cheap and useful preoperative diagnostic tool in the diagnosis of malignancy in parotid and submandibular gland, but as fine needle aspiration cytology partly depends on operator skill, it may give false negative and false positive result. Conclusion: FNAC is a useful preoperative diagnostic tool for malignant parotid and submandibular glands with high specificity and sensitivity. DOI: http://dx.doi.org/10.3329/bjo.v19i2.17634 Bangladesh J Otorhinolaryngol 2013; 19(2): 110-118

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Diagnosis and Management of Extracranial Head and Neck Schwannomas: A Review of 27 Cases

International Journal of Otolaryngology ◽

10.1155/2013/973045 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 40

Author(s):

Ryuji Yasumatsu ◽

Torahiko Nakashima ◽

Rina Miyazaki ◽

Yuichi Segawa ◽

Shizuo Komune

Keyword(s):

Head And Neck ◽

Postoperative Morbidity ◽

Tumor Resection ◽

Clinical History ◽

Needle Aspiration ◽

Vagus Nerves ◽

Surgical Data ◽

Needle Aspiration Cytology ◽

Clinical Records ◽

Complete Tumor

Objectives. Clinical records of 27 patients with extracranial head and neck schwannoma were retrospectively reviewed.Methods. Ultrasonography (US) was performed in all cases. Seven patients underwent CT. Twenty-five patients underwent MRI. Fine needle aspiration cytology (FNAC) was performed for 12 of the 27 patients. Clinical history, surgical data, and postoperative morbidity were analyzed.Results. The images of US showed a well-defined, hypoechoic, primarily homogeneous solid mass. At CT, only one of 7 cases (14%) was able to suggest the diagnosis of schwannoma. At MRI, twenty of 25 cases (80%) suggested the diagnosis of schwannoma. Only three of 12 cases (25%) displayed a specific diagnosis of schwannoma rendered on FNAC. The distribution of 27 nerves of origin was 10 (37%) vagus nerves, 6 (22%) sympathetic trunks, 5 (19%) cervical plexuses, 3 (11%) brachial plexuses, 2 (7%) hypoglossal nerves, and 1 (4%) accessory nerve. Complete tumor resection was performed in 11 patients, and intracapsular enucleation of the tumor was performed in 16 patients. The rate of nerve palsy was 100 (11/11) and 31% (5/16).Conclusions. MRI is sensitive and specific in the diagnosis of schwannoma. Intracapsular enucleation was an effective and feasible method for preserving the neurological functions.

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Review and characteristics of 585 salivary gland neoplasms from a tertiary hospital registered in the Polish National Major Salivary Gland Benign Tumors Registry over a period of 5 years: a prospective study

Otolaryngologia Polska ◽

10.5604/01.3001.0014.1261 ◽

2020 ◽

Vol 74 (5) ◽

pp. 1-6

Author(s):

Krzysztof Piwowarczyk ◽

Ewelina Bartkowiak ◽

Hanna Klimza ◽

Grażyna Greczka ◽

Małgorzata Wierzbicka

Keyword(s):

Salivary Gland ◽

Needle Aspiration ◽

Tertiary Hospital ◽

Tumor Location ◽

Salivary Gland Neoplasms ◽

Benign Tumors ◽

Tumor Diameter ◽

Major Salivary Gland ◽

Needle Aspiration Cytology ◽

A Prospective Study

Introduction: A Polish National Major Salivary Gland Benign Tumors Registry (SGR) is a report of benign salivary gland neoplasms (SGNs) from 26 different centres in Poland, introduced in 2014. The aim of this study is to analyze demographic characteristics and clinico-pathological factors of benign SGNs treated in large tertiary institutions and to determine possible correlations between selected variables. Material and method: Analysis of 585 patients recorded in SGR and operated on for SGNs in the Department of Otolaryngology and Laryngological Surgery, University of Medical Sciences, Poznań, Poland, over a 5-year period. Patient age, sex, occupation, place of residence, tumor location, size, histology, recurrence, facial nerve function after surgery, wound healing, surgery procedure, availability of pre-operative imaging examinations, fine-needle aspiration cytology (FNAC) results were analyzed. Results: 338 females and 247 males with a mean age of 53 years were operated on. In total, 96.2% of tumors originated from the parotid and 3.8% from the submandibular gland. The most frequent primary tumor diameter was 2–4 cm (59.5%) followed by <2 cm (29.2%) and >4 cm (8.4%). Tumors of over 4 cm were frequently removed by partial superficial parotidectomy, while those under 2 cm – by extracapsullar dissection (ECD). Pleomorphic adenomas (PA) were predominant (58.8%), followed by Warthin’s tumor (WT) – 37.1%. Patients with WT were on average 13.3 years older than patients with PA. Discussion: This research can be helpful to better understand the clinico-pathological features of SGNs. Long-termin hospital-based analysis is important for subsequent metaanalyses and comparisons with other centers. The reasons why not all patients’ data are reported to the national SGR should be further precisely analyzed.

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