Accuracy of the Milan System for Detecting Neoplastic vs Non-Neoplastic Salivary Gland Lesions: A Retrospective Review

Introduction/Objective Overlapping morphology and heterogeneity of salivary gland tumors (SGT) poses a diagnostic challenge. FNA is commonly used diagnostic tool for evaluation of superficial and deep lesions of any site, but above limitations restrict its maximum utility. To standardize reporting and to address above limitations, Milan system (MS) of reporting salivary gland cytology, has been developed and implemented by labs. We conducted a retrospective study, applying MS to salivary gland lesions (SGL) to evaluate its accuracy and usefulness in discriminating between neoplastic and non-neoplastic conditions, and thus directing patient management (PM) Methods/Case Report 10 yr retrospective review was performed to include patients with FNA for SGL, cytology diagnosis categorized using MS, cytology-histology (CH) correlation performed, and patients’ charts reviewed for follow up. Attention given to diagnostic discrepancies between MS categories and the histologic diagnosis Results (if a Case Study enter NA) 152 patients (20-88yrs) were retrieved, peak incidence 40-49 yrs; M:F ratio 1.2:1. Distribution of the cases in the MS categories: Non-diagnostic (ND) 24, Non-neoplastic (NN) 33, Atypia of Undetermined Significance (AUS) 4, Neoplasm (N) 71, Suspicious for malignancy (SUN) 7, and Malignant (M) 10. 60 cases identified with follow-up histology, of which 51 cases were correlated, distributed as 4 ND, 4 NN, 0 AUS, 37 N, 3 SUN, and 3 M. The uncorrelated 9 cases were distributed as 4 ND due to scant sampling; 2 NN, histologically Warthin’s tumor and sialolipoma; 2 AUS, histologically basal cell neoplasm and infarcted Warthin’s tumor; 1 malignant, histologically cystic mucoepidermoid carcinoma; 0 cases for neoplastic and suspicious for malignancy categories Conclusion Milan System is a useful cytologic tool for diagnosing and segregating patients with salivary gland pathologies, however, our study shows MS to be more reliable diagnostic tool with higher accuracy (combined 98%) in N, SUN & M categories as compared to ND, NN & AUS categories (combined 50%)

Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin’s tumor after partial parotidectomy

Introduction Warthin’s tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin’s tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey’s syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions. Case report We present a patient with multifocal Warthin’s tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy. Discussion Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey’s syndrome and negate the need for fat grafting for defect reconstruction. Conclusion UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.

Surgical treatment of benign parotid gland tumors in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s.

ntroduction: Salivary tumors represent a heterogeneous group of tumors of diverse location, histological structure and bio logical behavior. The purpose of this study was a retrospective evaluation of surgical treatment of a group of patients with newly dia gnosed benign tumors of the parotid salivary gland operated in the years 2014–2018 at the ENT department of Hospital České Budějovice, a.s. Material and methods: A type of surgery, defi nitive histology, postoperative complications and a number of recurrences were monitored. The data were evaluated by descriptive statistical methods. Results: A total of 190 surgeries with benign histological fi ndings in 182 patients were performed. The most common benign result was Warthin‘s tumor (90 cases, 47.4%), followed by pleomorphic adenoma (66 cases, 34.7%). Uncommon histological types of tumors were dia gnosed in 14 patients (7.4%). Non-tumorous fi ndings were found in 20 cases (10.5%). The most frequently performed procedure in 84 cases (44.2%) was extracapsular extirpation. Transient lesion in the area of innervation of the temporofacial and / or cervicofacial branch of the facial nerve was present in 34 (17.9%) patients. Permanent paresis of some of the branches of the facial nerve was reported in 2 (1.1%) patients. In 12 patients, the postoperative course was complicated by the development of salivary fi stula (6.3%). Pleomorphic adenoma relapsed after extracapsular extirpation in 5 cases (20.0%). After partial parotidectomy, one recurrence of pleomorphic adenoma (3.6%) was recorded. Warthin‘s tumor relapsed after simple extirpation in 4 cases (20.0%). Conclusion: Our evaluation results of the surgical treatment of benign parotid gland tumors lead us to make further eff orts improve the care of our patients. We see reserves mainly in the routine use of ultrasonographic examination with performance FNAC and thus planning a safe and suffi ciently radical operational solution. Keywords: parotid gland – pleomorphic adenoma – Warthin‘s tumor – parotidectomy – recurrence – facial nerve paresis – FNAC

Oncocytic papillary cystadenoma of right laryngeal ventricle

A case of oncocytic papillary cystadenoma in a 72-year old woman, a rare tumor of laryngeal seromucinous glands of unclear nature is presented. The patient had a history of chronic inflammation of laryngeal mucosa and both her age and tumor location were typical. The lesion was resected transorally without complications. Histological findings are shown in the present study. The controversial status of oncocytic papillary cystadenoma as either a true neoplasm or a combination of metaplastic and hyperplastic changes, its resemblance to Warthin’s tumor and optimal approach to treatment are discussed.

Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin’s tumor of the parotid gland

The purpose of this study was to explore conventional, diffusion, and dynamic contrast-enhanced MRI (DCE-MRI) characteristics for differentiating metaplastic Warthin’s tumor (MWT) from other tumor types of the parotid gland, including non-metaplastic Warthin’s tumor (non-MWT), pleomorphic adenoma (PA), and malignant tumor (MT). A total of 178 patients with histologically proven tumors of the parotid gland, including 21 MWTs, 49 non-MWTs, 66 PAs, and 42 MTs, were enrolled in the study. Conventional MRI was performed in all patients. One hundred and fifty patients had preoperative diffusion-weighted MR imaging (DWI), and 62 patients had preoperative DCE-MRI. The differences in the conventional, DCE-MRI, and DWI records between MWTs and the other three tumor types were statistically evaluated. Compared with non-MWTs and PAs, there was a statistically significant difference in circumscription ( p < 0.01). The ill-defined circumscription was more common in MWTs than non-MWTs and PAs. Compared with PAs, there was a statistically significant difference in morphology ( p < 0.05). The lobulated morphology was more common in PAs than MWTs. Compared with PAs and MTs, there was a statistically significant difference in the T2 signal of the solid component ( p < 0.01). The T2 moderate intensity of solid components was more common in MWTs than PAs and MTs. The solid components of PAs mostly showed hyperintense on T2-weighted imaging. Cyst/necrosis was more common in MWTs than PAs and MTs. Hyperintense of cyst/necrosis was more common in MWTs and non-MWTs. With respect to contrast enhancement, 52.4% MWTs exhibited moderate or marked enhancement, and most non-MWTs (81.6%) exhibited mild enhancement. Most PAs (84.8%) exhibited marked enhancement. The mean ADC value of MWTs (0.94 × 10−3 ± 0.11 mm2/s) was significantly lower than that of the PAs (1.60 × 10−3 ± 0.17 mm2/s) ( p < 0.001). On DCE-MRI, six of eight MWTs demonstrated TIC of type B. Although MWT is rare, conventional MRI characteristics, DWI and DCE-MRI can provide useful information for differentiating MWT from other parotid mass.

Cystic Parotid Lesions and Classification of Parotid Tumors

The causes of cystic parotid lesions may be congenital or acquired and may cause bilateral or unilateral cysts. Bilateral cystic lesions include Warthin's tumor, benign lymphepithelial lesions of human immunodeficiency virus, Sjorgrin's syndrome, and sialocele. Unilateral cystic lesions include Warthin's tumor, sialocele, first-branchial cleft cyst, parotid lymphoepithelial cyst, parotid lymphangioma, necrotic and infected lymph node. This chapter describes in more detail the etiology, clinical presentation, evaluation, and treatment of “sialocele” and “dermoid cyst of the parotid gland.” It also summarizes parotid gland tumors based on the World Health Organization histological classification, which categorizes parotid tumors into benign epithelial tumors (most commonly pleomorphic adenoma), soft tissue tumors (hemangioma), hematolymphoid tumors (lymphoma), and secondary tumors (represent less than 2% of all head and neck neoplasms).