Unexpected pathologies in pediatric parotid lesions: Management paradigms revisited

Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Av NW, Washington, DC 20010, USA.
International journal of pediatric otorhinolaryngology (Impact Factor: 1.19). 02/2011; 75(4):558-63. DOI: 10.1016/j.ijporl.2011.01.019
Source: PubMed


To present case vignettes of unusual pediatric parotid pathologies and discuss management paradigms in the context of these lesions.
Retrospective case series.
Free-standing, academic tertiary care pediatric hospital.
All patients over the past 18 months undergoing parotidectomy for a parotid mass were reviewed (N=5).
Ages ranged from 17 months to 16 years. All presented with a remarkably similar clinical course, consisting of a persistent parotid mass for more than 3 months which was usually painless. Most (4/5 patients) had been treated with antibiotics prior to Otolaryngology consultation. Fine-needle aspiration (FNA) was performed on 3 patients and was diagnostic in one. Complete excision of the mass was performed in each child through a parotidectomy approach (3 total, 2 lateral lobe). The final pathology showed metastatic neuroblastoma (17 months old), undifferentiated primitive sarcoma (22 months old), mucoepidermoid carcinoma (11 years old), nodular fasciitis (12 years old), and hyperplastic lymph node (16 years old). The patient with neuroblastoma died from complications of bone marrow transplant.
The differential diagnosis for a persistent pediatric parotid mass is expansive and differs from that found in the adult population. As this series highlights, in many cases, it is impossible to discern the pathology, or rule out malignancy, based upon the clinical course, imaging, or FNA results. Surgical excision remains the standard for management of these patients and is both diagnostic and therapeutic. Our anecdotal case series highlights the importance of having a low threshold for parotidectomy in these children.

1 Follower
4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The purpose of this study was to evaluate our 25-year experience of pediatric salivary tumors. Methods: Patients less than 19 years old with a diagnosis of salivary tumor were identified at Oral-maxillofacial Head and Neck Tumor Center, China Medical University from 1987 to 2011. Results: 122 patients were included in our study, 105 tumors were benign and 17 were malignant. The most common involved site was parotid gland, pleomorphic adenoma represented 91.4% in benign group, and mucoepidermoid carcinoma represented 47.1% in malignant group. All tumors in submandibular gland were benign. Warthin's tumor was diagnosed in one patient. In our follow-up, no regional recurrences occurred in patients without neck dissection. The 5- and 10-year overall survival rates of patients with malignant salivary tumors were 81.8% and 66.7% respectively. Conclusions: Epithelial salivary tumor was rare, parotid gland was most common involved site, pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumor respectively. The prognosis of patients with malignant salivary tumors was not very favorable.
    International journal of pediatric otorhinolaryngology 06/2013; 77(8). DOI:10.1016/j.ijporl.2013.04.034 · 1.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Conclusions: Parotidectomy remains the mainstay of treatment for both benign and malignant lesions of the pediatric parotid gland. Adjuvant radiation therapy should be used judiciously in pediatric patients due to the higher risk of post-irradiation complications. Objective: The purpose of this study was to define the incidence and treatment of pediatric parotid tumors, and to determine what factors are useful in the management of these lesions. Methods: From June 2002 to June 2012, 22 patients ≤18 years of age with parotid mass were treated at Chonnam National University Hospital. Information on patient characteristics, clinical and histopathologic tumor characteristics, and treatment modalities and their results was obtained from the medical records. Results: The 22 patients comprised 11 males and 11 females. Eighteen patients had a benign tumor and four patients had a malignant tumor. The most common benign tumor was pleomorphic adenoma (63.6%) and the most common malignant tumor was mucoepidermoid carcinoma (9%). The most common treatment was superficial parotidectomy. Three patients required adjuvant radiotherapy. None of the patients had major complications or facial nerve palsy.
    Acta oto-laryngologica 08/2013; 133(11). DOI:10.3109/00016489.2013.822554 · 1.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nodular fasciitis (NF), very uncommon in the parotid gland, is a benign myofibroblastic proliferation that may be mistaken for other neoplastic proliferations. The mass-like clinical presentation and histologic features result in frequent misclassification, resulting in inappropriate clinical management. There are only a few reported cases in the English literature. Cases within the files of the authors' institutions (retrospective) confined to the parotid gland were compared to cases reported in the English literature (Medline 1966-2014). The patients included five females and seven males, aged 11-70 years (mean 45.2 years). All patients presented with a mass lesion, present on average 1.9 months, without a documented history of trauma. The lesions were 0.7-5.2 cm (mean 2.2 cm). Seven patients had fine needle aspiration. The majority of the lesions were circumscribed (n = 9), composed of spindle-shaped to stellate myofibroblasts (MF) arranged in a storiform growth pattern, juxtaposed to hypocellular myxoid tissue-culture-like areas with extravasation of erythrocytes. Dense, keloid-like collagen (n = 7) and occasional giant cells were seen (n = 6). Mitotic figures (without atypical forms) were readily identifiable (mean 4/10 HPFs). By immunohistochemical staining, the MF were reactive with vimentin, actins, and calponin, while the histiocytes were reactive with CD68. All patients had surgical excision. One patient developed local recurrence (12 months later). All were alive and disease free at last follow-up, with a mean 133 months of follow-up. The principle differential diagnoses include fibrosarcoma, fibromatosis, pleomorphic adenoma, myoepithelioma, neurofibroma, schwannoma, solitary fibrous tumor, leiomyoma, fibrous histiocytoma and myxoma. NF of the parotid gland occurs in middle-aged patients who present with a mass (mean 2.2 cm) in the parotid gland of short duration (1.9 months). FNA misinterpretation frequently leads to excision. Separation from myoepithelial and mesenchymal lesions affecting the parotid gland results in appropriate management.
    Head and Neck Pathology 12/2014; 9(3). DOI:10.1007/s12105-014-0594-9
Show more