Neck masses secondary to heterotopic salivary gland tissue: A 25-year experience

Wake Forest University, Winston-Salem, North Carolina, United States
American Journal of Otolaryngology (Impact Factor: 0.98). 03/2005; 26(2):96-100. DOI: 10.1016/j.amjoto.2004.08.009
Source: PubMed


The aim of this study is to review salivary tumors arising from heterotopic salivary inclusions in the periparotid and cervical lymph nodal tissues over a 25-year span.
A retrospective chart review revealed 24 patients with asymptomatic neck masses treated between 1976 and 2001, whose pathology demonstrated heterotopic salivary tissue or neoplasms arising from heterotopic salivary tissue.
Nine cases were benign periparotid lymph nodes with heterotopic salivary inclusions, 3 of which had multimodal involvement. Fifteen cases of heterotopic salivary tumors were identified. The benign tumors were predominantly Warthin's tumor (8) with 1 pleomorphic adenoma. Malignant tumors included mucoepidermoid (3), acinic cell (2), and adenocarcinoma (1). Patients were treated by a superficial parotidectomy, neck dissection, or simple excision depending on site and preoperative workup. Adjuvant radiation therapy was included for high-grade malignancies. Among the 15 tumor patients, follow-up ranged from 1 month to 17 years. Nine patients are alive and disease-free, 5 are deceased, and 1 was lost to follow-up.
Heterotopic salivary tissue in periparotid and upper cervical nodes is a more common occurrence than historically recognized. Tumorigenic changes arise from heterotopic nodal inclusions, and although infrequent, should be considered in the differential diagnosis for isolated neck/periparotid masses and parotid Warthin's tumor. Suggested management, after a thorough clinical exam/needle aspiration biopsy, includes an imaging survey of the parotid gland and neck lymphatics with an appropriate resection to include a simple excision, parotidectomy, neck dissection, and/or irradiation as indicated. Isolated low-grade malignant lesions/benign lesions are adequately managed by excision or parotidectomy alone. High-grade malignant lesions require more extended surgery with possible irradiation.

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    • "According to Ferlito et al. a cervical lesion should be considered as primary tumor and treated as mentioned above if the preoperative search for primary malignancies is negative [23]. Consequently the exclusion of a major salivary gland neoplasm by clinical examination and radiographic imaging should preclude the removal of a major salivary gland [25]. There was a controversial discussion about the position of fine needle aspiration cytology in the diagnosis of Warthin's tumors or lesions of the parotid gland in general. "
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