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
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.
Available from: Norbert Kübler
- "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 . Consequently the exclusion of a major salivary gland neoplasm by clinical examination and radiographic imaging should preclude the removal of a major salivary gland . 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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ABSTRACT: Cystadenolymphomas (Warthin's tumors) are the second most frequent lesions of the parotid gland. Due to their benign clinical behavior, the low rates of recurrence and malignant transformation they were classified as tumor-like lesions. In addition, a polyclonal growth of the epithelial components of the tumor could be detected. Warthin's tumors occur bilateral in 7-10%, whereas a multifocal appearance is extremely rare. Even if the pathogenesis is still unclear a heterotopia of salivary tissue during embryogenesis is the most likely explanation for the origin of these tumors in the upper neck and periparotideal region. Here we present a rare case of bilateral, multifocal, extraglandular Warthin's tumors in lymph nodes of the upper neck and give a brief review of the literature. If a primary malignancy can be excluded by a careful staging procedure prior to the operation an isolated excision of the lesions of the neck is the adequate treatment.
Head & Face Medicine 04/2012; 8(1):11. DOI:10.1186/1746-160X-8-11 · 0.85 Impact Factor
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ABSTRACT: The histologic distinction of Spitz nevus and Spitzoid melanoma is notoriously difficult, and an additional complication is provided by the fact that there may be a group of Spitz tumors that has the propensity to spread regionally, but not to distant sites.The interpretation of regional spread is subject of controversy. Mones and Ackerman regard it is as formal proof of malignancy, whereas others have argued that this stance constitutes an oversimplification. The ongoing controversy regarding the typing of "difficult" Spitz tumors with regional spread reflects these different viewpoints. We review the arguments that support the notion that regional spread cannot be equated with distant metastasis, and provide a critical commentary on Mones' and Ackerman's interpretation of their data and their review of the relevant literature.We advocate the use of 3 diagnostic categories: Spitz nevus, Spitzoid melanoma, and a provisional group of "Spitz tumor of uncertain malignant potential." A discussion of the pros and cons of different terms and their usage concludes the article.
Advances in Anatomic Pathology 08/2006; 13(4):147-56. DOI:10.1097/00125480-200607000-00001 · 3.23 Impact Factor
Laryngo-Rhino-Otologie 01/2007; 86(1):44-47. DOI:10.1055/s-2006-925095 · 0.84 Impact Factor
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