parotid gland mass differential diagnosis

2005;27(10):923-926. Parotid tumor or parotid mass is a condition characterised by abnormal growths within the parotid glands. FOIA At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, nerve transfer or other facial reanimation procedure, Learn more about the Salivary Gland Center. 2020 Dec;9(6):2295-2311. doi: 10.21037/gs-20-530. official website and that any information you provide is encrypted -, Takahama Junior A, Almeida OP, Kowalski LP. The surgeons take care to identify the facial nerve, the nerve that controls the face, and trace out its branches. A review of 2410 cases with particular reference to histological types, site, age and sex distribution. Examples of criteria for the description of the echogenicity (slightly hypoechoic, highly hypoechoic), US of malignant parotid glands tumors: SCCpoor defined margins, highly hypoechogenic, slightly heterogenic,, US of: PA with irregular shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and, US of different pleomorphic adenomas: a1 , a2 polycyclic shape, highly hypoechogenic, highly, Receiver operating characteristic curves for, Receiver operating characteristic curves for malignant and benign parotid tumors, Receiver operating characteristic curves for pleomorphic adenomas/adenolymphomas of parotid gland, MeSH The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The patients often complain of facial pain and may present with facial paresis. Stage I and II cancers have good cure rates, although the prognostic survival curve never flattens even after 20 years. Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-10448, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10448,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/parotid-gland/questions/1919?lang=us"}. Cho CM, Tong SL, Bhatia KS, Wong KT, Yuen HY, Lee YP, Ahuja AT. The parotid glands are the two largest salivary glands in the body. The Johns Hopkins Salivary Gland Center offers the latest in evaluation, diagnosis and treatment for patients with salivary gland tumors and other salivary gland disorders. Comparative diagnostic imaging and pathological analysis of echo color/power Doppler and of magnetic resonance imaging. 2010 Dec;51(10):1103-10. doi: 10.3109/02841851.2010.519716. Epub 2021 Sep 30. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pommier A, Lerat J, Orsel S, Bessede JP, Aubry K. Bull Cancer. J Laryngol Otol. [8][9][Level 5], The t1w axial sequence of face reveals a lobulated hypointense well-defined mass lesion in the right parotid gland of 35-year-old male. Accessibility The tumors are slow-growing and cause no symptoms. Results of. 2006;26 (3): 147-53. 2008;66:419436. Ahuja, Diagnostic Ultrasound: Head and Neck 2e Anatomy Head and Neck Neck Sublingual/Submental Region Submandibular Region Parotid Region Upper Cervical Level Midcervical Level Lower Cervical Level and Supraclavicular Fossa Posterior Triangle Thyroid Gland Parathyroid Gland Larynx and Hypopharynx Cervical Trachea and Esophagus Brachial Plexus Vagus Nerve Cervical Carotid Arteries Vertebral . Talati V, et al. Salivary fistula: saliva leaking through the incision (this is usually temporary), Sialocele: a cavity or cyst containing saliva, Freys syndrome: a rare complication of parotid gland surgery that causes sweating or flushing in an area of the face when eating, especially spicy, salty or sour foods, Seroma: a pocket of serum that forms near the surgical incision. It is less common for a cancer arising in a location below the collarbone to spread to the gland.. The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice Eur Arch Otorhinolaryngol. The facial nerve should, if at all feasible, not be sacrificed; rarely, radical surgery is needed with resection of the facial nerve. The greater auricular nerve as a donor is an option, but it may be involved, so the sural nerve from the leg may be preferred. Dentomaxillofac Radiol. In: StatPearls [Internet]. Methods: A total of 208 patients with parotid gland tumors and presurgical MRI were included. sharing sensitive information, make sure youre on a federal The .gov means its official. Fine-needle aspiration biopsy (FNA) is the primary diagnostic tool for salivary gland lesions, but the role of FNA in the diagnosis of benign and malignant salivary gland disease still carries some controversy. ACUTE NECK MASSES Neck. 2021 Apr 28;11:644150. doi: 10.3389/fonc.2021.644150. Keywords: Benign lesions tend to be more common in women, but malignant lesions tend to occur with equal frequency in both genders. Complications from parotid surgery are well documented and include a scar, facial nerve injury, hematoma, seroma, salivary fistula, and Frey syndrome (gustatory sweating). Forty-nine patients with increased FDG uptake in the parotid gland were selected for the study group (29 men and 20 women; mean age, 63.14 12.32 years). Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Stephanie Ryan, Michelle McNicholas, Stephen J. Eustace. Parotid tumor treatment often involves surgery to remove the tumor. In experienced hands, this can distinguish malignant from benign disease in 80% to 90% of cases. During the follow-up care,the otolaryngologist can give patients personalized information aboutthe risk of recurrence. Accessibility The energy can come from sources such as X-rays and protons. The parotid glands are the most common place that salivary gland tumors happen. Sometimes, to reach the parotid tumor, the surgery team must manipulate this nerve, Eisele explains. StatPearls Publishing, Treasure Island (FL). Advertising revenue supports our not-for-profit mission. This site complies with the HONcode standard for trustworthy health information: verify here. How will you manage this? The https:// ensures that you are connecting to the These grow slowly and usually do not spread to local nodes. The patient concluded adjuvant radiotherapy and continued follow-up surveillance without evidence of relapse. 2018 Apr;275(4):987-995. doi: 10.1007/s00405-018-4895-6. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. Most parotid tumors are benign (not cancerous). Overall ~80% of all parotid masses are benign and the majority of these are pleomorphic adenomas. In experienced hands, this can distinguish malignant from benign disease in 80% to 90% of cases. This site needs JavaScript to work properly. 2022 Aug 28;14(8):256-271. doi: 10.4329/wjr.v14.i8.256. Laryngoscope. (2006) ISBN: 0323040683. Describe how to properly evaluate a patient for salivary gland tumors. The gland usually contains several intraparotid lymph nodes. Parotid tumors often cause swelling in the face or jaw. Other symptoms include problems swallowing or a loss of facial movement. Front Oncol. They are of 2 types: Benign or non-cancerous Malignant or cancerous In certain cases, the growth inside the parotid gland may not originate from parotid tissues but originate from enlarged lymph nodes which invade the glands. All studies aimed at the differential diagnosis of benign vs. malignant PGTs or the identification of the commonest PGT subtypes were identified, and five studies were found that focused on deep learning-based differential diagnosis of PGTs. All patients with a mass in a salivary gland should have an inspection and palpation of the mass itself. Head Neck. Most people with acute parotitis have extremely tender parotid glands. The differential diagnosis of a neck mass includes: Infectious lymphadenitis - most common cause of a neck mass. stata effettuata un'analisi statistica per identificare le caratteristiche RM pi indicative di malignit e per definire l'aspetto tipico degli istotipi pi comuni. Does routine preoperative imaging of parotid tumours affect surgical management decision making?. Bethesda, MD 20894, Web Policies Major Salivary Gland Imaging. Adjuvant postoperative radiation therapy (RT) can be given in such cases, but this should be discussed in an interprofessional team setting. 1985;146:5158. Squamous carcinoma of the left parotid gland. It is located in the parotid space. The most common type, pleomorphic adenoma, is slow-growing and has a low chance of becoming malignant. (, Warthin's tumour of the left parotid gland. 2009;3:271275. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Radiation therapy might be recommended after surgery. The distinction between tumor types can be difficult, particularly based on material from fine-needle aspiration (FNA). Salivary glands make saliva to help with chewing and digesting food. Taking a detailed history is important in treating patients with parotid lumps, as infectious, autoimmune, and inflammatory processes may masquerade as neoplasms. If the result of FNA is at variance with other findings, then clinical judgment should prevail. Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions. Epub 2016 Feb 20. Superficial parotidectomy with identification and exposure of was traditionally the preferred procedure. Thisis overall (for all glands) the most frequent malignant salivary gland tumor and may arise from any salivary tissue, but is more common in the minor (rather than in major) salivary glands. 23 (5): 353-4. Rapid growth, pain, tethering of the skin, ulceration of the skin, cervical lymphadenopathy, and facial nerve paralysis are all suggestive of malignancy. Bron L, Traynor S, McNeil E, O?? Howlett DC, Kesse KW, Hughes DV et-al. Due to the size discrepancy, in absolute numbers, the parotid gland has the most tumors. Lyu HX, Wang ZR, Gao YQ, Yu M, Li BQ, Zhang ZB. Epub 2010 Oct 1. Find more COVID-19 testing locations on Maryland.gov. Masks are required inside all of our care facilities. Preoperative identification of benign versus malignant parotid masses: a comparative study including positron emission tomography. The tumor usually presents as a slow-growing mass and tends to spread along nerve sheaths. The universal treatment for salivary gland tumors is surgery; hence, patients need to be told about the potential complication, including recurrence. sharing sensitive information, make sure youre on a federal This confirms the important role of DWI for the differential diagnosis of parotid lesions, as reported in previous studies ( 4, 9, 22, 29, 30 ). Bethesda, MD 20894, Web Policies Subtypes Benign epithelial Malignant parotid gland neoplasms; Monomorphic adenoma; Parotid gland tumor; Pleomorphic adenoma; Ultrasound. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. and transmitted securely. VTIQ and VTQ in combination with B-mode and color Doppler ultrasound improve classification of salivary gland tumors, especially for inexperienced physicians. Questo studio retrospettivo si basa sulla valutazione di esami RM pre-chirurgici di 94 pazienti con tumori parotidei. A comprehensive history and physical examination, in conjunction with judicious use of radiographic imaging (MRI, computed tomography, ultrasonography, nuclear medicine studies), laboratory studies, and pathologic analysis (fine-needle aspiration, core biopsy, incisional biopsy), facilitates making an accurate diagnosis. Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a population-based study. It has been linked to smoking and presents after the 4th decade of life. The facial nerveand its branches pass through the parotid gland, as does the external carotid artery and retromandibular vein. Reference article, Radiopaedia.org (Accessed on 18 Jan 2023) https://doi.org/10.53347/rID-2015, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2015,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/salivary-gland-tumours/questions/1919?lang=us"}. This activity outlines the evaluation and management of salivary gland tumors and reviews the role of the interprofessional team in evaluating and treating patients with this condition. Parotid gland pathology, Branchial cyst Parapharyngeal pathology (e.g. But malignant parotid tumors can invade adjacent structures, including the facial nerve, resulting in facial weakness or paralysis.. Examples of criteria for the description of the echogenicity (slightly hypoechoic, highly hypoechoic) and the homogeneity (slightly heterogenous, highly heterogenous) of the parotid gland tumors: US of malignant parotid glands tumors: SCCpoor defined margins, highly hypoechogenic, slightly heterogenic, and poor vascularity pattern (, US of: PA with irregular shape, well-defined margins, slightly hypoechogenic, slightly heterogenic, and no vascularity (. 2021 Feb 1;21(1):19-32. doi: 10.17305/bjbms.2020.5028. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Sood S, McGurk M, Vaz F. Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines. J Oral Maxillofac Pathol. There is one on each side of the face. National Comprehensive Cancer Network. On the other hand, lesions occurring in the submandibular gland and the minor salivary glands are more likely to be malignant. elebi and Mahmutoglu found that with the exception of low grade carcinomas the ES did not improve the sensitivity and specificity of standard ultrasound in differentiation of benign from malignant lesions [ 4 ]. 2005 Oct;31(10):1287-96. doi: 10.1016/j.ultrasmedbio.2005.06.011. The following MRI parameters were evaluated: shape, site, size, margins, signal intensity (SI) on T1w and T2w images, contrast enhancement, signal of cystic content, presence or absence of a capsule, perineural spread, extraglandular growth pattern and cervical adenopathy. HHS Vulnerability Disclosure, Help Parotitis is inflammation of the parotid gland. You have hundreds of salivary glands in and around your mouth that create saliva, which helps to keep your mouth moist and aids in swallowing, speaking and eating. HHS Vulnerability Disclosure, Help National trends in inpatient parotidectomy: A fourteen-year retrospective analysis. Sometimes patients notice a fullness or swelling of the cheek or an asymmetry in the mouth. Some agents include: Viral Adenovirus Coxsackie Epstein Barr virus Influenza Parainfluenza Other respiratory viruses Bacterial Staphlococcus aureus Streptococcus, group A beta-hemolytic Bartonella henselae Haemophilus influenzae Imaizumi A, Kuribayashi A, Okochi K, Ishii J, Sumi Y, Yoshino N, Kurabayashi T. Differentiation between superficial and deep lobe parotid tumors by magnetic resonance imaging: usefulness of the parotid duct criterion. We highlight the importance of considering BCAC in the differential diagnosis in salivary gland tumors. (2017) PLOS ONE. Three studies used semiquantitative elastographic score (ES) [ 3, 4, 8] in the discrimination of parotid gland masses. 12 (9): e0184633. These doctors are called ENT specialists or otolaryngologists. Nerve monitoring during surgery can help identify the nerve so it is protected. The differential diagnosis mainly relies on methemoglobin determination, B-type ultrasound and hepatic angiography. This article does not contain any studies with animals performed by any of the authors. Image courtesy S Bhimji MD, Superficial parotidectomy for a benign salivary gland tumor. -, Nagler RM, Laufer D. Tumors of the major and minor salivary glands: review of 25 years of experience. Sonohistology for the computerized differentiation of parotid gland tumors. A functioning facial nerve should be preserved unless found to be infiltrated with the tumoritself at the time of resection. 2003 Sep;32(5):295-9. doi: 10.1259/dmfr/32387150. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Saber M, Knipe H, et al. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Methods A total of 124 patients with parotid gland lesions for whom surgery was planned were examined using conventional ultrasound, Doppler examination, and shear wave elastography. Excretory stem cells give rise to mucoepidermoid and squamous cell carcinomas, while intercalated stem cells can lead to pleomorphic adenomas, adenoid cystic carcinomas, oncocytomas, adenocarcinomas, and acinic cell carcinomas. Cancers (Basel). All patients underwent DCE-MRI examination for pre-surgery evaluation of parotid gland tumors. Tian Z, Li L, Wang L, et al. A few weeks delays can make a significant difference to the complexity of the planned surgery, with tumors readily invading the skin andsurrounding structures. Parotid tumors can involve the superficial lobe or deep lobe of the parotid gland. Differential diagnosis includes chronic sialoadenitis, necrotizing sialometaplasia, and other carcinomas. ( a ) Axial T2w image,, Pleomorphic adenoma of the right parotid gland. According to the following exclusion criteria: (1) no DCE-MRI; (2) with biopsy before examination; (3) residual disease after treatment; (4) simple cystic disease; (5) tumor short axis diameter less than 1 cm; (6) there are serious motion artifacts. A tumor of the parotid salivary gland arises from an overgrowth of cells. This helps the surgeon decide how much of the parotid gland to remove. Wang Y, Xie W, Huang S, Feng M, Ke X, Zhong Z, Tang L. J Oncol. Ultrasoundis often the first diagnostic procedure to evaluate morphological and structural changes of the parotid gland; for small (<3 cm) and superficial lesions, ultrasound and cytology are often sufficient for a definitive diagnosis 2. appears homogeneous with increased echogenicity compared to nearby muscle 1, intraparotid lymph nodes are normally seen (unlike the submandibular gland), retromandibular veinand external carotid artery are also easily seen and by inference the facial nerve, which lies lateral to these vessels 1, difficulty visualizing deep lesions: the deep lobe is not able to be assessed as it is protected by the mandibular ramus, CT and MRI provide useful additional diagnostic imaging if malignancy is suspected 4, with the sensitivity approaching 100% for detecting parotid neoplasms 5, the parotid duct and retromandibular vein are usually seen and approximate the plane separating the superficial and deep lobes 12, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Federal government websites often end in .gov or .mil. Unable to load your collection due to an error, Unable to load your delegates due to an error, Squamous carcinoma of the left parotid gland. 1997;17:701707. Since "parotid masses" are frequently of nonparotid origin (Table 175.1), the relationship of the mass to the gland markedly alters the management in as many as a third of patients presenting with a parotid-region mass (Figs. This nerve is called the facial nerve. Damage to the facial nerve can occur and is associated with high morbidity. Ralph Weissleder. The P25 of ADC represents the ADC value associated with the tumor sub-volume with the most restrictive water molecule mobility. The facial nerve may be encased in scar tissue, so the traditional method of finding it may have to be augmented by exposing it in the mastoid bone, or more hazardously a peripheral branch traced back. The majority of patients first present to the primary care clinician or nurse practitioner with complaints of a painless lump. Your surgeon and team remove the parotid tumor along with some normal tissue surrounding the mass so it can be removed completely. Contributed by Roger Moukarbel, MD. ed that the ratio of malignancy in salivary gland tumors in children was . Lesions that have pseudopodia are most likely to recur after surgery. Teymoortash A, Hoch S. Congenital Unilateral Agenesis of the Parotid Gland: A Case Report and Review of the Literature. There is fatty infiltration or fatty replacement of the parotid glands with age 6. superior pole:external acoustic meatus,temporomandibular joint, lower pole: behind the angle of the mandible, anterior to the sternocleidomastoidand posterior belly of the digastric, anterior surface: clasps the ramus of the mandiblewith the masseteron its outer surface and medial pterygoidon its inner surface inferiorly (separated by the stylomandibular ligament), anterior border: formed by the lateral edge of the anterior surface where it meets the masseter, the parotid ductand five facial nervebranches emerge from this border, from the deeper part, the superficial temporaland maxillary arteriesleave the gland, deep surface: indented by the mastoid process and its attached muscles (sternocleidomastoidand posterior belly of the digastric),styloid processand its attached muscles (stylohyoid,styloglossus,stylopharyngeus) and two ligaments (stylomandibular,stylohyoid), the external carotid arteryenters the gland through this surface, the styloid processseparates the gland from the internal jugular veinand internal carotid artery, the temporozygomatic and cervicofacial branches of the facial nerve enter the gland between the mastoidand styloid processes8, ADVERTISEMENT: Supporters see fewer/no ads, arterial: external carotid artery and a specific branch of the artery, the transverse facial artery, venous drainage:the retromandibular vein drains the parotid gland and eventually into the external jugular vein. Intraoperative tumor spillage carries with it an increased rate of recurrence over a prolonged period of time, and so long-term follow-up is recommended in such cases. Ultrasound scan (USS) provides invaluable information about the site, size, and nature of salivary gland tumors and the presence of any significant cervical lymphadenopathy. 7th ed. 5. ( a ) Coronal T2w image,, Warthin's tumour of the left parotid gland. The role of imaging in the evaluation of parotid disease. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. calculus Bilateral mumps sarcoidosis lymphoma Mikulicz syndrome (early Sjogrens, bilateral, painless) alcohol-associated parotitis The WHO histological classification of salivary gland tumors now includes over 40 variantsas well as tumor-like lesions (e.g., salivary gland cysts). Causes Unilateral mumps (usually bilateral) tumor infiltration - usually facial nerve palsy blocked duct e.g. Parotid Gland Lesions: Multiparametric Ultrasound and MRI Features. 2013; doi:10.1001/jamaoto.2013.5217. Harish K. Management of primary malignant epithelial parotid tumors. Ishibashi M, Fujii S, Kawamoto K, Nishihara K, Matsusue E, Kodani K, Kaminou T, Ogawa T. Acta Radiol. 2015 May-Jun;81(3):301-6. doi: 10.1016/j.bjorl.2015.03.007. As a result, imaging can quickly narrow the diagnostic possibilities by excluding the extrinsic . Qiu S & Luna M. Testicular Seminoma Metastasizing to the Parotid Gland: Report of a Case. There are many salivary glands in the lips, cheeks, mouth and throat. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. It is important to seek out an experienced head and neck surgeon to perform this procedure. Some cases of a link between occupational exposure to silica dust and nitrosamines have been reported.[3]. 2016: 2672496. The parotid gland surrounds the nerve that moves the muscles of the face. McGuirt WF, Keyes JW Jr, Greven KM, Williams DW 3rd, Watson NE Jr, Cappellari JO. Epub 2013 Jun 6. Careers. Warthin tumor is the 2nd most common benign lesion. However, the only way to provide a definitive diagnosis is to excise the cyst and perform a histopathology examination. Please enable it to take advantage of the complete set of features! Unable to process the form. Review the treatment and management options available for salivary gland tumors. Will I have a scar? The parotid glands are salivary glands that sit just in front of the ears. This is the most prevalent malignant major salivary gland tumor and arises in any salivary tissue but predominantly the parotid gland. The parotid gland is wrapped around the mandibular ramusand extends to a position anterior and inferior to the ear. the differential diagnosis of diseases that occur with increased volume in the head, lymphadenopathy, drooling, dysphagia, and progressive weight loss. The Role of Radiomics in Salivary Gland Imaging: A Systematic Review and Radiomics Quality Assessment. ( a ) Axial T2w, MeSH Please enable it to take advantage of the complete set of features! (, Pleomorphic adenoma of the right parotid gland. Loss of appetite. This site needs JavaScript to work properly. The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively). 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