Ultrasound imaging of the salivary glands edward g. Multiparametric magnetic resonance imaging versus fine needle aspiration cytology for parotid gland neoplasms. A and b, pleomorphic adenoma and c and d, adenocarcinoma. Parotidectomy is a major surgical procedure to remove the parotid gland shaded blue in the image which is one of 2 major salivary glands found in the human body. Suvmax was not useful for differentiating benign from malignant parotid lesions because of the wide range of suvmax and high suvmax of benign. Pleomorphic adenoma is, by far, the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Surgical management of pleomorphic adenoma of parotid gland in. Fineneedle aspiration of the tumor was performed with sonographic guidance, and cytology confirmed its.
Management and prognostic factors of recurrent pleomorphic. Perfusion mr imaging detection of carcinoma arising from. Because of its propensity for invasion, pleomorphic adenoma of the parotid. They claimed that, dwi has the potential to differentiate only pleomorphic adenoma and myoepithelial adenomas from other parotid tumor types and state that in contrast to most other studies, an overlap regarding the adc values from warthin tumors and three different malignant subtypes of parotid gland lesions is present. Parotid pleomorphic adenoma patient history 46 yearold man, non smoker, with a right parotid mass detected several months ago. Diffusionweighted echoplanar mr imaging of primary parotid.
A large duct passes out of parotid gland and carries saliva into the oral cavity. Warthin tumor is the second most common tumor with a frequency of about 30%. Xueyu rong, qiang zhu, hongtao ji, jiangping li, and huilian huang. Mr imaging findings of parotid tumors with pathologic diagnostic clues a pictorial essay article in clinical imaging 282. Preoperative diagnostic strategy for parotid gland tumors. It is the commonest of all salivary gland tumors constituting up to twothirds of all salivary gland tumors. Diagnostic imaging techniques for salivary gland tumors include ultrasound, computer tomography ct and magnetic resonance. The pleomorphic adenoma, shown in the images below, is by far the most common.
This solid mass lies in the deep parotid lobe and at surgery was a pleomorphic adenoma. Sep 04, 2019 tumors of the salivary glands are uncommon and represent 24% of head and neck neoplasms. When tumors involve the parotid gland, a superficial parotidectomy is the treatment of choice. One hundred fortynine consecutive patients with suspected tumors of the parotid gland were examined with an epidwi sequence by using a 1. Imaging of salivary gland tumors request pdf researchgate. Of these, pleomorphic adenomas are the most common, compromising 7090% of salivary gland tumors 2.
Diagnostic criteria on 18ffdg petct for differentiating. Enhanced ct image shows a lobular mass in the left parotid gland. Fineneedle aspiration of the tumor was performed with sonographic guidance, and cytology confirmed its identification as a pleomorphic adenoma. A carcinoma ex pleomorphic adenoma cxpa arises from a longstanding. Even though many hypotheses for recurrences of parotid gland pleomorphic adenoma have been advanced, including cell biological and genetic factors 2, 3, obvious or underestimated tumor spillage, incomplete excision, and violation of the pseudocapsule of the tumor are considered the only proven reasons contributing to recurrent disease. Flickriver view images as a river of photos and more. Diffusionweighted mri in the differential diagnosis of. Pleomorphic adenoma is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Although pleomorphic adenomas most commonly occur in the parotid gland, it may also be encountered in the submandibular, lingual, and minor salivary glands. Venous malformations in the parapharyngeal space are rare and may be challenging to diagnose with imaging secondary to multiple overlapping features with pleomorphic adenoma, which is much more commonly found in this region. An mri is performed using conventional sequences, di. Interest of diffusionweighted and gadoliniumenhanced dynamic.
Pleomorphic adenoma, the most common salivary gland tumor. Pleomorphic adenoma is the most common parotid neoplasm. Pleomorphic adenomas account for 7080% of benign salivary gland tumors and are especially common in the. On ct and mr images, pas are shown as welldefined lesions occasionally accompanied by characteristic lobulated contours.
Sonography is sufficient for imaging benign parotid tumors before. Mr imaging malignancy test for parotid tumors, with a sensitivity and. Imaging features of recurrent parotid pleomorphic adenoma have been infrequently. Pleomorphic adenoma is the most common type of all salivary gland tumors, involving more frequently the parotid gland. Pleomorphic adenoma, parotid neoplasms and capsules researchgate, the. Facial nerve paralysis due to a pleomorphic adenoma with the. Parotid tumor, diffusion kurtosis imaging, magnetic resonance imaging introduction 80% of parotid tumors are benign tumors, among which about 85% are pleomorphic adenoma 1. On t2weighted images, typical pas show marked hyperintensity, which reflects the abundant myxochondroid stroma, with a hypointense rim. However, the distinction between malignant and benign parotid tumor may be. Diagnostic criteria on 18 ffdg petct for differentiating benign from malignant focal hypermetabolic lesions. Parotid gland, benign and malignant tumors, mri, apparent diffusion. It has epithelial, myoepithelial, and stromal components. Imaging evaluation of pediatric parotid gland abnormalities. Lesions in the deep parotid lobe may mimic mass lesions arising in the parapharyngeal space such as a minor salivary gland tumor.
While both lesions are t1 isointense and t2 hyperintense relative to skeletal muscle and demonstrate contrast enhancement, more uniform t2 hyperintensity and. For lesions in the salivary glands, ultrasonography us is an ideal tool for initial assessment. Metastasizing pleomorphic adenoma is the third type of malignant mixed tumor of salivary glands and is the rarest. Oct 09, 2015 the pleomorphic adenoma, shown in the images below, is by far the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Parotid gland tumors represent 23% of head and neck tumors and 0. Pleomorphic adenoma is a benign, slowgrowing neoplasm that most commonly affects the parotid gland. Feb 27, 2018 how is pleomorphic adenoma of salivary gland treated. Pleomorphic adenomas are common benign neoplasms of the major salivary glands. Pleomorphic adenoma, the most common salivary gland tumor, is also. Comparative diagnostic imaging and pathological analysis of echo colorpower doppler and of magnetic resonance imaging. Although pleomorphic adenomas most commonly occur in the parotid gland about 85%, this tumor may be encountered in the submandibular, lingual, and minor salivary glands as well. Pleomorphic adenomas of the salivary glands, also known as benign mixed tumors bmts, are the most common salivary gland tumors. Carcinoma ex pleomorphic adenoma 75% occur in parotid gland pleomorphic adenoma, true malignant mixed tumors of the salivary glands usually arise from preexisting pleomorphic adenomas 1,3.
Introduction saliva is a clear, alkaline, somewhat viscid secretion from the parotid, submandibular, sublingual and smaller mucous glands of. The most frequent problems involve variations in the expected cytology of pleomorphic adenoma pa. Parotidectomy parotid surgery to remove a parotid masstumor. This indicates that cnb may be spared in patients with tumors with a high adc. Imaging characteristics of recurrent pleomorphic adenoma of the parotid gland. The gross appearance of pleomorphic adenoma is that of a firm smooth mass within a pseudocapsule. Less frequent locations were the soft palate, parapharyngeal. Although ultrasound is the firstline imaging tool for salivary gland imaging, it has frequently been combined to contrastenhanced ct for localizing a deeper lesion and detecting sialolithiasis or metastatic lymph node 1, 2, 3. It is found mostly in the parotid gland in middleaged women. Pleomorphic adenoma in the superficial lobe of the left parotid gland. They may be broadly categorized into benign neoplasms, tumorlike conditions, and malignant neoplasms. Although pleomorphic adenoma is a benign tumor, it can metastasize especially when the excision was incomplete. Pleomorphic adenoma benign mixed tumor of the salivary glands is a benign, slowly growing neoplasm that has a predilection to the parotid where 80% of these tumors arise. From pleomorphic adenomas and carcinomas chihwei wang1,2 yuenghsiang chu3 dengyiv.
The salivary glands are the most common site of pleomorphic adenomas on imaging, they commonly present as well circumscribed rounded masses, most commonly located within the parotid gland, hypoechogenic on ultrasound and bright on t2wi with homogeneous. An ebook reader can be a software application for use on a computer such as microsofts free reader application, or a booksized computer the is used solely as a reading device such as nuvomedias rocket ebook. Mr imaging findings of parotid tumors with pathologic. It progresses slowly and, left untreated, can produce signi. One of the most common of these tumors in the parotid gland is a pleomorphic adenoma. The mass is solid but mobile, the patient shows no weight loss, nor pain or facial paralysis. Surgery is the most effective treatment method for parotid tumors 1. Surgical management of pleomorphic adenoma of parotid gland in elderly patients. The new quantification software vuebox bracco, italy was used to assess the perfusion, based on dicom datasets of ceus examination. Jul 31, 2015 minor salivary gland tumours vary according on the site of origin painless masses on the palate or floor of the mouth are the most common form but laryngeal salivary gland tumours can produce airway obstruction, dysphagia, or hoarseness. Original article susceptibility weighted imaging improved diagnostic accuracy of magnetic resonance in characterization of parotid gland lesions wei zhang 1, guanqiao jin, junjie liu2, lili wang3, dong xie 1, ningbin luo, xiangyang huang1, danke su1. Title, imaging techniques, the major salivary glands, parotid gland, schematic and sonographic images, submandibular gland, normal submandibular gland, normal submandibular gland. Imaging processing and data analysis all mri data were digitally transferred to a pc from the mri operating console and were processed by software developed in house with the use of a multiparadigm.
Most pleomorphic adenomas occur in the parotid gland 84%, 8% in the. It presents with metastases to lung, bone and soft tissues despite having. Metastasizing pleomorphic adenoma in the multiple organs. Original article susceptibility weighted imaging improved. While both lesions are t1 isointense and t2 hyperintense relative to skeletal muscle and demonstrate contrast enhancement, more uniform t2. The most common reason to remove this gland is due to an abnormal mass contained within.
A carcinoma ex pleomorphic adenoma cxpa arises from a longstanding pleomorphic adenoma pa and has a distinctive prognostic risk depending on the tumor growth. Apr 17, 2014 in the present case, the preoperative imaging showed a smooth mass centered on the facial nerve with erosion of the stylomastoid foramen with enhancement in the vertical segment of the intratemporal facial nerve, which led us initially to suspect a facial nerve schwannoma rather than a pleomorphic adenoma. Surgical management of pleomorphic adenoma of parotid gland. Dw images were achieved using a spinecho pulse sequence with a 1. Surgery is the most common form of treatment for pleomorphic adenoma. When observed in situ, the tumors are encased in a pseudocapsule and exhibit a lobulated appearance 4. Diffusionweighted echoplanar mr imaging of primary parotid gland tumors. Our aim was to determine the value of echoplanar diffusionweighted mr imaging epidwi in differentiating various types of primary parotid gland tumors. Research diagnostic value of ct perfusion imaging for. Like any structure in the body, the parotid gland is prone to the formation of abnormal growths which may either be benign or malignant. Magnetic resonance imaging mri images presenting 2 types of lesions within parotid glands. Pleomorphic adenoma pa is the most frequent benign tumor of the parotid gland and usually has a myxoid matrix retaining an abundance of free water molecules, which leads to a high adc1216.
Warthins tumor in 24, pleomorphic adenoma in 4, inflammation in 4 and other in 4. Monitoring parotid gland tumors with a new perfusion. It has a relatively high rate of recurrence after surgery. Contrastenhanced multidetector ct examination of parotid. Sonographic imaging of a pleomorphic adenoma of the salivary.
The pleomorphic adenoma, shown in the images below, is by far the most common benign salivary gland tumor, accounting for as many as 80% of all such tumors. Hyalinizing clear cell carcinoma arising in recurrent pleomorphic adenoma of parotid gland. Pleomorphic adenoma may show various architectural and cytologic features that resemble other salivary tumors identifying areas typical of pleomorphic adenoma with triphasic ductal, myoepithelial and stromal components is helpful to establish the diagnosis squamous cell carcinoma. Pleomorphic parotid adenoma benign tumor of the parotid. Mri provides superior soft tissue delineation such as perineural invasion when compared to ct only. Abstract hyalinizing clear cell carcinoma hccc is a neoplasm that predominantly affects the oral cavity in. Effects of region of interest sizes on apparent diffusion. Alternate the sections show a lesion with spindled myoepithelial cells and an epithelial component, on a background of a myxoid stroma. A carcinoma ex pleomorphic adenoma cxpa arises from a longstanding pleomorphic adenoma pa and has a distinctive prognostic risk depending on the tumor. If the pleomorphic adenoma is in your parotid gland it can be a delicate surgery due to the closeness to your facial nerves and the potential for the surgery to cause damage to these facial nerves. A complete surgical excision with clear or wide margins is the preferred mode of treatment of pleomorphic adenoma of salivary gland.
Differentiation of pleomorphic adenoma and warthins tumor. Imaging characteristics of recurrent pleomorphic adenoma of. The prognosis is generally good after the surgical removal, however, there is an increased incidence of recurrence particularly if the parotid gland is affected. Parotid gland tumors are mostly treated surgically, but the extent of parotidectomy is decided upon preoperative workup information. On imaging, they commonly present as well circumscribed rounded masses, most. Pleomorphic adenoma of the salivary glands radiology. Primary pulmonary pleomorphic adenoma is a very rare benign tumor that tends to arise in the large airways tumors tend to show small, branching, double layered ductules rather than ducts and less cartilaginous stroma as compared to pleomorphic adenomas arising in the salivary gland. In most series, it represents 4575% of all salivary gland neoplasms. Pleomorphic adenoma of parotid gland something about. The most common locations were the major salivary glands parotid and submandibular gland. Multiparametric magnetic resonance imaging versus fine. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. Sixtyfive patients including 37 with pa lesions, n37 and 28 with wt lesions, n36 were examined with diffusionweighted imaging dwi.
Pictures and imaging of parotid pleomorphic adenoma benign. Pleomorphic adenoma symptoms, causes, treatment, surgery. Contralateral nonaffected glands normal were also analyzed. Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. Pleomorphic adenoma surgery, symptoms, causes, treatment.
At mri, lowgrade mucoepidermoid carcinoma can mimic. Pleomorphic adenoma, the most common salivary gland tumor, is also known as benign mixed tumors bmts, because of its dual origin from epithelial and myoepithelial elements. Pleomorphic adenoma definition of pleomorphic adenoma by. A, t2weighted axial image shows an inhomogeneous, wellcircumscribed lesion arrow within the superficial lobe of the right parotid gland. Accordingly, tic profiles are characteristic of some benign and malignant salivary gland tumors. Pleomorphic adenoma of parotid gland with extensive bone formation. During the surgery the part of the organ that is affected by the pleomorphic. Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by.
Surgical management of pleomorphic adenoma of parotid. Diagnostic criteria on 18 ffdg petct for differentiating benign from malignant focal hypermetabolic lesions of. Title, imaging techniques, the major salivary glands, parotid gland, schematic and. Whartons duct, sublingual gland, inflammatory process. It constitute approximately 7080% of benign parotid gland tumors. Ultrasound imaging of the salivary glands ultrasound video. Distinguishing of pleomorphic adenomas from other types of. This type of tumor accounts for the vast majority of all parotid tumors. Imaging features of recurrent parotid pleomorphic adenoma have been infrequently reported in the radiology literature. Data were digitally transferred to the analyzing software mricro 1. The most frequent primary site of a metastasizing pleomorphic adenoma is the parotid gland, where complete excision is difficult due to critical. It is often firm, nodular, painless and almost always unilateral. Differentiation of pleomorphic adenoma and warthins tumor of. Core needle biopsy, fine needle aspiration fna, pleomorphic adenoma.
In parotid imaging, dwi is helpful for parotid tumor detection, and a few studies have reported that wt had lower adcs than those in pa 3,4,10,18,25. Pleomorphic adenoma, also referred to as benign mixed tumors bmts, is a benign or a noncancerous growth in the salivary gland, the most commonly occurring parotid tumor. Imaging characteristics of recurrent pleomorphic adenoma. Surgical management of pleomorphic adenoma 50 years ago consisted predominantly of local excision or enucleation technique, a procedure that yields recurrence rates from 20% to 45%. Pleomorphic adenomas of the salivary glands, also known as benign mixed. A patient presented with a painless palpable mass located just below the right ear. However, it has areas of considerable interpretational difficulties. May 29, 2018 pleomorphic adenoma pa is the most common salivary gland tumor and is characterized by cytomorphological and architectural diversity.
In parotid imaging, dwi is helpful for parotid tumor detection, and a few studies. Pleomorphic adenomas of the salivary glands, also known as benign mixed tumours bmts, are the most common salivary gland tumours. The age of the patient helps narrow the differential diagno. Recurrent pleomorphic adenoma of the parotid gland. Adc values of pleomorphic adenomas were significantly higher than those of all. Contemporary management of benign and malignant parotid. A, power doppler sonography showing no notable internal vascularity. They represent less than 5% of the neoplasms that occur in the soft tissues of the head and neck. Despite myoepithelial carcinoma is a rare salivary gland tumor, it shows highgrade malignancy mostly arising from pleomorphic adenoma in the parotid or other locations.
Myoepithelial carcinoma ex parotid pleomorphic adenoma. In our study, the mean adc of wt was also significantly lower than that of pa for the 12 rois, which is in agreement with previously reported results. Lesions of the parotid gland are associated with a vascularisation that differs from normal gland tissue. Types of benign parotid tumors pleomorphic adenoma. Although pleomorphic adenomas most commonly occur in the parotid gland, they may also affect the submandibular, lingual and minor salivary glands. Sep 17, 2010 fine needle aspiration cytology fnac is commonly being used with increasing frequency for the preoperative evaluation of salivary gland lesions.
The pleomorphic adenoma, shown in the images below, is by far the most common benign salivary gland tumor, accounting for as many as. Pleomorphic adenoma is the most common benign salivary gland neoplasm. The epidemiology of pleomorphic adenoma can cover all ages and both genders but is more prevalent among women from thirty to sixty years of age. Differentiation of pleomorphic adenoma and warthins tumor of the parotid gland. Our purpose was to determine the effects of roi size on adc measurements for the differentiation of pleomorphic adenoma pa, warthin tumor wt, and normal parotid parenchyma. Vascular pattern analysis on microvascular sonography for. Imaging evaluation of pediatric parotid gland abnormalities parotid gland lesions in children can be divided into benign or malignant. Widening of the stylomandibular space is seen in parotid masses, not seen in primary pathology of the parapharyngeal space. Pleomorphic adenoma is the most common tumor of all salivary glands with a reported incidence of 2. Pleomorphic adenoma of the right parotid gland in a 45. B, grayscale sonography left showing a hypoechoic tumor with a well. The tics were obtained using the dedicated siemens software for dynamic.
In the nasal cavity or paranasal sinus they cause nasal obstruction or sinusitis. Sonographic imaging of a pleomorphic adenoma of the. This mass was examined with sonography, and the appearance suggested the presence of a pleomorphic adenoma. Dec 26, 2014 in the parotid gland, the tumors are usually several centimeters in diameter but can reach much larger sizes if left untreated. Diffusionweighted echoplanar mr imaging of primary. Herein we reported this rare case of myoepithelial carcinoma ex parotid pleomorphic adenoma with high aggressiveness eight years after parotidectomy. The image demonstrates a soft tissue mass adjacent to the left. Pleomorphic adenoma of the salivary glands radiology reference. Gray scale and doppler ultrasonography features of the carcinoma.
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