Parotid

Primary Merkel cell carcinoma of the parotid gland

June 30, 2010     Mahmoud Ghaderi, DO, Jeffrey Coury, DO, Jacqueline Oxenberg, DO, and Harvey Spector, MD
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Abstract

Primary Merkel cell carcinoma (MCC) is a neuroendocrine tumor that typically affects older whites. It usually originates in the dermis, but in rare instances it has arisen in other primary sites, including the oral mucosa and the parotid gland. Explanations for the presence of MCC in these atypical locations have included theories of malignant transformation and neuroendocrine migration. We describe the case of a 35-year-old white woman who had an MCC in the parotid gland and no evidence of any other primary cutaneous lesion. A left superficial parotidectomy with facial nerve preservation was performed, and a histologic diagnosis of MCC was made. Positron-emission tomography was negative for other lesions, and postoperative radiation therapy was administered for local control. To the best of our knowledge, this is only the sixth case of a primary MCC of the parotid gland to be reported in the English-language literature; of these 6 patients, ours was by far the youngest. Otolaryngologists should be familiar with this rare but potentially fatal neoplasm.

Hamartoma of the parotid gland: Report of a unique case

April 30, 2010     Yamileth Nicolau, MD, William C. Faquin, MD, PhD, and Daniel G. Deschler, MD, FACS
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Abstract

Hamartomas of the parotid gland are very rare. We present the case of a parotid gland hamartoma with oncocytic and sebaceous metaplasia arising as a 3-cm mass in a 70-year-old man. To the best of our knowledge, there has been no previous report of a tumor with the same features. We present this case to create awareness of hamartomas as part of the differential diagnosis of parotid masses.

Primary parotid gland sarcoidosis: Case report and discussion of diagnosis and treatment

March 31, 2010     Nicole Longo, DO and Mahmoud Ghaderi, DO, FAOCO
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Abstract

Sarcoidosis is a systemic disease of unknown origin that is characterized by noncaseating granulomatous lesions. Primary otolaryngologic manifestations of sarcoidosis are not commonly seen. The documented incidence of parotid gland involvement (either primary or secondary) is only 6%. Extrapulmonary involvement can be present in up to 30% of patients with sarcoidosis and can present at the same time as pulmonary sarcoidosis. We report a case involving a patient with primary unilateral parotid sarcoidosis who returned with bilateral recurrence approximately 4 years after a total unilateral parotidectomy. To the best of our knowledge, this is only the second reported case in the English-language literature of primary parotid sarcoidosis that is the sole manifestation of the disease. We also discuss methods of diagnosis and treatment of head and neck manifestations of sarcoidosis.

Acute suppurative neonatal parotitis: Case report

February 1, 2010     Sardar U. Khan, DLO, FCPS, Peter G. O'Sullivan, BSc, MPhil, and John McKiernan, FRCPI
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Abstract

Neonatal suppurative parotitis is very rare. One review of the English-language literature spanning 35 years found only 32 cases. Most cases are managed conservatively with antibiotic therapy; early antibiotic treatment reduces the need for surgery. The predominant organism is Staphylococcus aureus. We report a new case of neonatal suppurative parotitis in a 3-week-old boy. The patient was diagnosed on the basis of parotid swelling, a purulent exudate from a Stensen duct, and the growth of pathogenic bacteria in culture. He responded well to 9 days of intravenous antibiotic therapy. We also discuss the microbiologic and clinical patterns of this disease.

Dermoid cyst of the parotid gland

February 1, 2010     Behrad Aynehchi, MD, Jason G. Newman, MD, and John S. Brooks, MD
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Abstract

A dermoid cyst is an ectodermally differentiated form of teratoma. Its occurrence in the parotid gland is very rare. Such a presentation must be properly evaluated in order to rule out malignancy. We describe the diagnostic evaluation and surgical management of a parotid dermoid cyst in an 18-year-old man. We also review the embryologic pathogenesis of the tumor and the usefulness of the physical examination, preoperative fine-needle aspiration cytology, magnetic resonance imaging, and computed tomography in evaluating the extent of the tumor, its histologic features, and its cystic characteristics. Finally, we discuss the role of surgical management in terms of preserving facial nerve integrity and preventing recurrence.

Carcinoma of the prostate presenting as a painful parotid mass with mandibular invasion: A case report

December 1, 2009     Christian S. Head, MD, Khashayar Hematpour, MD, Joel Sercarz, MD, Quang Luu, MD, and Carol J. Bennett, MD
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Abstract

Prostate cancer metastatic to the parotid gland is exceedingly rare, as only 10 cases have been previously reported in the literature. Symptoms may mimic a parotid infection or suggest a primary parotid tumor. We report a new case of carcinoma of the prostate metastatic to the parotid. The tumor was painful and had invaded the mandible. Fine-needle aspiration of the mass and immunohistochemical staining for prostate-specific antigen confirmed the diagnosis. The patient died 1 month later of an unrelated cause.

First branchial cleft cyst (type II)

October 31, 2009     Gadodia Ankur, MD, DNB, Ashu Seith Bhalla, MD, and Raju Sharma, MD

Sclerosing mucoepidermoid carcinoma of the parotid gland: Case report

October 31, 2009     Shai Y. Shinhar, MD, MSc
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Abstract

Mucoepidermoid carcinoma is the most common malignant salivary gland neoplasm. Its sclerosing morphologic variant, however, is an extremely rare entity. Only 7 cases have been reported in the literature, and only 2 of those reports have discussed this unusual malignancy in detail. This report describes a case involving a 57-year-old woman with an intermediate-grade sclerosing mucoepidermoid carcinoma of the parotid gland. She underwent superficial parotidectomy and radiation therapy with excellent results. Diagnosis and options for treatment are discussed, as well as a review of the literature, which demonstrates that this is an extremely rare malignancy with no strict protocol for treatment.

Atypical lipomatous tumor/well-differentiated liposarcoma of the parotid gland: Case report and literature review

September 30, 2009     Usama Mahmood, MD, John D. Nguyen, MD, John Chang, MD, Mai Gu, MD, PhD, and Brian J.F. Wong, MD, PhD
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Abstract

Although liposarcoma is the second most common soft-tissue sarcoma in adults, it is exceedingly rare in the head and neck. According to our MEDLINE search, only 11 cases of liposarcoma of the parotid gland have been reported since 1968. We report a new case of primary atypical lipomatous tumor/well-differentiated liposarcoma of the parotid gland in a 77-year-old man. Because only a very limited number of case reports and small series have been published on liposarcoma in the head and neck, we also provide a review of the literature on this uncommon disease entity.

Distal parotid duct pseudocyst as a result of blunt facial trauma

July 31, 2009     Ashkan Monfared, MD, Justin Ortiz, MD, and Carrie Roller, MD
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Abstract

The sequelae of sharp trauma to the parotid duct, such as sialocele and salivary fistula, are well known. In contrast, complications of blunt trauma to the parotid duct are not as common. A search of the English-language literature revealed 2 cases of parotid pseudocysts caused by blunt trauma. Although no well-known management protocol exists for complications of blunt trauma to the parotid duct, the treatment modalities for sharp trauma complications potentially could be applied. We describe a case of a blunt-trauma-induced distal parotid duct pseudocyst that remained refractory to conservative management, including repeated aspiration and cannulation of the duct. After characterizing and localizing the pseudocyst with sialography and cross-sectional imaging, we performed a surgical repair. This repair involved marsupialization of the parotid duct to the level of the pseudocyst. The edges of the opening of the proximal duct and the pseudocyst were sutured to the oral mucosa, and a small intraoral drain was left in the pseudocyst to prevent collapse and abscess formation. The drain was removed after 5 days, and the patient experienced no further problems during 14 months of follow-up.

Intraparotid facial nerve schwannoma: Clinician beware

July 31, 2009     Neil Tanna, MD, MBA, Philip E. Zapanta, MD, Leela Lavasani, MD, and Nader Sadeghi, MD
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Abstract

Intraparotid facial nerve schwannomas are rare neoplasms that are challenging to diagnose and manage. Many patients present with a painless, palpable facial mass. The presence of facial paralysis is variable. Imaging studies and fine-needle aspiration cytology are not always helpful in preoperative diagnosis. With early diagnosis of facial nerve schwannoma, management of the patient can be planned and, ultimately, facial nerve function optimized. By reviewing the literature and 2 cases from a series of patients seen in our practice, we provide insight into the current diagnosis and treatment of a rare pathology.

Oncocytoma of the parotid gland

April 30, 2009     Deba P. Sarma, MD and Eric E. Santos, MD
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