G Model
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ANORL-408; No. of Pages 2
European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
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Letter to the editor Giant tumour of the parotid gland 1. Introduction Salivary gland tumours represent a small proportion of head and neck tumours. They predominantly involve the parotid gland. Due to their painless nature and limited access to specialized health care structures in Africa, parotid gland tumours can exceptionally be very large, corresponding to “giant tumours”. The purpose of this article is to discuss the various aspects of these giant tumours in the light of four clinical cases. 2. Case report The authors report four patients with giant tumour of the parotid (Fig. 1): three women and one man aged between 16 and 60 years. The tumour had been present for between 2 and 25 years. Conservative total parotidectomy was performed in all patients. The operative specimen weighed between 1,000 and 1,600 g (Fig. 2) and the postoperative course was uneventful in every case. Histological examination was in favour of pleomorphic adenoma in all four cases with no signs of malignant transformation. 3. Discussion Pleomorphic adenoma is the commonest benign salivary gland tumour and usually arises in the parotid gland [1]. In countries
Fig. 1. Giant tumour of the parotid gland extending to the back of the neck.
with limited access to health care, these parotid tumours may be very large at the time of specialist management. These enormous tumours are exceptional in the career of a head and neck surgeon, as published cases often consist of isolated case reports [1,3]. The giant nature of the tumour is defined by the size and especially the weight of the tumour. No consensus has been reached concerning the weight beyond which an adenoma can be considered to be a giant tumour [2]. However, in most of the published cases, the weight exceeded 1 kg. In the largest series of giant parotid tumours, published in 1989 by Schultz-Coulon [1], the lower limit was 1,000 g. In our series, the weight of the tumours ranged between 1,000 and 1,600 g. The age of onset varies according to the series. Coulon reported a mean age between 20 and 40 years. In the recent literature, patients ranged between 54 and 81 years of age [2,3]. These tumours are characterized by their long course, which partly explains the advanced age of the patient at the time of diagnosis [4]. According to some authors, this long course is correlated with the risk of malignant transformation [5], described as “carcinoma ex-pleomorphic adenoma”. Like common parotid gland tumours, giant tumours predominantly correspond to pleomorphic adenoma. Conservative total parotidectomy is the treatment of choice [1,2,4]. It is performed according to the same technique as for common parotid gland tumours, generally via a wide incision corresponding to the three segments of the Redon incision. No particular difficulty of facial nerve dissection has been reported, and the postoperative course is usually uneventful [1,2,4]. Tumour resection results in an excess of skin that can be treated by “modelling” resection.
Fig. 2. Operative specimen of a giant parotid gland tumour.
http://dx.doi.org/10.1016/j.anorl.2015.03.011 1879-7296/© 2015 Published by Elsevier Masson SAS.
Please cite this article in press as: Ndiaye C, et al. Giant tumour of the parotid gland. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2015.03.011
G Model ANORL-408; No. of Pages 2
ARTICLE IN PRESS Letter to the editor / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
2
4. Conclusion Giant tumours of the parotid gland are rare. Limited access to health care, ignorance, negligence and fear of surgery are often responsible for the very large dimensions of these tumours. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Takahama Jr A, Elias da Cruz PD, Magrin J. Giant pleomorphic adenoma of the parotid gland. Med Oral Patol Oral Cir Bucal 2008;13(1):58–60. [2] Nitassi S, Oujilal M, Boulaich M. Giant pleomorphic adenoma of the parotid gland. Rev Stomatol Chir Maxillofac 2009;110(6):350–2.
[3] Maier H, Frühwald S, Tisch M. Epidemiology, diagnosis, and treatment of giant pleomorphic adenomas of the parotid gland. HNO 2007;55(10):812–8. [4] De Silva MN, Kosgoda MS, Tilakaratne WM. A case of giant pleomorphic adenoma of the parotid gland. Oral Oncol 2004;40:43–5. [5] Eneroth CM, Zetterberg A. Malignancy in pleomorphic adenoma. A clinical and microspectrophotometric study. Acta Otolaryngol 1974;77(6):426–32.
C. Ndiaye ∗ E.-S. Diom M.-S. Diouf E.-M. Diop Service d’ORL et de chirurgie cervico-faciale du CHU de Fann, Dakar, Senegal ∗ Corresponding author. E-mail address: [email protected] (C. Ndiaye)
Please cite this article in press as: Ndiaye C, et al. Giant tumour of the parotid gland. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2015.03.011
ARTICLE IN PRESS
ANORL-408; No. of Pages 2
European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
Available online at
ScienceDirect www.sciencedirect.com
Letter to the editor Giant tumour of the parotid gland 1. Introduction Salivary gland tumours represent a small proportion of head and neck tumours. They predominantly involve the parotid gland. Due to their painless nature and limited access to specialized health care structures in Africa, parotid gland tumours can exceptionally be very large, corresponding to “giant tumours”. The purpose of this article is to discuss the various aspects of these giant tumours in the light of four clinical cases. 2. Case report The authors report four patients with giant tumour of the parotid (Fig. 1): three women and one man aged between 16 and 60 years. The tumour had been present for between 2 and 25 years. Conservative total parotidectomy was performed in all patients. The operative specimen weighed between 1,000 and 1,600 g (Fig. 2) and the postoperative course was uneventful in every case. Histological examination was in favour of pleomorphic adenoma in all four cases with no signs of malignant transformation. 3. Discussion Pleomorphic adenoma is the commonest benign salivary gland tumour and usually arises in the parotid gland [1]. In countries
Fig. 1. Giant tumour of the parotid gland extending to the back of the neck.
with limited access to health care, these parotid tumours may be very large at the time of specialist management. These enormous tumours are exceptional in the career of a head and neck surgeon, as published cases often consist of isolated case reports [1,3]. The giant nature of the tumour is defined by the size and especially the weight of the tumour. No consensus has been reached concerning the weight beyond which an adenoma can be considered to be a giant tumour [2]. However, in most of the published cases, the weight exceeded 1 kg. In the largest series of giant parotid tumours, published in 1989 by Schultz-Coulon [1], the lower limit was 1,000 g. In our series, the weight of the tumours ranged between 1,000 and 1,600 g. The age of onset varies according to the series. Coulon reported a mean age between 20 and 40 years. In the recent literature, patients ranged between 54 and 81 years of age [2,3]. These tumours are characterized by their long course, which partly explains the advanced age of the patient at the time of diagnosis [4]. According to some authors, this long course is correlated with the risk of malignant transformation [5], described as “carcinoma ex-pleomorphic adenoma”. Like common parotid gland tumours, giant tumours predominantly correspond to pleomorphic adenoma. Conservative total parotidectomy is the treatment of choice [1,2,4]. It is performed according to the same technique as for common parotid gland tumours, generally via a wide incision corresponding to the three segments of the Redon incision. No particular difficulty of facial nerve dissection has been reported, and the postoperative course is usually uneventful [1,2,4]. Tumour resection results in an excess of skin that can be treated by “modelling” resection.
Fig. 2. Operative specimen of a giant parotid gland tumour.
http://dx.doi.org/10.1016/j.anorl.2015.03.011 1879-7296/© 2015 Published by Elsevier Masson SAS.
Please cite this article in press as: Ndiaye C, et al. Giant tumour of the parotid gland. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2015.03.011
G Model ANORL-408; No. of Pages 2
ARTICLE IN PRESS Letter to the editor / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2015) xxx–xxx
2
4. Conclusion Giant tumours of the parotid gland are rare. Limited access to health care, ignorance, negligence and fear of surgery are often responsible for the very large dimensions of these tumours. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Takahama Jr A, Elias da Cruz PD, Magrin J. Giant pleomorphic adenoma of the parotid gland. Med Oral Patol Oral Cir Bucal 2008;13(1):58–60. [2] Nitassi S, Oujilal M, Boulaich M. Giant pleomorphic adenoma of the parotid gland. Rev Stomatol Chir Maxillofac 2009;110(6):350–2.
[3] Maier H, Frühwald S, Tisch M. Epidemiology, diagnosis, and treatment of giant pleomorphic adenomas of the parotid gland. HNO 2007;55(10):812–8. [4] De Silva MN, Kosgoda MS, Tilakaratne WM. A case of giant pleomorphic adenoma of the parotid gland. Oral Oncol 2004;40:43–5. [5] Eneroth CM, Zetterberg A. Malignancy in pleomorphic adenoma. A clinical and microspectrophotometric study. Acta Otolaryngol 1974;77(6):426–32.
C. Ndiaye ∗ E.-S. Diom M.-S. Diouf E.-M. Diop Service d’ORL et de chirurgie cervico-faciale du CHU de Fann, Dakar, Senegal ∗ Corresponding author. E-mail address: [email protected] (C. Ndiaye)
Please cite this article in press as: Ndiaye C, et al. Giant tumour of the parotid gland. European Annals of Otorhinolaryngology, Head and Neck diseases (2015), http://dx.doi.org/10.1016/j.anorl.2015.03.011
