Parotid gland tumors in children – pre- and postoperative diagnostic difficulties

Abstract

Major salivary gland tumors are very rare in the developmental period. Confirming tumor changes in the salivary gland requires precise diagnostic imaging involving an ultrasonography scan, computed tomography and magnetic resonance. Needle aspiration biopsy (NAB) of the tumor is of high importance. Excision is the basic treatment method in cases of parotid gland tumor. The statistical data concerning tumors favor less invasive methods, which seems logical in the population of children. The surgical methods used in tumor treatment feature extracapsular excision of tumor, partial parotidectomy and total parotidectomy, sometimes followed by lymphatic node surgery. The clinical cases presented in the paper show difficulties with pre-and postoperative histopathological diagnosis in major salivary gland tumors in children. A core biopsy of the tumor may improve the accuracy of preoperative diagnosis but it does not exclude the possibility of misdiagnosis.

Salivary Gland Neoplasms in Children and Adolescents

“…However, a recent report suggested that computed tomography is not helpful for distinguishing benign and malignant disease but that magnetic resonance imaging features, such as T2 hypointensity, restricted diffusion, ill-defined borders, and focal necrosis, although not specific, should raise concerns about malignancy [15] . Occasionally, the use of fine-needle aspiration cytology or fine-needle core biopsy may be required to avoid major surgery in situations such a mass due to lymphoma [16,17] . The clinical utility of needle biopsy remains debatable, however, especially in younger patients, because of the need for an anaesthetic.…”

Facial Nerve Paralysis in Children

“…Pediatric facial nerve paralysis has been also described associated to leukemia (in many cases bilateral) or to parotid gland tumors [9,18] . Finally, traumas such as temporal bone fractures (longitudinal, transverse and oblique) can cause facial nerve palsy in children [19] , while iatrogenic paralysis can occur after surgery of the parotid gland, middle ear or mastoid [8,9] .…”

“…It is necessary to investigate about the onset and the time course of the paralysis and its eventual progression (e.g., a gradual onset, > 3 wk, may suggest a neoplastic etiology). All the associated symptoms should be identified, as well as any other comorbidities affecting the child [14,15,[18][19][20][21] . During the ENT examination, particular attention should be given to the inspection of the external auditory canal, the eardrum and the mastoid region.…”

“…Alternatively the use of a nerve graft is out when the history of the patient suggests a possible exposure, while in case of clinical suspicion of a neoplastic etiology, the computed tomography of petrous bone and the brainstem magnetic resonance imaging must be performed. Radiological images are required even when the child shows other neurological manifestations or in suspected chronic otitis media, acute mastoiditis or temporal bone fracture [14,15,[18][19][20][21] . Electrophysiological studies can be useful to identify the cause of the paralysis, to define the prognosis and follow-up of functional recovery, but they are still not considered necessary in all pediatric patients [14,15,[18][19][20][21] .…”

A case of intraparotid schwannoma in a juvenile: Clinical, pathological, ultrastructural, and immunohistopathological study, including an examination of Ki-67 and MCM-3 expressions

“…Tumors of the major salivary glands are very rare in juveniles, and 70% of the lesions occur between 16 and 20 years of age [1]. Although hemangiomas are diagnosed most frequently, the most common epithelial tumors of the major salivary glands in young patients are still pleomorphic adenomas [2].…”