Cases reported "Parotid Neoplasms"

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1/16. angiomyolipoma of the parotid gland: a case report.

    angiomyolipoma is a hamartomatous process that most frequently occurs as a single lesion or multiple foci in the kidneys of patients affected by tuberous sclerosis. angiomyolipoma can also arise in extrarenal sites, among which the liver is the most frequently recorded. Only rare cases of angiomyolipoma located in the head and neck region (ear and oral and nasal cavity) have been described. The purpose of the present article is to report a case of angiomyolipoma of the parotid gland. A 68-year-old woman appeared for treatment with a slow-growing nodule located in her right parotid gland. Ultrasound examination revealed a heterogeneous nodule with well-defined margins. The nodule was surgically removed by total parotidectomy and showed the characteristic appearance of angiomyolipoma, with an admixture of fat smooth muscle cells, and tortuous, thick-walled blood vessels. Careful physical examination of the patient failed to reveal features of tuberous sclerosis. angiomyolipoma should be considered in the differential diagnosis of mesenchymal lesions involving the salivary gland.
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2/16. A very rare benign tumour in the parotid region: calcium pyrophosphate dihydrate crystal deposition disease.

    calcium pyrophosphate dihydrate crystal deposition disease, exhibits several clinical manifestations, from absence of symptoms to severely destructive arthropathy or conditions simulating neoplasm, which is frequently related to the temporomandibular joint. Fifteen of the 31 reported cases of tophaceous pseudogout were found in the head and neck region. A patient presented with a parotid swelling, which initially was suspected to be malignant because of the following findings: radiodensity, progression into the joint, osseous destruction of the major ala of the sphenoid and a fine needle aspirate with crystals, osteoblasts, megakaryocytes and irregular cells of varying size. At surgery there was found a tumour consisting of a white, firm gritty material. It progressed to the skull base where material had to be left, because of the presence of the nerves and vessels. A frozen specimen was reported to be benign. Histological examination showed inflammatory cells, macrophages, a chondroid material with embedded metaplastic chondroid cells and giant cells of foreign body type. Crystal examination of x-ray diffraction revealed calcium pyrophosphate dihydrate.
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3/16. Dural cerebellopontine angle metastasis from malignant parotid oncocytoma.

    Malignant oncocytoma of the parotid gland is a quite rare tumor, with only 40 cases with unequivocal histological diagnosis reported in the literature. No cases with intracranial metastasis have been described. The authors report a very unusual case of malignant parotid gland oncocytoma with a large dural extracerebellar metastasis occurring in the contiguous cerebellopontine angle six months after surgery for the primary tumor. Only a partial removal of the dural metastasis was possible because of the cranial nerve and vessel encasement within the mass. Surgery and irradiation resulted in one-year survival. Interestingly, no destruction and infiltration of the petrous and temporal bones were found both at radiological and surgical exploration. We may suggest that metastatic spread from the parotid region to the cerebellopontine angle occurred through the mastoid cells or by haematogenous diffusion through the meningeal branches to the posterior fossa dura from the occipital or ascending pharyngeal arteries.
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4/16. Solitary fibrous tumor: report of a case with an unusual presentation as a spindle cell parotid neoplasm.

    BACKGROUND: Initially described as a pleural tumor, solitaryfibrous tumor of the parotid gland (SFT) is rare and has been reported at a wide range ofanatomic sites. Although cases of SFT arising in the parotid gland have been previously described, a review of the literature failed to reveal cytology-based reports of this entity. CASE: A 42-year-old man presented with a right parotid mass that had gradually enlarged over 3 years. He was otherwise asymptomatic. Fine needle aspiration biopsy of the mass showed a hypercellular smear composed of spindle cells in both clusters and isolated forms, with ovoid nuclei, evenly distributed chromatin, inconspicuous nucleoli and scant to moderate cytoplasm with focally wispy, collagenous, intercellular material. The background was hemorrhagic, without chondromyxoid matrix or inflammatory cells. There was no evidence of a myoepithelial component. A diagnosis of spindle cell neoplasm was rendered. Histologic examination of the total parotidectomy specimen revealed a SFT arising in the parotid gland. The diagnosis was supported by immunohistochemical studies. CONCLUSION: SFT is a well-circumscribed neoplasm composed of short, spindled, plump cells with scanty cytoplasm growing in a haphazard or "patternless" pattern. Tumor cells are intimately admixed with collagenous stroma. Hemangiopericytomalike vessels are frequently seen. Although SFT rarely occurs in the salivary gland and a definitive diagnosis based on cytologic preparations alone is difficult, the diagnosis of SFT can be considered when cytologic examination reveals a hypercellular smear composed of isolated, cohesive clusters of spindled, fibroblastlike cells associated with a collagenous component in ahemorrhagic background. The preoperative magnetic esonance image findings of a highly vascular neoplasm support the diagnosis.
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5/16. Neurogenic tumours of the parapharyngeal space in the paediatric age group.

    Two cases of neurogenic tumours of parapharyngeal space in children of 7 years old are presented. Difficulties during the diagnosis, investigations and management are discussed along with a review of the available literature. CAT scan with sialography, carotid angiography during surgery, angle mandibulectomy and liberal incision to expose the great vessels for better control of bleeding are stressed to minimise the peri-operative complication and to assist in complete removal of the tumours.
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6/16. Superselective embolization in an errosive haemorrhage of a carcinoma in the parotid gland.

    Haemorrhage due to errosion of blood vessels in tumors of the head and neck are a dramatic event. Superselective embolization plays an important role in the treatment of these entities. A therapeutic approach and method of embolization is described.
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7/16. Angiographic features of lateral cervical masses.

    An audible bruit may represent a clue to the vascular nature of the lesion. Angiography is definitely indicated in the presence of pulsatile cervical masses with or without an associated bruit, and should be more widely utilized in the future for evaluation of cervical masses. In addition to the nature of the mass, angiography may also be of value in outlining the extent of the mass and its relationship to major vessels. Magnification and subtraction angiographic techniques with their improved detail may play an important role in clarifying the etiology of cervical masses, and hence facilitate the plan of therapy. If reasonable uncertainty as to the clinical diagnosis exists, angiography should be considered a diagnostic aid.
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8/16. Cerebral necrosis following radiotherapy of extracranial neoplasms.

    We have examined 6 patients with delayed cerebral necrosis following irradiation of extracranial neoplasms. Four of the 6 patients received 1,760 rets (or less) tumor dose. The initial symptoms attributable to radiation necrosis appeared 4 to 31 months after irradiation and were those of a focal supratentorial mass. cerebral angiography delineated an avascular frontal or temporal lesion in all 6 patients; in 1 case a magnification study revealed narrowing, irregularity, and occlusion of small cortical vessels. Four of our 6 patients underwent craniotomy with partial or complete surgical extirpation of necrotic brain tissue. Two operated patients are alive and without disabling neurological symptoms 30 and 25 months, respectively, after the operation. The characteristic neuropathological features of delayed radiation necrosis of brain suggest that vascular injury rather than neuronal or glial damage is of primary pathogenetic significance.
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9/16. Dynamic positron emission tomography with 13N-ammonia in liver tumors.

    Dynamic positron emission tomography (PET) of the liver tumor was performed with a whole body multi slice PET device and 13N-ammonia. Sixteen patients with hepatocellular carcinoma (HCC) and seven patients with metastatic liver tumor were studied. In 12 of 16 patients with HCC, in which cases rich tumor vessels and dense tumor stain were proven by hepatic angiography, the tumors showed remarkable uptake of 13N-ammonia from the first scan, whereas the radionuclide accumulation was more gradual in the other part of the liver, and high tumor to liver ratio (T/L ratio) (2.62 /- 1.09) was observed in the 1st scan, so that the tumor was clearly visualized by high contrast. However, HCC with poor blood supply from the hepatic artery or central necrosis of the tumor were demonstrated as low T/L ratio. In seven cases with metastatic liver tumor, the accumulation of 13N-ammonia was also lower than the normal liver throughout the scan. The results suggested that hepatic arterial blood flow of the liver tumors can be assessed with dynamic PET, which may provide valuable information for the characterization of tumors as well as for the evaluation of the treatment.
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10/16. Metastatic basal cell carcinoma originating in the supra-parotid region.

    This case illustrates that massive tumor size, ulceration, or history of multiple recurrences are not absolute prerequisites for metastatic BCC. It supports the hypothesis that tumor proximity to major lymphatic systems or large-caliber blood vessels may be of significance. BCCs originating in skin overlying the parotid gland have the potential to penetrate to a rich vascular and lymphatic plexus as well as compromise the integrity of the facial nerve. Early treatment of these neoplasms utilizing accurate methods of microscopic control appears warranted to prevent the serious consequences of recurrences and deep tissue involvement.
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