Preoperative distinction of parotid lymphomas

Surgical parotidectomies place parotid lymphoma patients at increased risk of morbidity because of the diffuse infiltrative nature of the disease. These tumors usually respond to radiotherapy or chemotherapy, but are difficult to distinguish from other benign parotid gland tumors preoperatively. We sought to identify clinical and radiologic features that could aid in the preoperative distinction of parotid lymphomas.

We performed a retrospective chart review of 248 superficial parotidectomy patients.

Of 248 parotid lesions, 22 (8.8%) were lymphomas (21 non-Hodgkin's, 1 Hodgkin's). The lymphoma cases included four patients with a history of autoimmune disease, and four with a previous diagnosis of lymphoma. Palpable painless masses were present in all cases (14 right, 7 left, 1 bilateral). Two patients had multiple palpable parotid nodules and five had palpable cervical adenopathy. Of 17 patients receiving preoperative CT scans, 4 more patients were revealed to have bilateral disease, 7 more patients had cervical adenopathy, and 5 more patients had multiple parotid nodules. Tumors were poorly circumscribed in 7 of 17 (41%), and diffuse parotid changes were noted in 2. Preoperative fine needle aspiration biopsy was performed in 10 of the 22 lymphomas, revealing 3 reactive nodes, 3 suspicious for lymphoma and 3 nondiagnostic.

Although parotid lymphomas are uncommon, a history of autoimmune disease or previous lymphoma; clinical or radiologic evidence of bilateral, multiple, or poorly circumscribed parotid lesions; and cervical lymphadenopathy should suggest this diagnosis. This may alter the proposed surgery and decrease the potential morbidity associated with superficial parotidectomy in cases of parotid lymphoma.