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Unexpected pathologies in pediatric parotid lesions: management paradigms revisited
Eric M Jaryszak1, Rahul K Shah, Nancy M Bauman
1Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Av NW, Washington, DC 20010, USA.
Insights
Pediatric parotid masses present diverse pathologies, often mimicking benign conditions. Surgical excision is crucial for diagnosis and treatment of these rare childhood parotid tumors.
Area of Science:
- Pediatric Otolaryngology
- Surgical Pathology
- Pediatric Oncology
Background:
- Pediatric parotid masses are uncommon and present diagnostic challenges.
- Clinical presentation and initial investigations often fail to differentiate benign from malignant lesions.
Purpose of the Study:
- To review unusual pediatric parotid pathologies.
- To discuss management strategies for these rare pediatric parotid lesions.
Main Methods:
- Retrospective case series of 5 pediatric patients undergoing parotidectomy.
- Review of clinical course, diagnostic workup, and surgical outcomes.
Main Results:
- Ages ranged from 17 months to 16 years.
- Pathologies included metastatic neuroblastoma, sarcoma, mucoepidermoid carcinoma, nodular fasciitis, and hyperplastic lymph node.
- Fine-needle aspiration (FNA) had limited diagnostic utility.
Conclusions:
- The differential diagnosis for pediatric parotid masses is broad and distinct from adults.
- Surgical parotidectomy is essential for diagnosis and treatment.
- A low threshold for parotidectomy is recommended for persistent pediatric parotid masses.
Objectives:
To present case vignettes of unusual pediatric parotid pathologies and discuss management paradigms in the context of these lesions.
Study Design:
Retrospective case series.
Setting:
Free-standing, academic tertiary care pediatric hospital.
Methods:
All patients over the past 18 months undergoing parotidectomy for a parotid mass were reviewed (N=5).
Results:
Ages ranged from 17 months to 16 years. All presented with a remarkably similar clinical course, consisting of a persistent parotid mass for more than 3 months which was usually painless. Most (4/5 patients) had been treated with antibiotics prior to Otolaryngology consultation. Fine-needle aspiration (FNA) was performed on 3 patients and was diagnostic in one. Complete excision of the mass was performed in each child through a parotidectomy approach (3 total, 2 lateral lobe). The final pathology showed metastatic neuroblastoma (17 months old), undifferentiated primitive sarcoma (22 months old), mucoepidermoid carcinoma (11 years old), nodular fasciitis (12 years old), and hyperplastic lymph node (16 years old). The patient with neuroblastoma died from complications of bone marrow transplant.
Conclusions:
The differential diagnosis for a persistent pediatric parotid mass is expansive and differs from that found in the adult population. As this series highlights, in many cases, it is impossible to discern the pathology, or rule out malignancy, based upon the clinical course, imaging, or FNA results. Surgical excision remains the standard for management of these patients and is both diagnostic and therapeutic. Our anecdotal case series highlights the importance of having a low threshold for parotidectomy in these children.
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