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Pediatric parotideomasseteric pilomatrixoma in children
Richard Salzman1, Ivo Starek, Hitari Faisal
1Department of Otorhinolaryngology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
Insights
Pediatric salivary gland tumors include pilomatrixomas, a benign skin appendage tumor. Early diagnosis via clinical assessment and ultrasound-guided fine needle aspiration cytology is crucial for appropriate management.
Area of Science:
- Oncology
- Pathology
- Pediatric Surgery
Background:
- Great salivary gland tumors are rare in children.
- Pilomatrixoma, a benign skin appendage tumor, is an uncommon but significant cause of pediatric salivary gland masses.
Purpose of the Study:
- To review definitive histological diagnoses of pediatric great salivary gland tumors.
- To highlight the incidence and diagnostic considerations of pilomatrixomas in children.
Main Methods:
- Retrospective review of 12 pediatric patients (6 months to 18 years) with great salivary gland masses treated between 1995 and 2010.
- Analysis of clinical presentation, imaging, and fine needle aspiration cytology (FNAC) findings.
Main Results:
- Carcinomas predominated among true neoplasms (6/9), with low-grade mucoepidermoid and acinic cell carcinomas being most common.
- Pilomatrixoma was the most frequent benign diagnosis (2/6), accounting for 17% of all salivary gland lumps and 66% of benign neoplasms.
- Clinical findings included adherence to the skin but not underlying tissue.
Conclusions:
- Pilomatrixoma should be considered in the differential diagnosis of pediatric parotid region masses.
- Ultrasound-guided FNAC can strongly support the diagnosis of pilomatrixoma.
- Awareness of potential pilomatrixoma is essential for cytopathologists and surgeons to ensure proper sample handling and avoid unnecessary parotidectomy.
Aims:
To review definitive histological diagnoses of patients with great salivary gland tumors with focus on the relatively high incidence of pediatric pilomatrixomas. The authors focus on clinical investigation, imaging methods and fine needle aspiration cytology of pilomatrixomas.
Methods:
We treated 12 children with great salivary gland masses aged from 6 months to 18 years from 1995 to 2010. The records of these patients were reviewed to determine sex, age, clinical presentation, and histological findings.
Results:
Among children having true neoplasms, there was a prevalence of carcinomas (6 out of 9), with low-grade mucoepidermoid and acinic cell carcinomas (two each) as the dominating histopathological diagnosis. There was one adenoid cystic carcinoma and one curious undifferentiated carcinoma in a 6 month old baby. Among all 6 benign lesions, accounting for a half of the total, pilomatrixoma was the most common (2 out of 6) diagnosis, representing 17% (2 out of 12) of all salivary gland lumps and 66% (2 out of 3) of all true benign neoplasms.
Conclusions:
Pilomatrixoma should be included in the differential diagnosis of pediatric parotideomasseteric lumps. Clinical investigation reveals adherence to the skin but not to the underlying tissue. Clinical assessment and ultrasound guided fine needle aspiration cytology in typical findings strongly support the diagnosis. Cytopathologists must be aware of the preliminary diagnosis of a pilomatrixoma to use proper fixation of the smears. In doubts, frozen biopsy must be sent before parotidectomy is performed.
