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Pathologic correlation of the unknown solid parotid mass in children
A E Camacho1, M L Goodman, R D Eavey
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114.
Insights
Pediatric parotid masses are rarely malignant. This study found most unknown solid parotid masses in children were inflammatory, not cancerous, suggesting a lower malignancy rate than previously thought.
Area of Science:
- Pediatric Otolaryngology
- Head and Neck Pathology
- Surgical Oncology
Background:
- Parotid masses in children are often presumed to have a high malignancy risk (approx. 50%).
- This perception may lead to unnecessary concern and aggressive management strategies.
- Evaluating local experience is crucial to refine diagnostic and treatment approaches.
Purpose of the Study:
- To assess the actual incidence of malignancy in pediatric parotid masses.
- To compare findings with the established high malignancy rate.
- To guide clinical decision-making for pediatric parotid masses.
Main Methods:
- Retrospective chart review of 22 pediatric patients treated between 1979-1987.
- Inclusion criteria: unknown, solid parotid mass.
- Analysis of age range (16 months to 19 years) and final histopathological diagnoses.
Main Results:
- Only 1 of 22 patients (4.5%) had a malignant parotid tumor (mucoepidermoid carcinoma).
- Benign pleomorphic adenoma was diagnosed in 8 patients (36.4%).
- Inflammatory conditions accounted for 13 cases (59.1%), including cat-scratch disease, atypical mycobacteria, lymph node hyperplasia, and toxoplasmosis.
Conclusions:
- Solid parotid masses in pediatric patients are frequently inflammatory, not malignant.
- The presumed high malignancy rate for pediatric parotid masses should be reconsidered.
- Surgical excision remains the primary diagnostic and treatment modality for most parotid conditions in children.
Abstract:
A parotid mass in a pediatric patient is stated to have an approximately 50% likelihood of being malignant. To evaluate our experience in light of this suggested incidence, we conducted a retrospective study, which included 22 patients treated over an 8-year period, 1979 to 1987. Patients' ages ranged from 16 months to 19 years, and all patients presented with an unknown, solid parotid mass. One patient had a malignancy, mucoepidermoid carcinoma. Eight patients were diagnosed with benign pleomorphic adenoma. Thirteen patients had an inflammatory process consisting of one of the following conditions: cat-scratch disease (4); atypical mycobacteria (4); benign follicular hyperplasia of a lymph node (4); and toxoplasmosis (1). The histologic findings in this series suggest that unknown solid parotid masses that occur in children or adolescents are frequently the result of inflammatory conditions and are not likely to be malignant. We therefore recommend a reconsideration of the reputed estimation of malignancy in the parotid gland in children. The majority of pathologic conditions discovered, however, are still best diagnosed and treated by surgical excision.