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Parotid gland masses: outcomes in the pediatric age group
Alaa Younes1,2, Mohammad Fouad Taher3,4, Iman Sidhom5,6
1Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
Insights
Pediatric parotid tumors are often malignant, with mucoepidermoid carcinoma being most common. Surgical parotidectomy is key, with fine needle aspiration cytology (FNAC) aiding diagnosis and treatment planning for these rare childhood neoplasms.
Area of Science:
- Pediatric Oncology
- Head and Neck Surgery
- Diagnostic Cytopathology
Background:
- Childhood parotid neoplasms exhibit distinct characteristics compared to adult tumors.
- The rarity of pediatric parotid tumors presents diagnostic and therapeutic challenges.
- Understanding these differences is crucial for effective management.
Purpose of the Study:
- To analyze the clinical characteristics, treatment, and outcomes of pediatric parotid masses.
- To evaluate the efficacy of fine needle aspiration cytology (FNAC) in diagnosing pediatric parotid neoplasms.
- To assess the role of surgery, neck dissection, and adjuvant radiotherapy in managing these tumors.
Main Methods:
- Retrospective analysis of pediatric patients with parotid masses treated between January 2008 and December 2020.
- Surgical procedures included parotidectomy (superficial, deep, or total) and neck dissection when indicated.
- Diagnostic accuracy of FNAC and correlation between radiological and pathological staging were assessed.
Main Results:
- Twenty-one pediatric patients were included; 57.1% had malignant neoplasms (most common: mucoepidermoid carcinoma) and 28.6% had benign neoplasms (pleomorphic adenoma).
- Complications occurred in 33.3% of malignant cases. Adjuvant radiotherapy was used for high-risk tumors.
- FNAC demonstrated 88.9% sensitivity and 100% specificity for malignant neoplasms. Radiological-pathological staging correlation was fair (66.74%).
Conclusions:
- Parotidectomy is the primary treatment for pediatric parotid tumors (benign and malignant).
- Preoperative FNAC of parotid masses and suspicious lymph nodes is highly recommended.
- Neck dissection and adjuvant radiotherapy should be considered for high-risk cases based on FNAC and staging.
Background:
Childhood parotid neoplasms appear to have different characteristics from adults. This point, in addition to the rarity of these tumors, reflects the challenges faced in diagnosing and treating parotid neoplasms in children.
Patients And Methods:
This retrospective study included all children who presented to the Children's Cancer Hospital Egypt (CCHE, 57357) with parotid masses from January 2008 to December 2020.
Results:
Twenty-one patients were included. Malignant neoplasms were found in 12 (57.1%) of which mucoepidermoid carcinoma was the most common. Benign neoplasms were found in 6 (28.6%) all of them were pleomorphic adenoma, and non-neoplastic lesions were found in 3 (14.3%). Superficial, deep, or total parotidectomy was performed according to the involved lobes. The facial nerve was sacrificed in three cases because of frank invasion by the tumor. Neck dissection was considered in clinically positive lymph nodes and/or T3/4 masses. Complications occurred in 7 (33.3%) all were of the malignant cases. Adjuvant radiotherapy was restricted to high-risk cases (7 cases). Recurrence occurred in two cases, and one patient died of distant metastasis. Fine needle aspiration cytology (FNAC) showed 88.9% sensitivity and 100% specificity for diagnosing malignant neoplasms. The correlation of radiological and pathological staging was fair (66.74% for overall staging).
Conclusions:
Parotidectomy is the backbone treatment for benign and malignant pediatric parotid tumors. Neck nodal dissection should be considered after preoperative FNAC of suspicious nodes. Adjuvant radiotherapy is considered only in high-risk tumors. Preoperative FNAC of parotid masses and clinically suspicious lymph nodes is highly recommended.
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