이하선에 발생한 염증성 근육섬유모세포종 1예

한바다,이재욱,김민경,김정규 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.10

Inflammatory myofibroblastic tumor (IMT), which is composed of spindle shaped myofibroblasts accompanied by an inflammatory infiltrate, is an uncommon neoplasm. Herein we present a rare case of an IMT of the parotid gland. The patient was a 56-year-old woman with parotid mass, which developed a tingling sensation around the mouth angle when the mass was palpated. Ultrasound and CT scan showed a parotid mass with an ill-defined margin. Preoperative gun biopsy showed spindle shaped cell proliferation without cytological atypia. Surgery revealed that the mass was adhesive to buccal branch of facial nerve without encapsulation. The adhesive part of the facial nerve was excised with mass due to the possibility of malignancy. The final pathological report confirming IMT became available following the surgery. We stress that confirmation of IMT should be included in the differential diagnosis of parotid mass which shows spindle shaped cells in histology.

A better facial contour accomplished by parotid duct preserving superficial parotidectomy

박준호,최창용,위서영,이영만 대한두개안면성형외과학회 2018 Archives of Craniofacial Surgery Vol.19 No.1

Depression of facial contour after parotidectomy is still challenging to many of surgeons. A 68-year-old man presented with a 4-month history of a painless swelling in both parotid area. The mass was multiple and fixed at the parotid region. We conducted a parotid duct preserving bilateral superficial parotidectomy by one-stage operation to remove the multiple tumors. A lazy S incision was made in both preauricular area and the peripheral branches of the facial nerve were identified using surgical landmark. After dissecting the branches of the facial nerve and parotid duct, main parotid duct was preserved but only small fine ductules from the superficial lobe were ligated. Pa¬rotid gland was excised from its anterior aspect with about 1 cm of normal parotid tissue margin. The patient was followed up for 6 years to evaluate postoperative parotid gland function and the computed tomography (CT) was taken. Patient was satisfied with no sig¬nificant complication such as sunken changes in facial contour, facial nerve function. As far as we know, it is the first study to compare long-term soft tissue contours of soft tissue of duct preserving superficial parotidectomy with duct sacrificing superficial parotidectomy by means of CT findings.

이하선 종양에서 세침흡인검사의 유용성

이창희(Chang Hee Lee),이현섭(Hyun Sub Lee),진성민(Sung Min Jin),이상혁(Sang Hyuk Lee),표정수(Jung-Soo Pyo),손진희(Jin Hee Sohn) 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.2

Background and Objectives:The usefulness of fine needle aspiration biopsy(FNAB) for diagnosis of parotid gland tumors is controversial, because of the generalized belief requiring surgery for most parotid tumors. The aim of this study was to evaluate the efficacy of FNAB for diagnosis in parotid gland tumors. Material and Methods:FNAB was performed in 91 patients who underwent parotid surgery at Kangbuk Samsung Hospital from January 2007 to December 2010. The result of FNAB, 11 malignancies and 75 benign tumors and 5 non-neoplasms were analyzed and compared with the final histopathologic diagnoses. Sensitivity, specificity, accu-racy, positive predictive value(PPV), and negative predictive value(NPV) were calculated using final histopatho-logic diagnosis of the surgical specimen as the standard diagnostic reference for comparative analysis. Results: 86 specimens(94.5%) were suitable for evaluation. We compared the result of FNAB and the final histopathology in 79(89.4%) cases. The sensitivity, specificity, accuracy, PPV, and NPV of FNAB for detecting pleomorphic adenoma was 95.8%, 88.4%, 92.3%, 90.2%, and 95.0%. In Warthin’s tumor, results were 86.4%, 94.2%, 92.3%, 82.6%, and 95.6%. Among 11 patients who were diagnosed with malignancy on final histopathologic report, only 3(30%) patients were diagnosed with the same as on FNAB, the other 8 patients were initially diagnosed incor-rectly as benign tumors in FNAB. There were no complications related to FNAB. Conclusion:Diagnostic accu-racy for FNAB in benign parotid tumors was high. However, in malignant tumors, FNAB shows low diagnostic usefulness compared with benign tumors. FNAB can be effective and safe diagnostic technique for evaluating the benign parotid glands tumors.

이하선 종괴의 CT 및 MRI 소견 : 양성과 악성의 감별점

전영섭 대한영상의학회 1998 대한영상의학회지 Vol.38 No.4

Purpose : To determine the differential findings of benign and malignant parotid masses, as seen on CT and MR imaging. Materials and Methods : The CT(24 cases of benign and 10 cases of malignant masses) and MR imaging(18cases of benign and 9 cases of malignant masses) findings of parotid gland masses confirmed by surgery or histopathology were analyzed by two radiologists ; they focused on size, cystic change, the presence of calcification within the mass, density or signal intensity and margin, degree of contrast enhancement and homogeneity, location and bilaterality, associated findings-including infiltration into surrounding structures and lymphadenopathy. Results : In one of the 34 cases seen on CT, precontrast images were not available. In 15 of 23benign cases(65.2%), the density of the mass, as seen on pre-contrast enhanced CT scan, was lower than that of muscle. In ten malignant cases, density lower than that of muscle was noted in only two cases (20%). On T2-weighted images, low signal intensity to fat was noted in five of nine cases(55.5%) of malignant lesion, but in no cases involving benign parotid masses. On CT scanning, an indistinct margin of the masses was observed in five of 24 benign cases(20.8%) and three of ten malignant cases(30%), but on MR imaging, this was seen in three of 18benign cases(16.7%) and 6 of 9 malignant cases(66.7%). On pre-contrast enhanced CT scan, 15 of 23 benign cases showed homogenous density, but 12 of these 15 (80%) changed to inhomogenous on post-contrast enhanced CT scan. Among the 12, pleomorphic adenoma accounted for ten cases(83.3%). On CT scanning, infiltration into surrounding structures including subcutaneous fat tissue was observed in three of 24 benign cases(12.5%) and four of ten malignant cases(40.0%) ; and on MR imaging, in one of 18 benign cases(5.5%) and six of nine malignant cases(66.7%). Conclusion : If a mass of lower attenuation than that of muscle is seen on pre-contrast enhanced CT scan, or density patterns change from homogenous on pre-contrast CT to inhomogenous on post-contrast CT scan, the mass may be benign. However, for the differential diagnosis of benign and malignant parotid masses, the margin of the mass is not helpful. Masses which on T2-weighted MR images show an indistinct margin, lower signal intensity to fat and infiltration into surrounding structure are more likely to be malignant. CT and MR findings relating tomass size, cystic change within mass, and lymphadenopathy are not, however, helpful for the differential diagnosis of benign and malignant parotid masses.

Preoperative prediction of the location of parotid gland tumors using radiographic anatomical landmarks

Chung-O Lee,Chang-Hyun Ahn,Tae-Geon Kwon,Chin-Soo Kim,Jin-Wook Kim 대한구강악안면외과학회 2012 대한구강악안면외과학회지 Vol.38 No.1

Introduction: The location of parotid gland tumors in the superficial or deep lobes can affect the time and difficulty of operations. Therefore, accurate preoperative evaluation of the tumor location is important for surgical outcomes. Materials and Methods: A total of 16 patients with parotid gland tumors and who underwent a parotidectomy between April 2003 and March 2011 were retrospectively reviewed in terms of demographic background, tumor location, surgical treatment, and treatment outcomes. Tumor location was estimated by four landmarks on contrast enhanced computerized tomography scans, which were Conn s arc, the facial nerve (FN) line, the Utrecht line, and the retromandibular vein. Tumor location was confirmed by relative position depending on the facial nerve during surgery. It was assumed positive since the tumor lies in the superficial lobe of the parotid gland, the sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of each landmark were evaluated. Results: Our result revealed that the facial nerve line had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71.4%, and efficiency of 87.5%. Some would be more efficient preoperative evaluation methods of the relationship of parotid gland tumors to the facial nerve than others. Conclusion: In our study, the FN line was found to be the most reliable analysis method.

Intravoxel Incoherent Motion Magnetic Resonance Imaging for Assessing Parotid Gland Tumors: Correlation and Comparison with Arterial Spin Labeling Imaging

Ma Gao,Xu Xiao-Quan,Zhu Liu-Ning,Jiang Jia-Suo,Su Guo-Yi,Hu Hao,Bu Shou-Shan,Wu Fei-Yun 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.2

Objective: To compare and correlate the findings of intravoxel incoherent motion (IVIM) magnetic resonance (MR) imaging and arterial spin labeling (ASL) imaging in characterizing parotid gland tumors. Materials and Methods: We retrospectively reviewed 56 patients with parotid gland tumors evaluated by MR imaging. The true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and fraction of perfusion (f) values of IVIM imaging and tumor-to-parotid gland signal intensity ratio (SIR) on ASL imaging were calculated. Spearman rank correlation coefficient, chi-squared, Mann-Whitney U, and Kruskal-Wallis tests with the post-hoc Dunn-Bonferroni method and receiver operating characteristic curve assessments were used for statistical analysis. Results: Malignant parotid gland tumors showed significantly lower D than benign tumors (p = 0.019). Within subgroup analyses, pleomorphic adenomas (PAs) showed significantly higher D than malignant tumors (MTs) and Warthin’s tumors (WTs) (p < 0.001). The D* of WTs was significantly higher than that of PAs (p = 0.031). The f and SIR on ASL imaging of WTs were significantly higher than those of MTs and PAs (p < 0.05). Significantly positive correlation was found between SIR on ASL imaging and f (r = 0.446, p = 0.001). In comparison with f, SIR on ASL imaging showed a higher area under curve (0.853 vs. 0.891) in discriminating MTs from WTs, although the difference was not significant (p = 0.720). Conclusion: IVIM and ASL imaging could help differentiate parotid gland tumors. SIR on ASL imaging showed a significantly positive correlation with f. ASL imaging might hold potential to improve the ability to discriminate MTs from WTs.

이하선 천엽에 발생한 지방종의 치험례

김정한(Jung-Han Kim),김철훈(Chul-Hoon Kim),김민구(Min-Gu Kim),송진우(Jin-Woo Song),정유진(Eu-Gene Jung),김복주(Bok-Joo Kim) 대한구강악안면외과학회 2010 대한구강악안면외과학회지 Vol.36 No.5

A lipoma is a benign tumor of matured adipose tissue that usually occurs at the shoulder, back, and abdomen. 13% of lipomas occur in the head and neck area. However, the incidence of lipoma in the parotid gland is very low, approximately 2.5%. A conservational surgical excision is recommended in cases of lipoma of the parotid gland, with only 1-2% of lipomas recurring. We report a case of a lipoma in the parotid gland that was removed by conservational surgical excision. The lesion was exposed by the pre-auricular approach and the tissue was detached. After the parotid gland envelop was exposed, a yellowish mass is observed that was easy to remove due to capsulation. Most authors recommend a surgical excision of the superficial lobe of the parotid gland as the treatment for a lipoma in the parotid gland. However, enucleation only may be a sufficient treatment when a lipoma occurs in the superficial lobe or around the parotid gland. A patidectomy is not needed when a lipoma is located at the superficial lobe of the parotid gland, and a conservational surgical excision is suitable. Therefore, a clinical diagnosis is important for reducing the damage to the facial nerve.

이하선 종양의 초음파 소견

김호균,박준영,최성용,김정규 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.9

Background and Objectives Ultrasonography represents the initial imaging modality of choice for the assessment of the parotid gland tumors. The aim of this study is to evaluate the role of ultrasonography in differential diagnosis of the parotid gland tumors. Subjects and Method Ultrasonography of the 49 patients with parotid gland tumors were retrospectively reviewed. Histology of all cases was confirmed after parotidectomy. The ultrasonographic features of the most common two histologies, namely, pleomorphic adenoma and Warthin’s tumor, were compared. Results Pleomorphic adenomas were usually solid and they showed lobulation and an exophytic growth. Warthin’s tumors usually contained a cystic component, and were usually oval without lobulation and confined to the parenchyma. One of two malignancies showed well-defined margins and five benign tumors showed ill-defined margins. Conclusion The ultrasonographic features should be cautiously used to discriminate among the various histologies of parotid gland tumors.

주 타액선 종양에 대한 10년 간의 경험

공일규(Il gyu Kong),장동엽(Dong Yeop Chang),정은정(Eun-Jung Jung),정영호(Young Ho Jung),하정훈(J. Hun Hah),성명훈(Myung-Whun Sung),김광현(Kwang Hyun Kim) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2

Background and Objectives :This study reports our clinicopathological experiences of major salivary gland tumors. Materials and Methods :This study included 302 patients with major salivary gland tumors who had got the diagnosis from January 1995 through December 2004. Medical records were reviewed retrospectively. Results :We found 244 benign and 58 malignant major salivary gland tumors. Among 267 parotid tumors, the most common benign parotid tumor was pleomorphic adenoma. Mucoepidermoid carcinoma, adenoid cystic carcinoma, and acinic cell carcinoma were three most common parotid malignancies. Among 33 submandibular gland tumors, 20 cases were benign and 13 were malignant. There were one benign and one malignant su-blingual gland tumors. The duration of symptom of submandibular gland tumors was longer than that of parotid tumors. Most patients presented with asymptomatic mass. Seventy-one percent of salivary gland malignancies underwent postoperative radiation therapy. Five-year disease free survival rate of parotid malignant tumors seemed to be higher than that of submandibular one, although there was no statistical significance. Conclusion :Malignancy rate of each salivary gland followed old axiom that it is inversely related with the size of gland. Submandibular gland tumor tends to be delayed to reach diagnosis. Clinicians must be alert about this finding because submandibular gland tumors are known to have poorer prognosis than parotid tumors.

Multiple Myopericytoma of the Face and Parotid Gland

Yun-Ik Jung,정윤규,Seum Chung 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.2

Myopericytoma is a benign tumor that is composed of myoid-appearing oval to spindleshaped cells with a concentric perivascular pattern of growth. The tumor is morphologically heterogeneous and can exhibit a broad histologic spectrum. We describe a case of multiple myopericytoma occurring in the head and neck skin region with involvement of the parotid gland where it is known to occur very rarely. A 40-year-old woman noticed multiple enlarging,painless, round-shaped masses on her left cheek. The patient had experienced a similar lesion of the same area 8 years earlier which was completely excised and the pathological diagnosis was spindle cell type myoepithelioma. On a computed tomographic image, one mass involved the superficial parotid gland and was well encapsulated. Excision of the facial masses and superficial parotidectomy with facial nerve preservation were performed. A diagnosis of myopericytoma was established in light of the immunohistochemical pattern with the histopathological findings. Over the 4-year follow-up period, there was no evidence of recurrence. As many perivascular myoid neoplasms share common morphologic features with myopericytoma, we should consider the differential diagnosis, and confirm the histological findings with appropriate immunohistochemical staining. After identifying myopericytoma, it should be treated with wide surgical excision to prevent local recurrence.