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Review
. 2008 Oct;28(5):261-5.

Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches

B Sergi  1 , A Limongelli, E Scarano, A R Fetoni, G Paludetti
Affiliations
Review

Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches

B Sergi et al. Acta Otorhinolaryngol Ital. 2008 Oct.

Abstract
in English, Italian

Aim of the present report is to discuss and underline the diagnostic algorithm and the surgical approach to giant parotid pleomorphic adenomas arising in the deep lobe and growing in the parapharyngeal space. Three cases are described and a review is made of the international literature concerning giant deep lobe parotid gland pleomorphic adenoma. Diagnosis was based on imaging, computed tomography scan and magnetic resonance imaging and upon cytology, by means of fine needle aspiration biopsy. The surgical approach varied according to the location of the tumour. All patients were discharged without complications and no cases of permanent facial nerve palsy were observed. An exhaustive pre-operative diagnostic algorithm is required before approaching this lesion. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.

Scopo del lavoro è incentrare l’attenzione sul protocollo diagnostico e sulle tecniche chirurgiche in merito al trattamento degli adenomi pleomorfi giganti del lobo profondo della parotide con crescita nello spazio parafaringeo. Riportiamo la nostra esperienza con tre casi consecutivi recenti di adenoma pleomorfo gigante del lobo profondo della parotide con crescita nello spazio parafaringeo. La diagnosi si fonda sull’impiego di tomografia computerizzata, risonanza magnetica e dell’esame citologico mediante agobiopsia. Le tecniche chirurgiche variano a seconda dell’estensione e della localizzazione della neoplasia. Tutti i pazienti sono stati dimessi dopo una completa asportazione della neoplasia senza presentare complicanze intra- e peri-operatorie e, in particolare, deficit del nervo facciale. In conclusione, un completo e approfondito iter diagnostico è necessario prima di trattare neoplasie localizzate in questa sede. L’agobiopsia, secondo noi, è necessaria per evitare sorprese istologiche spiacevoli. L’approccio chirurgico deve fornire una ampia visione del letto chirurgico in modo da assicurare una completa escissione preservando le strutture neurovascolari.

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Figures

Fig. 1
Fig. 1
MRI axial and coronal scans reveal a large tumour with high contrast enhancement, located deep in left parapharyngeal space displacing muscles and provoking lateral swelling.
Fig. 2
Fig. 2
T1 and T2 MRI scans showing tumour in continuity with deep right parotid lobe causing swelling in parotid region.
Fig. 3
Fig. 3
T2 fat suppression MRI scans showing large tumour in left parapharyngeal space arising in oral cavity and reducing pharyngeal air column.
See this image and copyright information in PMC

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