A 70yo pt comes with swelling in the parotid region for the last
10y. Exam: gland is soft and cystic. Choose the most probable dx?
a. Pleomorphic adenoma
b. Carcinoma of the salivary glands
c. Mikulicz’s disease
d. Adenoid cystic carcinoma
e. Parotid duct stones
answer: A
Pleomorphic adenoma
Clinical features
The patient presents with a slow - growing swelling anywhere within the parotid gland, but usually
in the lower pole and in the region of the angle of the jaw. The lump is well defined, usually firm or hard but sometimes cystic in consistency.
It is usually placed in the superficial part of the gland but may
occasionally be in its deep prolongation and indeed may project into the
pharynx. The facial nerve is never involved, except by frankly
malignant tumours.
Treatment
Wide excision of the tumour and the surrounding parotid tissue,
with careful preservation of the fibres of the facial nerve
(superficial parotidectomy). Where the tumour involves one of the other
salivary glands, complete excision of the gland is performed.
Enucleation is not recommended as it is highly liable to recurrence.
Mikulicz’s syndrome
Mikulicz’s syndrome is characterized by enlargement of the salivary and lacrimal glands, and is
associated with dry eyes, leading to conjunctivokeratitis, and dry mouth (xerostomia). It may occur
in the following conditions:
• sarcoid (commonest);
• lymphoma, particularly non-Hodgkins lymphoma;
• tuberculosis;
•
Sjögren’s syndrome, principally affecting middle - aged women and
associated with connective tissue disorders such as rheumatoid arthritis
and systemic lupus erythematosus.
Carcinoma: rapid growth, will infiltrate facial nerve, ulcerate
Stones: associations with eating
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