Jain Ankit, Sudharshan Mahalingam, Vijayakumar Chellappa, Kumbhar Uday, Nelamangala Ramakrishnaiah Vishnu Prasad
Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND.
Cureus. 2021 Apr 18;13(4):e14539. doi: 10.7759/cureus.14539.
Tumors of the salivary glands constitute 3% of all head and neck tumors. The parotid gland (PG) is the most common site involved in 85% of cases. PG tumors' size varies from a few millimeters to several centimeters and is about 2-6 cm on average. However, because of insidious growth and asymptomatic nature, untreated tumors of the PG can attain large size. Pleomorphic adenoma (PA), as large as 33 cm in size or 26.5 kg in weight, has been reported in the literature. Similarly, untreated Warthin's tumor (WT) rarely becomes giant, size up to 20 cm is reported. Giant PG tumors are commonly symptomatic and have a rare tendency to become malignant. We are reporting two giant PG tumors with different histopathological diagnoses, PA and WT of size 15x15 cm and 10x8 cm, respectively. Therefore, with a size of 10 cm, our case is the second-largest WT reported in the literature. Both the giant PG tumors were present for 15-20 years, and mild pain and discomfort were the only symptoms. We had the differential preoperative tissue diagnosis in fine-needle aspiration cytology (FNAC) because of varying consistency. Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) of the neck were done for these cases for preoperative planning. Compared to the former, the latter was more informative about nerve involvement preoperatively. Both the patients underwent superficial parotidectomy, and meticulous dissection was done to identify and safeguard the facial nerve and its branches. We had a challenge in closing the flaps, which was achieved with an acceptable cosmetic outcome. Both the patients were discharged in stable condition with minimal facial nerve weakness.
涎腺肿瘤占所有头颈部肿瘤的3%。腮腺（PG）是最常受累的部位，85%的病例发生于此。PG肿瘤大小从几毫米到几厘米不等，平均约为2 - 6厘米。然而，由于其生长隐匿且无症状，未经治疗的PG肿瘤可能长得很大。文献报道多形性腺瘤（PA）大小可达33厘米或重量达26.5千克。同样，未经治疗的沃辛瘤（WT）很少会变成巨大肿瘤，有报道称其大小可达20厘米。巨大的PG肿瘤通常有症状，恶变倾向罕见。我们报告两例组织病理学诊断不同的巨大PG肿瘤，分别为大小15×15厘米的PA和10×8厘米的WT。因此，我们的病例大小为10厘米，是文献报道中第二大的WT。这两例巨大PG肿瘤均已存在15 - 20年，仅有轻微疼痛和不适症状。由于质地不同，我们通过细针穿刺细胞学检查（FNAC）进行了术前组织鉴别诊断。对这些病例进行了颈部增强计算机断层扫描（CECT）和磁共振成像（MRI）以进行术前规划。与前者相比，后者在术前对神经受累情况的信息提供更丰富。两名患者均接受了腮腺浅叶切除术，并进行了细致的解剖以识别和保护面神经及其分支。我们在关闭皮瓣时遇到了挑战，但最终获得了可接受的美容效果。两名患者均在病情稳定、面神经轻度无力的情况下出院。
