[Lymphoma of the parotid salivary gland].

INTRODUCTION

Lymphomas appear mostly in lymph nodes and parenchymal organs such as liver and spleen, while other localizations are less frequent. They are classified as Hodgkin and non-Hodgkin types, and these two are divided into subtypes, according to cell morphology and the characteristics of concurrent elements. Parotid salivary gland lymphomas are rare primary tumours of this region, although 80% of all salivary gland lymphomas, appear in parotid. They originate from intraparotid or periparotid lymph nodes, or from lymphoid elements of other pathological states in the gland such as sialadenitis, cysts with the presence of lymphoid tissue, parenchymal neoplasms with lymphoid component present and autoimmune illnesses, esp. Sjögren syndrome. Many authors (2-15) who have issued publications on this topic in foreign professional literature in the past ten years, agree that the primary localization of lymphomas in parotid salivary gland is very rare, although in recent decades more frequent than earlier (5). In majority of cases they appear on one side, although there are very rare cases of described parotid salivary glands on both sides. The illness most often starts as painless, soft knob in the region of parotid salivary gland. Other discomforts are very rare, and mostly appear as a feeling of pressure and mild painful sensations in the region of the change. In case of facial nerve paresis and/or strong pains, as well as adenopathy, there is a justified suspicion of carcinoma (20). The treatment is surgical. The method chosen is parotidectomy. According to histological type and clinical stadium, it includes radiotherapy or polychemotherapy. The prognosis depends on histological type of tumour, that is clinical stadium, and shows no specific characteristics compared with other forms of disease appearing outside parotid salivary gland.

CASE DESCRIPTION

The patient aged 66 was admitted to the ward with a tumefaction in the right parotid region. Family case history: negative. Personal case history excerpt: over 20 years of rheumatism, chronic bronchitis and hypertension. Present discomfort: tumefaction in the right parotid region, noticed about a year and a half earlier. The tumefaction was about 3 cm in diameter, painless to palpation, rubbery and smooth. She came to the Otolaryngology ward on May 31, 1995, when it was established that she had a tumour of the right parotid region and chronic otitis media on the left side. She was admitted on August 7, 1995. Local test results: the right parotid region contained a tumor of irregular round shape, about 6 cm in diameter, soft and painless to palpation, with smooth surface, the skin over the tumor was hyperaemic and sporadically livid. ORL status excerpt: subtotal reniform perforation of the left tympanic membrane enclosing all parts except the attic, with slight transparent secretion. Enlarged lymph nodes were not palpable. On August 10, 1995, under general endotracheal anaesthesia, a pre-operative aspiration of tumor was performed in three positions. The obtained substance contained blood, after which it was decided to perform an excision biopsy, which was done in the lower portion of the tumor. Histopathological analysis did not give a clearly defined character of tumor, so that hospitalisation was indicated and scheduled for further treatment. On the second admission on October 10, 1995, general condition and local results remain unchanged. On October 12, 1995, total parotidectomy was performed under general endotracheal anaesthesia. A tumor of about 5 cm in diameter and the removed salivary gland were sent to histopathological tests. The post-operative course was normal, the function of the facial nerve was preserved. Histopathological results: well-differentiated malignant lymphocyte lymphoma. The patient was sent to polychemotherapy on Cyclophosphamide Oncovin Pronisin (COP) protocol. One year after the surgery, the local findings are regular. (ABSTRACT TRUNCATED)