Mario Mannino*, Giorgio Barbera, Davide Soverina, Gemma Mastrantoni, Gianmarco Saponaro, Giulio Gasparini, Sandro Pelo and Alessandro Moro

Department of Maxillofacial Surgery, Università Cattolica del Sacro Cuore (RM), Italy

*Corresponding Author: Mario Mannino, Department of Maxillofacial Surgery, Università Cattolica del Sacro Cuore (RM), Italy.

Received: December 13, 2021; Published: December 31, 2021

Abstract

Introduction: Parotid tumors are usually slow growing, asymptomatic masses and the average size reported to be between 2 and 6 cm [9]. In the literature, some cases of ”giant tumors” of the parotid are mentioned, most of them benign, but there isn’t a clear definition of this term.

This article will examine all the lesions that include the term “giant”, trying to find a definition, a size cut-off, epidemiologic and clinical characteristics.

Materials and Methods: The search of the major databases (PubMed, Cochrane and Scopus) was performed until December 29, 2019.

Randomized controlled trials (RCTs), case series, case reports, reviews of the literature, interventional or observational studies were considered and the inclusion criteria were as follows:

• Studies reporting malignant or benign parotid tumors with dimension;
• Definition as “giant”, “huge” or other terms that emphasize the dimension of the tumor;
• Primary parotid

Letters to editor were excluded and the following exclusion criteria were applied:

• Studies without indications about tumor

Results: The studies included a total of 43 patients with giant parotid tumor. 37 out of 39 articles were case reports and 2 articles were case series.

The size of the lesion depends on the period of time from clinical onset to giant transformation reported (co-gtr).

In 2 cases of malignant tumor the growth was extremely fast.

The correlation between “size” and co-gtr is high and positive (equal to 0.69) and the ratio is statistically significant (P < 0.05), that means the larger the size the longer the time since clinical onset to giant transformation reported.

The average detected size was 14.2 cm and two peaks were found at 6cm and 20cm. (range 3-46cm).

The larger part of the tumours are benignant (75%), of which pleomorphic adenoma is the most represented (47%). In the malignant group, half of them are carcinoma ex pleomorphic adenoma.

Conclusion

• The size of the tumors depends on neglection and this does not only apply to underdeveloped countries but also to the western world, being largely linked to the refusal of treatment and perhaps to medical/patient wrong communication.
• Two dimensional peaks were find regarding the metrical size of the lesions. The first peak was the most numerous and equal to 6 cm and we suggest to take it as a cut-off to classify the lesion as GIANT. Lower values are therefore excluded and considered within the common size of parotid lesions.
• The evolution in malignant tumor of giant pleomorphic adenoma in 20 years is 20%. The absence of surgery leads to an increase in the size of the neoformation, an increased risk of cancer evolution that confirms the need of surgery in such lesions.

Keywords: Parotid Gland; Salivary Gland; Giant

References

1. Speight PM and Barrett AW. “Salivary gland tumours”. Oral Disease 2 (2002): 229-240.
2. George, K. “Surgical Techniques for Parotid and Submandibular Glands and Ranulae”. Maxillofacial Surgery (2017): 686-699.
3. Jaber MA. “Intraoral minor salivary gland tumors: a review of 75 cases in a Libyan population”. International Journal of Oral and Maxillofacial Surgery 35 (2006): 150-154.
4. Jones AV., et al. “The range and demograph- ics of salivary gland tumours diagnosed in a UK population”. Oral Oncology 44 (2008): 407-417.
5. Bouaity B., et al. “Predictors of malignancy in the management of parotid tumors: about 76 cases”. The Pan African Medical Journal 23 (2016): 112.
6. Buenting JE., et al. “Giant pleomorphic adenoma of the parotid gland: case report and review of the literature”. Ear Nose Throat Journal8 (1998): 634.
7. Schultz-Coulon HJ. “Pleomorphe Riesenadenome der Glandula parotis Pleomorphic giant adenomas of the parotid gland”. Laryngorhinootologie8 (1989): 445-449.
8. Spiro RH. “Salivary neoplasms: overview of a 35-year experience with 2,807 patients”. Head and Neck Surgery 3 (1986): 177-184.
9. Phillips DE and Jones AS. “Reliability of clinical examination in the diagnosisofparotidtumors”. The Royal College of Surgeons of Edinburgh 2 (1994): 100-102.
10. Auclair Pl and ellis gl. “Atypical features in salivary gland mixed tumors: their relationship to malignant transforma- tion”. Modern Pathology 9 (1996): 652-657.
11. yamamoto y. “Clinical signs and histology of carcinoma in pleomorphicadenoma”. Otologia 87: 1320-13204.
12. Eneroth Cm and Zetterberg A. “Malignancy in pleomorphic ad- enoma. A clinical and microspectrophotometric study”. Acta Oto-Laryngologica 77 (1974): 426-432.
13. Nouraei SAR., et al. “Metastasizing Pleomorphic Salivary Adenoma”. Archives of Otorhinolaryngology-Head and Neck Surgery 7 (2006): 788-793.
14. Som PM Shugar., et al. “Benign and malignant parotid pleomorphic adenomas: CT and MRI studies”. Journal of Computer Assisted Tomography (1988): 1265- 1269.
15. Batsakis JG. “Malignant element tumor”. Annals of Otology, Rhinology and Laryngology 91 (1982;): 342-343
16. Gnepp DR. “Malignant element tumours of the salivary glands: a review”. Pathology Annual 28 (1993): 279- 328
17. Bittar RF., et al. “Facial paralysis after superficial parotidectomy: analysis of possible predictors of this complication”. Brazilian Journal of Otorhinolaryngology4 (2016): 447-451.
18. Tian Z., et al. “Salivary gland neoplasms in oral and maxillofacial regions: a 23-year retrospective study of 6982 cases in an eastern Chinese population”. International Journal of Oral and Maxillofacial Surgery 39 (2010): 235-242.
19. Luna MA. “Salivary mucoepidermoid carcinoma: revisited”. Advances in Anatomic Pathology 6 (2006): 293-307.
20. Salaria N., et al. “Giant Warthin’s Tumour of the Parotid Gland: A Rare Case Report”. Indian Journal of Otolaryngology and Head and Neck Surgery1 (2019): 839-843.
21. Erda˘g TK., et al. “Giant Congeni- tal Sialolipoma of Parotid Gland with Parapharyngeal Extension”. Journal of Otorhinolaryngology 103 (2019): 119-122.
22. Adilbay D., et al. “A case of aggressive giant dermatofibrosarcoma protuberance occurring in the parotid gland”. International Journal of Surgery Case Reports 55 (2019): 58-61.
23. Quang V., et al. “A case report of minimal access approach to a giant parapharyngeal space tumor”. International Journal of Surgery Open 13 (2018): 6-9.
24. Rai DV., et al. “Undifferentiated pleomorphic sarcoma of the left parotid gland: a case report”.

Oral Radiology 33 (2017): 76-80.

25. Calvo-Henriquez, C. E., et al. “Giant Pleomorphic Adenoma of the Parotid Gland”. Acta Otorrinolaringologica (English Edition), 67.6 (2016): e40-e41.
26. Akintububo O B., et al. “Giant parotid pleomorphic adenoma in a Nigerian male”. Nigerian Journal of Clinical Practice 19 (2016): 681-684.
27. Santosh K. Swain., et al. “An ulcerated giant pleomorphic adenoma of the parotid gland - A case report”. Egyptian Journal of Ear, Nose, Throat and Allied Sciences 2 (2016): 111-114.
28. Datarkar AN and Deshpande A. “Giant Parapharyngeal Space Pleomorphic Adenoma of the Deep Lobe of Parotid Presenting as Obstructive Sleep Apnoea: A Case Report Review of the Diagnostic and Therapeutic Approaches”. Journal of Oral and Maxillofacial Surgery 3 (2015): 532-537.
29. Tarsitano A., et al. “Giant pleomorphic adenoma of the parotid gland: an unusual case presentation and literature review”. ACTA Otorhinolaryngologica Italica 4 (2015): 293-296.
30. Begum, S. K., et al. “Squamous Cell Carcinoma Ex Pleomorphic Adenoma of the Parotid Gland A Case Report with Clinicopathological Review”. Journal of Medicine2 (2015): 118-121.
31. Ahmet Erim Pamuk., et al. “A neglected giant parotid gland mass: Ex- cision and reconstruction with facial nerve preservation”. Otolaryngolo- gia Polska6 (2014): 333-337.
32. Ghodrat Mohammadi and Rezvan Notash. “A rare case of bilobe parotid lipoma: Involving both superficial and deep lobe of parotid”. Egyptian Jour- nal of Ear, Nose, Throat and Allied Sciences1 (2014): 69-71.
33. Octavian Chis and Silviu Albu. “Giant Solitary Fibrous Tumor of the Parotid Gland”. Case Reports in Medicine 4 (2014).
34. Morariu I., et al. “Giant parotid pleomorphic adenoma in parapharyngeal space causing severe obstructive sleep apnoea”. Irish Medical Journal 6 (2012): 184-185.
35. C etin MA., et al. “Giant pleomorphic adenoma of the parotid gland. Kulak Burun Bogaz Ihtis Derg”. 22.2 (2012): 116-118.
36. Infante-Cossio P., et al. “Management of parapharyngeal giant pleomorphic adenoma”. Journal of Oral and Maxillofacial Surgery 4 (2011): 211-216.
37. Fernandez-Barriales M., et al. “Tumor de Warthin gigante”. Acta Otorrinolaringologica Española - Journals 62 (2011): 477-478.
38. Palluch, F., et al. “The rapid growth of a pleomorphic adenoma of the parotid gland in the third trimester of pregnancy. Journal of Medical Case Reports 5 (2011): 141.
39. Kim Dong-Seok MD., et al. “Surgical Treatment of a Giant Lipoma in the Parotid Gland”. Journal of Craniofacial Surgery5 (2009): 1601-1602.
40. Dai XM., et al. “Giant pedunculated fibrolipoma arising from right facial and cervical region”. Journal of Oral and Maxillofacial Surgery 6 (2009): 1323-1326.
41. Martin H., et al. “Gi- ant epithelial-myoepithelial carcinoma of the parotid gland, Clinical Imaging”. 33. 3 (2009): 237-239.
42. Takahama A Jr., et al. “Giant pleomorphic adenoma of the parotid gland”. Medicina Oral, Patologia Oral, Cirugia Bucal 1 (2008): E58-60.
43. Sergi B., et al. “Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches”. Acta Otorhinolaryngology5 (2008): 261-265.
44. Botev B., et al. “A giant sarcoma of the parotid gland: a case report and review of the literature”. In Vivo6B (2006): 907-910.
45. Wu CW., et al. “Giant lipoma arising from deep lobe of the parotid gland”. World Journal of Surgical Oncology 4 (2006): 28.
46. Honda T., et al. “Giant pleomorphic adenoma of the parotid gland with malignant transformation”. Annals of Plastic Surgery 5 (2005): 524-527.
47. N de Silva., et al. “A case of giant pleomorphic adenoma of the parotid gland”. Oral Oncology Extra 40.3 (2004): 43-45.
48. PANOUSSOPOULOS., et al. “Giant Pleomorphic Adenoma of the Parotid Gland Involving the Parapha- ryngeal Space Treated by a Totally Extraoral Transparotid Approach”. Journal of Surgical Oncology 81 (2002): 155-157
49. Zeev Abraham., et al. “Skin Ulcerat the Blunt Apex- of a Giant Warthin’s Tumor”. The Journal of Dermatology 27 (2000): 523-528.
50. CASE REPORTS. “Giant parotid pleomorphic adenoma involving the parapharyn- geal space: Report of a case Javier Rodr´ıguez-Ciurana”. Carlos Bassas 58 (2000): 1184-1187.
51. Akgu¨ner M., et al. “Malignant mixed tumor of the parotid with myoepithelial carcinomatous and papillary adenocarcinomatous com- ponents”. Annals of Plastic Surgery 6 (1997): 656-658.
52. Takato T., et al. “Giant hemangioma of the parotid gland associated with Kasabach-Merritt syndrome: a case report”. Journal of Oral and Maxillofacial Surgery4 (1993): 425-428.
53. Lung T and Juncar M. “Carcinoma ex-pleomorphic adenoma - a giant tumor. Chirurgia (Bucur)”. 108.2 (2013): 273-276.
54. Dwivedi S., et al. “Giant solitary neurofibroma presenting as a neck mass in an infant”. Journal of Neurosciences in Rural Practice 1 (2010): 32-34.
55. He Y., et al. “Giant cell angiofibroma misdiagnosed as a vascular malformation and treated with absolute alcohol for one year: a case report and review of the literature”. World Journal of Surgical Oncology 117 (2014).
56. Huang EC., et al. “Giant cell-rich osteosarcoma of the parotid gland: An exceptionally rare entity at an unusual site”. Diagnostic Cytopathology 12 (2016): 1107-1111.
57. Takahama A Jr., et al. “Nonlymphoid mesenchymal tumors of the parotid gland”. Oral Oncology 10 (2008): 970-974.

Citation

Citation: Mario Mannino., et al. “The Giant Size Parotid Lesions".Acta Scientific Otolaryngology 4.1 (2022): 55-65.

Copyright

Copyright: © 2022 Mario Mannino., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.