Adenoma of the Parotid Gland
An 83-year-old woman-who had not visited a physician for 20 years-presented to the emergency department with a 1-day history of urinary retention and a 1-month history of gross vaginal bleeding. The mass on the left side of her face was a secondary finding.
An 83-year-old woman-who had not visited a physician for 20 years-presented to the emergency department with a 1-day history of urinary retention and a 1-month history of gross vaginal bleeding. The mass on the left side of her face was a secondary finding.
The patient was admitted to the hospital. Cystoscopic and pelvic examinations and a CT scan revealed an apparent cervical carcinoma that extended to the bladder and obstructed both ureters.
A biopsy of the facial mass revealed a pleomorphic adenoma of the parotid gland. The patient elected not to have surgery to reduce the size of the tumor and refused treatment for her cervical cancer. She was stabilized medically, a left ureteral stent was placed, and she was discharged to home hospice care.
Dr Brian L. Patterson of Providence Hospital and Medical Centers in Southfield, Mich, writes that parotid tumors comprise approximately 80% to 85% of salivary gland tumors. Despite the fact that the superficial and deep lobes of the parotid gland are separated by the facial nerve, only 10% of persons with these tumors present with pain or facial nerve paralysis.1 Most of the growths that cause pain or nerve paralysis arise in the deep lobe and place pressure on the nerve itself or transgress the facial nerve from the deep lobe to the superficial lobe. Typically, only painless swelling over the affected side of the face occurs with superficial lobe parotid tumors.
About 65% of parotid tumors are benign. Women are affected more often than men; the average age of onset is between 60 and 70 years.2 This woman had a pleomorphic adenoma, or benign mixed tumor, the most common parotid neoplasm; it comprises 50% of all parotid tumors.2 Such adenomas are discrete, slowly enlarging masses that are rarely symptomatic. Treatment is surgical excision to clear margins. A superficial parotidectomy usually is performed on tumors that are superficial to the facial nerve. Those that are deep to the nerve require a conservative total parotidectomy, which involves sacrificing the facial nerve. There is a 1% to 5% recurrence rate after complete resection.
REFERENCES:1. Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. St Louis: Mosby; 2001.
2. Sabistan DC Jr, Lyerly HK, eds. Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Philadelphia: WB Saunders Company; 1997.
Woman With Abdominal Pain, Ascites, And Dyspnea
March 2nd 2006A34-year-old woman presents to the emergency department(ED) with rapidly progressive dyspnea.The patient has a history of metastatic vaginal clearcell adenocarcinoma secondary to diethylstilbestrol exposurein utero. Following her diagnosis in 1990, she wastreated with surgery, chemotherapy, and radiation. Shehad done well for years until a recurrence of the cancer tothe left lung was found last year. She completed a courseof chemotherapy with doxorubicin hydrochloride andcisplatin 1 month ago.
