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Introduction: Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade malignancy that occurs primarily in the parotid gland and is most common in women aged 60 to 70 years. Cases of parotid EMC have been reported previously. Furthermore, some studies have suggested an increased risk of salivary gland tumors with secondary primary malignancies. There have been few reports of parotid EMC with other primary tumors., Patient Concerns: A 62-year-old Chinese man visited the hospital with a complaint of a mass on his left cheek that had persisted for 20 years. Routine pulmonary computed tomography showed a local ground glass shadow in the lower lobe of the right lung., Diagnosis: The pathological diagnosis of lung was right lower lobe lung adenocarcinoma (pT1N0). Immunohistochemistry analysis showed that cytokeratin (CK)-7, NapsinA, and thyroid transcription factor-1 tested positive, while CK5/6, P40, and ALKD5F3 tested negative. The pathological diagnosis of left parotid gland: EMC. On immunohistochemistry staining, the outer cells expressed myoepithelial markers, such as CK5/6, P63, smooth muscle actin, while the inner cells expressed glandular epithelial markers, such as low-molecular-weight CK7 and CK8., Interventions: The patient underwent resection of the lung and parotid tumors, and received preventive radiotherapy in the parotid gland area., Outcomes: The patient is in good condition. No symptom recurrence, distant metastatic spread or significant toxicity occurred during or after the treatment. The patient remains under regular surveillance., Conclusion: We report a rare case of parotid EMC with a second primary lung adenocarcinoma. This case is the third case of primary lung cancer associated with parotid EMC reported to date and the first to be reported in nearly 30 years.

Objectives: Malignant myoepithelioma of salivary glands is a rare neoplasm; most arise in the parotid gland and minor salivary glands of the palate. Surgery has been the mainstay of treatment., Methods: This is case report of a patient treated with primary radical radiotherapy and retrospective review of institutional experience., Results: An 87-year-old man with locoregionally advanced malignant myoepithelioma of the parotid gland received radiotherapy alone with complete clinical response and sustained 39 months of posttreatment. Between 1981 and 2012, 15 cases of malignant myoepithelioma of the parotid were seen. Thirteen patients received surgical excision and adjuvant radiotherapy. At a median follow-up of 47 months, 12 patients were alive without recurrence, 2 died without recurrence, and 1 died with metastatic myoepithelioma., Conclusions: Durable locoregional disease control and disease-free-survival was achieved in the majority of patients. The case reported suggests radiation therapy may be an effective treatment option for inoperable cases.

Mammary analogue secretory carcinoma of salivary glands harbors the recurrent ETV6-NTRK3 gene fusion because of the translocation t (12; 15) (p13; q25) and resembles breast secretory carcinoma. This tumor composed of papillary, cystic, solid, and cribriform patterns. Immunohistochemically, the tumors are positive for mammaglobin, CK7, CK8, STAT5a, vimentin, and S100. In this report, the authors presented a patient of recurrent parotid gland mammary analogue secretory carcinoma in a 22-year-old woman. The patient received extended parotidectomy with partial adhesive masseter surgery. The facial nerve was preserved during the surgery and adjuvant radiotherapy was performed postoperation. The patient did not suffer local recurrence and facial paralysis in the 18 months follow-up period.

Objective: The aim of the study was to describe the successful treatment of delirium with electroconvulsive therapy (ECT)., Methods: The method of the study was a case report., Results: A 75-year-old man, with a recently diagnosed carcinoma of the parotid gland, was admitted with a fluctuating psychiatric syndrome. Delirium was diagnosed, although an acute underlying somatic cause could not be readily established. Antipsychotics and benzodiazepines were not effective. After 7 sessions of ECT, all symptoms ceased. This enabled him to receive radiotherapy for his tumor and enjoy a good quality of life for the remaining 8 months of his life., Conclusions: Electroconvulsive therapy is not only a powerful treatment for catatonia, neuroleptic malignant syndrome, and delirious mania but also for the most commonly occurring fluctuating psychiatric syndrome--delirium.

Objective: To study osteoradionecrosis (ORN) of the temporal bone., Study Design: Retrospective case review., Setting: Academic medical center., Patients: Patients were included who had previously undergone radiation to the head and neck and then developed exposed necrotic bone within the ear canal that persisted at least 3 months., Interventions: Patients were treated with a variety of modalities, including conservative therapy with antibiotic ear drops and in-office debridements, hyperbaric oxygen therapy, and surgery., Main Outcome Measures: To describe the presentation and management of patients with temporal bone osteoradionecrosis., Results: Thirty-three patients with temporal bone osteoradionecrosis were included. The most common site of primary tumor was the parotid gland (n = 11), followed by the nasopharynx (n = 7). The time to development of ORN varied between 1 and 22 years, with mean of 7.9 years. The mean radiation dose was 62.6 Gy to the primary tumor, 53.1 Gy to the affected temporal bone, and 65.2 Gy to the affected tympanic bone. The most common symptoms of ORN were otorrhea (n = 15), hearing loss (n = 13), and otalgia (n = 12). Fifteen patients had bacterial superinfection, most commonly Staphylococcus aureus (n = 9). Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. Surgery was used for recalcitrant pain, infection, cholesteatoma, cranial neuropathies, and intracranial complications., Conclusion: Osteoradionecrosis is a rare complication of radiation to the temporal bone. Management should be aimed at relief of symptoms, eradication of superinfection, and treatment of other commonly present radiation effects like cholesteatoma and hearing loss.

Recurrent pleomorphic adenoma (RPA) of the parotid gland represents a challenging task for maxillofacial surgeons. The role of radiotherapy in the treatment of RPA of the parotid gland has been studied in previous experiences, and its use has been considered questionable. The aims of our article were to analyze and illustrate a case of RPA, initially treated with enucleations at another institution, showing a multinodular pattern with positivity for S-100 protein and cytokeratin, managed with conservative parotidectomy and neutron radiotherapy.

Purpose of Review: This article reviews the predictors, prognosis, and treatment of nodal metastases in cutaneous squamous cell carcinoma of the head and neck., Recent Findings: There is a better understanding of the risk factors that predict metastatic disease in cutaneous squamous cell carcinoma. Recent data has simplified the relationship between the site of the primary tumour and nodal disease, allowing for a more selective approach to the neck, in terms of both surgery and radiotherapy. Newer staging systems that take into account the clinicopathological factors allow better prognostication, and their application has been discussed. There is ongoing research on concurrent chemoradiotherapy, sentinel node biopsy, and epidermal growth factor receptor overexpression., Summary: The status of the parotid and level II/III nodes has important implications for the management of the neck, and therefore dissection of level I and level IV/V nodes is required in selected cases only. Prognostic stratification is needed to tailor treatment algorithms that intensify therapy in high-risk disease and minimize toxicity in selected low-risk patients.

Purpose: The purposes of this study are to report the first case of parotid gland adenoid cystic carcinoma (ACC) metastatic to the iris and ciliary body and suggest a successful treatment option., Methods: A 64-year-old white man presented with a diffuse multilobulated amelanotic mass involving the peripheral iris and anterior chamber angle. Fine needle aspiration with a 27-gauge needle was performed, disclosing epithelial cells with positive staining for AE1/AE3 and morphologic features consistent with metastatic parotid gland ACC. Treatment with I plaque radiotherapy (40 Gy to the apex) was provided., Results: Five months later, the tumor remained regressed., Conclusions: The systemic prognosis of salivary gland ACC is poor, with frequent local recurrences and late distance metastases. Even though uncommon, ocular metastases should be considered, and plaque radiotherapy may be useful to treat these patients.

Objective: To assess the incidence of osteoradionecrosis (ORN) of the temporal bone after surgery with radiotherapy for malignant parotid tumors., Setting: A tertiary care, academic medical center., Patients: All patients who underwent surgical resection with postoperative radiotherapy (RT) for a malignant parotid tumor between July 1988 and July 2007., Interventions: A retrospective chart analysis to determine the extent of surgery, the RT parameters, and the incidence of ORN of the temporal bone., Main Outcome Measures: The incidence of ORN in 3 subgroups of patients., Results: The 221 patients with malignant parotid tumors who underwent surgical resection with postoperative RT were divided into groups 1, parotidectomy only; 2, parotidectomy with mastoidectomy; and 3, parotidectomy with subtotal petrosectomy. The overall incidence of temporal bone ORN in group 1 was 2 (2%) of 106; in group 2, 8 (13%) of 64; and in group 3, 0 (0%) of 51., Conclusion: The incidence of temporal bone ORN is higher after mastoidectomy for facial nerve identification or resection in patients undergoing parotidectomy with postoperative radiotherapy. Oversew of the ear canal with mastoid obliteration should be considered in this subgroup of patients to avoid this long-term complication of radiotherapy used in the treatment of malignant parotid tumors.

Osteosarcoma can develop secondary to malignant transformation within a preexisting benign bone lesion, such as Paget disease, osteonecrosis, fibrous dysplasia, and chronic infection, or it can arise in previously irradiated areas. This article presents the case of a 36-year-old woman who was affected by a radioinduced osteosarcoma after radiotherapy for an adenoid cystic carcinoma of the left parotid gland treated when she was 24 years old.

This work focuses on the use of revascularized free flaps for the reconstruction of the major defects of the mandible after the removal of advanced-stage tumors in irradiated patients. It uses three representative cases to study the problems of complex patients and the possible reconstructive options. The cases, all three young patients (two females and one male), had undergone a mandibulectomy and adjuvant radiotherapy for malignant neoplasms. In each case, secondary reconstruction of the mandible and soft tissue was necessary and was performed using microvascular free flaps. An osteomyocutaneous iliac crest free flap was used in two cases, whereas a double flap (fibula free flap + rectus abdominis free flap) was used in the other case. In all three cases, after the microvascular reconstruction, an orthognathic procedure was performed to obtain the correct maxillomandibular relationship. The advantages and disadvantages of the various techniques used are discussed.

Objective: To describe a rare complication of intratympanic injection of steroids in susceptible ears., Patients: We present two patients with a history of irradiation involving the injected ear., Intervention: Therapeutic., Main Outcome Measure: Tympanic membrane condition after intratympanic injection of steroids., Results: Total or near-total breakdown of the irradiated tympanic membrane., Conclusion: Tympanic membranes with an impaired wound-healing ability, together with exposure to intratympanic steroids, may be at risk for total or near-total breakdown.

Two hundred and thirty sequential parotid tumors seen from March 1985 to 1995 were reviewed for their clinical presentation, diagnostic evaluation, pathological diagnosis, treatment modalities, and age and sex distribution. An asymptomatic mass was the most common clinical presentation. All of the operations were performed by the same surgical team. Total and superficial parotidectomy was used for the treatment of the lesions and none of the patients underwent limited excision. Retrograde approach in 79 (34.4%) patients and anterograde approach in 151 (65.6%) was used. Eighteen patients with malignant tumors were followed up in cooperation with the radiation oncology clinic. Tumors were classified according to their histopathologic diagnosis. Among 192 (83%) benign and 38 (17%) malignant tumors, the most common benign tumor of parotid gland was pleomorphic adenoma (79.1%) while the most common malignant lesion was adenocystic carcinoma (44.7%). Incidences of pleomorphic adenoma, adenocystic and epidermoid carcinoma were greater in male patients. Complication rates in benign and malignant tumors were presented and statistically significant difference could not be found between anterograde and retrograde approach in terms of facial nerve injury (P > 0.05).

To evaluate the best surgical strategy in cases of parotid gland carcinoma, local risk factors (T, N, histology, and treatment) were analyzed in a series of 134 patients. The efficacy of the facial nerve sacrifice in case of macroscopic tumor infiltration was tested by means of survival analyses (Kaplan-Meier and Cox algorithms). This study demonstrated that nerve preservation resulted in a better prognostic value when compared with resection only in the group of patients having a T1 or T2. In patients affected by T3 and T4, the different treatment did not show any difference in survival rate. In conclusion, the sacrifice of the facial nerve is not always able to improve the survival rate.

Between 1984 and 1989, six patients with recurrent pleomorphic adenomas of the parotid gland were treated with fast neutron radiotherapy. All of the patients in this series had one or more unfavorable prognostic features, which would predict suboptimal local tumor control rates with the utilization of standard surgical and adjuvant photon/electron radiation therapies. These prognostic features included multiply recurrent disease in three patients, known gross postoperative residual disease in one patient, extensive unresectable disease in one patient, and multiply recurrent disease plus gross postoperative residual disease in one patient. Patients had an average of three surgeries for recurrent adenomas before their neutron irradiation. The median period from the original diagnosis to the time of neutron treatment was 11 years, with a range of 1.3-32 years. With a median follow-up of 52 months, an overall local control rate of 100% was achieved. Only one grade III (European Organization for Research and Treatment of Cancer-Radiation Therapy Oncology Group scale) late complication occurred secondary to the neutron irradiation. Similar to their malignant counterparts, benign salivary gland neoplasms appear to display excellent response and control rates to treatment with fast neutron irradiation. Neutron irradiation of pleomorphic adenomas should be considered an appropriate therapeutic approach in situations, such as recurrent disease and postoperative gross residual disease, where one may be concerned about potential local failures with the use of standard surgical and radiotherapeutic modalities. Neutron radiation also carries a low risk of facial nerve damage, a consideration that may argue for limiting the extent of surgical resection of recurrent disease.

Squamous cell carcinoma involving the parotid gland is an aggressive and rapidly advancing lesion which if not recognized and treated early will result in a high morbidity and mortality. We reviewed 30 patients with squamous cell carcinoma involving the parotid gland. Twenty-four patients had had previous epidermoid skin lesions in an area known to drain to the parotid gland and three resulted from direct extension into the gland from an overlying skin carcinoma, whereas only three were primary lesions of the gland. Patients who presented with involvement of the gland more than 4 months after excision of the skin lesion had a poor prognosis. Patients with epidermoid skin cancer in areas with a propensity to secondarily involve the parotid gland must be closely followed after treatment of the primary skin lesion.