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Malignant tumor of the peripheral nerve sheaths in the parotid gland – a case report

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Movila A., Didora V., Zagacki D., Braun M., Morawiec-Sztandera A., Kaczmarczyk D.
Polski Przegląd Otorynolaryngologiczny
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2020
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vol. 9(1)
34-38
EN
Introduction: Neoplasms of the parotid glands constitute about 6% of head and neck tumours, the most common of which are: adenoma multiforme and Warthin’s tumor. Schwannoma is benign, encapsulated tumor of the nerve cells (lemocytes, Schwann cells), most often it occurs in the trunk, head, extremely rarely observed in the parotid gland. 9% Schwannomas derives from the facial nerve sheath, constituting from 0.5–1.2% of all salivary gland tumors. The literature describes 80 cases of intraparotid Schwannoma. Malignant Schwannoma (MPNST) account for 5% to 10% of all soft tissue sarcomas. Highgrade MPNST tumors are aggressive, with a tendency to relapse and metastasis. Case report: We present a case report of a 84-year-old female patient presented to the Head and Neck Oncology Clinic of the Medical University of Lodz, due to the painful tumor of the left parotid region. The tumor appeared six months before hospitalization. During the physical examination, there was a polycyclic tumor with reduced mobility, the skin on the tumor was slightly red, lymph nodes uninvolved, facial nerve function preserved. BACC revealed tumour tissue composed of sheets and spindle-shaped cells. The patient was qualified for surgical treatment. Under the general anesthesia the superficial lobe of the parotid gland along with the tumor was removed. After the procedure, no facial nerve palsy was found. The patient did well post-operatively and was discharged home on the 8th day after surgery. Immunohistochemical staining showed the tumour cells to be diffusely and strongly immunoreactive for S-100 protein and Ki67 40–50%. Strong and diffuse staining for S-100 protein were consistent with the malignant peripheral nerve sheath tumour (MPNST). The patient was referred for radiotherapy, due to the postoperative outcome and advanced age, no adjuvant treatment was proposed. The patient has been in observation for 1 year. No relapse was found in the follow-up studies.
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Advanced sinonasal malignancy – therapeutic challenge. Report of two cases and literature review

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Bieńkowska K., Rzepakowska A., Osuch-Wójcikiewicz E., Niemczyk K.
Polski Przegląd Otorynolaryngologiczny
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2019
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vol. 8(3)
24-30
EN
Maxillofacial tumors are rare malignancies that constitute about 0.2–0.5% of all human malignancies. The initial symptoms of the disease are non-typical and imitate inflammation of paranasal sinuses. Most often, patients report one-sided nasal obstruction with bloody and purulent discharge and headaches. In addition to physical examination – often with the use of endoscopic nasal cavity assessment, it is necessary to perform computed tomography of the paranasal sinuses and magnetic resonance for accurate assessment of the extent of the lesions. Histopathological examination of tumor specimens is necessary for making the final diagnosis and planning treatment. Squamous cell carcinoma is the most common histological type in the sinonasal region. Other common malignancies in this area include adenocarcinoma, carcinoma adenoides cysticum, lymphomas, melanoma, and olfactory neuroblastoma. The treatment of choice of all malignant changes in the sinonasal complex, except for lymphomas, is surgical treatment. Unfortunately, a still high percentage of lesions is diagnosed at an advanced stage of the disease, when the infiltration includes the skull base. In these cases, the decision to perform a radical surgical treatment in the patient is very difficult and requires a lot of experience in the surgery of the skull base. However, due to the low radiosensitivity and low effectiveness of chemotherapy in sinonasal malignancy, resection of lesions and complementary treatment contribute to the prolongation of overall survival in this group of patients. The article discusses the cases of two patients with advanced cancer of the sinonasal complex reffered to the Otolaryngology Department of the Medical University of Warsaw.
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