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•RESULTS: during this operation we observed a tumoralinfiltration of the masseter muscle and the mandible bone. Weperforme...
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Giant Cylindroma Of The Parotid Gland


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case-report of a giant cylindroma of the parotid gland operated in Senegal

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Giant Cylindroma Of The Parotid Gland

  1. 1. GIANT CYLINDROMA OF THE PAROTID GLAND. A CASE-REPORT FROM SENEGAL ABBAS A , ESSALKI I , TALL A , DIOUF R , NDIAYE IC , DIOP EM 1 2 2 2 2 2 1 ENT Resident of Marseille – CHU Timone - (France) 2 Clinique ORL – CHU A. Le Dantec – Dakar (Senegal)• OBJECTIVE: The aim of this poster is to report a historical case of a giant cylindroma of the parotid gland, observed in Senegal. By this case-report, we show the difficulties of head and neck surgery practice in under-medicalized countries: diagnosis and treatment management. Fig 1: giant tumor of Fig 2: ulcerative and parotid gland polylobed aspect• MATERIAL AND METHODS: a case-report of a 27-year- old woman with a parotid tumour evolved for ten years, with a faster progression in the last year after a scarification (Fig 1), hospitalized in November 2004 in the ENT department of the university hospital of Dakar (Senegal). The patient had a facial palsy (Stade III of House and Brackmann classification) and a cervical lymphatic metastasis. The tumor measured 9x8 cm and was polylobed (Fig 2, 3a & 3b), sensible and with a parotid duct inflammatory. The tumour was classified T4bN1MX (according to classification TNM 2002). Without RMN imaging neither needle aspiration biopsy, we decided to perform a non-conservative surgery: radical (removal Fig 3a & 3b: giant tumor of parotid gland measuring 9x8 cm of facial nerve) and total parotidectomy.
  2. 2. •RESULTS: during this operation we observed a tumoralinfiltration of the masseter muscle and the mandible bone. Weperformed a hemi-mandiblectomy followed by a neck dissection(Fig 4). We realized the reconstruction of the parotidocervical defectby using the left pectoralis major myofascial flap (Fig 5). The tumor weighed 1 kg. The histopathological study concluded acylindroma (adenoid cystic carcinoma). An unbinding suture with flap necrosis appeared in thepostoperative month (Fig 6), requiring a second operation with atemporal flap reconstruction (Fig 7). Fig 4: Surgical treatment: Nevertheless four months after the first operation, the patient died parotidectomy followed by hemi-with cerebral metastasis. mandiblectomy Fig 5: Reconstruction by pectoralis major•DISCUSSION: myofascial flap delay of patient’s consultation in under-medicalized countries => giant tumours [1,2] lack of technical equipment: deficiency of RMN imaging, needleaspiration biopsy, punch biopsy (freezed) cylindroma: epithelial tumor of high-grade of malignancy, with ahigh level of recurrences, and bony and pulmonary latedmetastasis[3,4]. The literature reports that TNM classificationrepresents the best prognosis factor of malignant tumours, morethan the factor of the size [5,6]. Total surgical eradication seems not tobe always possible in cylindroma tumours. It requires alsopostoperative radiotherapy, often unavailable in these countries [7,8].•CONCLUSION: Tumours of the major salivary glands, andespecially of the parotid gland, are difficult to evaluate, mostlyin under-medicalized countries and especially in sub-saharan Fig 6: one monthe later: Fig 7: second operation:Africa. This case-report brings us to mind the difficulties of necrosis of the pectoralis temporal flapparotid gland diagnosis and surgical treatment. major myofacial flap REFERENCES ABSTRACT We report a case of an unusual giant cylindroma of the[1] MASANJA MI, KALYANYAMA BM, SIMON EN. Salivary gland tumours in Tanzania. East Afr Med J2003;80:429-34. parotid gland of a 27-year-old woman native of[2] VUHAHULA EA. Salivary gland tumors in Uganda: clinical pathological study. Afr Health Sci 2004;4:15-23. Mauritania. This tumor had evolved for ten years, with[3] DIOP EM, NDIAYE IC, DIOUF R, DJONGA O, TALL A, WOTTO-GAYE G. Les tumeurs de la glandeparotide (à propos de 80 observations). Rev Laryngol 1994;115:57-60. a faster progression in the last year. The histopathological[4] HUANG M, MA D, SUN K, YU G, GUO C, GAO F. Factors influencing survival rate in adenoid cysticcarcinoma of the salivary glands. Int J Oral Maxillofac Surg 1997;26:435-9. study concluded a cylindroma. This clinical case reminds[5] MATSUBA HM, SPECTOR GJ, THAWLEY SE, SIMPSON JR, MAUNEY M, PIKUL FJ. Adenoid cysticsalivary gland carcinoma. A histopathological review of treatment failure patterns. Cancer 1986;57:519-24. us the difficulties of managing these malignant giant[6] PARIS J, COULET O, FACON F, CHRESTIAN MA, GIOVANNI A, ZANARET M. Cancers primitifs de la tumors of the parotid gland and especially inparotide: approche anatomo-clinique. Rev Stomatol Chir Maxillofac 2004;105:309-15.[7] HARBO G, BUNDGAARD T, PEDERSEN D, SOGAARD H, OVERGAARD J. Prognostic indicators for under-medicalized countries.malignant tumours of the parotid gland. Clin Otolaryngol 2002;27:512-6.[8] POHAR S, GAY H, ROSENBAUM P, KLISH D, BOGART J, SAGERMAN R, HSU J, KELLMAN R. Key words: cylindroma, adenoid cystic carcinoma,Malignant parotid tumors: presentation, clinical/pathologic prognostic factors, and treatmentoutcomes. Int J Radiat Oncol Biol Phys 2005;61:112-8. parotid gland, giant tumor.