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) email@example.com 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.
•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 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 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 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 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 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 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. 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. 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.