Am J Otolaryngol Head Neck Surg | Volume 6, Issue 1 | Research Article | Open Access
Ramphul A* and Kumar A
Department of Otolaryngology, Palmerston North Hospital, New Zealand
*Correspondance to: Ramphul A*Fulltext PDF
Purpose: To analyze tumor diversity and identify patient and tumor characteristics predictive of primary parotid malignancy. Materials and Methods: Records were reviewed for patients who underwent parotidectomy at The Palmerston North Hospital in New Zealand. Patients with primary parotid neoplasms were separated into benign or malignant subgroups. A multivariate logistic regression model was employed to compare categorical (gender, lesion side, nature of presentation, ethnic group, background of immunosuppression) and numerical variable (age) between the benign and malignant groups. Results: 105 patients underwent parotidectomy between 2012 and 2022. Eighty-six that is 82% (86/105) of the patient cohort had benign pathology. Malignant pathology was present in 19 patients, that is 18% (19/105) of our cohort. Pleomorphic adenoma was the most common primary parotid tumor, making 51.4% (54/105) of cases followed by Warthin’s tumor with 21.9% (23/105) of cases. The most common malignant tumor was Acinic cell carcinoma. This tumor represented 21% (4/19) of the cases in the malignant group. Ninety-four percent (99/105) of patients had a palpable lump on presentation. No statistically significant relationship existed between malignancy and age, nature of presentation, lesion side and ethnic group. There was a predominance of males in the malignant group with them representing 73.7% (14/19) of cases in this cohort. This was statistically significant (p=0.01). Forty seven percent (9/19) patients in the malignant group had a background history of immunosuppression as compared to 15 out of 86 patients in the benign group (17%). There was a statistically significant difference between the two groups (p=0.007). Conclusion: Our results show that most of these patients present with an asymptomatic slow growing parotid lump. Benign lesions are more common than malignant ones. The most common diagnosis for a patient presenting with a parotid lump is pleomorphic adenoma followed by Warthin’s tumor. A malignant tumor is more likely to be present in a male patient presenting with a parotid lump. Immunosuppression is another significant patient characteristic that is predictive of malignancy. In summary , this study shows that in a cohort of patients who present with a parotid lump, with no signs of facial nerve palsy or skin changes, a higher degree of clinical vigilance is warranted in males and in patients with a background history of immunosuppression. In the context of increasing pressures on Health systems which was made even worse by the recent COVID pandemic, this information can assist clinicians in their decision-making process when triaging and decision to expedite investigations when assessing a referral of a patient with a parotid lump.
Ramphul A, Kumar A. Tumor Diversity of Primary Parotid Neoplasms and Tumor and Patient Characteristics Predictive of Malignancy. Am J Otolaryngol Head Neck Surg. 2023; 6(1): 1224.