Der Einfluss des Kapseldefektes als Risikofaktor für die Rezidivbildung beim pleomorphen Adenom der Glandula parotidea

Zusammenfassung

Hintergrund Ziel dieser Arbeit war es, verschiedene Aspekte des Kapseldefekts eines pleomorphen Adenoms zu beleuchten und den Einfluss dieses Faktors mithilfe der vorliegenden Daten und der relevanten Literatur auf das Rezidivrisiko zu analysieren.

Material und Methoden Es handelt sich um eine retrospektive Analyse aller Patienten, welche zwischen 2005 und 2020 bei einem pleomorphen Adenom der Glandula parotidea behandelt wurden. Es erfolgte eine erneute histopathologische Untersuchung der Paraffinblöcke aller Fälle sowie eine Analyse der patientenbezogenen Daten, des Ausmaßes des primären operativen Eingriffs und des Rezidivrisikos. Die Nachsorgeuntersuchung erfolgte im Sinne einer klinischen und sonografischen Untersuchung.

Ergebnisse Insgesamt wurden 845 Patienten in einer Datenbank erfasst. Hierunter fanden sich 7 (0,8 %) Rezidive, jedoch alle bei „in sano“ resezierten Tumoren. Positive Ränder zeigten sich in 37 Fällen (4,4 %). Bei 13 der 37 Fälle war dies intraoperativ festgestellt worden, wohingegen der Defekt bei 24 der 37 Fälle erst histopathologisch identifiziert wurde. Bei den 13 Fällen der makroskopischen Tumoreröffnung wurde in 2 Fällen bei der sonografischen Untersuchung der Verdacht auf ein unilokuläres Rezidiv des pleomorphen Adenoms gestellt, welches zunächst sonografisch kontrolliert wurde.

Schlussfolgerung Die positiven Ränder beim parotidealen pleomorphen Adenom scheinen nicht zwangsläufig zum vorprogrammierten Rezidiv zu führen.

Abstract

Objective Aim of this study was to enlighten various aspects of the capsular defect of a pleomorphic adenoma and to analyze its influence on recurrence rate with the help of our data and the relevant literature.

Material and Methods The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2005 and 2020 were evaluated retrospectively. The histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. The records of the cases with a capsular defect were examined for information on age, gender, type of surgery and surgical outcome.

Results A total of 845 patients were included in the primary group. 7 (0.8 %) recurrences were detected, all of these were resected without a capsular rupture. Positive margins were found in 37 cases (4.4 %). In 13/37 cases the capsular defect was detected intraoperatively, whereas the defect was only identified histopathologically in 24 of the 37 cases. In the group of the intraoperative capsular opening, with a median follow-up of 62 months, the sonographic examination suspected a unilocular recurrence of the pleomorphic adenoma in two cases.

Conclusion The intraoperative capsule opening does not inevitably seem to lead to a pre-programmed recurrence.

Schlüsselwörter

Glandula parotidea - pleomorphes Adenom - Kapsel - Tumoreröffnung - Rezidiv - Rezidivrate

Key words

parotid gland - pleomorphic adenoma - capsule - capsule opening - recurrence - recurrence rate

Publikationsverlauf

Eingereicht: 08. April 2021

Angenommen: 14. Juni 2021

Artikel online veröffentlicht:
22. Juni 2021

• Literatur

• 1 Bailey H. The treatment of tumours of the parotid gland with special reference to total parotidectomy. Br J Surg 1941; 28: 337-346
• 2 Mc Farland J. Mysterious mixed tumors of salivary glands. Surg Gynecol Obstet 1943; 23-34
• 3 Bailey H. The surgical anatomy of the parotid gland. BMJ 1948; 2: 245-248
• 4 Touquet R, Mackenzie IJ, Carruth JA. Management of the parotid pleomorphic adenoma, the problem of exposing tumour tissue at operation. The logical pursuit of treatment policies. Br J Oral Maxillofac Surg 1990; 28: 404-408
• 5 Natvig K, Soberg R. Relationship of intraoperative rupture of pleomorphic adenomas to recurrence: an 11–25 year follow-up study. Head Neck 1994; 16: 213-217
• 6 Mantsopoulos K, Sievert M, Iro AK. et al Histopathologic comparison of pleomorphic adenomas of the parotid and submandibular gland. Oral Dis 2021; [online ahead of print]
• 7 Mantsopoulos K, Iro H. Tumour spillage of the pleomorphic adenoma of the parotid gland: A proposal for intraoperative measures. Oral Oncol 2021; 112: 104986
• 8 Riad MA, Abdel-Rahman H, Ezzat WF. et al. Variables related to recurrence of pleomorphic adenomas: outcome of parotid surgery in 182 cases. Laryngoscope 2011; 121: 1467-1472
• 9 Stennert E, Wittekindt C, Klussmann JP. et al. Recurrent pleomorphic adenoma of the parotid gland: a prospective histopathological and immunohistochemical study. Laryngoscope 2004; 114: 158-163
• 10 Stennert E, Guntinas-Lichius O, Klussmann JP. et al. Histopathology of pleomorphic adenoma in the parotid gland: a prospective unselected series of 100 cases. Laryngoscope 2001; 111: 2195-2200
• 11 Dulguerov P, Todic J, Pusztaszeri M. et al. Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables. Front Surg 2017; 4: 26
• 12 Seifert G, Langrock I, Donath K. [A pathological classification of pleomorphic adenoma of the salivary glands (author's transl)]. HNO 1976; 24: 415-426
• 13 Zbaren P, Stauffer E. Pleomorphic adenoma of the parotid gland: histopathologic analysis of the capsular characteristics of 218 tumors. Head Neck 2007; 29: 751-757
• 14 Iro AK, Agaimy A, Muller SK. et al. Satellite nodules in pleomorphic adenomas of the parotid gland: A nightmare for less invasive parotid surgery?. Oral Oncol 2021; 115: 105218
• 15 Mantsopoulos K, Iro A, Sievert M. et al Is extracapsular dissection for pleomorphic adenoma rather a euphemism for enucleation jeopardising the intactness of the capsule?. Br J Oral Maxillofac Surg 2021; [online ahead of print]
• 16 Mantsopoulos K, Iro AK, Sievert M. et al. Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas. Acta Otolaryngol 2021; 1-5
• 17 Bar B, Mantsopoulos K, Iro H. Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases. Laryngoscope 2020; 130: 1941-1946
• 18 Fleming WB. Recurrent pleomorphic adenoma of the parotid. Aust N Z J Surg 1987; 57: 173-176
• 19 Piekarski J, Jeziorski A, Baklinska M. et al. Patients with Paget disease of nipple and with palpable mass in breast have unfavorable prognosis. J Exp Clin Cancer Res 2004; 23: 33-37
• 20 Mantsopoulos K, Scherl C, Iro H. Investigation of arguments against properly indicated extracapsular dissection in the parotid gland. Head Neck 2017; 39: 498-502
• 21 Andreasen S, Therkildsen MH, Bjorndal K. et al. Pleomorphic adenoma of the parotid gland 1985-2010: A Danish nationwide study of incidence, recurrence rate, and malignant transformation. Head Neck 2016; 38 (Suppl. 01) E1364-1369
• 22 Espinosa CA, Fernandez-Valle A, Lequerica-Fernandez P. et al. Clinicopathologic and Surgical Study of Pleomorphic Adenoma of the Parotid Gland: Analysis of Risk Factors for Recurrence and Facial Nerve Dysfunction. J Oral Maxillofac Surg 2018; 76: 347-354
• 23 Valstar MH, de Ridder M, van den Broek EC. et al. Salivary gland pleomorphic adenoma in the Netherlands: A nationwide observational study of primary tumor incidence, malignant transformation, recurrence, and risk factors for recurrence. Oral Oncol 2017; 66: 93-99
• 24 McGurk M, Renehan A, Gleave EN. et al. Clinical significance of the tumour capsule in the treatment of parotid pleomorphic adenomas. Br J Surg 1996; 83: 1747-1749
• 25 Valstar MH, Andreasen S, Bhairosing PA. et al. Natural history of recurrent pleomorphic adenoma: implications on management. Head Neck 2020; 42: 2058-2066
• 26 Tretiakow D, Stodulski D, Mikaszewski B. Regarding the „Tumour spillage of the pleomorphic adenoma of the parotid gland: A proposal for intraoperative measures“. Oral Oncol 2021; 113: 105026
• 27 Ghosh S, Panarese A, Bull PD. et al. Marginally excised parotid pleomorphic salivary adenomas: risk factors for recurrence and management. A 12.5-year mean follow-up study of histologically marginal excisions. Clin Otolaryngol Allied Sci 2003; 28: 262-266
• 28 Patel S, Mourad WF, Wang C. et al. Postoperative radiation therapy for parotid pleomorphic adenoma with close or positive margins: treatment outcomes and toxicities. Anticancer Res 2014; 34: 4247-4251
• 29 Mendenhall WM, Mendenhall CM, Werning JW. et al. Salivary gland pleomorphic adenoma. Am J Clin Oncol 2008; 31: 95-99
• 30 Henriksson G, Westrin KM, Carlsoo B. et al. Recurrent primary pleomorphic adenomas of salivary gland origin: intrasurgical rupture, histopathologic features, and pseudopodia. Cancer 1998; 82: 617-620
• 31 Piekarski J, Nejc D, Szymczak W. et al. Results of extracapsular dissection of pleomorphic adenoma of parotid gland. J Oral Maxillofac Surg 2004; 62: 1198-1202
• 32 Park GC, Cho KJ, Kang J. et al. Relationship between histopathology of pleomorphic adenoma in the parotid gland and recurrence after superficial parotidectomy. J Surg Oncol 2012; 106: 942-946