Search Results (45)

Background: Accurate differentiation between benign and malignant cervical lymphadenopathy remains clinically important for diagnostic stratification and treatment planning. This study evaluated the diagnostic performance of conventional morphological magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) values in a mixed cohort of cervical lymphadenopathies. Methods: This retrospective lesion-based diagnostic study included 88 cervical lymph nodes from 39 patients who underwent head-and-neck MRI between September 2023 and December 2025. The cohort had malignant entities such as squamous cell carcinoma metastases, thyroid carcinoma, non-Hodgkin lymphoma, adenoid cystic carcinoma, and medullary thyroid carcinoma, as well as benign/reactive, inflammatory, CMV-related, tuberculous, Warthin tumor-associated, and cystic lymphangioma-related lymphadenopathies. MRI examinations were performed for heterogeneous indications, including the initial assessment of palpable cervical lymphadenopathy, oncological staging, post-biopsy follow-up, suspected recurrence, and benign/inflammatory lesion characterization; therefore, not all patients underwent MRI for the same clinical indication. Most examinations were performed during the initial diagnostic work-up, while six cases represented post-biopsy follow-up. Morphological features and ADC values were analyzed using Mann–Whitney U tests, chi-square tests, ROC analysis, DeLong testing, Firth penalized logistic regression, generalized estimating equations (GEE), patient-level bootstrap resampling, and calibration analysis. Statistical analyses were performed using Python (Version 3.12), with exploratory verification in JASP. Statistical significance was set at p < 0.05. Results: The cohort included 39 patients with a mean age of 54 years (range: 18–74 years), with 20 males and 19 females. Of the 88 lymph nodes, 33 were malignant and 55 benign. Malignant nodes demonstrated significantly lower ADC values than benign nodes (0.87 ± 0.23 vs. 1.25 ± 0.22 × 10⁻³ mm²/s; U = 207, p < 0.001). ADC alone showed good diagnostic performance, with an AUC of 0.886 (95% CI: 0.803–0.960). The optimal ADC cutoff was 0.900 × 10⁻³ mm²/s, yielding 75.8% sensitivity and 89.1% specificity. The final GEE model, including the ADC, nodal shape, and margin characteristics while accounting for intra-patient clustering, achieved an apparent AUC of 0.956. Leave-one-patient-out cross-validation yielded an AUC of 0.929, and the bootstrap optimism-corrected AUC was 0.949. DeLong testing confirmed that the combined model significantly outperformed the ADC alone (AUC improvement = 0.070; p = 0.006), and the inter- and intra-observer reproducibility for ADC was excellent. Conclusions: ADC values, nodal shape, and margin characteristics provide complementary diagnostic information for differentiating benign from malignant cervical lymph nodes. A structured multiparametric MRI approach demonstrated high diagnostic performance, although the findings should be interpreted in the context of the retrospective single-center design and histopathological heterogeneity. Full article

Benign parotid tumors are increasingly treated with parenchyma-sparing extracapsular enucleation, yet postoperative salivary collections and Frey syndrome can still generate clinically relevant morbidity; we evaluated whether a standardized intraoperative bundle combining intraparotid botulinum toxin A (BTX-A) and bovine collagen membrane interposition is associated with fewer complications than standard enucleation alone. In this retrospective comparative cohort at a tertiary Head and Neck Surgery Unit, consecutive adults undergoing extracapsular enucleation for pleomorphic adenoma or Warthin tumor (2010–2025) were allocated by institutional era-based protocol to Group A (2010–2017, standard enucleation) or Group B (2018–2025, enucleation plus intraoperative intraparotid BTX-A 50 IU and bovine collagen membrane placement over the repaired parotid fascia). Prespecified endpoints were sialocele/salivary fistula, surgical-site infection (SSI) within 30 days, and clinically recorded Frey syndrome within 6 months; effect sizes with 95% confidence intervals were reported. A total of 188 patients were analyzed (94 per group). Sialocele occurred in 20/94 (21.3%) in Group A versus 2/94 (2.1%) in Group B [Relative Risk (RR) 0.10]. SSI occurred in 14/94 (14.9%) versus 2/94 (2.1%) (RR 0.143), and clinically recorded Frey syndrome in 18/94 (19.1%) versus 4/94 (4.3%) (RR 0.222). This combined protocol was associated with lower complication rates through 6 months; prospective controlled studies with standardized Frey assessment and longer follow-up are warranted. Full article

Background/Objectives: Warthin’s tumor (WT) is a benign parotid neoplasm increasingly managed with tissue-preserving surgical approaches to reduce postoperative morbidity. Partial superficial parotidectomy (PSP) and extracapsular dissection (ECD) are commonly performed, whereas extracapsular enucleation (EN) remains less systematically evaluated. This study compared postoperative morbidity among EN, PSP, and ECD in a matched cohort of patients with unifocal WT. Methods: A retrospective matched cohort study was conducted at a single tertiary referral center, including patients with histologically confirmed, unifocal WT treated between 2009 and 2023. A total of 360 patients were organized into 120 matched triplets (EN, PSP, ECD), with exact matching on age group and sex and balancing for smoking status, body mass index, and alcohol use. To enable comparison under technically uncomplicated conditions, cases with documented intraoperative capsular rupture or tumor spillage were excluded. The primary endpoint was overall postoperative morbidity, defined as the occurrence of at least one predefined complication. Associations between surgical technique and morbidity were assessed using conditional logistic regression, with estimation of odds ratios (ORs), absolute risk differences (RDs), and numbers needed to treat (NNT). Results: Overall complication rates were 8.3% after EN, 29.2% after ECD, and 32.5% after PSP (p < 0.001). EN was associated with lower odds of postoperative complications compared with ECD (OR 0.23, 95% CI 0.10–0.50) and PSP (OR 0.18, 95% CI 0.08–0.41). Adjusted absolute risks were 8.3% for EN, 29.3% for ECD, and 32.4% for PSP, corresponding to absolute risk differences of 21% and 24% and numbers needed to treat of 4.8 and 4.2, respectively. Conclusions: In this selected cohort of unifocal, anatomically favorable Warthin’s tumors without intraoperative capsular violation, ΕΝ was associated with lower observed postoperative morbidity compared with ECD and PSP. These findings are context-dependent and reflect outcomes achieved under strict selection and technical conditions. Therefore, they should not be extrapolated to anatomically complex, inflamed, or diagnostically uncertain lesions. Prospective multicenter studies with standardized selection criteria are warranted to better define the role of EN in contemporary WT management. Full article

Salivary gland tumors have diverse biological behaviors, and the exact molecular factors underlying their pathogenesis remain unclear. The expression of Annexin V and its potential association with Ki-67 in these tumors has not been explored. Therefore, this study aimed to evaluate the immunohistochemical expression of Ki-67 and Annexin V and to assess their relationship in salivary gland tumors. This study included 45 formalin-fixed, paraffin-embedded blocks (5 normal salivary gland tissues, 10 pleomorphic adenomas, 10 Warthin tumors, 10 mucoepidermoid carcinomas, and 10 adenoid cystic carcinomas). Immunohistochemical staining for Ki-67 and Annexin V was performed and evaluated semi-quantitatively. Depending on the results of the normality test, one-way ANOVA or the Kruskal-Wallis H test was used for group comparisons. Spearman’s rho test was used to assess correlations among the markers under study. A p-value < 0.05 was considered statistically significant. Both markers and their ratio showed statistically significant differences among the groups (p-value < 0.001). Normal salivary gland tissue and pleomorphic adenoma showed negative Ki-67 expression, whereas Warthin tumor, mucoepidermoid carcinoma, and adenoid cystic carcinoma showed weak proliferation indices. Annexin V expression was highest in the normal salivary gland tissue. Within individual tumor types, Ki-67 and Annexin V exhibited no significant correlation. The combined evaluation of Ki-67 and Annexin V expression, along with their relationship, may provide preliminary insights into the biological behavior of salivary gland tumors and warrant further clinicopathological investigation. Full article

Background/Objectives: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. The classic variant (cPTC) is characterized by indolent behavior and excellent prognosis. However, rare subtypes of PTC most often exhibit adverse clinical behavior. The aim of the study was to assess the aggressiveness of rare variants of PTC by analyzing clinicopathological characteristics (CPCs) and survival outcomes. Methods: We analyzed 80 patients with rare PTC variants treated between 2009 and 2019 who were compared with cPTC and matched with a control group for age and tumor size. The variants were categorized into high-risk (HRV: tall cell, diffuse sclerosing, columnar cell, and hobnail variants), intermediate-risk (IRV: solid variant (SV)), and low-risk (LRV: oncocytic (OV) and Warthin-like (WLV)) variants. Different CPCs (capsule and blood vessel invasion, lymphonodal metastases, microscopic and macroscopic extrathyroid extension, multifocal and bilateral presentation) and survival outcomes—overall (OS), disease-specific (DSS), and disease-free survival (DFS) were compared. Results: HRVs exhibited significantly more aggressive CPCs and worse OS, DSS, and DFS compared to cPTC (p < 0.001). IRVs showed no significant difference in CPCs or survival outcomes compared to cPTC. LRVs showed excellent survival but were associated with several unfavorable CPCs. Multivariate analysis identified classification in HRVs as the only independent predictor of recurrence (p = 0.014). Conclusions: Tumors in the HRV group should retain their status as aggressive PTC variants due to unfavorable behavior and poorer prognosis. SVs, despite earlier assumptions, do not exhibit aggressive characteristics. Although the OV and WLV have similar survival to cPTC, their potential for adverse CPCs requires caution. Full article

Background: Parotid gland tumors pose diagnostic and surgical challenges due to their histological heterogeneity and proximity to the facial nerve. This study aimed to evaluate clinicopathological features and postoperative outcomes with a specific focus on facial nerve function in patients undergoing parotidectomy. Methods: This retrospective study included 314 patients who underwent parotidectomy between 2008 and 2024 at a tertiary center. Demographic data, tumor histology, and postoperative complications—particularly facial nerve paralysis within the first three months—were analyzed. Histopathological features including capsular, perineural, and lymphovascular invasion were also assessed. Results: Of all cases, 79% were benign, 14.6% malignant, and 6.4% non-neoplastic. Pleomorphic adenoma and Warthin tumor were the most common benign entities, while mucoepidermoid carcinoma was the most frequent malignancy. Malignant tumors were associated with higher rates of positive surgical margins (44.2% vs. 12.5%, p < 0.001), capsular invasion (25% vs. 7%, p < 0.001), and tumor necrosis (22% vs. <1%, p < 0.001). Facial paralysis occurred in 4.4% of patients, largely transient and significantly associated with malignant tumors (p < 0.001) and extensive lymph node dissection (p < 0.001). Capsular invasion and necrosis were rare in benign lesions but still observed, especially in pleomorphic adenoma. Conclusions: Histopathologic aggressiveness markers were associated with malignant disease and postoperative facial nerve dysfunction. These findings support a risk-stratified approach to follow-up: all patients undergo universal early assessment at two weeks and three months, after which surveillance intensity may be individualized according to histopathologic features—such as necrosis, perineural invasion, capsular invasion, or positive margins. Full article

Background: Epidemiological studies on benign epithelial salivary gland tumors are challenging due to their rarity, pathological heterogeneity, variable tumor locations, and the limited national data collection in Romania. Our study aimed at the evaluation of benign epithelial salivary gland tumors collected over fifteen years in a tertiary center, in order to characterize their demographic and histopathological profiles and to contribute to their diagnostic and therapeutic strategies. Materials and Methods: A retrospective analysis of 404 cases of benign epithelial salivary gland tumors diagnosed in “Sf. Spiridon” County Hospital, Iasi, from 2010 to 2024, has been performed. Results: The analyzed cases showed a slight female predominance (52.97%) and a mean patient age of 54.55 ± 14.207 years. Tumor frequency increased progressively with age, peaking in the sixth and seventh decades of life. The most common histological types were pleomorphic adenoma (62.62%) and Warthin tumor (29.95%), both types showing a predominant parotid gland involvement (88.51%). The recurrences were rare, being registered only in 1.58% of pleomorphic adenomas. A significant association between tumor histological type and both gender (p < 0.001) and age group (p < 0.001) was registered, while no significant correlation between gender and age group (p = 0.288) or between tumor location and gender or age group (p = 0.382; p = 0.383) was found. Conclusions: The frequency of pleomorphic adenoma is increasing, showing an age-related distribution and parotid gland propensity. Key morphological features in each histological type support a better preoperative stratification, a more confident margin assessment, and an individualized extent of excision with function preservation. Full article

Background/Objectives: Parotid incidentalomas are increasingly detected during brain MRI and PET-CT, particularly in patients with serious diseases such as cancer. This study aimed to evaluate the clinical significance of incidentally identified parotid lesions. Methods: We retrospectively reviewed the records of 44,952 patients (≥19 years) who underwent brain MRI and 10,957 who underwent PET-CT between January 2014 and December 2023. The incidence, imaging findings, and pathological results of parotid incidentalomas were analyzed. Results: Among 44,952 brain MRIs, 100 incidental parotid lesions (0.22%) were detected, compared with 92 lesions (0.84%) among 10,957 PET-CT scans. The mean patient age was slightly higher in the PET-CT group. Of the MRI-detected lesions, 35 patients underwent further evaluation and 14 underwent surgery, with final pathology confirming only benign tumors, including pleomorphic adenomas, Warthin tumors, and basal cell adenomas. In contrast, among 23 PET-CT patients who underwent additional evaluation, 7 had surgery, and final pathology revealed both benign and malignant tumors. Malignant cases included mucoepidermoid carcinoma, metastatic Merkel cell carcinoma, metastatic sebaceous carcinoma, and adenoid cystic carcinoma. Notably, two patients with initially benign cytology and negative PET-CT findings were later confirmed to have malignancies after surgery, Primary sites of metastatic disease included the thyroid, cervix, head and neck, and skin. Conclusions: Most parotid incidentalomas detected on brain MRI are benign and may be managed conservatively. However, incidentalomas identified on PET-CT require thorough evaluation, as they may indicate metastatic disease or a second primary malignancy, particularly in patients with head and neck or skin cancers. Full article

Warthin’s tumor is a benign salivary gland neoplasm that can exhibit intense FDG uptake, potentially mimicking malignant lesions on oncologic imaging. We report a case of a 78-year-old man undergoing staging for suspected lung cancer, in whom a hypermetabolic lesion was incidentally detected in the left parotid gland on [¹⁸F]FDG PET/CT. Correlation with prior salivary scintigraphy, MRI, and CT supported the likelihood of Warthin’s tumor, which was subsequently confirmed by fine-needle aspiration cytology. This case illustrates how multimodality imaging can provide complementary diagnostic information that helps characterize the parotid lesion, but not replace cytologic confirmation. Recognition of characteristic imaging features, an understanding of each modality’s diagnostic strengths and limitations, and cytologic confirmation when indicated are essential to avoid misinterpretation and optimize patient management. Full article

Background/Objectives: Despite the relative rarity of salivary gland tumours (SGT), they are a complex and challenging pathology. This is primarily due to the complexity of surgical treatment, the difficulty of diagnosis, and the sometimes ambiguous prognosis. Methods: This retrospective study examined parotid gland tumors in patients admitted for diagnosis and treatment at the Municipal Hospital of Timisoara–Oral and Maxillofacial Surgery Clinic, Romania, from 2016 to 2023, with the objective of verifying the hypothesis regarding the increasing incidence of benign tumors in the major salivary glands, particularly the parotid gland. Results: A total of 207 consecutive parotid nodular lesion cases were analysed, with 186 having a histopathological analysis. The findings encompass demographic patterns, temporal dynamics, histopathological profiles, malignancy characteristics, and statistical associations. The cohort was evenly distributed by sex (102 females, 105 males) with a median age of 58 years (IQR: 46–69). The largest age group was ≥60 years (n = 99; 47.8%), followed by 40–59 years (n = 76; 36.7%) and <40 years (n = 32; 15.5%). No significant sex difference in age distribution was observed. Annual case volumes showed a high plateau between 2017–2019 (40–41 cases/year), then fell sharply during the pandemic (2020–2022), reaching a nadir in 2021 (11 cases). A partial rebound occurred in 2023 (21 cases). The relative proportion of malignant diagnoses remained stable between pre-pandemic (20.0%) and pandemic/post-pandemic (8.9%) intervals, consistent with prioritization of oncologic surgeries during service restrictions. Benign tumors predominated (n = 126; 60.9%), led by pleomorphic adenoma (n = 64; 50.8% of benign) and Warthin tumor (n = 59; 46.8% of benign). Malignant tumors accounted for 31 cases (15.0%), most commonly squamous cell carcinoma (n = 6), mucoepidermoid carcinoma (n = 6), and adenocarcinoma of salivary origin (n = 5). Mann–Whitney U tests confirmed no significant differences in median age between malignant and benign cases, or between pre-pandemic and pandemic/post-pandemic intervals. Odds ratios suggested clinically relevant but non-significant increases in malignancy risk for males (OR ≈ 2.1) and for patients ≥60 years (OR ≈ 1.2). Linear regression of annual case counts revealed a downward slope of –3.5 cases/year (p ≈ 0.074), driven by the sharp pandemic-era decline. Conclusions: This study illustrates that, despite a significant decrease in surgical case volume during the COVID-19 pandemic, the relative distribution of parotid tumor pathology remained stable. Malignant lesions mostly occurred in older patients and males, with no statistically significant differences seen among demographic or clinical subgroups. The preservation of consistent malignancy detection rates, despite limited surgical capacity, underscores the efficacy of oncologic prioritization under healthcare disruptions. Full article

Background: The majority of parotid gland tumors are benign, e.g., pleomorphic adenoma (PA) and Warthin’s tumor (WT). From a biomedical point of view, oxidative stress is of significant importance due to its established association with the initiation and progression of various types of cancer, including parotid gland cancers. This study aimed to assess whether blood prooxidant–antioxidant markers could aid in diagnosing and guiding surgery for recurrent malignancies after parotid tumor treatment. Methods: We examined patients (n = 20) diagnosed with WT (n = 14) and PA (n = 6) using histopathological verification and computed tomography (CT) who qualified for surgical treatment. Blood samples were taken before the surgery and again 10 days later for biochemical analysis. The activities of the antioxidant enzymes (SOD, CAT and GPx), the non-enzymatic antioxidants (GSH and UA) and oxidative stress markers (MDA and TOS) were determined in the blood. The activities of CK and LDH and the concentrations of Cor and TAS were measured in the serum. Hb and Ht were determined in whole blood. Results: The patients’ SOD, CAT, and GPx activities after surgery did not differ significantly from their preoperative levels. However, following surgery, their serum TOS levels were significantly elevated in all the patients compared to baseline. In contrast, the plasma MDA concentrations were markedly reduced after surgery. Similarly, the GSH concentrations showed a significant decrease postoperatively. No significant changes were observed in the CK and LDH activities, TAS concentrations, or levels of Hb, Ht and Cor following surgery. Conclusions: The surgical removal of salivary gland tumors did not result in a reduction in oxidative stress at 10 days after surgery. Therefore, further studies are needed to determine the effectiveness of endogenous defense mechanisms in counteracting the oxidative stress induced by salivary gland tumors. Full article

Background: The objective of this study was to compare the value of ultrasound (US), magnetic resonance imaging (MRI), and US-guided fine-needle aspiration biopsy (FNAB) in the preoperative evaluation of parotid tumors. Methods: A three-year prospective study, including 35 patients, was conducted. Preoperative ultrasound, MRI, and US-guided FNAB were performed on each patient, after which an imaging and cytological diagnosis was obtained. Each patient underwent surgical treatment. The imaging and cytological diagnoses were compared with the histopathological reports. Results: Ultrasound and MRI showed the same diagnostic performance in discriminating benign from malignant parotid tumors: sensitivity—80%, specificity—97%, and accuracy—94%. In this regard, FNAB registered a sensitivity, specificity, and accuracy of 100%, 97%, and 97%, respectively. US, MRI, and FNAB were recorded as having high diagnostic accuracy in the detection of pleomorphic adenoma and Warthin tumors. Conclusions: Ultrasound and US-guided FNAB allow for the preoperative differential diagnosis of parotid tumors located in the superficial lobe. When US and FNAB results are inconclusive, MRI becomes mandatory. Full article

Background/Objectives: Differentiating between benign and malignant parotid gland tumors (PGT) is essential for establishing the treatment strategy, which is greatly influenced by the tumor’s histology. The objective of this study was to evaluate the role of MRI-based radiomics in the differentiation between Warthin’s tumors (WT) and malignant tumors (MT), two entities that proved to present overlapping imaging features on conventional and functional MRI sequences. Methods: In this retrospective study, a total of 106 PGT (66 WT, 40 MT) with confirmed histology were eligible for radiomic analysis, which were randomly split into a training group (79 PGT; 49 WT; 30 MT) and a testing group (27 PGT; 17 WT, 10 MT). The radiomic features were extracted from 3D segmentations of PGT performed on the following sequences: PROPELLER T2-weighted images and the ADC map, using a dedicated software. First- and second-order features were derived for each lesion, using original and filtered images. Results: After employing several feature reduction techniques, including LASSO regression, three final radiomic parameters were identified to be the most significant in distinguishing between the two studied groups, with fair AUC values that ranged between 0.703 and 0.767. All three radiomic features were used to construct a Radiomic Score that presented the highest diagnostic performance in distinguishing between WT and MT, achieving an AUC of 0.785 in the training set, and 0.741 in the testing set. Conclusions: MRI-based radiomic features have the potential to serve as promising novel imaging biomarkers for discriminating between Warthin’s tumors and malignant tumors in the parotid gland. Nevertheless, it is still to prove how radiomic features can consistently achieve higher diagnostic performance, and if they can outperform alternative imaging methods, ideally in larger, multicentric studies. Full article

Backgrounds: Imaging of parotid tumors is crucial for surgery planning, but it cannot distinguish malignant from benign lesions with absolute reliability. The aim of the study was to establish a diagnostic MRI algorithm to differentiate parotid tumors. Methods: A retrospective study was conducted including all patients with parotid tumors, who underwent 3T-MRI and surgery. Morphological characteristics and normalized T2 and late postcontrast T1 signal intensities (SI) were assessed. “Ghosting sign” on late postcontrast T1 sequence was defined as indistinguishability of the tumor except for a thin peripheral enhancement. Patients were divided according to histology and imaging data were compared. A diagnostic MRI algorithm was established. Results: Thirty-six patients were included. The combination of normalized late T1 postcontrast SI, normalized T2 SI and “ghosting sign” allowed for the distinguishing of malignant from benign parotid tumors with high sensitivity (100%), specificity (93%), positive predictive value (80%), negative predictive value, (100%) and accuracy (94%). Moreover, pleomorphic adenomas often showed a homogeneous T2 signal and a complete capsule (p < 0.01), Warthin tumors protein-rich cysts and calcifications (p < 0.005 and p < 0.05), and malignant tumors an inhomogeneous contrast enhancement (p < 0.01). Conclusions: High field MRI represents a promising tool in parotid tumors, allowing for an accurate differentiation of malignant and benign lesions. Full article

Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. Clinical report: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. Conclusions: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the “wait and see” approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery. Full article