PAROTİS BEZİ KİTLELERİNİN BENİN MALİN AYRIMINDA ULTRASONOGRAFİ VE BİLGİSAYARLI TOMOGRAFİNİN ROLÜ

AMAÇ: Parotis bezi kitlelerinde ultrasonografi (US) ve bilgisayarlı tomografi (BT) bulgularının benin-malin ayrımındaki rolünü araştırmak. GEREÇ VE YÖNTEM: Fizik muayene ile parotis bezinde kitle saptanan 45 hastaya US ve BT incelemesi yapıldı. US’de kitlelerin yeri (yüzeyel lob-derin lob), boyutu, konturu (iyi sınırlı (düzgün-lobüle), irregüler), ekojenitesi (anekoik, hipoekoik, izoekoik veya hiperekoik), eko yapısı (homojen veya heterojen) değerlendirildi. BT’de boyut, kontur (iyi sınırlı (düzgün-lobüle), irregüler), kontrast tutulumu (homojen, heterojen) değerlendirildi. Otuzdokuz olgu opere oldu ve histopatolojik tanı aldı. Altı olguya ince iğne biyopsisi sonrası histopatolojik tanı kondu. BULGULAR: Kırk beş kitlenin 39’u (86.7%) benin, 6’sı (13.3) malindi. Benin olan 39 kitlenin 28’i pleomorfik adenom, 5’i Warthin tümörü, 1’i kapiller hemanjiom, 1’i, dermoid kist, 1’i lipom, 2’si tüberküloz lenf adenit, 1’i granülomatöz lenf adenit tanısı aldı. Malin olan 6 olgunun 1’i adenoid kistik kanser, 2’si lenfoma, 1’i malin melanom, 1’i kondrosarkom, 1’i mukoepidermoid karsinom tanısı aldı. Benin lezyonların tümünde US’de ve BT’de düzgün veya lobüle kontur saptanmış olup lezyonlar iyi sınırlıydı. Lenfoma saptanan 2 olguda iyi sınırlı ve lobüle konturluydu. Malin olan 4 lezyonda US ve BT’de irregüler kontur izlendi. US’de pleomorfik adenomların %79’unda, Warthin tümörlerinin %40’ında, lenfomalı 2 olguda homojen eko yapısı saptandı. Pleomorfik adenomların %21’inde ve tüm malin kitlelerde heterojen eko saptandı. BT’de pleomorfik adenomların %92.9’unda, Warthin tümörlü olguların %40’ında, lenfomalı iki olguda homojen kontrastlanma saptanırken, pleomorfik adenomların %7.1’inde, malin olan 4 olguda heterojen kontrastlanma izlendi. Warthin tümörlü 3 olguda kistik komponent izlendi. SONUÇ: US ve BT parotis kitlelerinde benin-malin ayrımında ve lezyonların ayırıcı tanısında kullanılabilir. İrregüler kontur ve çevre dokulara invazyon maliniteyi düşündürmelidir. BT ile lezyonların yerleşim ve uzanımları US’ye göre daha iyi değerlendirilmektedir.

THE ROLE OF ULTRASONOGRAPHIC AND COMPUTERIZED TOMOGRAPHY IN BENIGN MALIGN DISCRIMINATION OF PAROTID GLAND MASSES

OBJECTIVE: To investigate the role of Ultrasonography (US) and Computed-Tomography (CT) in discrimination of the benign and malign masses in the parotid gland. MATERIAL AND METHODS: Forty-five patients with parotid gland mass lesions were examined with US and CT. US features of the parotid masses including location (superficial-deep lobe), dimensions, margins (well defined (smooth-lobulated) or, irregular), echogenity (anechoic, hypoechoic, isoechoic or hyperechoic), echotexture (homogeneous or heterogeneous) were examined. Contrast enhancement (homogeneous, heterogeneous) contour (well-defined (smooth-lobulated irregular)) was assessed in CT. Thirty - nine cases were operated and diagnosed histopathologically. Six cases were diagnosed histopathologically after needle biopsy. RESULTS: Forty-five of 39 (86.7%) mass lesions were benign, and 6 (13.3) were malign. Of the 39 benign lesions, 28 were diagnosed with pleomorphic adenoma, 5 with Warthin tumor, 1 with capillary hemangioma, 1 with dermoid cyst, 1 with lipoma, 2 with tuberculous lymphadenitis, 1 with granulomatous lymphadenitis. Of the 6 malignant cases, 1 had adenoid cystic cancer, 2 had lymphoma, 1 had malignant melanoma, 1 had chondrosarcoma, and 1 had mucoepidermoid carcinoma. All benign lesions had a smooth or lobulated contour in the US and CT and the lesions were well-defined. Lymphoma was well-defined and lobulated in the two detected cases. Irregular contour was observed in 4 malign lesions with both US and CT. Homogeneous echotexture was detected in 79% of pleomorphic adenomas, 40% in Warthin tumors, and in two cases with lymphoma. Heterogeneous echotexture was found in 21% of the pleomorphic adenomas and in all malignant masses. Homogeneous contrast enhancement was observed in 92.9% of pleomorphic adenomas, 40% in Warthin tumors, and 2 cases of lymphoma in CT. 7.1% of pleomorphic adenomas, and 4 cases of malignant masses showed heterogeneous contrast enhancement. Cystic component was observed in 3 cases with Warthin tumor. CONCLUSIONS: US and CT can be used in discrimination of benign and malignant parotid masses and differential diagnosis of the parotid gland lesions. Irregular contour and invasion into the surrounding tissues should suggest malignancy. The location and extent of lesions are better evaluated by CT than US.

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1. Nagler RM, Laufer D. Tumors of the major and minor salivary glands: review of 25 years of experience. Anticancer Res. 1997;17:701–707.

2. Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a population-based study. Otolaryngol Head Neck Surg. 1999;120(6):834-40.

3. Eracleous E, Kallis S, Tziakouri C, Blease S, Gourtsoyiannis N. Sonography, CT, CT sialography, MRI and MRI sialography in investigation of the facial nerve and the differentiation between deep and superficial parotid lesions. Neuroradiology. 1997;39(7):506-11.

4. Murray ME, Buckenham TM, Joseph AE. The role of ultrasound in screening patients referred for sialography: a possible protocol. Clin Otolaryngol 1996;21:21–3.

5. Goto TK, Yoshiura K, Nakayama E, et al. The combined use of US and MR imaging for the diagnosis of masses in the parotid region. Acta Radiol 2001;42:88–95.

6. Jin GQ, Su DK, Xie D, Zhao W, Liu LD, Zhu XN. Distinguishing benign from malinant parotid gland tumours: low-dose multi-phasic CT protocol with 5-minute delay. Eur Radiol. 2011;21(8):1692-8.

7. Rudack C, Jörg S, Kloska S, Stoll W, Thiede O. Neither MRI, CT nor US is superior to diagnose tumors in the salivary glands--an extended case study. Head Face Med. 2007;3:19.

8. Liu Y, Li J, Tan YR, Xiong P, Zhong LP. Accuracy of diagnosis of salivary gland tumors with the use of ultrasonography, computed tomography, and magnetic resonance imaging: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(2):238-245.e2.

9. Gritzmann N, Rettenbacher T, Hollerweger A, Macheiner P, Hubner E. Sonography of the salivary glands. Eur Radiol. 2003;13:964–75.

10. Yousem DM, Kraut MA, Chalian AA. Major salivary gland imaging, Radiology. 2000;216:19–29.

11. Thoeny HC. Imaging of salivary gland tumours. Cancer Imaging. 2007;7:52-62.

12. Candiani FMartinoli C Salivary glands. In: Solbiati L, Rizzatto G, eds. Ultrasound of Superficial Structures. Edinburgh, Scotland: Churchill Livingstone; 1995:125-139.

13. Wu S, Liu G, Chen R, Guan Y. Role of ultrasound in the assessment of benignity and malignancy of parotid masses. Dentomaxillofac Radiol. 2012;41(2):131-5.

14. Białek EJ, Jakubowski W, Karpińska G. Role of ultrasonography in diagnosis and differentiation of pleomorphic adenomas: work in progress. Arch Otolaryngol Head Neck Surg. 2003;129(9):929-33.

15. Kim J, Kim EK, Park CS, Choi YS, Kim YH, Choi EC. Characteristic sonographic findings of Warthin’s tumor in the parotid gland. J Clin Ultrasound 2004;32:78–81.

16.Howlett DC. High resolution ultrasound assessment of the parotid gland. Br J Radiol 2003;76:271–277.

17. Yonetsu K, Ohki M, Kumazawa S, Eida S, Sumi M, Nakamura T. Parotid tumors: differentiation of benign and malignant tumors with quantitative sonographic analyses. Ultrasound Med Biol 2004;30:567–574.

18. P. Corr, P. Cheng, C. Metreweli The role of ultrasound and computed tomography in the evaluation of parotid masses Australas Radiol, (1993); 37 :195-197.

19. K.M. Hasebroock, N.J. SerkovaToxicity of MRI and CT contrast agents Expert Opin Drug Metab Toxicol, (2009); 5: 403-416.

20. Kakimoto N, Gamoh S, Tamaki J, Kishino M, Murakami S, Furukawa S. CT and MR images of pleomorphic adenoma in major and minor salivary glands. European Journal of Radiology. 2009; 69: 464-472.