[Recurrences of pleomorphic adenomas of the parotid: development of concepts].
OBJECTIVE
The aim of this study was to examine the surgical and pathological factors that led to recurrent parotid pleomorphic adenomas. The study also tried to determine best practice for the treatment of recurrence. In addition the study looked at the correlation between fine needle cytology and definitive histology.


METHODS
Histological study was undertaken on 100 pleomorphic adenomas surgically removed from patients in our institution between 1992 and 2002. Study of diagnostic value of fine needle cytology aspiration and MRI for pleomorphic adenoma diagnosis was performed in 181 patients operated on for parotid tumors.


RESULTS
Hypocellular pleomorphic adenomas often have a thin capsule and constitute the most frequently encountered histological type in recurrence. Pseudopodias are considered as an additional factor in recurrence. In our series, cytological study had an excellent diagnostic value with a sensitivity of 92% and a PPV of 96%. MRI study had a sensitivity of 83% and a PPV of 89%.


CONCLUSIONS
According to these findings, enucleation surgery on a pleomorphic adenoma should not be performed anymore. Parotidectomy techniques (total or lateral) constitute the surgical treatment of choice. Fine needle aspirate cystology in a useful diagnostic procedure. Management of recurrences is based on surgery with total parotidectomy and facial nerve preservation. Role of radiotherapy is still indeterminate.
Paris
J
J
CHU La Timone, Fédération d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, 264 rue Saint-Pierre, F-13385 Marseille, France. paris.j@wanadoo.fr
Facon
F
F
Chrestian
M A
MA
Giovanni
A
A
Zanaret
M
M
D000236:Adenoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local; D010307:Parotid Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors