title: Unexpected pathologies in pediatric parotid lesions: management paradigms revisited.
abstract: OBJECTIVE
  To present case vignettes of unusual pediatric parotid pathologies and discuss management paradigms in the context of these lesions.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Free-standing, academic tertiary care pediatric hospital.
  
  
  METHODS
  All patients over the past 18 months undergoing parotidectomy for a parotid mass were reviewed (N=5).
  
  
  RESULTS
  Ages ranged from 17 months to 16 years. All presented with a remarkably similar clinical course, consisting of a persistent parotid mass for more than 3 months which was usually painless. Most (4/5 patients) had been treated with antibiotics prior to Otolaryngology consultation. Fine-needle aspiration (FNA) was performed on 3 patients and was diagnostic in one. Complete excision of the mass was performed in each child through a parotidectomy approach (3 total, 2 lateral lobe). The final pathology showed metastatic neuroblastoma (17 months old), undifferentiated primitive sarcoma (22 months old), mucoepidermoid carcinoma (11 years old), nodular fasciitis (12 years old), and hyperplastic lymph node (16 years old). The patient with neuroblastoma died from complications of bone marrow transplant.
  
  
  CONCLUSIONS
  The differential diagnosis for a persistent pediatric parotid mass is expansive and differs from that found in the adult population. As this series highlights, in many cases, it is impossible to discern the pathology, or rule out malignancy, based upon the clinical course, imaging, or FNA results. Surgical excision remains the standard for management of these patients and is both diagnostic and therapeutic. Our anecdotal case series highlights the importance of having a low threshold for parotidectomy in these children.
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Av NW, Washington, DC 20010, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Jaryszak
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bauman
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Howell
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Rossi
authors.forename: Diego A
authors.initials: DA
authors.lastname: Preciado
mesh_terms: D000293:Adolescent; D000367:Age Factors; D044963:Biopsy, Fine-Needle; D018277:Carcinoma, Mucoepidermoid / Q000473:pathology / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D009447:Neuroblastoma / Q000473:pathology / Q000601:surgery; D010305:Parotid Diseases / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010306:Parotid Gland / Q000473:pathology* / Q000601:surgery*; D010307:Parotid Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012509:Sarcoma / Q000175:diagnosis / Q000473:pathology; D013514:Surgical Procedures, Operative / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome