CA PAROTID TUMOUR

Dr. Kamran Cheema

Medical Officer
Surgical Unit – III
 PERSONAL BIODATA
 NAME:- Jamal Din.
 AGE:- 75 yrs.
 SEX:- Male.
 MARITAL STATUS:- Married.
 M.O.A:- O.P.D.
 D.O.A:- 22/10/03.
 R/O mian channu.
 OCCUPATION:- Farmer.
PRESENTING COMPLAINTS
 Swelling left preauricular region=20 yrs
 Off & on discharge & ulceration=2
months
 Pain in swelling=2 days
 HISTORY OF PRESENTING
ILLNESS.
 Patient has developed a painless swelling at
left parotid region for the last 20 yrs.Swelling
gradually increased in size & become
ulcerated 2 months back.Pt. also c/o off & on
yellowish watery discharge from the ulcerated
lesions.now for the last 2 days,he’s c/o pain
in the swelling,pain aggravates on movement
of jaw &relieved on taking rest.there’s h/o wt.
Loss.On systemic inquiry,there’s no significant
complain.
 PAST HISTORY

 No significant medical history.

 FAMILY HISTORY
 Married for 50 yrs.
 He has 4 sons(all alive & healthy)
 No family history of
diabetes,HTN,IHD,T.B.
 PERSONAL HISTORY
 Huqqa smoker for the last 30 yrs.
 Non diabetic.
 Non hypertensive.
 Not significant
 G.P.E.
 An old man of average built sitting
comfortably on bed,he’s cooperative & well
oriented in time,place & person.
 PULSE=70 mins
 B.P.=130/80 mm of Hg.
 R/R=18/min.
 TEMP.=Afebrile.
 No pallor,cyanosis,jaundice,edema,
clubbing,lymph nodes,thyroid.
 LOCAL EXAMINATION
 A 4x6 cm multinodular swelling at angle
of mandible.
 Swelling is hard,nontender&immobile.
 Over lying skin is ulcerated(multiple
discharging sinuses present)
 swelling is fixed to skjn.
 Drainage L.nodes of the area & post.
Cervical chain involved.
 WORKUP
 CBC
– To investigate any evidence of leukocytoisis
and any infectious and any
lymphoproliferative disease

 FNA Biopsy
 TREATMENT POLICY
PRE OP
 To build hemogloben
 Counseling of the patient (about fascial
nerve and cosmesis
 Fitness for GA
 SURGICAL OPTIONS
 Parotidectomy with fascial nerve
preservation
 Parotidectomy with radical neck
dissection
 Other options (including
mandibulectomy
 RECOVERY
 Uneventful with preservation of fascial
nerve.
 HISTOPATHOLOGICAL
 On excision biopsy shows malignant
growth of squamoid orgin neoplastic
cells are large pliomarphic with large
hyperchromatic nuclei, surgical margin
and lymph nodes free from the tumor
cells

Squamous cell Ca well differentiated

 RADIOTHERAPY
 Role is controversial
 Primnary radiation has little place to
play in the treatment of malignant SGT
but adjuvant role to surgery
 CLASSIFICATION
WHO SGT
 Adenoma
– Pleomorphic adenoma
– Warthin Tumor
 Carcinoma
– Acinic Cell Ca
– Mucoepidermoid Ca
– Adenoid Cystic Ca
– Adeno Ca
– Squamous Cell Ca
– Undifferentiated Ca
– Carcinoma in plemorphic adenoma
CLASSIFICATION contd….
 Non Epithilial Tumors
– Hemangioma
– Lymphangioma
– Neurofibroma
– Neuro lemoma
 Malignant Lymphoma
 Squamous Cell Ca
 Rare tumor in SGT
 Never occur in minor glands
 Two third patient are men
 Age incidence 7th Decade
 Aggressive Tumor
 Shows no tendency to encapsulation
 It grows rapidly
– Causing pain
– Skin fixcation
– Ulceration
– Fascial paralysis
 One half of the patient have metastatic lymph
node when first seen
 Squamous Cell Ca contd…

 Diagnostic error
– Tumor may be arise from parotid lymph
node
– And may be mets from another head and
neck site
 MESSAGE
 Counseling of the patient in
advanced Ca paroited about
fascial nerve palsy of utmost
important instead of routine
surgery
THANKS