[size=20px]Five years after treatment for leukemia, a teenager presents with increasing, painless right parotid swelling. A magnetic resonance imaging study (MRI) confirms the presence of a parotid mass and fine needle aspiration is non-diagnostic. The next best step in management of a patient with a parotid mass and history of leukemia is

 

A follow-up exam in three months.

 

B warm compresses and oral antibiotics.

 

C sialogram.

 

D panendoscopy.

 

E parotidectomy.[/size]

 

First one with correct answer with justification win.

B warm compresses and oral antibiotics.

think again my friend

C sialogram

think again my friend

A follow-up exam in three months

think again my dear

E parotidectomy

E parotidectomy

correct

 

With the increasing long term survival of pediatric cancer patients undergoing aggressive systemic multimodal therapy, a six-fold increased risk of secondary malignant neoplasms (SMN) has been identified with a cumulative risk of 3.5% after 25 years.

 

Parotid tumors are rare in children. Salivary gland tumors make up eight to 10% of all pediatric head and neck tumors and half are malignant. The majority of these malignancies are mucoepidermoid carcinoma. Mucoepidermoid carcinoma of the parotid has been described following treatment of leukemia, lymphoma and sarcoma.

 

Although radiation therapy appears to have played a role in the development of these tumors in the past, increasing numbers of patients have radiation fields distant from the site of the secondary malignancy or received no radiation at all.

 

The initial evaluation of a patient with a parotid mass and a history of previous malignancy should include contrast enhanced magnetic resonance imaging and fine needle aspiration. Complete resection with parotidectomy with facial nerve preservation should be performed if the aspiration shows malignancy, is non-diagnostic or the mass is enlarging. There is no consensus about the role of regional lymph node dissection although the trend has been to do these procedures if there is clinical or imaging evidence of nodal disease and not perform prophylactic dissections.