Abstract
The objective of the study is to present a large case series of parapharyngeal space tumors (PPST) and the most comprehensive literature review of tumor histopathologic distribution. The study was designed as internal case series and full Pubmed/MEDLINE electronic database review in a tertiary academic medical center. Tumor histopathology and patient demographics were obtained from a comprehensive Pubmed/MEDLINE database review, as well from an internal case series of 117 patients referred to our center between 1993 and 2013. Main outcome and measures of the study were to define the age, gender, and histopathology of PPST within a large internal case series and among the current body of published literature, and to propose a diagnostic and treatment algorithm for these tumors. Our cohort included 117 cases, 58 females and 59 males, with benign tumors comprising 85 % (n = 99) and malignant tumors 15 % (n = 18). A systematic review of published literature from 1963 to the present revealed 37 case series, and when combined with our present series, yielded a total of 2160 cases. Benign tumors are most common (78.8 %), with tumors of salivary gland (44.4 %), neural (34.4 %), and vascular (2.64 %) origin representing the largest subtypes. Pleomorphic adenomas (30.9 %), paragangliomas (13.1 %), and schwannomas (12.3 %) comprised the majority of all cases. Due to their rarity, data regarding the histopathologic distribution of PPST is scarce. We provide one of the largest case series and the most comprehensive review of these tumors in the literature to date, and offer our algorithm for evaluation and treatment.
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Cummings W Jr, Haughey BH, Thomas JR et al (2005) Cummings otolaryngology head and neck surgery, 4th edn. Mosby, St. Louis
Riffat F, Dwivedi RC, Palme C, Fish B, Jani P (2014) A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral Oncol 50(5):421–430. doi:10.1016/j.oraloncology.2014.02.007
Silver AJ, Mawad ME, Hilal SK, Sane P, Ganti SR (1983) Computed tomography of the nasopharynx and related spaces. Part II: pathology. Radiology 147(3):733–738
Batsakis JG, Sneige N (1989) Parapharyngeal and retropharyngeal space diseases. Ann Otol Rhinol Laryngol 98(4 Pt 1):320–321
Manolidis S, Shohet JA, Jackson CG, Glasscock ME 3rd (1999) Malignant glomus tumors. Laryngoscope 109(1):30–34
Lee JH, Barich F, Karnell LH et al (2002) National Cancer Data Base report on malignant paragangliomas of the head and neck. Cancer 94(3):730–737
Gimenez-Roqueplo AP, Favier J, Rustin P et al (2003) Mutations in the SDHB gene are associated with extra-adrenal and/or malignant pheochromocytomas. Cancer Res 63(17):5615–5621
Papaspyrou K, Mewes T, Rossmann H et al (2012) Head and neck paragangliomas: report of 175 patients (1989–2010). Head Neck 34(5):632–637
Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM (1986) Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer 57(10):2006–2021
Miller FR, Wanamaker JR, Lavertu P, Wood BG (1996) Magnetic resonance imaging and the management of parapharyngeal space tumors. Head Neck 18(1):67–77
Khafif A, Segev Y, Kaplan DM, Gil Z, Fliss DM (2005) Surgical management of parapharyngeal space tumors: a 10-year review. Otolaryngol Head Neck Surg 132(3):401–406
Oliai BR, Sheth S, Burroughs FH, Ali SZ (2005) “Parapharyngeal space” tumors: a cytopathological study of 24 cases on fine-needle aspiration. Diagn Cytopathol 32(1):11–15
Mondal P, Basu N, Gupta SS, Bhattacharya N, Mallick MG (2009) Fine needle aspiration cytology of parapharyngeal tumors. J Cytol 26(3):102–104
McIlrath DC, Remine WH (1963) Parapharyngeal tumors. Surg Clin N Am 43:1041–1047
Work WP, Hybels RL (1974) A study of tumors of the parapharyngeal space. Laryngoscope 84(10):1748–1755
Som PM, Biller HF, Lawson W, Sacher M, Lanzieri CF (1984) Parapharyngeal space masses: an updated protocol based upon 104 cases. Radiology 153(1):149–156
Ferlito A, Pesavento G, Recher G, Nicolai P, Narne S, Polidoro F (1984) Assessment and treatment of neurogenic and non-neurogenic tumors of the parapharyngeal space. Head Neck Surg 7(1):32–43
Maran AG, Mackenzie IJ, Murray JA (1984) The parapharyngeal space. J Laryngol Otol 98(4):371–380
Shoss SM, Donovan DT, Alford BR (1985) Tumors of the parapharyngeal space. Arch Otolaryngol 111(11):753–757
Stell PM, Mansfield AO, Stoney PJ (1985) Surgical approaches to tumors of the parapharyngeal space. Am J Otolaryngol 6(2):92–97
Dankle SK (1987) Neoplasms of the parapharyngeal space. Ear Nose Throat J 66(12):491–501
Allison RS, Van der Waal I, Snow GB (1989) Parapharyngeal tumours: a review of 23 cases. Clin Otolaryngol Allied Sci 14(3):199–203
Carrau RL, Myers EN, Johnson JT (1990) Management of tumors arising in the parapharyngeal space. Laryngoscope 100(6):583–589
Stanley RE (1991) Parapharyngeal space tumours. Ann Acad Med Singapore 20(5):589–596
Olsen KD (1994) Tumors and surgery of the parapharyngeal space. Laryngoscope 104(5 Pt 2 Suppl 63):1–28
Pensak ML, Gluckman JL, Shumrick KA (1994) Parapharyngeal space tumors: an algorithm for evaluation and management. Laryngoscope 104(9):1170–1173
Hughes KV 3rd, Olsen KD, McCaffrey TV (1995) Parapharyngeal space neoplasms. Head Neck 17(2):124–130
Shahinian H, Dornier C, Fisch U (1995) Parapharyngeal space tumors: the infratemporal fossa approach. Skull Base Surg 5(2):73–81
Tincani AJ, Martins AS, Altemani A et al (1999) Parapharyngeal space tumors: considerations in 26 cases. Sao Paulo Med J 117(1):34–37
Malone JP, Agrawal A, Schuller DE (2001) Safety and efficacy of transcervical resection of parapharyngeal space neoplasms. Ann Otol Rhinol Laryngol 110(12):1093–1098
Pang KP, Goh CH, Tan HM (2002) Parapharyngeal space tumours: an 18 year review. J Laryngol Otol 116(3):170–175
Hazarika P, Dipak RN, Parul P, Kailesh P (2004) Surgical access to parapharyngeal space tumours–the Manipal experience. Med J Malays 59(3):323–329
Ulku CH, Uyar Y, Arbag H (2004) Management of parapharyngeal space tumors. Ir Med J 97(5):140–142
Attia A, El-Shafiey M, El-Shazly S, Shouman T, Zaky I (2004) Management of parapharyngeal space tumors at the National Cancer Institute, Egypt. J Egypt Nat Cancer Inst 16(1):34–42
Luna-Ortiz K, Navarrete-Aleman JE, Granados-Garcia M, Herrera-Gomez A (2005) Primary parapharyngeal space tumors in a Mexican cancer center. Otolaryngol Head Neck Surg 132(4):587–591
Shahab R, Heliwell T, Jones AS (2005) How we do it: a series of 114 primary pharyngeal space neoplasms. Clin Otolaryngol 30(4):364–367
Cohen SM, Burkey BB, Netterville JL (2005) Surgical management of parapharyngeal space masses. Head Neck 27(8):669–675
Farrag TY, Lin FR, Koch WM et al (2007) The role of pre-operative CT-guided FNAB for parapharyngeal space tumors. Otolaryngol Head Neck Surg 136(3):411–414
Kawashima Y, Sumi T, Sugimoto T, Kishimoto S (2008) First-bite syndrome: a review of 29 patients with parapharyngeal space tumor. Auris Nasus Larynx 35(1):109–113
Chijiwa H, Mihoki T, Shin B, Sakamoto K, Umeno H, Nakashima T (2009) Clinical study of parapharyngeal space tumours. J Laryngol Otol 123(Suppl 31):100–103
Zhi K, Ren W, Zhou H, Wen Y, Zhang Y (2009) Management of parapharyngeal-space tumors. J Oral Maxillofac Surg 67(6):1239–1244
Suarez-Fente V, Llorente-Pendas JL, Gomez-Martinez J, Garcia-Gonzalez LA, Lopez-Alvarez F, Suarez-Nieto C (2009) Primary tumours of the parapharyngeal space. Our experience in 51 patients. Acta Otorrinolaringol Esp 60(1):19–24
Dimitrijevic MV, Jesic SD, Mikic AA, Arsovic NA, Tomanovic NR (2010) Parapharyngeal space tumors: 61 case reviews. Int J Oral Maxillofac Surg 39(10):983–989
Papadogeorgakis N, Petsinis V, Goutzanis L, Kostakis G, Alexandridis C (2010) Parapharyngeal space tumors: surgical approaches in a series of 13 cases. Int J Oral Maxillofac Surg 39(3):243–250
Arnason T, Hart RD, Taylor SM, Trites JR, Nasser JG, Bullock MJ (2012) Diagnostic accuracy and safety of fine-needle aspiration biopsy of the parapharyngeal space. Diagn Cytopathol 40(2):118–123
Gangopadhyay M, Bandopadhyay A, Sinha S, Chakroborty S (2012) Clinicopathologic study of parapharyngeal tumors. J Cytol 29(1):26–29
Cassoni A, Terenzi V, Della Monaca M et al (2014) Parapharyngeal space benign tumours: our experience. J Cranio-Maxillofac Surg 42(2):101–105
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Esther Eshkol is thanked for editorial assistance.
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Locketz, G.D., Horowitz, G., Abu-Ghanem, S. et al. Histopathologic classification of parapharyngeal space tumors: a case series and review of the literature. Eur Arch Otorhinolaryngol 273, 727–734 (2016). https://doi.org/10.1007/s00405-015-3545-5
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DOI: https://doi.org/10.1007/s00405-015-3545-5