case-report of a giant cylindroma of the parotid gland operated in Senegal

1. GIANT CYLINDROMA OF THE PAROTID GLAND.
A CASE-REPORT FROM SENEGAL
ABBAS A , ESSALKI I , TALL A , DIOUF R , NDIAYE IC , DIOP EM
1 2 2 2 2 2
1
ENT Resident of Marseille – CHU Timone - (France) aliabbas07@yahoo.fr 2
Clinique
ORL – CHU A. Le Dantec – Dakar (Senegal)
• OBJECTIVE: The aim of this poster is to report a historical
case of a giant cylindroma of the parotid gland, observed in
Senegal. By this case-report, we show the difficulties of head and
neck surgery practice in under-medicalized countries: diagnosis
and treatment management.
Fig 1: giant tumor of Fig 2: ulcerative and
parotid gland polylobed aspect
• MATERIAL AND METHODS: a case-report of a 27-year-
old woman with a parotid tumour evolved for ten years, with a
faster progression in the last year after a scarification (Fig 1),
hospitalized in November 2004 in the ENT department of the
university hospital of Dakar (Senegal).
The patient had a facial palsy (Stade III of House and Brackmann
classification) and a cervical lymphatic metastasis. The tumor
measured 9x8 cm and was polylobed (Fig 2, 3a & 3b), sensible
and with a parotid duct inflammatory. The tumour was classified
T4bN1MX (according to classification TNM 2002).
Without RMN imaging neither needle aspiration biopsy, we
decided to perform a non-conservative surgery: radical (removal Fig 3a & 3b: giant tumor of parotid gland measuring 9x8 cm
of facial nerve) and total parotidectomy.

2. •RESULTS: during this operation we observed a tumoral
infiltration of the masseter muscle and the mandible bone. We
performed a hemi-mandiblectomy followed by a neck dissection
(Fig 4). We realized the reconstruction of the parotidocervical defect
by using the left pectoralis major myofascial flap (Fig 5).
The tumor weighed 1 kg. The histopathological study concluded a
cylindroma (adenoid cystic carcinoma).
An unbinding suture with flap necrosis appeared in the
postoperative month (Fig 6), requiring a second operation with a
temporal flap reconstruction (Fig 7). Fig 4: Surgical treatment:
Nevertheless four months after the first operation, the patient died parotidectomy followed by hemi-
with cerebral metastasis. mandiblectomy Fig 5: Reconstruction by
pectoralis major
•DISCUSSION:
myofascial flap
 delay of patient’s consultation in under-medicalized countries
=> giant tumours [1,2]
 lack of technical equipment: deficiency of RMN imaging, needle
aspiration biopsy, punch biopsy (freezed)
 cylindroma: epithelial tumor of high-grade of malignancy, with a
high level of recurrences, and bony and pulmonary lated
metastasis[3,4]. The literature reports that TNM classification
represents the best prognosis factor of malignant tumours, more
than the factor of the size [5,6]. Total surgical eradication seems not to
be always possible in cylindroma tumours. It requires also
postoperative radiotherapy, often unavailable in these countries [7,8].
•CONCLUSION: Tumours of the major salivary glands, and
especially of the parotid gland, are difficult to evaluate, mostly
in under-medicalized countries and especially in sub-saharan Fig 6: one monthe later: Fig 7: second operation:
Africa. This case-report brings us to mind the difficulties of necrosis of the pectoralis temporal flap
parotid gland diagnosis and surgical treatment.
major myofacial flap
REFERENCES ABSTRACT
We report a case of an unusual giant cylindroma of the
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