0:02

This is a lesson that we should learn regarding

0:05

the aspiration and biopsy of parotid masses.

0:09

Early on, there was a lot of literature representing a concern

0:14

that by doing a biopsy of a parotid mass,

0:18

particularly a cancer,

0:20

you might lead to seeding along the biopsy tract.

0:24

And for that reason, it's an adage that you should use as small a needle

0:31

as possible to do aspiration of parotid masses.

0:36

In general, doing these,

0:38

I usually use a 22-gauge needle for doing cytology and

0:43

I try to stick with 18-gauge or less tenmo biopsy

0:48

gun for doing the histology of parotid masses.

0:53

And the vast majority of them can be

0:55

diagnosed based on that. However,

0:57

were you to be using twelve-gauge needles or ten-

1:01

gauge needles or much larger biopsy needles,

1:04

there is that possibility that there could be seeding

1:06

of the tumor along the tract of the needle.

1:10

In this case, it was indeed a patient who had a pleomorphic

1:15

adenoma that was biopsied.

1:16

And you can see the scarring here overlying

1:19

where the biopsy had occurred.

1:21

And what you see is all of these

1:24

little seeds along the tract,

1:27

both from the superficial as well as deep portion of

1:31

the parotid gland extending even into the parapharyngeal

1:36

space fat. And this was all tumor infiltration.

1:40

This patient had this tumor there for a long,

1:44

long period of time. And on the most recent biopsy,

1:48

it proved to be adenocarcinoma.

1:50

So this was a pleomorphic adenoma with seeding along the

1:54

biopsy track with a ten-gauge needle into

1:58

the deep lobe and parapharyngeal space,

2:02

and over the course of time,

2:05

malignant degeneration into an adenocarcinoma.

2:09

And you can see on the T2-weighted scan,

2:11

somewhat mixed signal intensity here,

2:13

a little bit of that scarring that I said at the skin

2:16

surface here. And on the post-contrast-enhanced scan,

2:20

you see all these little acinar patterns of the tumor

2:25

where it had seeded the tract and came

2:30

back again with here, as you can see,

2:32

a little bit of the scarring again of adenocarcinoma.