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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (1): 35-42. doi: 10.19723/j.issn.1671-167X.2019.01.007

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Clinicopathological features and possible prognostic factors in parotid lymphomas

Qian SU1,Xin PENG1,Chuan-xiang ZHOU2,△(),Guang-yan YU1,△()   

  1. 1. Department of Oral and Maxillofacial Surgery, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2018-10-15 Online:2019-02-18 Published:2019-02-26
  • Contact: Chuan-xiang ZHOU,Guang-yan YU E-mail:zhoucx2008@126.com;gyyu@263.net

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Abstract:

Objective: To investigate the clinicopathological features and prognostic factors in lymphoma of parotid origin. Methods: Clinicopathological data of the patients with parotid lymphoma who were initially diagnosed in Peking University Hospital of Stomatology from 2006 to 2016 were collected and analyzed retrospectively. The patients were followed-up for 5 to 149 months with a median period of 45 months, and the factors influencing the prognosis were evaluated. Results: A total of 41 patients with primary parotid lymphoma were included in this retrospective study. The rate of male to female was 1 ∶2.15. The median age was 57 years (ranging from 8 months to 91 years). According to WHO classification, 40 cases (97.1%) were diagnosed as non-Hodgkin lymphoma (NHL), including 15 cases of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), 14 cases of diffuse large B cell lymphoma (DLBCL) as well as 4 cases of follicular lymphoma, while other subtypes of NHL were rare. Only one case was diagnosed as Hodgkin lymphoma. Regarding the clinical staging at the initial diagnosis, 37 patients (90.2%) were diagnosed as stage ⅠE or ⅡE of the disease, while 4 patients (9.8%) as stage ⅢE or stage ⅣE. Seven patients (17.1%) had a history of Sjögren syndrome (SS), all of whom were MALT lymphoma. The mean ill duration of the 41 patients were 20.7 months. Thirty-two patients (78%) presented a slowly growing painless mass in the parotid gland. Treatment options included localized therapy and systemic therapy, all of whom had good curative effect. Nine patients (21.9%) died during the follow-up period. The overall survival rates of 2-year and 5-year were 84.5% and 81.3% respectively. The univariate analysis demonstrated statistically significant differences for accelerated growth of tumor (P=0.005), and presence of tumor capsule (P=0.011). The multi-univariate analysis demonstrated statistically significant differences for presence of tumor capsule (P=0.041). Conclusion: A large majority of primary parotid lymphoma were NHL, among which MALT lymphoma and DLBCL were common subtypes. Most patients presented an indolent mass in parotid gland, which should be distinguished from the parotid benign tumors. SS is closely related to the pathogenesis of MALT lymphoma. The prognosis is better than that of other malignant parotid tumors. Absence of tumor capsule may predict a poor prognosis in patients with parotid lymphoma.

Key words: Lymphoma, Parotid gland, Clinical pathology, Prognosis

CLC Number: 

  • R733.41

Table 1

Clinicopathologic features of 41 patients with parotid lymphoma"

Clinical features n (%)
Gender
Female 28 (68.3)
Male 13 (31.7)
Age
≥60 years 23 (56.1)
<60 years 18 (43.9)
Accelerated growth of tumor 11 (26.8)
Tumors without capsule 15 (36.6)
Extent
Unilateral 36 (87.8)
Bilateral 5 (12.2)
Location
Superficial lobe 38 (92.7)
Deep lobe 3 (7.3)
Histologic classification
MALT 15 (36.6)
DLBCL 14 (34.1)
FL 4 (9.7)
LL 2 (4.9)
LBL 2 (4.9)
Other NHL 3 (7.3)
HL 1 (2.4)
Ann Arbor stage
Stage Ⅰ and Ⅱ 37 (90.2)
Stage Ⅲ and Ⅳ 4 (9.8)
Autoimmune disorders 8 (19.5)
Sjögren syndrome 7 (17.1)
Rheumatoid arthritis 1 (2.4)
Cervical lymph node enlargement 12 (34.3)
Local symptoms 9 (22.0)
Spontaneous pain 9 (22.0)
Facial paralysis 2 (4.8)
Special infection 4 (9.8)
HCV 1 (2.4)
HBV 3 (7.3)
HIV 0
Elevated LDH level 1 (2.4)
B symptoms 0

Figure 1

MALT lymphoma in parotid gland A, diffuse infiltration of neoplastic cells around glandular tissue (HE ×100); B, infiltration of neoplastic cells and destruction of glandular epithelium in lymphoepithelial lesion (HE ×200); C, marked CD20 positive expression of neoplastic cells with diffuse infiltration around glandular tissue (CD20 immunohistochemical ×100); D, keratin positive expression in residual glandular tissue in the tumor tissue (CK immunohistochemical ×200)."

Figure 2

Follicular lymphoma in parotid gland A, most of the neoplastic cells are small to medium-sized centrocytes (HE ×400); B-D, diffuse neoplastic cells positive for CD20 (×200), Bcl-2 (×400) and CD10 (×200)."

Figure 3

Treatment of 41 patients with parotid lymphoma CT, chemotherapy; Obs, observation; RT, radiation; S, surgery."

Figure 4

Overall survival curve for patients with parotid lymphoma"

Table 2

Analysis of risk factors associated with survival for patients with primary parotid lymphoma according to univariate analysis"

Risk factor 2-year
OS/%		 5-year
OS/%		 Log-rank
χ2		 P according to
Log-rank		 HR (95%CI) P according to Cox
Gender 0.014 0.907 0.960 (0.479-1.922) 0.907
Female 84.6 84.6
Male 84.5 79.5
Age 4.128 0.042 0.475 (0.216-1.043) 0.063
≥60 years 76.2 69.8
<60 years 90.9 90.9
Accelerated growth of tumor 7.846 0.005 5.446 (1.446-20.516) 0.012
Yes 47.7 47.7
No 96.0 90.9
Location 1.825 0.177 4.005 (0.455-35.283) 0.211
Superficial lobe 86.3 83.0
Deep lobe 50.0 50.0
Local symptoms 2.414 0.120 3.004 (0.701-12.876) 0.138
Yes 57.1 57.1
No 90.2 86.1
Histologic classification 0.843 0.359 0.697 (0.317-1.532) 0.369
MALT 92.3 83.1
Other subtypes 80.0 80.0
Ann Arbor stage 2.480 0.115 0.545 (0.224-1.216) 0.138
Stage Ⅰ and Ⅱ 85.9 82.3
Stage Ⅲ and Ⅳ 66.7 66.7
Sjögren syndrome 0.383 0.536 0.5203 (0.065-4.224) 0.543
Yes 81.5 81.5
No 100 83.3
Surgery 0.270 0.603 0.660 (0.136-3.206) 0.606
Yes 87.0 83.1
No 75.0 75.0
Tumor capsule 6.410 0.011 0.131 (0.026-0.653) 0.013
Yes 95.2 63.0
No 77.9 64.9

Table 3

Analysis of risk factors associated with survival for patients with primary parotid lymphoma according to multivariate analysis"

Risk factor HR (95%CI) P
Accelerated growth of tumor (Yes/No) 3.715
(0.943-14.632)		 0.061
Tumor capsule (Yes/No) 0.178
(0.034-0.932)		 0.041

Figure 5

Survival curves according to presence of tumor capsule"

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