Problems of systematization and treatment of vascular lesions of the parotid gland in children and adults: literature review and clinical observations

Abstract

The classification of vascular lesions of the parotid gland remains a subject of considerable debate, complicating clinical management. This article addresses these controversies by proposing a systematic categorization into malformations, hyperplasias, and tumors (hemangiomas). We advocate for a diagnostic and therapeutic approach guided by the assessment of GLUT‑1 and CD34 immunohistochemical markers to resolve diagnostic uncertainty. The objective is to investigate the issues surrounding the classification and treatment of parotid salivary gland vascular lesions in children and adults, summarize contemporary literature, and analyze our own clinical observations with particular consideration of immunohistochemical markers (GLUT‑1, CD34). Materials and methods. We conducted a review of current literature on the classification, diagnosis, and treatment of parotid gland vascular pathologies. Three clinical cases of patients aged 33 to 57 years with vascular lesions of the parotid salivary gland were analyzed. Diagnostic methods included clinical examination, ultrasonography with Doppler imaging, magnetic resonance imaging, fine-needle aspiration biopsy, and subsequent histological and immunohistochemical studies. The recommended principles of bioethics were adhered to during the research. The research was conducted as part of the scientific research project ‘Development of methods for surgical and comprehensive treatment of patients with congenital and acquired pathologies of the maxillofacial region with restoration of functions and taking into account concomitant pathologies’, state registration number 0123U100745, completion date – 2023-2028. Results. The analyzed cases demonstrated different vascular pathologies: capillary hemangioma, a combined hemangioma and pleomorphic adenoma, and vascular hyperplasia. Immunohistochemical analysis with GLUT‑1 and CD34 markers confirmed the diagnoses. Treatment involved partial parotidectomy with tumor excision using organ-preserving techniques and intraoperative facial nerve monitoring. All patients experienced an uneventful postoperative recovery. Conclusions. Vascular lesions of the parotid salivary gland in children are typically hemangiomas with a characteristic clinical course. In adults, rare variants such as epithelioid hemangiomas and vascular hyperplasias are more common. Precise differential diagnosis requires a combination of clinical presentation, imaging modalities, and immunohistochemical profiling. Surgical intervention remains the treatment of choice in complicated or progressive cases.