Metastatic malignant disease to the parotid gland

A survey of over 250 consecutive parotidectornies performed at The Mason Clinic indicates a surprising incidence of metastatic malignant disease to the parotid gland. Four percent of all parotidectornies performed indicated a metastatic focus of malignancy from an unsuspected primary outside areas of the head and neck usually implicated in parotid disease. Twenty-five percent of all cancer discovered at parotidectomy was metastatic malignant disease to the parotid gland. The most common site was the lung. A high index of suspicion, evaluation of pathologic specimens by electron microscopy, and detailed metastatic work-up for patients with malignant disease in parotid lymph nodes are recommendations which should be considered by the surgeon performing parotid procedures.     

Metastatic neuroendocrine tumors of the parotid gland

OBJECTIVES: To present 2 cases of neuroendocrine tumors of the parotid gland and to review the clinical presentation, histopathologic, and immunohistochemical findings and treatment of these rare tumors. STUDY DESIGN: Case series. METHODS: This study reviews 2 patients who both presented with firm masses in the parotid gland diagnosed as neuroendocrine carcinoma by histopathologic and immunohistochemical examination. The evaluation, diagnosis, and treatment are discussed. RESULTS: Both patients underwent complete tumor extirpation via a total or subtotal parotidectomy. Both patients received postoperative radiation therapy and chemotherapy. CONCLUSIONS: Neuroendocrine tumors of the parotid gland are uncommon lesions; however, they have a favorable prognosis as compared to their pulmonary counterparts with early diagnosis and aggressive treatment. Diagnosis is based on the immunohistochemical characteristics of the tumor. Appropriate treatment includes complete surgical excision with postoperative radiation therapy to the parotid bed with the addition of postoperative chemotherapy in patients suspected to have metastatic disease.     

Renal carcinoma metastasis to the parotid gland

Metastatic tumours in major salivary glands are uncommon with a higher incidence of primary sites from the head and neck. The lungs and breast are the common primary sites, while metastases from the kidney are very rarely found. The authors describe a case of renal clear-cell carcinoma with metastasis to the parotid gland. The incidence of a metastasis in the parotid gland from a primary renal carcinoma, even if rare, should not be overlooked in making a correct differential diagnosis with acinic cell carcinoma and monomorphic clear cell adenoma.     

Metastatic renal carcinoma to larynx

The larynx is a most unusual site for metastatic cancer. A case of metastatic renal cell carcinoma of the larynx is presented to illustrate the following features: its exceptional indolent course; the difficulty in arriving at a correct diagnosis, and the good result following local excision.     

Histopathological findings in parotid gland metastases from renal cell carcinoma

Metastatic tumours involving the parotid gland arising from non-head and neck origin are rare. Immunohistochemistry has improved the differential diagnosis of these lesions. Current immunohistochemical markers allow the distinction between a number of potential primary tumours (e.g., lung, kidney and breast). We present the clinical and histomorphological features of three renal cell carcinoma (RCC) patients presenting with a parotid mass, review the literature of various non-head and neck malignancies metastasizing to the parotid gland, and discuss their differential diagnosis. Two females and one male, aged 58 to 76 years, presented with a parotid tumour of renal cell origin. In one case, the parotid mass was the first clinical manifestation. In the two other cases, a nephrectomy had been performed 5-9 years earlier because of RCC. The cases showed a highly vascular parotid lesion causing difficulty in interpretation of the fine needle aspirate. Two patients underwent a superficial parotidectomy and one patient an open biopsy of the parotid gland tumour. Immunohistochemical stainings for vimentin, CD10 and PNRA were positive suggesting renal cell origin, which was later confirmed. Clinical and radiological evaluations and diagnosis by fine needle aspiration may prove difficult partly due to the vascular nature of parotid metastasis of renal cell carcinoma. Immunohistochemical staining is useful in identifying the primary tumour.     

Metastatic sweat gland carcinoma

Only 48 cases of metastatic sweat gland carcinoma have been published. Our case report is of an elderly lady with a sweat gland carcinoma of the scalp with metastatic disease in the neck. She was treated with radical neck dissection and wide local excision. Follow-up of three years has revealed no recurrence. The most common location of sweat gland carcinoma is on the scalp. The diagnosis of malignant non-metastatic sweat gland carcinoma is difficult because there are no definite histologic criteria for diagnosing these tumors. Of the tumors that metastasize, most involve the regional lymph nodes. The differentiation between apocrine and eccrine metastatic sweat gland carcinoma is quite difficult and the criteria are not adequate to be of practical use. Sweat gland tumors may remain the same size for many years and then show a rapid period of growth followed by metastasis. Most metastases are in the regional lymph nodes, however, systemic disease does occur. Wide local excision of the primary tumor with resection of the involved regional lymph nodes is the recommended initial treatment. Prognosis of metastatic sweat gland carcinoma is poor although a few cases may have rather long survivals.     

Metastatic renal cell carcinoma to the nose

A rare case of metastasis of a renal carcinoma to the nasal cavity is presented.     

Epithelial-myoepithelial carcinoma of the parotid gland

We report a rare case of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. A 70-year-old man presented with a 4-months-history of right-sided subauricular swelling. Computed tomographic scans revealed a well-defined mass with cystic lesion, measuring about 40 mm in diameter, in the right parotid gland. Because the tumor occupied superficial lobe, he underwent superficial parotidectomy with preservation of the facial nerve. On the basis of the histological and immunohistochemical findings, the tumor was diagnosed as EMC. His post-operative course was uneventful, and he is currently free from disease 6 months after surgery. Diagnosis, clinical behavior and treatment of EMC are reviewed from perusal of the literature.     

Sebaceous carcinoma of the parotid gland

Sebaceous carcinoma is a rare tumor, from the adnexal epithélium of the sebaceous glands. Usually, lesions arise in meibonian glands of the eyelid. However, extraocular lesions within head and neck have been reported. We report a case of recurrent sebaceous carcinoma of the parotid gland without metastases.     

Ductal carcinoma of the parotid gland

A case of ductal carcinoma of the parotid gland is described. The medical literature contains only 13 previous reports on this kind of adenocarcinoma of the parotid gland. The tumour is characterized by its histologic resemblance to ductal carcinomas of the breast and prostate. The course of previously described cases suggests that this tumour has a highly aggressive biological behaviour.     

Metastatic carcinoma of the parotid gland. Review of the literature. Report of two cases

The great majority of parotid gland tumours are benign. Metastatic malignant ones are scarce in number. The source of these metastasis are growths localized either in head and neck or distant tumours spreading on intra- or periparotid lymph nodes. Two cases of metastatic parotid growths diagnosed and treated last year are reported. Bibliographic review of the topic.     

Sclerosing mucoepidermoid carcinoma of the parotid gland

Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland. Its clinical behavior is determined by the relative ratio of mucous and epidermoid cells with pathologic high-grade tumors containing a greater proportion of epidermoid cells. Sclerosing mucoepidermoid carcinoma is a rarely reported variant with unclear long-term clinical behavior. A 23-year-old female was found to have a deep lobe parotid mass on imaging studies. Preoperative evaluation was non-diagnostic. Intraoperatively, the tumor was found to be adherent to the lower division of the facial nerve and portions of the posterior digastric muscle. Frozen section specimens showed only squamous metaplasia with background inflammatory fibrosis. Final pathological analysis demonstrated multiple solid and cystic nests and glands within a background of dense, sclerotic, collagenized stroma and inflammatory infiltrate consistent with low-grade sclerosing mucoepidermoid carcinoma. Sclerosing mucoepidermoid carcinoma is a very rare salivary gland tumor with uncertain behavior. Complete surgical excision with tumor-free margins with preservation of the facial nerve (in the absence of clinical invasion) is recommended. Postoperative radiation therapy is suggested for positive or close margins given the adherent nature of the tumor and the risk of recurrence and distant disease found in some case reports. Patients should be followed closely with serial MRI imaging studies of the tumor bed with complete clinical evaluation of the regional lymphatics and chest to evaluate for evidence of recurrence or metastasis.There is no grant support for this project. This report has not been presented at any scientific meeting.