Metastatic hepatocellular carcinoma to the parotid gland: Case report and review of the literature

INTRODUCTIONHepatocellular carcinoma, the most frequent primary hepatic tumor, metastasizes in more than 50% of cases. However, parotid gland metastatic HCCs are very uncommon. We report a patient in whom the finding of a left parotid mass revealed metastatic HCC.PRESENTATION OF CASEA thirty-six-year-old male presented with a round palpable left neck mass that persisted for 3 months. He had received right hemihepatectomy for hepatocellular carcinoma (HCC). Preoperative evaluation revealed a benign tumor of the parotid gland. We performed superficial parotidectomy. Metastatic hepatocellular carcinoma of the parotid gland was diagnosed.DISCUSSIONAlthough HCC metastases to the oral cavity have been reported, to date, only 4 cases HCC metastasis to the parotid gland have been reported. Although clinicians and cytopathologists alike both agree that salivary gland fine needle aspiration biopies (FNABs) are highly useful and safe diagnostic alternatives to biopsies and resections, we believe that in specific clinical situations, awareness of potential diagnostic pitfalls in salivary gland FNAB is a necessary part of the microscopic interpretations of these lesions.CONCLUSIONAlthough rare, since HCC can metastasize to the parotid gland, high suspicion should be maintained in a patient presenting with a parotid mass with a history of HCC. In addition, since potential diagnostic pitfalls in salivary gland fine-needle aspiration (FNA) biopsies exist, incisional or excisional biopsy may be necessary for definite diagnosis of metastatic HCC to the parotid gland.     

Extra-cranial metastasis of glioblastoma multiforme presenting as acute parotitis

We present an unusual case of extracranial metastasis of glioblastoma multiforme (GBM) to the parotid gland and cervical lymph nodes. The patient had previously undergone two craniotomies to debulk a left frontal GBM, followed by radiotherapy. After the second craniotomy, while waiting for chemotherapy, the patient was re-admitted with a short history of a painful swelling of his left parotid gland. The initial diagnosis was infective parotitis; however, as there was no improvement with broad-spectrum antibiotics, CT was undertaken, which revealed a mass in the parotid gland with a necrotic centre and enlarged cervical lymph nodes. Parotid gland biopsy revealed a parotid GBM metastasis. This case illustrates how GBM behaves in an aggressive manner even outside the CNS. A brief review of the literature and of the theories, which might explain the extra-neural metastasis of this tumour is also presented.     

Parotid gland metastasis from renal carcinoma

The salivary gland most frequently involved with secondary cancer is the parotid gland. Metastases are responsible for 21-42% of malignant parotid tumors. Malignant melanoma and squamous cell cancer are the two most common tumors to metastasize to the parotid gland. Metastatic adenocarcinoma to this site has rarely been reported. Secondary renal cell carcinoma has been reported in many structures, including the brain, sinonasal tract, lungs, abdomen, genitourinary tract, bone, soft tissue, and lymphatics. Histologically proven parotid metastasis has been previously reported in only one patient. Two patients have recently been diagnosed and treated at our institution for this rare disease. The clinical presentation of each patient was quite different. One patient presented with parotid and pulmonary metastases seven years after resection of a renal tumor. Another patient had resection of a parotid mass revealing an occult metastasis from a renal cell carcinoma. Further evaluation revealed a locally extensive asymptomatic hypernephroma. The survival from the time of discovery of the parotid metastasis was 46 months for the former patient, while the latter patient is alive after 20 months. Differentiation of these tumors from vascular disorders (aneurysm or arteriovenous fistula) required selective angiography and computed tomography. Surgical excision via superficial parotidectomy with facial nerve preservation is necessary for palliation, particularly to avoid massive hemorrhage which may occur upon tumor extension into the oropharynx.     

Postirradiation necrosis of the temporal lobe presenting as a glioma. Case report.

A patient is reported who presented with manifestations of a space-occupying lesion in the left temporal lobe thought to be a metastasis, but on radiological examination and surgical exploration appeared to be a diffuse infiltrative glioma. Some 21 months earlier he had received a course of fast neutron therapy to a carcinoma of the left parotid gland. Diagnosis by microscopic examination revealed changes characteristic of delayed radiation necrosis.     

Squamous cell carcinoma of the parotid gland

BACKGROUND: Our objective was to evaluate the outcome of patients treated for squamous cell carcinoma (SCC) of the parotid gland. METHODS: We conducted a retrospective chart review of the tumor registry from 1982 through 2003 at a tertiary referral medical center. Patients with SCC of the parotid gland were identified and followed for a minimum of 2 years after therapy. RESULTS: SCC involving the parotid was identified in 66 patients. The tumor was a metastasis from a known primary site in 41 patients (62%). In 16 patients (24%), no other primary site was identified, and the tumor may have originated in the parotid gland. Nine patients (14%) were undetermined. Therapy frequently included surgery. The integrity of the facial nerve was preserved in 92% of surgical patients. Only eight patients initially had clinical evidence of cervical metastasis; however, cervical metastasis was identified in 25 patients (44%), changing the course of therapy. CONCLUSION: SCC of the parotid gland was metastatic from a known primary tumor in more than half of the patients. The most common site of the primary tumor was a cutaneous malignancy of the head and neck. The high incidence of cervical lymph node involvement underscores the diagnostic and therapeutic importance of neck dissection with parotidectomy.     

Metastatic adenoid cystic carcinoma to the kidney in a young woman

The incidence of an adenoid cystic carcinoma on major salivary glands is low, constituting only about 10% to 15% of all parotid malignancies. Cases of delayed metastasis have been reported, but reports of specific renal involvement have not been extensively found. We present the case of a 21-year-old woman with a left renal metastasis from an adenoid cystic carcinoma of the parotid gland that had been surgically treated 7 years previously. The patient underwent successful left radical nephrectomy. During follow-up, the patient developed pulmonary nodules that were metastatic adenoid cystic carcinoma and were surgically excised. At last follow-up, the patient was doing well with no evidence of disease.     

Laparoscopic adrenalectomy for solitary metachronous adrenal metastasis from lung cancer: Report of a case

We report herein the case of a 69-year-old man who underwent laparoscopic adrenalectomy for a solitary adrenal metastasis 10 months after a left lower lobectomy for T2N1M0 lung cancer. A 30×20 mm tumor was found in the left adrenal gland, and dissected using an ultrasonically activated scalpel. Histological examination revealed metastatic squamous cell carcinoma. The patient recovered uneventfully and his condition is now stable 18 months after the second operation, with no evidence of local recurrence or metastatic disease. Although laparoscopic resection for malignant adrenal tumors is still controversial, we consider that laparoscopic adrenalectomy may be an optional treatment for metastatic adrenal tumors, provided the tumor is solitary, small in size, and well-localized. To our knowledge, only 14 cases of laparoscopic adrenalectomy for malignant tumors have been reported to date; however, this is the first case of successful laparoscopic adrenalectomy for a metastasis from lung cancer.     

Stensen’s Duct Carcinoma with a Papillary Architecture

Primary carcinoma of the parotid duct (Stensen’s duct carcinoma) is a rare entity, first described in 1927 and with approximately thirty-one cases reported in the English literature. Criteria for diagnosis are primarily demonstration of an origin from the Stensen’s duct lining and exclusion of parotid gland, accessory parotid, oral mucosal and adjacent minor salivary gland origin. The carcinoma is usually of a specific type, and most have been described as squamous, mucoepidermoid, or undifferentiated adenocarcinomas. We report an unusual case of Stensen’s duct carcinoma showing a primarily basaloid phenotype with focal squamous differentiation and a partial papillary architecture raising the possibility of malignant transformation in a ductal papilloma. Wide local excision was performed with postoperative radiotherapy and the patient is free of complications one and a half years postoperatively. Due to the small number of cases reported, the overall prognosis is not well defined, but seems to depend on the tumour size. Regional metastasis confers a 14 % mortality rate but there appears to be no relationship between histological type and prognosis.     

Parotid metastasis from a gastroesophageal carcinoma: report of a case

Carcinomas of the lower esophagus, gastroesophageal junction or stomach rarely metastasize to the cervical lymph nodes. Furthermore, the parotid gland is an even more unusual site of metastasis from a carcinoma located at these sites. We describe the case of a 45-year-old male patient who was diagnosed 2 months after transhiatal gastroesophagectomy for a primary gastric adenocarcinoma with metastasis in the left parotid gland. In the literature we have only found one other case report.     

Synchronous Parotid and Thyroid Gland Metastases from Breast Cancer

SUMMARY: BACKGROUND: Metastases to the parotid and thyroid glands from breast cancer are rare and have a poor prognosis. CASE REPORT: We present the case of a patient with breast carcinoma and synchronous involvement of both the parotid and thyroid gland, and review the literature on this subject. CONCLUSION: Metastatic malignancy in clinically suspect thyroid and parotid nodules could be detected more frequently with routine use of fine needle aspiration biopsy.     

Whole-body bone scintigraphy in the diagnosis and follow-up of the evolution of breast cancer

We have studied 75 patients, diagnosed with breast cancer, (39 on the right, 36 on the left and 4 on the two breasts), the TNM classification being: stage I--13.3%, stage II--36%, stage III--40% and stage IV--10.6%. Each patient has undergone a whole body scan, 2 hours after a 20-25 mCi 99mTc MDP i.v. dose, using a Siemens Diacam gamma camera. Three parameters where assessed: 1) the distribution of multiple metastasis bone sites; 2) an index, the counts/pixel ratio between the metastatic site interest region and a homologous normal bone interest region (IMDP); 3) a graphic representation of the metastasis heterogeneity radiotracer uptake. RESULTS: Bone metastasis have been found in 23 patients (30.6%), 16 cases having multiple sites; the rate between right and left breast cancer, for these metastases, was 13:10, according with the previous mentioned breast frequency. From all the 23 cases, the most involved site was the ribs (18 cases), followed by the spine (in 17 cases), the iliac bone (9 cases), the femur (7 cases), the skull (3 cases). On the spine, the more frequent involved was the dorsal spine (49.23%), than the lumbosacral (26.13%) and last the cervical spine (12.3%). On the dorsal vertebrae, in 91% the metastasis were localized between D8 and D12. The highest values of I-MDP characterize the femoral metastasis. The heterogeneity was high only for the vertebrae multiple sites. In conclusion, our study show pattern characteristics on the distribution and also on the uptake radiotracer bone metastasis quantification in breast cancer, in respect with others neoplasm's bone metastasis.     

Long-Term Partial Remission with Capecitabine/Trastuzumab in a Patient with Metastatic Breast Cancer Following Progression on Trastuzumab Alone

BACKGROUND: Since the introduction of trastuzumab into the treatment of Her-2/neu-positive metastatic breast cancer, cases of long-term survival have become more frequent. Even after tumor progression, trastuzumab seems to retain its antitumor activity which is potentiated by the combination with a chemotherapeutic agent. CASE REPORT: We are reporting about the unusual clinical course of a young patient with Her-2/neu-positive breast cancer, who experienced progression of pulmonary and bone metastases under treatment with trastuzumab. Upon progression, a combination therapy with capecitabine/trastuzumab was initiated, and a partial remission was achieved which has continued for over 4 years. CONCLUSION: This unusual clinical course shows that continuing trastuzumab-based therapy beyond progression is a safe, effective, and well-tolerated option which can induce long-term remissions in some patients with Her-2/neu-positive metastatic breast cancer.     

Histologically benign recurrent meningioma metastasizing to the parotid gland: case report and review of the literature.

This report presents a very rare case of metastatic meningioma of the parotid gland from a recurring intracranial lesion. The primary tumor, intracranial residues, and parotid metastasis were histologically benign. Meningiomas rarely metastasize; even rarer are cases in which both the primary and the secondary tumors have benign histological characteristics. The 11 cases reported in the literature have been critically reviewed. The case we present is noteworthy also for the exceptional localization of the metastasis in the parotid gland.     

Isolated pericardial metastasis of parotid tumor origin

Involvement of the heart in cases of parotid tumors has rarely been described and then only in cases where there was widespread metastatic disease. We report here the case of a patient with a pleomorphic-type adenocarcinoma arising from a parotid gland, in which the patient developed a malignant pericardial effusion as the first and only evidence of distant metastasis. The effusion resolved following radiation therapy (4,000 rad) to the pericardial area, and the patient was alive and disease-free one year after the diagnosis of pericardial metastasis was established. The literature on the metastatic spread of malignant parotid tumors with particular emphasis on cardiac dissemination is reviewed.     

Solitary metastasis of renal cell carcinoma to the parotid gland 10 years after radical nephrectomy

Abstract Renal cell carcinoma metastasis to the parotid gland after tumor nephrectomy is extremely rare. We report a case of solitary parotid metastasis from clear cell renal cell carcinoma in a 59‐year‐old woman, who presented 10 years after primary treatment. To our knowledge this is the first case in the published literature presenting with solitary parotid metastasis after such a long time. Superficial parotidectomy with preservation of the facial nerve was performed. One year after, the patient developed contralateral multiple kidney tumors and underwent left radical nephrectomy. She is currently on a dialysis program and no additional metastasis has been observed for 18 months.     

Cutaneous Metastasis From Adenoid Cystic Carcinoma of the Parotid Gland

BACKGROUND: Cutaneous metastasis from adenoid cystic carcinoma of the salivary gland is very rare. OBJECTIVE: To present an unusual case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. METHODS: A 63-year-old woman with multiple subcutaneous nodules on the abdomen and a gradually enlarged mass over the right parotid area was examined. A skin biopsy was taken from one of the abdominal nodules. RESULT: Skin biopsy demonstrated the characteristic histopathologic features of metastatic adenoid cystic carcinoma. A subsequent computerized tomography of the head and neck revealed a huge soft tissue mass involving the right parotid gland. Computerized tomography of the chest revealed extensive nodular pleural thickening, and pleural biopsy also showed typical histopathologic features of metastatic adenoid cystic carcinoma. All of these results are consistent with the diagnosis of an adenoid cystic carcinoma of the right parotid gland with disseminated metastases. CONCLUSION: We report a rare case of cutaneous metastasis from adenoid cystic carcinoma of the right parotid gland. The presentation of cutaneous metastasis is often nonspecific and may mimic benign lesions. Subcutaneous nodules that are rapidly developing or eruptive, are rapidly growing and have stony hardness in nature, have pain or tenderness, and have nonhealing ulceration remind us of the possibility of cutaneous metastases. Dermatologists and dermatologic surgeons should keep the diagnosis of cutaneous metastasis in mind and always perform skin biopsy when encountering these lesions.     

Breast cancer metastatic to the submandibular gland. Case report

Metastatic disease in the major salivary glands is rare and the parotid gland is most frequently involved. Secondary deposits in the submandibular gland are very uncommon. We report a case of a 50-year-old woman who developed a metastasis from breast cancer in the right submandibular gland, 9 years after primary surgery for G3 T1c N0 ipsilateral breast carcinoma. The peculiarity of the case was the unusual site of the metastatic disease and the difficulty in differential diagnosis with primitive ductal salivary carcinoma.     

Breast carcinoma metastasis and meningioma. A case report

BACKGROUND: The simultaneous occurrence of meningioma and breast cancer with or without brain metastasis is an unusual but well-known event. However, contiguous occurrence of meningioma and brain cancer metastasis is a less rare evidence and we are aware of only one previously published case in the literature. CASE DESCRIPTION: A 72-year-old woman presented with headache, nausea and vomiting, and diminished mentation and memory. Seven years ago, she had had simple mastectomy at another hospital. Histopathologic examination had been reported as breast carcinoma. The patient had not gone to the controls and was unaware of the diagnosis. Cranial MRI examination of the patient showed two extraaxial masses. Histopathologic examination of the lesion at the frontal convexity, which was reported as en plaque meningioma radiologically, revealed meningioma but the other tumor at the sylvian fossa resembling the other meningioma was reported as breast carcinoma metastasis at histopathologic examination. CONCLUSIONS: Although meningiomas have well-known radiological features, the other pathologies like breast metastasis may simulate them. A possible hormonal relationship between breast cancer and meningioma has not been clarified. We are not sure that this has played a role in dissociation of both tumor cells in our case.     

Metachronous adrenal masses in resected non-small cell lung cancer patients: therapeutic implications of laparoscopic adrenalectomy.

OBJECTIVE: In literature only few reports focused on the resection of solitary adrenal gland metastasis in patients operated on for non-small cell lung cancer (NSCLC). We report our experience on laparoscopic adrenalectomy for suspected or confirmed metachronous solitary adrenal metastasis from NSCLC and discuss its therapeutic role. METHODS: From June 1993 to March 2003, 14 patients (pts), who had been undergone lung resection for NSCLC, with suspected or confirmed solitary adrenal gland metastasis at the follow-up, underwent 15 laparoscopic adrenalectomy (in 1 patient it was bilateral). All the patients had enlarged adrenal glands at the abdominal ultrasound or CT. All but 2 pts underwent at least 1 adrenal fine needle aspiration. All the patients underwent a careful staging to exclude other sites of metastasis. The adrenal gland was in 6 cases the right, in 9 cases the left. RESULTS: In 7 cases we had a preoperative cytological diagnosis of metastasis. In 1 case adrenalectomy was not performed because of infiltration of vena cava and in 1 case it was necessary to perform a small laparotomy because of bleeding. The pathologic examination confirmed in 11 cases a NSCLC metastasis while in 4 cases it was a cortical adenoma. Regarding the 10 patients with NSCLC metastases, 3 are still alive and well at 37-80 months from the lung resection. One patient (who underwent bilateral adrenalectomy) is still alive at 44 months with local relapse. Two patients died 5 and 6 months after the adrenalectomy for other causes, 1 died at 14 months for local and systemic relapse and the remaining 3 patients died at 12 to 38 months for systemic relapse. CONCLUSIONS: Laparoscopic adrenalectomy in patients resected for NSCLC is a safe mini-invasive procedure. Even though this series is still too small, laparoscopic adrenalectomy should be considered an effective therapeutic tool in case of progressive adrenal gland enlargement, also with negative cytological examinations. A bigger series and other institution experiences will clarify its oncological value.     

Bilateral adrenal gland metastasis of renal adenocarcinoma--a case report

A 72-year-old male patient, who suffered from a renal adenocarcinoma with bilateral adrenal gland metastasis, is reported herein. The patient consulted the urology clinic with complaints of fever and dysuria. On drip infusion pyelography, a mass lesion was discovered in the upper pole of the left kidney. Computerized tomography (CT) revealed the presence of bilateral adrenal masses. On the basis of aortography and CT studies, the patient was diagnosed as having renal cancer with metastasis in bilateral adrenal glands. No other metastasis could be found. Radical left nephrectomy and bilateral adrenectomy were performed. Thereafter, interferon alpha of 3 million units every day was administered intramuscularly for the first 2 months and then, the same dose was given once a week to the present. Supplementary corticosteroids were also administered. His course was uneventful for 18 months after the operation, with no evidence of recurrence.