SESSION TYPE: Cancer Cases II
PRESENTED ON: Tuesday, October 23, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: The parotid gland is an uncommon site for metastasis from carcinomas arising outside the head and neck region. Involvement of the parotid gland as an initial site of metastasis or presentation is rare. We report an elderly man whose first presentation of an asymptomatic right lung squamous cell carcinoma of the lung was a rapidly growing fungating left parotid mass with left sided cervical lymphadenopathy.
CASE PRESENTATION: A 66 years old AAM presented with bleeding from an ulcerated mass over left mandible. He had painless swelling extending from below the left ear to the left side of chin involving the entire Left lower jaw. He smoked for 4 years and quit 40 years back. Exam revealed left sided facial ulcerated swelling under ear; left sided cervical lymphadenopathy. His cardiopulmonary and abdominal examination as well as neurological exam was unremarkable. Initial libratory data showed leukocytosis. CT scan of neck showed multiple soft tissue mass lesions at left upper neck with extensive lymphadenopathy; a large soft tissue mass lesion seen at the right lung apex. CT of chest revealed paratracheal and suprahilar lymphadenopathy in addition to a large solid pulmonary mass (5.4 cm x 6.5 cm) in right upper lobe in close proximity to mediastinum. Parotid mass biopsy showed poorly differentiated squamous cell carcinoma. Right upper lung mass biopsy revealed poorly differentiated squamous carcinoma. Tissue of origin testing proved lung as primary cancer with metastasis to parotid gland. Patient received palliative radiation.
DISCUSSION: Distinction between malignant primary tumors and metastasis of other primary tumors to the parotid gland is very important because it changes therapeutic approach as well as prognosis. Primary Head and neck squamous cell carcinoma (HNSCC) with solitary metastasis to lung is common in advanced stage but Primary lung squamous cell carcinoma metastasis to parotid gland is rarity. HNSCC usually presents in early stage of disease and are treated with either primary surgery or definitive radiation therapy, while patient with metaststatic squamous cell of lung do not benefit from surgical treatment. Both could have similar radiological, and immunohistochemical features. Genomic testing can be done to find primary vs synchronous tumor.
CONCLUSIONS: Immunohitochemistery is inconclusive for diagnosis as HNSCC and lung squamous cell carcinoma as both share similar fetures. Further genomic testing for tissue of origin is helpful in making the right diagnosis.
1) [Parotid tumors of non-glandular origin: local and distant metastases in the parotid gland]. Franzen A, Pfaltz M. Laryngorhinootologie. 1997 Dec; 76(12):735-9.
DISCLOSURE: The following authors have nothing to disclose: Ameer Rasheed, Viswanath Vasudevan, Farhad Arjomand
No Product/Research Disclosure InformationThe Brooklyn Hospital Center, Brooklyn, NY