Lung Pathology: Student/Resident Case Report Poster - Lung Pathology II |

A Case of Parotid Acinar Cell Carcinoma With Metastasis to the Lung FREE TO VIEW

Alexander Miller, DO; Vanessa Yap, MD; Erik Folch, MD; Omar Ibrahim, MD
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University of Connecticut Health Center, West Hartford, CT

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):811A. doi:10.1016/j.chest.2016.08.907
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SESSION TITLE: Student/Resident Case Report Poster - Lung Pathology II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Acinar cell carcinoma (ACC) is the third most common malignant salivary gland tumor, however it usually follows an indolent course. When metastasis occurs, it is usually to local lymph nodes with distant metastasis only rarely occurring. Here, we describe an uncommon case of primary parotid ACC with metastasis to the lung and mediastinal lymph nodes.

CASE PRESENTATION: The patient is a 60 year old female with history of hypertension who initially presented to her primary care physician with left facial swelling. She felt generally well and had no other complaints. She has no smoking history but does have a strong family history of lung cancer which includes her mother, father, and sibling. She was referred to ENT for biopsy of her left parotid gland which revealed a high grade ACC. Subsequently, she underwent surgical resection and regional lymph node dissection which revealed a 6cm high grade mass in the parotid gland plus local lymph node involvement with extranodal extension. A subsequent work up with a CT of the chest identified numerous parenchymal and pleural based lung nodules and multiple enlarged mediastinal lymph nodes concerning for metastatic disease vs lung primary. An endobronchial ultrasound (EBUS) with transbronchial needle aspiration was performed with resultant pathology consistent with metastatic ACC. Prior to bronchoscopy the patient saw medical oncology and began radiation therapy to the neck, but currently is undergoing chemotherapy.

DISCUSSION: This illustrates a rare case of primary parotid ACC with metastasis to the lungs. Typically, these tumors present as slow growing masses, most often localized to the parotid. Distant metastasis only rarely occurs, and there have been case reports of ACC metastasizing to lung and bone. Metastatic ACC carries a poor prognosis with 5-year survival rates of less than 50%, thus highlighting the importance of identifying these cancers early in their disease course. To our knowledge, this is the first case report of metastatic ACC being diagnosed with EBUS. Given the high mortality rate of metastatic ACC, the identification of metastatic disease to the lung can change the course of treatment if found early in the disease process.

CONCLUSIONS: Salivary ACC only rarely presents with distant metastasis, however EBUS is an available technique that can be used to identify metastatic disease in the lung and help shape the course of treatment.

Reference #1: Al-Zaher N, Obeid A, Al-Salam S, et al. Acinic cell carcinoma of the salivary glands: a literature review. Hematol Oncol Stem Cell Ther 2009;2:259—64

Reference #2: Hoffman H, Karnell L, Menck H, Robinson R, Pinkston J. National Cancer Data Base report on cancer of the head and neck: Acinic cell carcinoma. Head And Neck [serial online]. July 1, 1999;21(4):297-309.

Reference #3: Tavora F, Rassaei N, Shilo K, Foss RD, Galvin JR, Travis WD, et al. Occult primary parotid gland acinic cell adenocarcinoma presenting with extensive lung metastasis. Arch Pathol Lab Med. 2007;131:970-3.

DISCLOSURE: The following authors have nothing to disclose: Alexander Miller, Vanessa Yap, Erik Folch, Omar Ibrahim

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