Diagnostic dilemma involving a mass in the parapharyngeal space: A metastatic breast carcinoma masquerading as a malignant salivary gland tumor (original) (raw)
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Turkish Journal of Pathology, 2009
A 58-year-old male patient with a mass in the left side of the neck for 3 months was admitted to hospital. Physical examination revealed two masses; a mobile, painless, left jugular mass (lymphadenopathy?) and a parapharyngeal mass behind the left tonsilla palatina. Computed tomography examination of the cervical region and pharynx demonstrated two soft tissue masses. Th e fi rst mass was in the left parapharyngeal region and about 3.5x3x3 cm in dimensions. Th is mass was well-circumscribed and showed heterogeneous contrast uptake. Th e second one was 4.5x2.5x2 cm, sharply delineated and homogeneous. It was partly embedded in the caudal region of the left parotid gland. Th e initial clinical diagnosis was a probable metastatic malignant tumor. Fine needle aspiration was done for the
A Diagnostically Challenging Parotid Gland Tumor With Hybrid Features
Cureus, 2021
Salivary gland tumors are relatively uncommon with most being benign. When diagnosed the most common benign and malignant tumors are pleomorphic adenoma and mucoepidermoid carcinoma (MEC), respectively. However, not uncommonly, it is difficult to differentiate between the histopathological entities, leading to a diagnostic dilemma that can impact a patient's treatment and prognosis. A 24-year-old woman presented with a three-year history of asymptomatic left-sided facial swelling. She denied any prior history of head and neck radiation. There was no history of alcohol consumption or smoking exposure and there was no personal or family history of head and neck cancers. Additionally, she did not have any known occupational or environmental exposures. Due to the chronicity and painless nature of this facial mass, our patient did not pursue evaluation initially. Subsequently, she experienced an increase in size and pain for a few months exacerbated by swallowing. She had no other symptoms. On physical examination, a 3 x 3 cm left parotid gland mass was noted. There was no associated head or neck lymphadenopathy and compression of the left facial mass did not elicit secretions from the opening of Stensen's duct. Due to the rapid increase in size, she was sent for CT neck/soft tissue with contrast which confirmed a 3.56 x 2.67 cm solid nodule within the superficial portion of the left parotid gland. This was followed by an MRI orbit/face/neck with and without contrast, for further delineation, which demonstrated a 4 x 3.7 x 3 cm complex heterogeneous mass within the superficial left parotid gland. Thereafter the patient underwent an uncomplicated ultrasound-guided biopsy of the parotid mass. The histopathological appraisal concluded that this was a cellular pleomorphic adenoma, with mucinous and squamous metaplasia with reactive lymph nodes. Due to the new rapid increase in size and intense painful nature of this tumor, nerve-sparing left parotidectomy, fat grafting and reconstruction were completed. Cellular pleomorphic adenomas are benign low-grade neoplasms, typified as biphasic with both epithelial and myoepithelial components. However, they have increased cellularity and focally increased mitotic activity, not advanced enough to qualify as malignant. The presence of mucinous and squamous metaplasia is of diagnostic interest as it makes diagnosis on fine-needle aspiration (FNA) morphologically challenging. These findings are typical of MEC and on FNA can be misleading in the setting of a pleomorphic adenoma. However, on histopathological evaluation of the gross specimen along with immunohistochemical staining the diagnosis is made much easier. A diagnosis of MEC would have potentially required neck dissection and adjuvant therapy with a potential increased risk of morbidity and mortality. This case emphasises the importance of an adequate tissue biopsy in regards to parotid gland tumors to optimise a patient's care plan.
Palatal Presentation of Para-Pharyngeal Mass
Volume 5 - 2020, Issue 8 - August, 2020
Para-pharyngeal space tumors showed a varied presentation and through a great challenge to the surgeon in respect to pre-operative evaluation as well as surgical approach. Para-pharyngeal space (PPS) is an inverted cone-shaped potential space that extends from the hyoid bone to the base of the skull.It is filled with fat and areolar tissue lie laterally on either sides of pharynx; and is bounded and subdivided by various condensations of fascia1 . Tumors, although rare less than1% of head neck neoplasm can arise from any structures of this space. Mostly they are benign70-80% and 20-30% are malignant. Salivary gland tumor, particularly deep lobe parotid constitutesmore than 80%2,3. Imaging studies are invaluable to define the site of origin, extension, relationship to the great vessels of the neck and other neurovascular structures4 . Surgery is the mainstay of treatment. Several approaches have been discussed in the text books. We present a case of a huge parapharyngeal space tumor ...
Parotid Gland Metastasis from Breast Origin
Journal of Clinical Case Reports, 2018
Introduction: Metastatic involvement of parotid gland from breast carcinoma is rare. According to a literature review, only 24 cases have been reported. Case report: A 48-year-old woman with a history of left breast cancer complained of swelling in the right parotid gland. Biopsy was performed and made the diagnosis of metastasis from breast carcinoma. The patient was treated by chemotherapy and radiotherapy. Conclusion: Local control of the disease should not be underestimated and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be given every time it seems possible.
Mammary analog secretory carcinoma of the parotid gland: A case report and literature review
International Journal of Surgery Case Reports, 2015
BACKGROUND: Mammary analog secretory carcinoma (MASC) was first described in 2010 by Skálová et al. This entity shares morphologic and immunohistochemical features with the secretory carcinoma (SC) of the breast. MASC usually presents as an asymptomatic mass in the parotid gland and predominantly affects men. This tumor is considered a low-grade carcinoma but has the potential for high-grade transformation. We report one MASC case and a review of world literature. CASE REPORT: A 66-year-old male patient presented because he noticed a mass of approximately 3 × 3 cm on the right pre-auricular region. Physical examination demonstrated a 3 × 3.5 cm, firm, fixed, non-tender mass in the right pre-auricular region. An MRI of the head and neck showed an ovoid heterogeneous lesion, dependent of the right parotid gland of 27 × 28 mm. We performed a superficial parotidectomy with identification and preservation of the facial nerve. The immunophenotype was positive for epithelial membrane antigen (EMA), CK8/18, vimentin, S-100 protein, and mammoglobin. No further surgical interventions or adjuvant therapies were needed. The patient will have a close follow up. CONCLUSION: The presence of t(12;15) (p13;q25) translocation which results in the ETV6-NTRK3 gene fusion or positive immunochemical studies for STAT5, mammoglobin and S100 protein, are necessary to confirm the diagnosis of MASC. MASC treatment should mimic the management of other low-grade malignant salivary gland neoplasms. The inhibition of ETV6-NTRK3 gene fusion could be used as treatment in the future.
Mammary Analogue Secretory Carcinoma of the Parotid Gland: A Case Report and Literature Review
International Journal of Surgery Case Reports, 2015
Mammary analog secretory carcinoma (MASC) was first described in 2010 by Skálová et al. This entity shares morphologic and immunohistochemical features with the secretory carcinoma (SC) of the breast. MASC usually presents as an asymptomatic mass in the parotid gland and predominantly affects men. This tumor is considered a low-grade carcinoma but has the potential for high-grade transformation. We report one MASC case and a review of world literature. A 66-year-old male patient presented because he noticed a mass of approximately 3×3cm on the right pre-auricular region. Physical examination demonstrated a 3×3.5cm, firm, fixed, non-tender mass in the right pre-auricular region. An MRI of the head and neck showed an ovoid heterogeneous lesion, dependent of the right parotid gland of 27×28mm. We performed a superficial parotidectomy with identification and preservation of the facial nerve. The immunophenotype was positive for epithelial membrane antigen (EMA), CK8/18, vimentin, S-100 protein, and mammoglobin. No further surgical interventions or adjuvant therapies were needed. The patient will have a close follow up. The presence of t(12;15) (p13;q25) translocation which results in the ETV6-NTRK3 gene fusion or positive immunochemical studies for STAT5, mammoglobin and S100 protein, are necessary to confirm the diagnosis of MASC. MASC treatment should mimic the management of other low-grade malignant salivary gland neoplasms. The inhibition of ETV6-NTRK3 gene fusion could be used as treatment in the future.
Parotid Gland: An Unusual Site for Breast Cancer Metastasis—A Case Report and Review of Literature
Archives of Breast Cancer
Background: Breast cancer, which is the most common site-specific cancer in women, usually metastasizes to lung, liver, bone, and brain, although other sites can be involved less frequently. Parotid gland invasion by breast cancer, first reported in 1950, is extremely rare with very few reports worldwide. Case presentation: A 54-year-old woman with stage IIIA breast cancer presented with a right parotid mass and signs of facial nerve palsy 3 months after treatment completion, which was finally diagnosed as metastatic involvement of parotid gland. Conclusion: Breast cancer metastasis to parotid gland is extremely rare but can happen metachronously or synchronously even years after the primary disease. Therefore, this diagnosis should be kept in mind in any patient with a history of breast cancer presenting with a periauricular mass. Despite proposed treatments, including surgery, radiation, and chemotherapy, patients have a poor prognosis with a reported 5-year survival rate of 10%. ...
Salivary duct carcinoma in situ of the parotid gland
Histopathology, 2008
Salivary duct carcinoma in situ of the parotid gland Aims: To describe three cases of purely in situ salivary duct carcinoma, so as better to define the entity. Methods and results: Three primary tumours of the parotid gland are presented, in each case composed of cysts and ducts and lined by high nuclear grade epithelial cells. All parts of each tumour were surrounded by a myoepithelial cell rim and there was no evidence of invasion. The tumour cells expressed immunohistochemical markers seen in invasive salivary duct carcinoma of usual (high-grade) type. In two cases the androgen receptor (AR) reaction was strong, but there was no immunohistochemical expression of HER2 protein or gene amplification by in situ hybrid-ization. In the remaining case, fewer nuclei stained for AR, but both HER2 protein and gene amplification were demonstrated. Conclusions: Salivary duct carcinoma in situ is morphologically similar to breast ductal carcinoma in situ and, although our cases are few, salivary duct carcinoma in situ can possibly be subdivided into luminal and non-luminal cell types, as can analogous mammary neoplasms. The present study cannot determine whether low-grade cribriform cystadenocarcinoma, architecturally similar but immunohistochemically different, is part of the spectrum of salivary duct carcinoma in situ, or whether it represents a separate entity.
Cystic Lesion of the Parotid Gland with Squamous Metaplasia Mistaken for Squamous Cell Carcinoma
Acta Cytologica, 1998
BACKGROUND: The diverse range of diseases that affect the salivary glands may lead to problems and pitfalls in cyto-diagnosis. While false negative diagnosis of cystic salivary gland tumors is well known, false positive cytodiagnosis in nonneoplastic salivary cysts is less well documented. CASE: An 85-year-old female presented with a painless left parotid gland swelling of three months' duration. Fine needle aspiration cytology yielded fluid, smears of which showed keratinizing squamous cells with nuclear atypia leading to a cytologic diagnosis of cystic squamous cell carcinoma. A total radical parotidectomy followed. Histopathologic study showed cystic dilatation of many of the salivary ducts, which were lined with metaplastic squamous epithelium that showed atypia. There was no evidence of squamous cell carcinoma. CONCLUSION: Squamous metaplasia is known to