Diagnostic dilemma involving a mass in the parapharyngeal space: A metastatic breast carcinoma masquerading as a malignant salivary gland tumor (original) (raw)
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.
Metastasis to the sublingual gland of metaplastic breast carcinoma – a case report
Revista Portuguesa de Estomatologia, Medicina Dentária e Cirurgia Maxilofacial
Metastatic spread to the salivary glands is rare, occurring primarily from head and neck tumors to the parotid gland. So far, only one sublingual gland metastasis has been reported in the literature. We herein report the second case of metastasis to this gland occurring in a woman in her 50s, previously diagnosed with HER2-positive metaplastic breast carcinoma (MpBC) with chondroid differentiation, with lymph node and diffuse organ metastases. The sublingual lesion presented as a tumefaction on the floor of the mouth, causing masticatory discomfort. Histologically it was formed by epithelial cells with high-grade cytomorphological features with a large central area of chondroid differentiation. The case was clinically and pathologically challenging, given the rarity of the primary MpBC and the improbable secondary location. Alternative primary salivary gland tumors with chondroid differentiation were considered, but ultimately the clinical integration was crucial in establishing the...
Breast metastasis from squamous cell carcinoma of the oropharynx: a case report
Journal of Medical Case Reports, 2017
Background: Breast metastases from extramammary tumors are extremely rare, the most common primary tumors being contralateral breast carcinoma, followed by lung, gynecological, gastrointestinal, melanoma, and hematological cancers. Only a few cases deriving from head and neck squamous cell carcinoma have been reported in the literature to date. Case presentation: We report a case of a 47-year-old Caucasian woman who presented to our hospital with a solitary breast lesion in the right upper external quadrant associated with multiple bone and visceral metastases. Two years before, she had undergone radical resection of a squamous cell carcinoma of the oropharynx (stage pT2, pN1), which was followed by adjuvant radiotherapy. Breast ultrasound showed a hypoechogenic tumor lesion of 4 cm in the right upper external quadrant that was associated with multiple axillary and infra-/supraclavicular adenopathies. A positron emission tomographic scan documented multiple visceral and bone metastases with a single hypermetabolic lesion of the right breast. The results of histology and immunohistochemistry were consistent with a metastasis from a squamous cell carcinoma. The patient died of acute respiratory insufficiency 1 month after her breast metastasis diagnosis and before starting any systemic antitumoral treatment. Conclusions: Although breast metastases are extremely rare, they should be considered in any patient with a history of cancer and confirmed by histology and immunohistochemistry because they are very difficult to distinguish from other primary breast tumors based only on clinical and radiological features. There are no standardized treatment guidelines for breast metastasis management. Surgery and radiotherapy can play a role in symptom palliation, but they do not have any relevant impact on survival, the prognosis being poor, with an estimated overall survival less than 1 year from diagnosis.
Mammary analogue secretory carcinoma of the salivary glands
ecancermedicalscience
Background: Mammary analogue secretory carcinoma (MASC) is a new disease among tumours affecting the salivary glands. It was first reported in 2010, and few cases have been reported worldwide. MASC is often incorrectly diagnosed as salivary gland acinic cell carcinoma. We present here the case of a patient with an asymptomatic parotid tumour who underwent a parotidectomy of the superficial lobe. Case report: A 78-year-old female patient came to the clinic for a tumour of approximately 2.5 × 2.5 cm and a hard, elastic consistency that had grown insidiously in the right preauricular region. Magnetic resonance imaging of the head and neck showed a heterogeneous ovoid lesion located in the lower part of the superficial lobe of the right parotid gland, measuring 29 × 27 × 27 mm. A superficial parotidectomy was performed with the facial nerve identified and preserved. Immunohistochemistry was positive for S100, mammaglobin, periodic acid Schiff (PAS) and GATA-3. Fluorescence in situ hybridisation analysis was subsequently performed and Translocation-ETS-Leukemia Virus (ETV6) gene rearrangement observed. These findings were consistent with diagnosis of a MASC. The patient then required no new interventions or adjuvant therapy. At publication, she was free of disease and continues in clinical follow-up. Conclusion: MASC is a tumour of the saliva glands that is recently described and rare. There are no studies that describe its biological behaviour or prognosis precisely.
Parotid adenocarcinoma metastasis to the breast: a case report
Journal of Surgical Case Reports
Metastatic salivary gland tumors are rare clinical entities of the head and neck. Parotid gland carcinoma with distant metastases heralds a poor prognosis with a median survival of 4.3–7.3 months. The lungs, long bones, liver and brain are the most common sites of metastasis for parotid gland cancer, along with a few reported cases describing metastasis to the ileum, spleen and iliac crest. We present the first case to our knowledge of parotid adenocarcinoma metastasis to the breast.