Adenocarcinoma of the parotid gland – primary tumor or metastasis?

Introduction:

An otherwise healthy 80-year-old patient introduces herself with a painful mass in the area of the left parotid gland, which has been in existence for 5 weeks.

Methods:

In B-mode sonography, the mass is without sharply defined edges. No neoplastic cells are detectable in a fine needle aspiration cytology. However, in case of clinical suspected malignancy, surgical treatment controlled by frozen section analysis takes place in the sense of a radical parotidectomy with neck dissection and resection of the frontoorbital N. facialis with reconstruction by an N. auricularis magnus interponate. Histopathologically, adenocarcinoma is diagnosed.

On the fourth postoperative day the patient develops a painless icterus.

Cholestasis parameters are significantly increased. In a sonography of the upper abdomen, a hepatic metastatic pancreatic head carcinoma is suspected. The tumor markers CA 19 – 9 and CEA are partly elevated excessively.

An ERCP with stent placement in the common bile duct for biliary drainage is performed. It shows an invasion of the tumor into the duodenum. The histopathological examination also shows adenocarcinoma here.

Result:

In immunohistochemical analysis it is proved that this is a metastasis of adenocarcinoma of the pancreas in the area of the parotid gland.

The patient receives a palliative system therapy.

Conclusion:

A metastasis in the area of the parotid gland originating from hitherto undiagnosed adenocarcinoma of the pancreas has not yet been described. This unusual case highlights the challenge of managing salivary gland malignancies.

Publication History

Publication Date:
23 April 2019 (online)