Elsevier

Auris Nasus Larynx

Volume 43, Issue 2, April 2016, Pages 187-191
Auris Nasus Larynx

Parotid gland metastases of distant primary tumours: A diagnostic challenge

https://doi.org/10.1016/j.anl.2015.09.010Get rights and content

Abstract

Objective

Metastatic disease is common among parotid malignancies. The majority of primary tumours are located in the head and neck, but primary tumours below the clavicle must also be considered, especially in histological types not usually found in primary parotid or skin tumours.

Methods

We performed 644 consecutive parotidectomies between 1980 and 2012. Benign tumours were found in 555 patients (86%) and malignant tumours in 89 patients (14%).

Results

Of 89 malignant tumours, 39 were metastases (44%). In 5 cases, the primary tumour was located below the clavicle (6% of malignant tumours). A carcinoma of the bronchus was subsequently diagnosed in three patients: one patient had breast carcinoma and one renal cell carcinoma.

Conclusion

The majority of metastases in the parotid gland arise from primary tumours of the head and neck. In 10–20% of metastases, the primary tumour arises below the clavicle. Parotid metastases can be the first clinical manifestation of a malignant tumour, and can also occur years after curative intent treatment. Histopathology and immunohistochemistry will offer clues to a possible metastatic process and to primary tumour location. Parotidectomy with complete excision of the tumour can be a curative measure or form an essential part of symptom control and should be considered in all but the most moribund patients.

Section snippets

Objective

Malignant tumours of the parotid gland show great variety of histological types; they include epithelial and non-epithelial neoplasm of the parotid; in addition to this, the parotid gland is frequently affected by metastasis through the lymphogenic and haematogenic routes. Metastases usually arise from primary tumours of the head and neck, with primaries of the skin of the head and neck the most common type of primary tumour. Metastasis from primary tumours below the clavicle is less common [1]

Patients and methods

We retrospectively examined 644 consecutive cases of parotidectomy. All procedures were performed by the same Consultant Head and Neck Surgeon in a Head and Neck unit at a university teaching hospital between 1980 and 2012. Either total conservative parotidectomy with facial nerve preservation where possible or superficial parotidectomy was performed. In cases where the tumour infiltrated the facial nerve, the facial nerve was sacrificed. Neck dissections were not performed contemporaneously.

Results

We operated on 644 consecutive patients with a parotid tumour. A benign tumour was found in 555 patients (86%), and 89 patients (14%) had a malignant tumour. Metastases of a primary tumour located outside the parotid gland were diagnosed in 39 patients or 44% of all malignant lesions. The majority of primary tumours were located in the head and neck. 26 patients, or 67% of all patients with metastatic lesions, had a primary squamous cell carcinoma of the skin. Other types of malignant skin

Discussion

Secondary neoplastic lesions of the parotid gland are frequently observed in parotidectomy specimens. The vast majority of primary tumours metastasising into the parotid gland originate in the head and neck. The most frequent route of metastasis is from squamous cell carcinoma of the skin of face, scalp and neck, whose drainage paths include lymph nodes anterior and lateral to the parotid. This was also observed in our series, where 67% of all metastatic lesions had spread from known skin

Conclusion

Malignant tumours of the parotid gland represent metastases in approximately 50% of cases, and metastasis should always be considered and the patient staged accordingly when there is clinical suspicion or medical history suggestive of a malignant process. The majority of metastases arise from primary tumours of the head and neck, most commonly squamous cell carcinoma of the face and scalp. Metastatic spread of tumours located below the clavicle to the parotid gland is relatively rare but must

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