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Calo L, Alboni T, Bruno C, Policardo F, Feraco A, Tralongo P, Vegni F, Mulè A, Brigato F, Rossi G, Bussu F, Pantanowitz L, Galli J, Rossi ED. Metastases to the parotid glands: An institutional experience. Cytopathology 2024; 35:488-496. [PMID: 38752464 DOI: 10.1111/cyt.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Metastatic lesions to the salivary gland are rare and mostly affect the parotids. Metastases represent 8% of all malignant lesions of the parotid gland. Around 80% originate from squamous cell carcinomas (SCC) of the head and neck region. Fine needle aspiration (FNA) plays a crucial role in distinguishing primary salivary gland lesions from metastases. Herein we describe our series of metastases to the parotid glands. MATERIALS AND METHODS We analysed 630 parotid gland FNAs over a decade including conventional and liquid-based cytology specimens. Ancillary techniques such as immunocytochemistry (ICC) were conducted on cell blocks. RESULTS Eighty (12.4%) cases were malignant lesions, of which 53 (63.75%) were metastases including 24% melanoma, 22.6% SCC, 19% renal carcinomas, 7.5% breast carcinomas, 11.3% lung, 9% intestinal and 1.8% testicular, malignant solitary fibrous tumour and Merkel cell carcinoma. The 53 cases, classified according to the Milan system for salivary cytopathology, belonged to 5 Suspicious for malignancy (SFM) and 48 malignant (M) categories. Forty had a known history of primary malignancy (75.4%), while 13 were suspicious to be a metastatic localisation (24.5%), distributed as 5SFM (2SCC and 3Melanoma) and 8 M. A combination of clinical history, cytomorphology and ICC identified 100% of them. CONCLUSIONS Fine needle aspiration plays a central role in the diagnostic workup of patients with metastatic lesions to their parotid glands, thereby defining the correct management. Diagnostic accuracy may be enhanced by applying ICC. Although melanoma and SCC are the most common histological types, several other malignancies may also metastasize to the parotid glands and should be kept into consideration.
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Affiliation(s)
- Lea Calo
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Tiziana Alboni
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Carmine Bruno
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Policardo
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Vegni
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Antonio Mulè
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Francesca Brigato
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Giorgia Rossi
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Francesco Bussu
- Division of Head and Neck, Policlinico di Sassari, Sassari, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacopo Galli
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
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Aga N, Shreevats R, Gupta S, Sandhu H, Hassan ME, Prajapati HV. Oral Soft Tissue Metastasis from Breast Cancer as the Only Primary Source: Systematic Review. Avicenna J Med 2024; 14:22-38. [PMID: 38694143 PMCID: PMC11057901 DOI: 10.1055/s-0044-1779674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background Breast cancer is one of the most lethal neoplasms causing death. Oral cavity is the rare site of distant metastasis from breast cancer. Very little research has been conducted to date to analyze breast cancer as the sole primary source of metastasis to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from breast cancer as the only primary source to date. Methods An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ("Breast cancer", OR "Breast carcinoma") AND ("Metastasis" OR "Metastases"), And ("Oral soft tissues" OR "Tongue" OR "Palate" OR "Tonsil" OR "Buccal mucosa" OR "Floor of mouth" OR "Vestibule" OR "Salivary glands"). We also searched all related journals manually. The reference list of all articles was also checked. Results Our research revealed 88 relevant papers (September 1967-September 2023) with 96 patients in total. The most predominant oral soft tissues involved were salivary glands followed by the gingiva, tonsils, tongue, and buccal mucosa. A total of 23% of patients died with an average survival time of 1 to 15 months. Conclusions Oral soft tissue metastasis from breast cancer is a rare event and has a bad prognosis. More cases need to be published to raise awareness of these lesions.
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Affiliation(s)
- Nausheen Aga
- School of Dentistry, University of Dundee, Dundee, Scotland, United Kingdom
| | - Ruchira Shreevats
- Department of Orthodontics, Primadent Dental Centre, Bangalore, Karnataka, India
| | - Sonia Gupta
- Department of Oral Pathology and Microbiology and Forensic Odontology, Yamuna Institute of Dental Sciences & Research, Gadholi, Yamunanagar, Haryana, India
| | - Harman Sandhu
- General Dentistry, Building Smiles Dental Clinic, Mohali, Punjab, India
| | - Muna E.M. Hassan
- Department of Preventive and Restorative Dentistry, University of Sharjah, United Arab Emirates
| | - Harnisha V. Prajapati
- General Dentistry, Bhavya Dental Clinic and Implant Centre, Palanpur, Gujarat, India
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Laforga JB. Fine‐needle aspiration cytological findings in three cases of metastatic amelanotic melanoma to the parotid gland with divergent differentiation. Diagn Cytopathol 2021; 50:E123-E128. [DOI: 10.1002/dc.24920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 12/19/2022]
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Jung HK, Lim YJ, Kim W. Breast Cancer Metastasis to the Parotid: A Case Report with Imaging Findings. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934311. [PMID: 34813583 PMCID: PMC8628566 DOI: 10.12659/ajcr.934311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Female, 59-year-old
Final Diagnosis: Breast cancer metastasis to the parotid
Symptoms: Growing mass in the parotid gland
Medication:—
Clinical Procedure: —
Specialty: Radiology
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Affiliation(s)
- Hyun Kyung Jung
- Department of Diagnostic Radiology, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Yun-Jung Lim
- Department of Diagnostic Radiology, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Woogyeong Kim
- Department of Pathology, Pathology, Inje University Haeundae Paik Hospital, Busan, South Korea
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Agarwal R, Rana D, Gupta L, Singh M, Jain S, Rathi AK. Mucinous breast carcinoma metastatic to parotid gland: Report of a case diagnosed by fine needle aspiration. Cytopathology 2018; 30:128-130. [DOI: 10.1111/cyt.12645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Radhika Agarwal
- Department of Pathology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Deepika Rana
- Department of Pathology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
- Department of Radiotherapy; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Latika Gupta
- Department of Pathology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Meeta Singh
- Department of Pathology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Shyama Jain
- Department of Pathology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
| | - Arun Kumar Rathi
- Department of Pathology; Maulana Azad Medical College and Lok Nayak Hospital; New Delhi India
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Franzen A, Buchali A, Lieder A. The rising incidence of parotid metastases: our experience from four decades of parotid gland surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:264-269. [PMID: 28872155 PMCID: PMC5584096 DOI: 10.14639/0392-100x-1095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 09/21/2016] [Indexed: 11/23/2022]
Abstract
Secondary neoplasia in the parotid gland is increasingly frequent. We examined outcomes from 40 years of parotid surgery to analyse patterns for metastasis, review the staging procedure and discuss management. We retrospectively examined 772 consecutive cases of parotid surgery in a university hospital between 1975 and 2015 and assessed changes in incidence and management over four decades. In all, 71% percent of patients were male and 29% were female, with a mean age of 68 years, aged between 23 and 93 years. We diagnosed 683 parotid tumours of which 15.8% (n = 108) were malignant; 44% (n = 48) of all malignant lesions were metastases. The incidence of malignant tumours rose from 8% in the first decade, 14% in the second, 17% in the third to 21% in the fourth. The incidence increased even further from 10% in the first to 57% in the final decade. Most frequent tumours were metastases of squamous cell carcinoma (79%), and the majority of these lesions (87%) arose from above the clavicle, with 30 primary tumours in the skin. In most cases, the skin tumour had been excised between 6 and 24 months prior to parotid metastasis. Management consisted of surgery with neck dissection. 48 patients (67%) received adjuvant therapy, but despite aggressive multimodal treatment, disease progressed in the majority of cases, in 57% squamous cell carcinoma of the skin primaries, 67% of mucosal primaries above the clavicle and 83% of infraclavicular primaries. Parotid malignant tumours are increasing in incidence, mostly due to a rise in metastatic malignant tumours within the parotid gland, most of which are metastases of skin tumours, commonly squamous cell carcinoma. Despite multimodal therapy, their recurrence and progression rate remains high. We propose inclusion in head and neck follow-up in all cases of head and neck skin cancers.
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Affiliation(s)
| | - A Buchali
- Department of Radio-Oncology and Radiotherapy, Head and Neck Surgery, Brandenburg Medical University-Theodor Fontane, Neuruppin, Germany
| | - A Lieder
- Department of Otorhinolaryngology
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Wick MR. Primary lesions that may imitate metastatic tumors histologically: A selective review. Semin Diagn Pathol 2018; 35:123-142. [DOI: 10.1053/j.semdp.2017.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Wang H, Hoda RS, Faquin W, Rossi ED, Hotchandani N, Sun T, Pusztaszeri M, Bizzarro T, Bongiovanni M, Patel V, Jhala N, Fadda G, Gong Y. FNA biopsy of secondary nonlymphomatous malignancies in salivary glands: A multi-institutional study of 184 cases. Cancer Cytopathol 2016; 125:91-103. [DOI: 10.1002/cncy.21798] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- He Wang
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Raza S. Hoda
- Department of Pathology; Massachusetts General Hospital, Harvard University; Boston Massachusetts
| | - William Faquin
- Department of Pathology; Massachusetts General Hospital, Harvard University; Boston Massachusetts
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Nihar Hotchandani
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Tianlin Sun
- Department of Pathology; Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Marc Pusztaszeri
- Department of Pathology; Geneva University Hospital; Geneva Switzerland
| | - Tommaso Bizzarro
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | | | - Viren Patel
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Nirag Jhala
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Guido Fadda
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Yun Gong
- Department of Pathology; Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
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Metachronous, Single Metastasis to the Parotid, from Primary Breast Cancer: A Case Report and Review of the Literature. Case Rep Oncol Med 2016; 2016:3965283. [PMID: 26942028 PMCID: PMC4749787 DOI: 10.1155/2016/3965283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022] Open
Abstract
Background. The parotid gland is an unusual site for metastatic disease and when metastasis occurs, it commonly originates from head and neck primaries. Spread from distant infraclavicular sites such as the breast, into the parotid, is even more unusual with very few cases reported in the literature. Case Report. We describe the case of a 65-year-old woman presenting for a rapidly enlarging right parotid mass. She had a history of an invasive ductal carcinoma of the right breast and was disease-free in the past 6 years prior to her presentation. She was thereafter diagnosed as having a solitary parotid metastasis from breast origin. A total parotidectomy was done and she was referred for adjuvant radiotherapy. Conclusion. Any parotid metastasis should be investigated, especially in patients with a prior history of cancer where the possibility of metastasis, even if improbable, should be kept in mind. Fine needle aspiration biopsy (FNAB) is the first diagnostic procedure to be done and immunocytochemistry can provide valuable information even if it is not always needed for diagnosis. Superficial parotidectomy when feasible with adjuvant radiotherapy is the preferred approach for solitary metastasis of the parotid. The prognosis, however, remains poor regardless of the treatment modality used.
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Alath P, Kapila K, Hussein S, Amanguno H, Hebbar HG, George SS, Francis IM. Parotid gland metastasis of breast cancer diagnosed on fine needle aspiration cytology: case report and review of literature. Cytopathology 2013; 25:346-8. [DOI: 10.1111/cyt.12108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. Alath
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
| | - K. Kapila
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
| | - S. Hussein
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
| | - H. Amanguno
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
| | - H. G. Hebbar
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
| | - S. S. George
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
| | - I. M. Francis
- Department of Pathology and Radiology; Hussein Makki Al Juma Center for Specialized Surgery, Kuwait and Faculty of Medicine; Kuwait University; Safat Kuwait
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Ando K, Masumoto N, Sakamoto M, Teraoka K, Suzuki T, Kurihara T, Abe S, Tozaki M, Fukuma E, Hoshi K. Parotid Gland Metastasis of Breast Cancer: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2011; 6:471-473. [PMID: 22419903 DOI: 10.1159/000335222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND: Parotid gland metastasis in breast cancer is extremely rare, and only 14 cases have been reported between 1982 and 2010. CASE REPORT: A 67-year-old female patient was diagnosed with invasive lobular carcinoma of the left breast. Although clinical staging was T1N3M1 (stage IV), the tumor experienced a complete response to chemotherapy. We therefore performed a mastectomy followed by radiotherapy, and continued administration of trastuzumab. However, 11 months later, the patient complained of a swelling in the left parotid gland. Histology following a partial parotidectomy revealed a parotid gland metastasis from the breast. CONCLUSION: Treatment with capecitabine in addition to trastuzumab, which is one of the strategies applied in HER2-positive breast cancer, was effective in our patient. Analysis of the 14 cases of parotid gland metastasis from the breast reported between 1982 and 2010 revealed that the metastasis may occur not by direct lymphatic but by hematogenous spread.
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