[Secondary malignant tumors of the parotid]

Atypical presentations and rare metastatic sites of renal cell carcinoma: a review of case reports

Renal cell carcinoma is a potentially lethal cancer with aggressive behavior and a propensity for metastatic spread. Due to the fact that the patterns of metastases from renal cell carcinomas are not clearly defined, there have been several reports of cases of renal cell carcinoma associated with rare metastatic sites and atypical presenting symptoms. The present review focuses on these atypical rare clinical presentations of renal cell carcinomas both at the time of diagnosis of the primary tumor but also in the years after radical nephrectomy.

Metastatic adenocarcinoma of parotid gland originating from the ampulla of vater: case report and review of the literature

AIM

To report a rare case of metastasis from an adenocarcinoma of the ampulla of Vater to the parotid gland.

PATIENTS AND METHODS

In February 2004, a 61-year-old male underwent Whipple surgery due to a grade II adenocarcinoma of the ampulla of Vater (stage IB:pT2N0M0). Post surgery, the patient did not receive any adjuvant treatment, but was followed up regularly. Two years post surgery, an abdominal computed tomography (CT) revealed metastatic hepatic lesions. The patient subsequently underwent three lines of chemotherapy without significant response. Two months after chemotherapy (April 2007), the patient complained of a painless lump in the parotid region that was progressing fast. Not long after presentation, the mass caused severe local pain that was hardly managed with opioid analgesics. A head and neck CT depicted a 5 x 4 x 3 cm solid mass that was infiltrating the masseter and pterygoid muscles, the mandible, and parotid gland. Fine needle aspiration showed that the infiltrating mass was due to an adenocarcinoma of the ampulla of Vater. The patient subsequently received palliative radiotherapy (50.4 Gy), achieving a considerable therapeutic response.

CONCLUSIONS

Metastasis of adenocarcinoma of the ampulla of Vater to the parotid gland has not to our knowledge been previously reported. Radiotherapy offers an excellent means of palliation with minimal morbidity.

US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls

Ultrasonography (US) is useful for differential diagnosis of diseases of the salivary glands. In acute inflammation, salivary glands are enlarged and hypoechoic with increased blood flow; they may contain multiple small, oval, hypoechoic areas. In chronic inflammation, salivary glands are normal sized or smaller, hypoechoic, and inhomogeneous. Sialolithiasis appears as markedly hyperechoic lines or points with distal acoustic shadowing. Sialosis appears as enlarged hyperechoic glands without focal lesions or increased blood flow. The US features of advanced Sjögren syndrome include inhomogeneous salivary glands with scattered small, oval, hypoechoic or anechoic areas, usually well defined, and increased parenchymal blood flow. Pleomorphic adenomas are usually hypoechoic, well-defined, lobulated lesions with posterior acoustic enhancement that may contain calcifications; Warthin tumors are usually oval, hypoechoic, well-defined lesions that often contain anechoic areas and are often hypervascularized. Malignant neoplasms of the salivary glands may have irregular shapes, irregular borders, blurred margins, and a hypoechoic inhomogeneous structure or may have a benign appearance. Salivary gland cysts have well-defined margins, anechoic contents, posterior acoustic enhancement, and no internal blood flow. However, US appearances of some diseases may overlap, thus producing diagnostic pitfalls.