Malignant tumors of Stensen's duct

Papillary Carcinoma of Stensen's Duct with Intestinal Differentiation

Stensen's duct carcinoma (StDC) is an extremely rare neoplasm, with fewer than 40 cases reported in the literature. We report a unique case of primary StDC with papillary features and intestinal differentiation of a 74-year-old male. We discuss the radiologic and pathologic correlation along with the differential diagnosis of this rare entity.

A clinical study of malignant tumors of Stensen's duct

CONCLUSION

Malignant tumors of Stensen's duct are often squamous cell carcinomas. Surgery is the treatment of choice, and maintaining an adequate safety margin and performing parotidectomy may help to reduce postoperative recurrence.

OBJECTIVES

Since malignant tumors of Stensen's duct are extremely rare, the number of cases is limited in single-facility studies, making it difficult to perform a sufficient number of clinical examinations. Therefore, we reviewed 26 cases with Stensen's duct malignancies to examine their clinical features.

METHODS

We conducted a retrospective study of 26 cases with Stensen's duct malignancies, including 1 patient whom we treated and 25 cases previously reported in the English literature, and analyzed their clinical parameters, including age, sex, affected side, chief complaint, tumor size, histopathology, treatment method, and treatment outcome.

RESULTS

Most cases were diagnosed in patients between 40 and 69 years of age. The chief complaint was swelling in the cheek in 24 patients, in 14 of whom the swelling was painful. The most common tumor diameter range was 10-19 mm. Squamous cell carcinoma was the most frequent histopathology. The recurrence rate in surgical patients who did not undergo parotidectomy was 60%, whereas in patients who underwent parotidectomy, the recurrence rate was only 7%.

Stensen's Duct Carcinoma with a Papillary Architecture

Primary carcinoma of the parotid duct (Stensen's duct carcinoma) is a rare entity, first described in 1927 and with approximately thirty-one cases reported in the English literature. Criteria for diagnosis are primarily demonstration of an origin from the Stensen's duct lining and exclusion of parotid gland, accessory parotid, oral mucosal and adjacent minor salivary gland origin. The carcinoma is usually of a specific type, and most have been described as squamous, mucoepidermoid, or undifferentiated adenocarcinomas. We report an unusual case of Stensen's duct carcinoma showing a primarily basaloid phenotype with focal squamous differentiation and a partial papillary architecture raising the possibility of malignant transformation in a ductal papilloma. Wide local excision was performed with postoperative radiotherapy and the patient is free of complications one and a half years postoperatively. Due to the small number of cases reported, the overall prognosis is not well defined, but seems to depend on the tumour size. Regional metastasis confers a 14 % mortality rate but there appears to be no relationship between histological type and prognosis.

Management of sarcomatoid salivary duct carcinoma of the submandibular gland duct with coexisting seropositive human immunodeficiency virus

BACKGROUND

Sarcomatoid salivary duct carcinoma of the submandibular gland is extremely rare. This paper highlights the impact of surgery and adjuvant radiation therapy on the outcome of this disease.

METHODS

A 59-year-old man with human immunodeficiency virus presented with a painless, rapidly growing left neck mass. Biopsy followed by surgical excision of the left submandibular gland revealed sarcomatoid salivary duct carcinoma of the submandibular gland duct with perineural invasion and close margins, for which he underwent adjuvant radiotherapy. Post-operative positron emission tomography and computed tomography revealed no residual or metastatic disease. Pathological analysis of tumour-node-metastasis staging revealed a T2 N0 M0 (stage II) tumour.

RESULTS

The patient tolerated his treatment without serious acute or long-term side effects. There was no evidence of disease on comprehensive examination or on positron emission tomography or computed tomography scans at the 4.6-year follow up.

CONCLUSION

Surgery followed by adjuvant radiotherapy provided practical locoregional control with acceptable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.

Bilateral carcinoma in situ of Wharton's duct after chronic obstructive sialadenitis: inflammation as the cause of malignancy?

A case of bilateral carcinoma in situ of Wharton's duct after chronic sialadenitis is reported. The patient, a 54-year-old man, complained of recurrent pain and swelling in the left lower submandibular region. Computed tomography showed large stones in the hilar area of both submandibular glands. The patient underwent bilateral submandibular excision. Histologic and immunohistochemical examination revealed squamous metaplasia with areas of carcinoma in situ in both right and left ducts adjacent to the calculus. To the best of our knowledge, this is the first case report in the literature describing an association between obstructive sialadenitis and carcinoma in situ of Wharton's duct. We discuss etiologic factors and chronic inflammation as a possible cause of malignancy.

Primary squamous cell carcinoma of Stensen's duct in a patient with HIV: the role of magnetic resonance imaging and fine-needle aspiration

BACKGROUND

Primary malignant tumors involving Stensen's duct are rare neoplasms, with less than 30 cases reported. We report a case of primary squamous cell carcinoma (SCC) involving Stensen's duct in a patient infected with human immunodeficiency virus (HIV) and describe the role of fine-needle aspiration (FNA) and MRI in the diagnosis of this rare entity.

METHODS

A 47-year-old man with HIV presented with intermittent parotid swelling and pain unresponsive to conservative treatment. He subsequently developed a mass emanating from Stensen's duct, and an MRI and ultrasound-guided FNA revealed carcinoma of Stensen's duct. Total parotidectomy with postoperative external beam radiation therapy was performed.

RESULTS

The patient remains disease free 31 months after treatment.

CONCLUSIONS

Primary SCC of Stensen's duct is a rare entity that may mimic benign obstructive parotid disease. FNA and MRI are useful in the diagnosis and assessment of disease extent.

Image interpretation for squamous cell carcinoma of Stensen duct

A case of squamous cell carcinoma presumed to have arisen from the right Stensen duct is reported. The patient, a 62-year-old man, was referred to our hospital with swelling in the right cheek. Magnetic resonance imaging (MRI), including contrast-enhanced MRI, and contrast-enhanced computerized tomography (CECT) enabled diagnosis of a solitary mass in the Stensen duct. Fat-suppressed T(2)-weighted imaging, in particular, demonstrated a mass-like lesion in the dilated Stensen duct and obstructive parotitis where the duct transitions into the parotid gland. Gadolinium-DTPA-enhanced T(1)-weighted imaging demonstrated the mass-like lesion surrounded by signal-hyperintense layer showing continuous transition from the thickened Stensen duct wall, which was also hyperintense. The CECT revealed peripheral annular enhancement surrounding the tumorous mass, with no enhancement of the duct wall itself, reflecting an increase in micro blood vessels in the stroma of the neoplasm. These image findings correlated well with subsequent histopathologic findings. A mass with rim enhancement and dilated Stensen duct accompanied by parotitis and no salivary calculus may suggest a differential diagnosis of malignant tumor of Stensen duct.

Squamous cell carcinoma arising from Stensen's duct

We report a case of squamous cell carcinoma presumably arising from the left Stensen's duct. The tumor was discovered during management of recurrent left parotitis. Ultrasonography, computed tomography, and magnetic resonance imaging were useful for estimating the tumor and coexisting obstructive parotitis. Relapsing symptoms and the presence of parotitis seemed to be characteristic of tumors of Stensen's duct. For a mass accompanied by obstructive parotitis or relapsing parotitis without salivary calculus, a tumor of Stensen's duct should be included in the differential diagnosis.

Undifferentiated carcinoma arising from the Stensen's duct: a case report and review of the literature

Primary carcinoma arising in Stensen's duct is an extremely rare and poorly understood tumor. A 38-year-old man was referred with a malignant lesion situated in the right cheek. The patient was treated by local resection, total parotidectomy, and modified radical neck dissection. Microscopic examination revealed tumor cells of basaloid pattern with squamous differentiation in some areas. The tumor showed a very aggressive behaviour with early local recurrence and metastatic disease. The histological and radiological findings suggest the origin from the Stensen's duct. Primary carcinoma of Stensen's duct should be histologically consistent with epidermoid, mucoepidermoid, or undifferentiated carcinoma. The diagnosis of true Stensen's duct carcinoma can be performed on the basis of clinical presentation, radiological findings, and tumor histology. Criteria for determination of origin in the duct are revised and compared with this case.

Mucoepidermoid carcinoma of Stensen's duct: A case report and review of the literature

BACKGROUND

Mucoepidermoid carcinoma of Stensen's duct is a rare neoplasm, with only five cases reported in the literature.

METHODS

We report another case of mucoepidermoid carcinoma of Stensen's duct and review the literature.

RESULTS

Stensen's duct neoplasms tend to be symptomatic at an early stage by causing an obstruction of the parotid duct. New imaging techniques such as MR sialography and sialoendoscopy are very helpful in diagnosis and patient management.

CONCLUSIONS

Although the rarity of this condition prevents definitive conclusions about the optimal treatment, we propose that Stensen's duct neoplasms should be treated like similar neoplasms occurring in the parotid gland tissue, taking into consideration clinical stage, tumor grade, and surgical margins.

Accessory parotid gland masses

Three cases of accessory parotid gland lesions are reported. The literature concerning accessory gland disease and its diagnosis and treatment is reviewed.