Case Report Annals of Clinical Case Reports Published: 16 Nov, 2018

Salivary Duct Carcinoma of : A Rare Malignancy

Ji Hoon Choi* Department of Radiation Oncology, Kosin University Gospel Hospital, Korea

Abstract Salivary duct carcinoma is an aggressive tumor with a worse prognosis. A 58-year-old patient diagnosed as salivary duct carcinoma of right parotid gland. He had total right parotidectomy and right neck dissection. There was no locoregional recurrence after postoperative radiotherapy for 12 months. He had severe back pain. Bone scan revealed multiple bone metastases. Despite therapy, the clinical outcome for salivary duct carcinoma is unsatisfactory.

Introduction Salivary duct carcinoma of the parotid gland is a rare tumor which is highly aggressive. A few cases have been reported in the literature resulting in limited data regarding the biologic and the clinical characteristics of this tumor. It represents a rare tumor with an estimated incidence of 1% to 3% of all malignant tumors [1-3]. Case Presentation A 58 year-old man with no significant past medical history presented right side parotid mass. Tumor-related symptoms included progressive facial paralysis. Physical examination of patient showed a mass of the right parotid gland which was hard, non-movable and painless on palpation. Computed Tomography (CT) and MRI examination of neck showed 5 cm sized heterogeneously enhancing mass in right parotid gland and multiple enlarged with heterogeneous enhancement in right neck level II to V (Figure 1). Computed Tomography (CT) of Chest and Positron Emission Tomography (PET-CT) using 2-deoxy-2-[fluorine-18]-fluoro-D-glucose showed no distant . The needle biopsy proven histology of parotid gland was salivary duct carcinoma. A total right parotidectomy and right neck lymph node dissection was performed. On OPEN ACCESS gross examination, parotid mass was 4.8 cm sized, ill-defined and firm. Microscopic examination *Correspondence: showed salivary duct carcinoma extended to dermis of skin. Lymph nodes were infiltrated by the Ji Hoon Choi, Department of Radiation same malignant tumor in right level II, III, IV, V. All resection margins were free from tumor. He Oncology, Kosin University Gospel was scheduled for postoperative radiotherapy, consisting of parotid bed and right neck lymph node Hospital, 34 Amnam-dong, Seo-gu, area with a total dose of 60 Gy in 30 fractions. The radiation therapy was delivered with 6-MV Busan 602-702, Korea, Tel: 82-51-990- photons using Intensity-Modulated Radiotherapy (IMRT) Technique. There were no recurrences with 12 months of follow-up. At the time of 12 months after completion of treatment, he had 6399; severe back pain. A bone scan revealed multiple bone metastases (Figure 2). However, there was no E-mail: [email protected] recurrence of parotid and regional lymph nodes. Received Date: 13 Nov 2018 Accepted Date: 15 Nov 2018 Published Date: 16 Nov 2018 Citation: Choi JH. Salivary Duct Carcinoma of Parotid Gland: A Rare Malignancy. Ann Clin Case Rep. 2018; 3: 1556. ISSN: 2474-1655 Copyright © 2018 Ji Hoon Choi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work Figure 1: Neck CT at diagnosis. is properly cited.

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Conclusion Salivary duct carcinoma is an aggressive and rare disease with poor prognosis. Advanced stage at presentation was common. Despite multimodality therapy, the clinical outcome for salivary duct carcinoma is unsatisfactory. The rates of local and distant recurrence are high. References 1. Seifert G, Caselitz J. Epithelial salivary gland tumors: Tumor markers. In: Fenoglio-Preiser, CM, Wolff M, Rilke F, editors. Progress in surgical pathology. Volume 9. New York: Field and Wood; 1989. p. 157-87. 2. Gal R, Strauss M, Zohar Y, Kessler E. Salivary duct carcinoma of the parotid gland. Cytologic and histopathologic study. Acta Cytol. 1985;29(3):454-6. 3. Al-Qahtani KH, Tunio MA, Bayoumi Y, Gurusamy VM, Bahamdain FA, Figure 2: Bone scan shows multiple bone metastases. Fatani H. Clinicopathological features and treatment outcomes of the rare, salivary duct carcinoma of parotid gland. J Otolaryngol Head Neck Surg. Discussion 2016;45(1):32. Malignant tumors of the salivary glands account for approximately 4. Foote RL, Olsen KD, Bonner JA. Salivary gland . In: Gunderson LL, Tepper JE, editors. Clinical radiation oncology. Philadelphia: Churchill 3% of all head-and-neck [4]. The parotid gland is most Livingstone; 2000. p. 518-34. commonly involved site. Salivary duct carcinoma accounts for 1% to 6% of all parotid's tumors [5]. Salivary duct carcinoma frequently 5. Etges A, Pinto DS Jr, Kowalski LP, Soares FA, Araujo VC. Salivary duct involves the facial nerve and has a propensity to metastasize through carcinoma: Immunohistochemical profile of an aggressive salivary gland tumor. J Clin Pathol. 2003;56(12):914-8. the temporal bone via perineural spread [6]. Patients are usually elderly men with a mean age ranging between 55 to 61 years. It 6. Nguyen BD, Roarke MC. Salivary duct carcinoma with perineural presents as a rapidly growing mass, which develops aggressively spread to facial canal: F-18 FDG PET/CT detection. Clin Nucl Med. 2008;33(12):925-8. with possibilities of early distant metastases, local recurrence and high mortality. Facial paralysis is observed in 40% to 60% of cases. 7. Qian K, Di L, Guo K, Zheng X, Ji Q, Wang Z. Cervical lymph node Lymphadenopathy is noted in 35% of cases [7]. Optimal management metastatic status and adjuvant therapy predict the prognosis of salivary of salivary duct carcinoma is not well defined because of the limited duct carcinoma. J Oral Maxillofac Surg. 2018;76(7):1578-86. data. However, many authors recommend total parotidectomy even 8. De Riu G, Meloni SM, Massarelli O, Tullio A. Management of midcheek in T1 tumors in parotid gland tumors. If facial paralysis is present, masses and tumors of the accessory parotid gland. Oral Surg Oral Med a radical parotidectomy is appropriate [8]. Postoperative radiation Oral Pathol Oral Radiol Endod. 2011;111(5):e5-11. therapy is indicated in case of extra parotid extension, pathological 9. 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In the large and immunohistologic typing of salivary duct carcinoma: A report of 50 study reviewed 50 patients of salivary duct carcinoma with a mean cases. Cancer. 2005;103(12):2526-33. follow-up of 96 months. Most patients were male with mean age at 12. Johnston ML, Huang SH, Waldron JN, Atenafu EG, Chan K, Cummings diagnosis was 62.5 years, the primary site was the parotid gland, and BJ, et al. Salivary duct carcinoma: Treatment, outcomes, and patterns of two-thirds of the patients were initially with advanced disease. Most failure. Head Neck. 2016:E820-6. patients (56%) had cervical lymph node metastasis at diagnosis. Local 13. Boon E, Bel M, van Boxtel W, van der Graaf WTA, van Es RJJ, Eerenstein recurrence was seen in 48% of patients only 17 months after treatment SEJ, et al. A clinicopathological study and prognostic factor analysis of [11]. Johnston et al. [12] reported on 54 cases over 11 years, with a 177 salivary duct carcinoma patients from the Netherlands. Int J Cancer. median follow-up of 5.7 years and a 5-year OS of 43%. Univariate 2018;143(4):758-66. analysis showed significantly decreased OS with N2b/c stage, ECS, 14. Felix A, El-Naggar AK, Press MF, Ordonez NG, Fonseca I, Tucker SL, and lymphovascular invasion, and multivariable analysis confirmed et al. Prognostic significance of biomarkers (c-erbB-2, p53, proliferating poor OS with N2b or N2c stage and demonstrated a trend for ECS. cell nuclear antigen, and DNA content) in salivary duct carcinoma. Hum Johnston et al. [12] also reported a large comprehensive review of Pathol. 1996;27(6):561-6. the major series with their study. Negative prognostic indicators associated with worse survival included PNI, vascular invasion, ECS, higher N stage, and facial nerve involvement [13,14].

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