CASE OF THE MONTH

Parotid Duct CA


This 73 year old male presents to his doctor with a right anterior neck mass of about 6 months duration. It is not painful or tender and has been stable in size. Ultra sound of the mass showed
1.1 x 1.3 x 1.8 cm hypoechoic mass within the tail of the parotid gland. An FNA was done on the mass at the angle of the mandible and gave a diagnosis of salivary duct carcinoma. The mass was excised and a 2.5 x 1.5 x 1.4 cm fairly circumscribed mass was found. The mass was close to the deep margin of surgical excision.

Microscopically the tumor had areas that resembled ductal carcinoma of the breast (figure 1)


figure 1

but most of the tumor was composed of irregular glands and cords of cells that characteristically elicit a desmoplastic reaction (figure 2), as seen in invasive mammary ductal carcinoma.


figure 2

Salivary duct carcinoma is an aggressive adenocarcinoma with histological resemblance of high grade ductal breast carcinoma. With this in mind breast hormone markers were performed with estrogen and progesterone markers negative and Her2 negative. This triple negative result is observed in 11% in one study. The proliferative index (Ki67) was increased to 45%. Patients with salivary duct carcinoma face a poor outcome and pose in most cases a difficult therapeutic challenge.

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