Abstract | November 18, 2023

Primary Squamous Cell Carcinoma of the Parotid Gland: A Rare Occurrence

Virginia Velez Quinones, MD, Internal Medicine, PGY3, University of Miami / JFK Medical Center, West Palm Beach, FL

Catherine Ostos Perez, MD, Internal Medicine, Graduate, University of Miami / JFK Medical Center, West Palm Beach, Fl; University of Miami / JFK Medical Center, MD, Internal Medicine, PGY2, University of Miami / JFK Medical Center, West Palm Beach, Fl; Kristina Menchaca, MD, Internal Medicine, Graduate, University of Miami / JFK Medical Center, West Palm Beach, Fl; Shaun Isaac, MD, Internal Medicine, Medical Director of HHA at JFK, University of Miami / JFK Medical Center, West Palm Beach, Fl

Learning Objectives

  1. Learn about presentation of squamous cell carcinoma of the parotid gland
  2. Understand the importance of earlier detection strategies

Introduction: The parotid gland is a unusual site of metastasis and a remarkably rare site for primary malignancy. Reported cases of metastasis to the parotid gland usually occurs as a direct extension from tumors in the external ear or skin. Primary squamous cell carcinoma of the parotid gland is an aggressive entity, more common in old age between the 7th and 8th decade of life. In patients with metastatic disease the tumor associated morality is estimated to be more than 50%. Common sites of metastasis for primary parotid cancer are lungs, bone, liver and brain. Due to parotid location, a tumor can lead to Bell’s palsy. We present a case of primary parotid gland squamous cell carcinoma who presented with progressive dyspnea and oropharyngeal dysphagia with associated hypercalcemia of malignancy and complicated by Bell’s palsy.

Case presentation: A 77-year-old female presented with progressive dyspnea and oropharyngeal dysphagia. Physical exam was notable for a painless, immobile, cystic-like mass on the right submandibular region and normal skin exam. Laboratory studies showed a corrected calcium of 13.2. On day 1 of admission, the patient suffered an acute right facial droop. MRI brain showed a tiny punctuate area of acute restricted diffusion and T2 prolongation of transaxial FLAIR imaging involving the right cerebellar hemisphere compatible with subacute infarction. Carotid Doppler US showed a 50-69% stenosis of right and left internal carotid arteries. Neurology was consulted and started on appropriate management, but it was determined the facial droop to be result of the parotid mass. CT chest showed bilateral pleural fluid collections and multiple nodular opacifications to the lung bases. US of the neck showed a 3.5 cm heterogenous, hypoechoic, poorly marginated mass containing calcifications at the right submandibular region. CT abdomen and pelvis showed no acute abnormality. ENT and Hematology/Oncology were consulted. Patient underwent parotidectomy and pathology report diagnosed squamous cell carcinoma of the right parotid gland. It was determined Stage IVA Primary Parotid Squamous Cell Carcinoma (SCC) due to spread to a large right supraclavicular lymph node. Further lab tests of PTH, calcium and phosphate confirmed hypercalcemia of malignancy. Oncologist determined the patient had advanced disease and recommended radiotherapy, but the patient opted for comfort measures and hospice care.

Outcome: Primary squamous cell carcinoma of the parotid gland is an aggressive malignancy that can have nonspecific varying presentations. Symptoms can be related to metastatic disease such as: dyspnea, bone pain or focal neurological deficits. Our patient opted for comfort measures given the stage of the disease. This case highlights the need for earlier detection strategies for parotid malignancy given the high mortality rate, aggressiveness of metastasis, and associated complications.

References and Resources

  1. Franzen A, Lieder A, Guenzel T, Buchali A. The Heterogenicity of Parotid Gland Squamous Cell Carcinoma: A Study of 49 Patients. In Vivo. 2019 Nov-Dec;33(6):2001-2006. doi: 10.21873/invivo.11696. PMID: 31662530; PMCID: PMC6899102.
  2. Gaughan RK, Olsen KD, Lewis JE, RICHTSMEIER WJ. Primary Squamous Cell Carcinoma of the Parotid Gland. Arch Otolaryngol Head Neck Surg. 1992;118(8):798–801. doi:10.1001/archotol.1992.01880080020006
  3. Jo U, Song JS, Choi SH, Nam SY, Kim SY, Cho KJ. Primary squamous cell carcinoma of the salivary gland: immunohistochemical analysis and comparison with metastatic squamous cell carcinoma. J Pathol Transl Med. 2020 Nov;54(6):489-496. doi: 10.4132/jptm.2020.07.19. Epub 2020 Aug 31. PMID: 32854490; PMCID: PMC7674762.
  4. Akhtar K, Ray PS, Sherwani R, Siddiqui S. Primary squamous cell carcinoma of the parotid gland: a rare entity. BMJ Case Rep. 2013 May 15;2013:bcr2013009467. doi: 10.1136/bcr-2013-009467. PMID: 23682090; PMCID: PMC3669887.
  5. Whelan A, Al-Sayed AA, Bullock M, Taylor SM. Primary parotid lymphoepithelial carcinoma: A case report and literature review of a rare pathological entity. Int J Surg Case Rep. 2020;72:610-614. doi: 10.1016/j.ijscr.2020.06.035. Epub 2020 Jun 12. PMID: 32698300; PMCID: PMC7332494.
Posted in: Medicine & Medical Specialties74
Back to Abstracts