A 36-year-old woman presented to our department with a swelling in her left parotid gland, not able to close her left eye completely, and the corner of the mouth turned to the right when smiling like peripheral facial paralysis (Fig. ) in May 2017, which appeared two months ago. Meanwhile, the patient presented with right upper limb and right shoulder pain. The study has been approved by the Shandong Cancer Hospital Affiliated to Shandong University Ethics Committee (No. SDTHEC20171004). Written, informed consent was obtained from the patient.\nThe patient was diagnosed with carcinoma in left breast in January, 2015, and received breast conservative surgery and axillary lymph node dissection in another hospital. Invasive ductal carcinoma of 1.2 cm × 1.0 cm and grade II with lymph vessel invasive were confirmed by routine pathology examination, and all margins were negative, whereas 2 of 22 lymph nodes were metastases. Positive by immunohistochemistry (IHC) for estrogen receptor (ER) (70% of nuclei stained) and progesterone receptor (PR) (about 50% of nuclei stained), and negative for human epidermal growth factor receptor-2 (HER-2) by IHC. The average Ki-67 labeling index was 40%, which belonged to luminal B subtype. Adjuvant chemotherapy, radiotherapy, and endocrine therapy were recommended according to the clinical practice guideline of breast cancer, but all strategies for postoperation treatment were declined by the patient.\nBecause patient did not receive any treatments after breast cancer surgery, distant metastases were suspected when admitted first time to our department. So, PET/CT was recommended to the patient. The results of PET/CT revealed accumulation of standardized uptake value (SUV) 6.5 in the parotid gland (Fig. ) and identified a hypermetabolic mass in the contralateral side of the primary lesion (right breast) with a SUV 5.3. Additionally, PET/CT scan found multiple lymph nodes metastases (including left rotter lymph node, left supraclavicular lymph node, right hilar region lymph node, and mediastinal lymph node), multiple bone metastases, and bilateral interlobular pleural metastasis.\nLumpectomy of the mass in the right breast was performed, and invasive carcinoma was confirmed by routine pathology examination. The results of IHC were as follows: ER (+50%), PR (−), Her-2 (−). The average Ki-67 labeling index was 2%. The molecular subtype was also luminal B. According to the conclusion of multidisciplinary team, the patient decided and received 8 cycles of first-line rescue chemotherapy (4 cycles of bi-weekly epirubicin [100 mg/m2] plus cyclophosphamide [600 mg/m2], followed by 4 cycles of 3-weekly docetaxel [100 mg/m2]), combining with 4 mg zoledronic acid in treatment of bone metastasis every 4 weeks, followed by the combination of endocrine therapy (Tamoxifen 10 mg, twice daily) and ovarian function suppression (Goserelin 10.8 mg, every 3 months) after chemotherapy. No serious side effects were found. The size of the tumor in the parotid gland was clinical complete response revealed by PET/CT examination after 8 cycles of chemotherapy (Fig. ). Follow-up 6 months after chemotherapy, the patient is in stable condition and undergoing endocrine therapy.
A 56-year-old female came with the chief complaints of deep nodular swelling in the left parotid region. The examination of the nodule revealed firm to hard in consistency with restricted mobility. The swelling was solitary. FNAC was carried out. Smears revealed discohesive cell sheets with internal attempted ducts. The cells carried hyperchromatic pleomorphic nuclei with irregular chromatin and infrequent nucleoli. The nuclei of the cell sheets showed rare mitosis. The background was hemorrhagic with dissociated malignant cells. The diagnosis of metastases of well-differentiated ductal carcinoma was presented [] with advice to search for primary in the breast. On examination, left breast revealed 1.5 cm lump in the upper outer quadrant. The lump underwent FNAC followed by tru-cut biopsy. The offered diagnosis on these investigations was of well-differentiated ductal carcinoma. The patient later underwent surgical management for the lump in the left breast.