A 61-year-old Chinese male presented with a progressive painful swelling in the right parotid gland for one month prior to attending our hospital. The patient had a history of heavy smoking, but did not complain of hemoptysis or other symptoms related to lung cancer. A clinical examination showed the size of the mass to be approximately 1 × 1 cm, with a good activity and a moderate texture. An ultrasound showed there to be a hypoechoic nodule with a size of 1.3× 1.3 × 0.9 cm. Therefore our initial diagnosis was that of a primary parotid tumor and we recommended surgical treatment. However, in preoperative routine examinations, a chest X-ray (Figure ) showed there to be a high density shadow in the right hilar. At this stage we highly suspected that the mass was metastases and required further examination. A lung computational tomography (CT) scan (Figure ) revealed a shadow in the right upper lobe, with a size of approximately 5.4 × 6.3 cm. The CT value was 40HU, and the enhanced CT value was 60HU, with multiple lymph nodes in the mediastinum appearing enlarged. After consulting with the patient, we performed an operation constituting of a partial parotidectomy and facial nerve dissection. Postoperative pathology reported a small-cell lung cancer metastases to parotid (Figure ). Immunohistochemistry showed TTF(thyroid transcription factor)-1(+), Syn (Synaptophysin) (+), actin (-), S-100(-), P63 (-), EMA (epithelial membrane antigen) (-), ck(cytokeratin)20 (-). Therefore, we recommended that the patient receive postoperative radiation and chemotherapy.
A 68-year-old male complained of superficial but nodular swelling in the right parotid region. The patient complained of pain in ear and the swelling. The swelling measured 3 cm in diameter with restricted mobility and showed erythematous skin over it. The examination of ear, nose and throat was reported to be normal. The patient was advised to be assessed by USG-guided FNAC. The aspirate revealed dissociated to polygonal cells carrying centrally placed hyperchromatic nuclei with rounds prominent nucleoli. Few of the cells showed bi-nucleation. The cytoplasm of these cells carried granules of altered hue. The background showed infrequent melanin containing macrophages []. Cytodiagnosis of melanoma was made with advice to search for primary of melanoma. The re-examination showed 1 cm size of brown-colored tumorous lesion uncomplained by the patient. This primary lesion of the scalp underwent FNAC followed by excision revealing similar diagnosis of melanoma on both occasions.