In October 2018, a 64-year-old man presented at the Department of Otolaryngology, Head and Neck Surgery, First Hospital of Jilin University, Changchun, Jilin Province, China with a painless mass below the right ear and complained of peripheral facial paralysis for a month. A physical examination found a 2.0 × 2.0 cm mass, with poor mobility, in the right parotid region. The accompanied peripheral facial paralysis on the right side was classified as House-Brackmann Grade III. Neck ultrasound identified a solid mass in the right parotid gland with enlargement of the lymph nodes in the gland and the right submandibular lymph nodes. Lung computed tomography (CT; ) demonstrated abnormalities in the upper and middle lobes of the right lung and intermediate bronchus, with obstructive pneumonia, as well as enlargement of the right hilar and mediastinal lymph nodes. The patient showed no symptoms of coughing, expectoration or haemoptysis.\nThe patient insisted on confirming the malignancy of the solid mass in the right parotid gland but refused to undergo preoperative needle biopsy. Intraoperative pathology confirmed a malignant tumour with metastatic potential. Thus, the right parotid gland and facial nerve were resected and selective neck dissection performed. Postoperative histopathological analysis demonstrated small cell carcinoma in the right parotid gland () with involvement of the right neck lymph nodes (one of eight). Bronchoscopy was performed and the pathological results were small cell carcinoma (. Immunohistochemical analysis of the postoperative pathological specimen indicated positive staining for pan-cytokeratin, CD56, chromaffin granule protein A, synapsin (Syn) and thyroid transcription factor-1 (TTF-1) (), partial positive staining of Ki-67 and cytokeratin 7, and negative staining for CD99, cytokeratin 5/6 and common leukocyte antigen (LCA). Immunohistochemical analysis of the bronchoscopy pathological specimen demonstrated positivity of pan-cytokeratin, CD56, Syn, TTF-1, partial positivity of Ki-67, but no staining of P40, cytokeratin 20, cytokeratin 5/6, vimentin and LCA, suggesting possible metastasis of small cell lung cancer to the parotid gland. Positron emission tomography (PET)/CT identified a hypermetabolic lesion in the right upper and middle lobes of lung and intermediate bronchus (), suggesting possible central lung cancer with distal obstruction and inflammation. Multiple lymph nodes were involved, and localized peritoneal thickening with hypermetabolism was observed under the right lobe of the liver, suggesting possible liver metastasis. Although hyperplasia, calcification and a hypermetabolic area were observed in the prostate under PET/CT, analysis of prostate-specific antigen in the serum and magnetic resonance imaging (MRI) showed no lesion.\nThe patient recovered well after the surgery and was scored 1 on the Eastern Cooperative Oncology Group performance scale. From postoperative day 15, the patient started to undergo six cycles of adjuvant chemotherapy with a combination of cisplatin + etoposide: days 1–3, 75 mg/m2 cisplatin intravenously + 100 mg/m2 etoposide intravenously; day 4, 100 mg/m2 etoposide intravenously; day 5, 50 mg/m2 etoposide intravenously; and the cycle was repeated every 20 days. Supportive therapy was also provided. No complications of the chemotherapy were observed after three cycles, treatment and follow-up are ongoing. Ethical approval was not required for this case report. The patient provided written informed consent for the publication of their data.
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.