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 60-year-old multiparous postmenopausal female patient, with no prior known medical or surgical comorbidities or any drug allergy, presented with a history of lump in the right breast of 4 weeks’ duration which is gradually increasing in size. The lump was not associated with any pain, deformity, or bloody nipple discharge. There was no history of any axillary swelling, trauma, surgery, or systemic symptoms such as fever or weight loss. Family history was insignificant. On examination, there was 4 cm × 3 cm lump in the lower quadrant of the breast, not fixed to underlying structures or skin. The fine-needle aspiration cytology (FNAC) of lump was suspicious of malignancy, while biopsy revealed invasive ducal carcinoma Grade III, which demonstrated estrogen and progesterone receptor positive and HER2/Neu receptor negative. She underwent right breast conservation surgery with oncoplastic reconstruction. Final histopathology report revealed an invasive ducal carcinoma Grade III, with tumor size of 2.3 cm × 3.0 cm and node negative status, that is, Stage IIA (T2N0M0) breast cancer. She received six cycles of adjuvant chemotherapy with five flurouracil, epirubicin, and cyclophosphamide followed by adjuvant radiation therapy and then started on adjuvant hormonal therapy with tablet anastrozole 1 mg OD.\nWithin 9 months of adjuvant endocrine therapy, she presented with swelling over right preauricular region which she noticed incidentally. There was no history of any associated pain, trauma, sialorrhea, or difficulty in chewing food. PET scan revealed a focus of increased avidity in the right parotid gland without any metastatic focus elsewhere in the body [] while contrast-enhanced computed tomography (CT) fused 18F-fluorodeoxyglucose (18F-FDG) PET/CT axial and coronal sections showed a well-defined nodular lesion measuring 1.8 cm × 1.7 cm × 1.6 cm in the right parotid gland with good postcontrast enhancement and mild FDG avidity []. She underwent right superficial parotidectomy with Level II and Level III neck node dissection which revealed metastatic infiltrating ductal carcinoma involving the right parotid gland with intraparotid node [Panel A, ]. On immunohistochemistry, cells were positive for CK 7 and GATTA 3, while negative for CK 20, PAX 8, and TTF1 suggesting metastasis from breast primary [Panel B, ]. In view of limited parotid metastasis and no other evidence of any visceral crisis, she was started on second-line hormonal therapy with tablet exemestane 25 mg OD and tablet everolimus 5 mg OD. At resent, she is on regular follow-up on same second-line hormonal therapy and disease free for the last 16-month postsurgery.