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 65-year-old male patient sort medical advice for complains of hematuria, lump in abdomen and shortness of breath along with a nodular swelling in the right parotid. The patient was provisionally diagnosed of lump in the abdomen probably malignant arising from right kidney. Meanwhile, his workup for other complains was being carried out, nodule in the right parotid underwent FNAC. It revealed the tubular structures of cuboidal epithelial cells in isolation or within the sheets of cells. The cells carry low-grade malignant nuclei but revealed vacuolated clear appearing cytoplasm with little granularity in a few. Background of smear shows fine vesicles of lipids with few loops of endothelial cells due to consideration to his clinical presentation, a diagnosis highly suspicious of metastases of clear cell RCC was offered []. The patient underwent multiple investigations. FNAC from the sites of renal mass and suspected metastatic nodule of the left lung revealed the cytomorphology consistent with RCC and metastases of RCC in the lung, respectively.\nSuperficial parotidectomy was performed in one case of melanoma. The other cases (n = 2) of metastatic ductal carcinoma breast underwent excision of the nodule within the parotid. The cases diagnosed with metastases of small cell carcinoma and RCC underwent medicinal management (chemotherapy). All five cases showed complete concordance between cyto-histological diagnoses.