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 45-year-old female presented to the general surgery OPD with nodular swelling in the right parotid region. The examination of the nodule revealed firm-to-hard consistency with restricted mobility. The swelling was single in the preauricular area. FNAC was carried out. Smears revealed a typical ductal cell carcinoma cytomorphology that showed the cytoarchitecture of sheets and ductal placements of malignant ductal cells. The background showed tumor necrosis and malignant diathesis. The diagnosis of metastases of well-differentiated ductal carcinoma was offered [] with advice to search for primary in the breast. On examination, ipsilateral breast revealed 2 cm lump in the upper inner 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 the surgical management for the lump in the right breast.