Case Report - (2020) Volume 10, Issue 11
Introduction: Parotid metastases of breast cancer are extremely rare. Only 31 cases have been reported between the years of 1982 and 2019.
Case report: We report the case of 41 years-old woman who’s parotidian metastasis has been revealed 4 years after the diagnosis of her breast cancer.
Discussion and Conclusion: Any parotid mass occurring in a patient with a history of breast cancer should be considered metastatic until proven otherwise, and a multimodal care should be started as soon as possible.
Breast cancer • Parotid gland • Metastasis
Parotid malignant tumors represent 1% to 4% of head and neck cancers,  of which only 10.4% to 35.6% are secondary lesions. In a majority of cases, the primary lesion is located in the cervico-facial region . We report a case of parotid metastasis from breast cancer with review of literature.
Ms. L. M., a 41-year-old woman, presented in 2015 and infiltrating ductal carcinoma of the right breast treated by mastectomy, axillary lymph node dissection, adjuvant chemotherapy followed by loco regional radiotherapy. A hormone therapy (Tamoxifen) was prescribed for four years. She presented in January 2019 a painless swelling in the left parotid region. Clinical examination revealed the presence of a mass in the left parotid region measuring 3 cm/2 cm, firm, painless, mobile, without inflammatory signs and without facial nerve palsy or a limitation of mouth opening and a normal Stenon orifice. Head and neck CT showed an enlarged left parotid, located in its superficial lobe with an oval formation 27 mm long in the long axis, with bilateral cervical lymph nodes below centimeters (Figure 1). The patient underwent a left superficial parotidectomy with the performance of an extemporaneous pathological examination, which revealed the presence of a malignant proliferation, following which a totalization was performed with conservation of the facial nerve. The complement of the anatomopathological and immunohistochemical study was in favor of a secondary localization of the breast carcinoma. The patient subsequently received five additional cycles of adjuvant chemotherapy, radiotherapy then followed by a hormone therapy. One year after the initial diagnosis, the patient was alive with no signs of local or regional recidivism and no facial nerve palsy.
Malignant tumors represent 9% to 14% of parotid tumors . Two thirds of parotid metastases originate from tumors of the head and neck , and only 0.16% to 0.4% originate from primary subclavicular sites. These metastases could be explained by lymphatic dissemination via the thoracic duct or hematogenous via the venous connections that exist between the face and the para-vertebral venous plexus of Batson [3,5]. The first case of parotid metastasis from breast cancer was reported by Abrahams et al., in 1950 in a series of 167 autopsies of patients with breast cancer where only one case of parotid metastasis was detected . From 1982 to 2019 31 cases of breast cancer metastatic to the parotid gland were reported worldwide (Table 1) [3-30]. The management of parotid metastases is controversial. According to the majority of authors, total or superficial parotidectomy with preservation of the facial nerve followed by postoperative radiotherapy of the parotid and neck would be the protocol for most tumors restricted to the parotid, without clinical involvement of the cervical lymph nodes. However, in the case of large parotid tumors, the facial nerve may have to be sacrificed because its preservation can compromise the surgical margins. However, others have concluded that radical parotid surgery does not improve life expectancy . Some authors propose parotidectomy followed by adjuvant chemotherapy and explain this by the possible coexistence of occult and microscopic metastases. An ipsilateral cervical lymph node dissection has been proposed by some authors but few references exist to study its benefits [3-14]. Almost all current treatment procedures for metastatic parotid disease are palliative, as the prognosis of patients with parotid metastases remains bleak, with only 5-10% as a survival rate .
|References||Age||Location (breast)||Stage (TNM)||Location (parotide)||Symptoms||Therapy|
|Wiesel, et al. ||62||Left||Stade IV||Left||Mass||RT, HT|
|Bissett, et al. ||41||Right||-||Left||Mass+FNP||PT, RT|
|Calvo, et al. ||57||Right||-||Left||Pain||PT|
|Kollias, et al. ||66||Right||-||Left||Mass||SP, RT, HT|
|52||Right||-||Right||Mass||SP, RT, HT|
|57||Left||-||Left||Mass||SP, RT, HT|
|Joyce, et al. ||71||Right||T2N0M0||Right||Mass+FNP||TP|
|Szymansky, et al. ||66||Right||-||Right||PNF||TP|
|58||Right||-||Right||Mass||TP, RT, CT|
|Zhang, et al. ||40||Left||-||Right||Mass||-|
|Perez, et al.||61||-||-||Left||Mass||TP, RT, CT|
|Laforga, et al. ||52||Left||T1N0M0||Left||Mass||TP, RT, CT|
|Dangore, et al. ||42||Right||T3N0M1||Left||Mass||TP, LND, RT, CT|
|Ramesh, et al. ||63||Right||M1||Right||Mass||HT|
|Ando, et al. ||65||Left||T1N3M1||Left||Mass||TP, CT|
|Cihan, et al. ||70||Left||T2N3M0||Left||Mass||SP, RT, CT|
|Sellinger, et al. ||74||Left||T2N1M0||Right||TP|
|Alath, et al. ||43||Right||T2N2M1||Left||Mass||TP|
|Duncan, et al. ||76||Right||-||Right||Mass||HT|
|Akcan, et al. ||61||Right||-||Right||Mass||TP|
|Kmeid, et al. ||65||Right||-||Right||Mass||TP|
|El Mrabet, et al. ||43||Right||T4d N1M0||Left||Mass||CT|
|Rawet, et al. ||71||Left||-||Left||Mass||HT|
|Bohli, et al. ||48||Right||T2N0M0||Right||Mass||RT, CT|
|Assarian, et al. ||54||Right||IIIA||Right||Mass+FNP||RT, CT|
|Cao, et al. ||36||Left||-||Left||Mass+FNP||CT, HT|
|Agrawal, et al. ||60||Right||T2N0M0||Right||Mass||SP, HT|
|Our case||43||Right||Left||Mass||TP, RT, CT|
Parotid gland metastases from breast origin are extremely rare. Any parotid mass occurring in a patient with a history of breast cancer should be considered metastatic until proven otherwise. Multimodal treatment combining surgery, radiotherapy and chemotherapy should be started as soon as possible in order to obtain better local control and a quality of life.