Male 59yo, BMI: 24, no risk factor (smoke, alcool), nothing in personal medical history, biker.
3x3cm righy parotid mass growing in the last 4 months, not painful, no facial nerve deficit.
Citology --> non-resolving, not atypical cells
External parotidectomy --> one intra parotid lymph node with squamous cell carcinoma metastases , ECE+. No sign of malignancy in the glandular parenchyma.
NBI endoscopy of the URT --> negative
PET-CT scan --> negative
HPV, EBV on the node --> negative
Dermatology consult/Skin observation (bald patient) --> negative
How to manage?
A) Follow up
B) Total parotidectomy
C) Total parotidectomy + RT on parotid gland
D) Total parotidectomy + RT on parotid gland and neck
E) Total parotidectomy + RT on parotid gland + CT
F) Total parotidectomy + RT on parotid gland and neck + CT
G)Total parotidectomy + ND
H)Total parotidectomy + ND + RT
I)Total parotidectomy + ND + RT/CT
L) RT on parotid gland
M) RT on parotid gland and neck
N) RT on parotid gland + CT
O) RT on parotid gland and neck + CT
P) ND only
Q) ND + RT on parotid gland
Parotid mass or intraParotid lymph node metastasis?
If its Parotid tumour, FNA & MRI will help the diagnosis. Most Parotid tumour are candidate for surgery.
If it is Lymph node; please search for primaryin Head & Neck area including Nasopharynx. If there is no evidence of Primary, PET scan is recommended to establish it as Metastasis of unknown origin (MUO). Radical neck dissection followed by Radiation Therapy +/- ChemoTherapy is recommended. IHC may be helpful to know characteristics of the metastasis & prognosis.
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