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  Table of Contents  
Year : 2015  |  Volume : 52  |  Issue : 2  |  Page : 248-249

Bone-confined extensive disease as the presentation of disease recurrence in the setting of malignant transformation of pleomorphic adenoma of parotid gland with excellent locoregional control: Value of whole body skeletal survey

1 Radiation Medicine Centre, Bhabha Atomic Research Centre, Parel, Bombay, India
2 Department of Pathology, Tata Memorial Hospital, Jerbai Wadia Road, Parel, Bombay, India

Date of Web Publication5-Feb-2016

Correspondence Address:
S Basu
Radiation Medicine Centre, Bhabha Atomic Research Centre, Parel, Bombay
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.175833

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How to cite this article:
Basu S, Shet T. Bone-confined extensive disease as the presentation of disease recurrence in the setting of malignant transformation of pleomorphic adenoma of parotid gland with excellent locoregional control: Value of whole body skeletal survey. Indian J Cancer 2015;52:248-9

How to cite this URL:
Basu S, Shet T. Bone-confined extensive disease as the presentation of disease recurrence in the setting of malignant transformation of pleomorphic adenoma of parotid gland with excellent locoregional control: Value of whole body skeletal survey. Indian J Cancer [serial online] 2015 [cited 2021 Sep 18];52:248-9. Available from: https://www.indianjcancer.com/text.asp?2015/52/2/248/175833


An unusual case of extensive bone-confined metastatic disease from ductal adenocarcinoma of the parotid gland (arising in the setting of pleomorphic adenoma) is described. A 66-year-old male having the clinical presentation of painless swelling of the right parotid gland of 3 months duration had undergone superficial parotidectomy 1 year previously. There was no associated involvement of the facial nerve. The preoperative computed tomography demonstrated well-defined mass of 2.8 × 2.2 cm with heterogeneous enhancement; the location of the tumor was confined to the superficial lobe of the right parotid and infiltrating to overlying subcutaneous tissue. The fine needle aspiration cytology carried out in a different center was suggestive of an epithelial cell neoplasm of the parotid. The postoperative histopathology was suggestive of high-grade ductal adenocarcinoma of the right superficial parotid gland, arising in the setting of malignant transformation of pleomorphic adenoma [Figure 1]. He was referred for bone scan for skeletal evaluation in view of the recent onset complaints of backache. The 99m Tc-methylene diphosphonate (MDP) skeletal scintigraphy [Figure 2] demonstrated avid tracer uptake in multiple vertebrae and ribs, with few areas of focal uptake in the ribs and the right sacroiliac joint and faint visualization of bilateral kidneys. The other investigations were negative for any involvement of lymph node or other distant organs.
Figure 1: (a) Scanner view reveals a fairly circumscribed mass in parotid. (b) ×20 view demonstrates areas with hyalinized stroma and benign tubules representing remnant of pleomorphic adenoma. (c) Higher power (×40) view shows tubular glands with high nuclear grade in a desmoplastic stroma

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Figure 2: Planar skeletal scintigraphy carried out 3 h after injection of 15 mCi99m Tc-methylene diphosphonate demonstrating extensive skeletal involvement with faint visualization of both kidneys. Irregular areas of tracer uptake are observed in the dorsal vertebrae, left-sided ribs posteriorly, and the right sacroiliac joint. Partly, the skeletal scintigraphy was reminiscent of a superscan like picture, which is undescribed in the setting of parotid carcinoma

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Salivary gland ductal carcinomas are highly aggressive tumors that most commonly involve the parotid gland. High-grade invasive form may, at times, develop in preexisting pleomorphic adenomas.[1],[2],[3] The likelihood of developing distant metastasis in salivary gland tumors has been proposed to be increased with high-grade tumors, such as adenoid cystic carcinoma, salivary duct carcinoma, high-grade mucoepidermoid carcinoma, and tumors located in the submandibular gland, posterior tongue, and pharyngeal tumors.[4] Habin et al. described in an animal case study extensive metastatic disease in lung, lymph nodes, eyes, and skeleton in primary parotid salivary gland adenocarcinoma.[5] McDermott et al. reported their experience with an adenocarcinoma of the buccal submucosa that metastasized to multiple bones as the initial sites of distant disease after a local recurrence.[6] Conibeara et al. reported a female patient suffering from adenocarcinoma of the right parotid gland, who presented with bony metastasis in her left proximal femur.

Superscan by definition refers to symmetrical, homogeneous uptake of tracer throughout the skeleton, an increased ratio of bone to soft tissue tracer activity, and faint or absent renal activity.[7] This pattern is usually observed in the malignancies like breast or prostate carcinoma. The present case is reported as an unusual one because of the following: (a) Widespread skeletal metastasis on skeletal scintigraphy, somewhat similar to that of “superscan” (but not exactly a classical superscan), as a presenting feature of disease recurrence is rare in the context of malignant transformation of pleomorphic adenoma and is unreported till date; (b) secondly, such clinical picture of extensive bone-confined metastatic disease on bone scan with the rest of the whole body without any obvious evidence of metastasis is also relatively rare to encounter.[8] The case underscores the value of whole body skeletal survey in such settings for appropriate assessment of disease status.

  References Top

Grenko RT, Gemryd P, Tytor M, Lundqvist PG, Boeryd B. Salivary duct carcinoma. Histopathology1995;26:261-6.  Back to cited text no. 1
Kumar RV, Kini L, Bhargava AK, Mukherjee G, Hazarika D, Shenoy AM, et al. Salivary duct carcinoma. J SurgOncol 1993;54:193-8.  Back to cited text no. 2
Luna MA, Batsakis JG, Ordonez NG, Mackay B, Tortoledo ME. Salivary gland adenocarcinomas. A clinicopathologic analysis of three distinctive types. Semin Diagn Pathol 1987;4:117-35.  Back to cited text no. 3
Schwentner I, Obrist P, Thumfart W, Sprinzl G. Distant metastasis of parotid gland tumors. Acta Otolaryngol 2006;126:340-5.  Back to cited text no. 4
Habin DJ, Else RW. Parotid salivary gland adenocarcinoma with bilateral ocular and osseous metastases in a dog. J Small Anim Pract 1995;36:445-9.  Back to cited text no. 5
McDermott M, Gamis AS, el-Mofty S, Dehner LP. Adenocarcinoma of minor salivary gland origin with skeletal metastasis in a child. Pediatr Pathol Lab Med 1996;16:89-98.  Back to cited text no. 6
Basu S, Nair N, Awasare S, Tiwari BP, Asopa R, Nair C. 99Tc (m)(V) DMSA scintigraphy in skeletal metastases and superscans arising from various malignancies: Diagnosis, treatment monitoring and therapeutic implications. Br J Radiol 2004;77:347-61.  Back to cited text no. 7
Conibeara J, Jayadevb C, Sharmac A, Achanb P, Amena S. A rare case of bone metastases from adenocarcinoma of the parotid gland. Grand. Rounds 2009;9:59-62.  Back to cited text no. 8


  [Figure 1], [Figure 2]


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