A rare case of iliac crest metastasis from acinic cell carcinoma of parotid gland
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
A rare case of iliac crest metastasis from acinic cell carcinoma of parotid gland Sergio Sessa1*, Antonio Ziranu1, Giulio Di Giacomo1, Almadori Giovanni2 and Giulio Maccauro1
Abstract A case of acinic cell carcinoma of the right parotid gland metastasizing to the right iliac crest is presented. Generally, for this rare low-grade malignant salivary gland neoplasm, 20% of cases may have local recurrences whereas about 10% of cases have distant metastases. They may arise many years after the initial presentation of the original tumor. The most frequent locations are the cervical lymph nodes, liver, lungs, contralateral orbit and bones. Occurrence in the appendicular skeleton is very rare and in our knowledge this is the first report of metastases to the pelvis. Keywords: Parotid gland, Pelvic metastasis, Acinic cell carcinoma
Background There are many histological types of salivary gland neoplasms. They include benign and malignant tumors of epithelial, mesenchymal and lymphoid origin. The 2005 World Health Organization (WHO) Classification of salivary gland tumors is complex and includes 10 benign and 23 malignant entities of epithelial origin [1]. Nonepithelial neoplasms are rare. Of the salivary glands, the parotid is the most frequently affected by neoplasms (accounting for 75% of the total) [2]. Generally these lesions are benign and only 25% of them are malignant. Acinic cell carcinoma is an uncommon malignancy of salivary gland origin. The parotid gland is the most common primary site. Interestingly, this type of carcinoma was considered benign until 1953 when Buxton demonstrated its ability to metastasize and recur locally [3]. Moreover it has been observed that an acinic cell carcinoma can recur many years after the primary diagnosis and subsequent removal [4]. Spiro reported two cases of recurrence after 30 years of follow-up [5]. However, many authors has asserted that 20 years of follow-up is adequate [6,7]. The percentage of distant metastases from salivary gland tumors is relatively low and their occurrence is associated with high-grade tumors [8]. Metastases occur in bones and the axial skeleton is the most * Correspondence: [email protected] 1 Department of Geriatrics, Orthopedics and Neurosciences, Agostino Gemelli University Hospital, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy Full list of author information is available at the end of the article
common site. We report the case of a 37-year-old man with an acinic cell carcinoma of a parotid gland metastasizing to the iliac crest 3 years after resection of the primary tumor.
Case presentation In June 2008, a man went to our hospital because of a harsh, fixed and indolent swelling in the parotid region. He had an ultrasound exam, which showed three swollen lymph nodes (maximum diameter 2.1 cm) near the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI) and a positron emission tomography–computed tomography (PET-CT) scan confirmed
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