Gallego et al. Journal of Medical Case Reports 2011, 5:11 http://www.jmedicalcasereports.com/content/5/1/11 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Oncocytic carcinoma of the parotid gland with late cervical lymph node metastases: a case report Lorena Gallego1, Luis García-Consuegra1, Eduardo Fuente2, Nicolás Calvo1, Luis Junquera3,4* Abstract Introduction: Oncocytic carcinoma is a rare proliferation of cytomorphologically malignant oncocytes mainly found in glandular tissue, accounting for 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. Case presentation: We report a case of oncocytic carcinoma arising in the parotid gland of a 65-year-old Caucasian man. Our patient initially underwent left superficial parotidectomy, including the removal of the mass. A close follow-up was made, and four years after first surgery cervical lymph node metastases were confirmed. Therefore, a complete parotidectomy and radical neck dissections were performed. There were no complications and no sign of recurrence after six months of follow-up. Conclusion: Oncocytic carcinoma is an extremely rare malignancy in the salivary glands. Prophylactic neck dissection may be indicated for tumors larger than 2 cm in diameter (our patient’s tumor was 2.5 cm at its greatest diameter). The clinical course of our patient, with the appearance of cervical lymph node metastases after four years of follow-up, supports this approach. Further investigation of the prognosis and correct treatment of patients with oncocytic carcinoma are required as more cases are reported. Introduction Oncocytic carcinoma (OC) is an unusual proliferation of cytomorphologically malignant oncocytes and adenocar- cinomatous architecture phenotypes mainly found in glandular tissue [1]. The terms oncocytic carcinoma, oncocytic adenocarcinoma, malignant oncocytoma and malignant oxyphilic adenoma are synonymous. Its malignant nature is distinguished from oncocytoma by abnormal morphological features and infiltrative growth [2]. Necrosis, peri-neural spread, pleomorphism, intra- vascular invasion, and distant metastasis to the cervical lymph nodes, kidneys, lungs, and mediastinum are the main features of this high-grade malignant tumor [1]. This tumor represents 5% of all oncocytic salivary gland neoplasms and less than 1% of all salivary gland tumors [3]. OC may occur in many sites in addition to the salivary glands, including the nasal and thoracic cav- ities, ovary, kidney, thyroid gland, breast and * Correspondence: Junquera@uniovi.es 3University of Oviedo Dental School, Spain Full list of author information is available at the end of the article parathyroid. The majority of OC cases have occurred in the parotid glands, but tumors that involved the sub- mandibular gland and minor glands of the palate have also been described [4]. In this case report we describe a case of OC that arose in our patient’s parotid gland and presented regional lymph node metastases four years after first surgery. Case presentation A 65-year-old Caucasian man presented with a one-year history of a painless mass in the left parotid gland. Phy- sical examination revealed an elastic, movable and non- tender mass. There was no facial palsy or regional lym- phadenopathy. A computed tomography (CT) scan revealed a 20×25 mm mass in the anterior portion of the gland, near the parotid duct, resembling a mixed tumor (Figure 1A). The cervical and peri-aortic lymph nodes were not enlarged. No calcification or cystic com- ponent was seen within the tumor. Fine-needle aspira- tion cytology (FNAC) results showed no signs of malignancy. © 2011 Gallego et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.