# Metastatic Liposarcoma to the Parotid

Authors: Amel Trabelsi; Soumaya Ben Abdelkrim; Hela Jemni; Wided Stita; Chadia Ouni; Abdelmejid Dhouibi; Sihem Hmissa; Moncef Mokni; Sadok Korbi
Journal: Journal of Oncology
 (2008)

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## Abstract

Distant metastases of the parotid gland are uncommon. They arise from primary tumors located in the head and neck, mainly melanoma and epidermoid carcinoma. Other histological types of metastasis are very rare. We report an exceptional case of parotid metastasis of myxoid liposarcoma in a 42-year-old man and insist on the worse prognosis of this entity.


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## Body

## 1. Introduction

Parotid metastases are uncommon; they arise from cancers located in head and neck [1].
Metastatic liposarcoma to the parotid is exceptional [2]. We report a new case
and discuss the therapeutic and prognosis features.


## 2. Case Report

A 42-year-old man presented with a painless mass in the left preauricular area which had been
rapidly enlarging over a period of 1 month. There was no evidence of tumor
spread beyond the parotid gland. The patient has a history of liposarcoma of
the thigh soft tissues 5 years before, treated by surgery and radiotherapy. At the time, no metastatic disease was
identified at the medical examination including X-ray of the chest and abdominal ultrasound. No other past medical or surgical
history is noticed.Computed tomographic scan revealed a 6 cm heterogeneous mass of the parotid with areas of
adipose density (see Figure1). The patient underwent a total parotidectomy
with facial nerve sacrifice but without lymph node dissection.Figure 1
Computed tomographic scan revealed a 6 cm heterogeneous mass of the parotid with
areas of adipose density.The original resection consisted of a parotidectomy specimen measuring7×4,5×4 cm
and weighing 65 g. The tumor was a relatively well-demarcated tan/yellow,
measuring 5,5×3×2,5 cm, with focal myxoid areas, surrounded by scant glandular
parenchyma.Microscopically, the tumor
infiltrated extensively the parotid gland (see Figure2). It had a nodular growth
pattern, and it consisted
of a proliferation of mixture of uniform round to oval-shaped primitive nonlipogenic
mesenchymal cells and small signet-ring lipoblasts without significant mitotic
activity in a myxoid background
and delicate plexiform capillary network (see Figure 3).Figure 2
Tumor cells surrounded by parotid parenchyma.Figure 3
High magnification of lipoblast showing hyperchromatic nuclei scalloped by
cytoplasmic vacuoles.A postoperative radiotherapy was performed but the patient developed pulmonary
and cerebral metastasis two months after the diagnosis, and he died of disease
two weeks after.


## 3. Discussion

Secondary malignant tumors of the parotid are rare. Head and neck cutaneous tumors
especially squamous cell carcinomas and melanomas are the most common primary
tumors [1]. Parotid metastasis from extracutaneous head and neck tumors such as
breast carcinomas, prostate carcinomas and kidney, and gastro-intestinal tumors
is very rare [3, 4]; these tumors have the capability to metastasize to the
parotid gland through the thoracic duct or the batson's paraspinal venous
plexus, bypassing pulmonary vascular filtration [3].More rarely Merkel cell carcinoma and rhabdomyosarcoma can metastasize to the parotid
[3].However, metastatic liposarcoma to the parotid was exceptional. To our knowledge, only
one case has been reported in the English literature by Alemán López et al. [2]; it was a
liposarcoma of the leg. In our case, parotid metastatic liposarcoma is
metachronous to the primary tumor.Distinction between primary liposarcoma and metastatic
liposarcoma to the parotid gland is of
particular importance for therapy and prognosis; it can be difficult especially
if the primary site is unknown. Surgical excision with wide free surgical margins appears to be the best
treatment for primary liposarcoma. In the head and neck region, the close proximity of vital neurovascular
structures tampers the extent of excision which may result in severe morbidity;
nonsurgical treatment modalities have limited value [5]. The appropriate management of
metastasis to the parotid gland is not unified. The combination of total parotidectomy
and adjuvant radiotherapy is probably effective, conservative facial
nerve-sparing parotidectomy is possible if the nerve is not affected by the
tumor, and neck dissection is indicated if there are clinically pathologic
lymph nodes [3].In our case, a total parotidectomy and a sacrifice of facial nerve were preformed with adjuvant radiotherapy
because surgical margins were positive.In our case and one more case before [2], metastatic liposarcoma to the parotid seems to be associated
with a poor prognosis with a high frequency of recurrence and metastases despite
combined treatment modalities.In our case, patient died of disease from pulmonary and cerebral metastases, ten weeks
after the diagnosis.



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*Source: 715153-2008-12-14.xml*