A115
Primary invasive ductal carcinoma of the parotid gland: A case report, literature review and optimal management plan for this rare condition
Sanjoy Chatterjee1, Amitabha Chakrabarti1, Philip Sloan1, Werner Dobrowsky1, Helen Cocks2, S Joseph1, Charles Kelly3
1Northern Centre for Cancer Care, Newcastle, UK, 2Sunderland Royal Hospital, UK, 3Newcastle University, UK
Background
We describe an interesting case with the above pathology and outline the natural history, tumour biology and optimal management of invasive ductal carcinoma of the parotid (PIDC).
Method
A 60 yr old male was diagnosed with right parotid PIDC. He had a right total parotidectomy and ipsilateral neck dissection. Post-operative pathology revealed the diagnosis of PIDC of the parotid gland. The tumour stained positive for Her2 receptor. In view of multiple positive nodes he received adjuvant radiotherapy. Seven months later, he was diagnosed to have vertebral metastases when bone biopsy confirmed Her2 +ve metastatic IDC and he received palliative RT to the spine. Literature review of this rare condition showed that most cases metastasize to visceral organs like lung and liver rather than bone only disease, which this gentleman had. Taxotere as a chemotherapeutic agent and Trastuzumab as a biological agent have been used in the treatment of IDC arising from the breast. Interestingly, there is emerging evidence of near complete response using the above combination regimen in IDC from the parotid. Our patient was therefore prescribed Docetaxel and Trastuzumab.
Results
Locoregional control was achieved in the head and neck area with adjuvant radiotherapy. Good systemic response has been achieved with chemotherapy.
Conclusion
IDC of parotid behaves similar to IDC of breast. Both can stain positive for Her2, and respond to Herceptin. There is interesting morphological and clinical correlation between IDC of breast and that of the parotid. This warrants the thought if adjuvant chemotherapy and biological therapy (like that used in breast cancer), should routinely be considered for node positive IDC arising from the parotid gland. A detailed literature review and analysis of optimal management of this condition will be presented We await oestrogen receptor status and the role of anti-oestogens in PIDC needs to be explored.
