|Year : 2015 | Volume
| Issue : 1 | Page : 34-36
Malignant parotid tumor with sialadenitis: A diagnostic dilemma
Pandiaraja Jayabal, Viswanathan Subramanian
Department of General Surgery, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||4-Jun-2015|
Dr. Pandiaraja Jayabal
Department of General Surgery, Government Stanley Medical College and Hospital, Chennai - 600 001, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Malignant parotid tumor associated with chronic sialadenitis is a rare entity. These tumors mostly arise from epithelial component of chronic sialadenitis. Chronic sialadenitis of parotid with malignant epithelial tumor even rare compared to chronic sialadenitis of the other salivary gland with malignant component. This is a rare case report of a 70-year-old male smoker with diagnostic difficulty for painless parotid mass. Finally, the patient diagnosed as malignant parotid tumor with chronic sialadenitis.
Keywords: Chronic sialadenitis, malignant parotid tumor, parotidectomy, secondary deposit, undifferentiated carcinoma, World Health Organization
|How to cite this article:|
Jayabal P, Subramanian V. Malignant parotid tumor with sialadenitis: A diagnostic dilemma. J Health Res Rev 2015;2:34-6
|How to cite this URL:|
Jayabal P, Subramanian V. Malignant parotid tumor with sialadenitis: A diagnostic dilemma. J Health Res Rev [serial online] 2015 [cited 2019 Dec 8];2:34-6. Available from: http://www.jhrr.org/text.asp?2015/2/1/34/158127
| Introduction|| |
Chronic sclerosing sialadenitis or Kuttner tumor is an uncommon benign chronic inflammatory condition affecting submandibular gland. Kuttner tumor mimics a malignant neoplasm clinically because of presentation of hard swelling. These lesions recognized as tumor-like lesions of the salivary gland by the World Health Organization. ,,,
Malignant epithelial tumors associated with autoimmune sialadenitis are less common compared with malignant lymphomas. The benign lymphoepithelial lesion described by Godwin is an autoimmune disease affecting salivary tissue and it may occur with or without the clinical picture of Sjogren's syndrome. 
| Case report|| |
A 70-year-old male smoker presented with painless gradually enlarging mass over the right parotid region for 6 months duration. There is no history of dryness of mouth or alternation in his taste or any other symptoms. No history of fever, excessive salivation, or dry eyes. On examination, a single nontender, firm-to-hard swelling present in the right parotid region. Clinically, there was no evidence of cervical lymphadenopathy. Examination of both submandibular gland and left parotid gland was normal [Figure 1] and [Figure 2].
|Figure 1: Single nontender firm-to-hard swelling with well-defined borders with irregular surface seen on the right parotid region|
Click here to view
Investigations reveal normal parameters except elevated random and postprandial blood sugar. He was negative for both HIV and HbSAg, but showed positive for ASO and CRP. His peripheral smear showed micro-hypochromic anemia. Fine-needle aspiration cytology (FNAC) of parotid mass showed negative aspiration with hemorrhagic background on repeated aspiration. Ultrasound of parotid showed large heteroechoic lesion noted in the right parotid region with tiny cervical lymph node enlargement. Ultrasound-guided aspiration of parotid gland showed chronic sialadenitis. Ultrasound-guided FNAC of lymph node was inconclusive. MRI parotid showed features of chronic sialadenitis with cervical lymph node enlargement [Figure 3]. So preoperative diagnosis made as chronic sialadenitis and planned for parotidectomy.
|Figure 3: MRI parotid shows features of chronic sialadenitis with cervical lymph node enlargement|
Click here to view
Intraoperative findings showed well-circumscribed parotid tumor with adjuvant enlarged lymph node. Histopathological examination showed islands of solid undifferentiated carcinoma separated by fibrous septae containing lymphocyte and plasma cell [Figure 4]. Metastatic tumor was present in lymph node. After histopathology report patient underwent modified radical neck dissection with adjuvant radiotherapy.
|Figure 4: Histopathological examination shows islands of solid undifferentiated carcinoma separated by fibrous trabeculae-containing lymphocyte and plasma cell|
Click here to view
| Discussion|| |
Malignant epithelial tumor may arise from epithelial component of autoimmune sialadenitis by progression of metaplasia to dysplasia to frank malignancy.  Severe epithelial dysplasia in parotid with benign ductal elements has been described in association with these tumors. The absence of salivary tissue and paucity of autoimmune sialadenitis may obscure the diagnosis and leads to misdiagnosis of metastatic carcinoma of the lymph node.
In 1952, Godwin introduced the term benign lymphoepithelial lesion to describe a lymphoid infiltrate of salivary gland tissue associated with glandular atrophy and proliferation of salivary duct elements to island of epithelial lesion. There is an increased incidence of development of carcinomas and malignant lymphomas following benign lymphoepithelial lesion.  If the parotid swelling is diagnosed as chronic sialadenitis based on FNAC report, Doppler scan with USG-guided FNAC has more yield compared with conventional FNAC.  These patients have to be screened for connective tissue disorders such as Sjogren's syndrome. Most of these patients have diagnostic difficulties, which are confirmed by histopathological diagnosis after parotidectomy.
Island of solid undifferentiated carcinomas separated by fibrous septae containing a lymphocyte and plasma cell infiltrate. The tumor cells are round to oval and spindle-shaped with large nuclei and numerous mitoses.
FNAC of palpable lymph node is mandatory for parotid mass where FNAC of parotid is inconclusive. Most of the time parotid malignancy developed following autoimmune sialadenitis is undifferentiated carcinoma, but there is a documented evidence of squamous cell carcinoma following autoimmune sialadenitis. 
| Conclusion|| |
Malignant parotid tumor associated with chronic sialadenitis is a rare entity. Most of the cases present with features of sialadenitis. But FNAC alone cannot provide diagnosis. FNAC with Doppler may improve diagnosis. Most of the time tissue diagnosis only obtained after parotidectomy.
| References|| |
Agale SV, Momin YA, Agale VG. Kuttner tumor: A report of an underdiagnosed entity. J Assoc Physicians India 2010;58:694-5.
Chou YH, Tiu CM, Li WY, Liu CY, Cheng YC, Chiou HJ, et al
. Chronic sclerosing sialadenitis of the parotid gland: Diagnosis using color Doppler sonography and sonographically guided needle biopsy. J Ultrasound Med 2005;24:551-5.
Chan JK. Kuttner tumor (chronic sclerosing sialadenitis) of the submandibular gland: An under recognized entity. Adv Anat Pathol 1998;5:239-51.
Seifert G. Tumour-like lesions of the salivary glands. The new WHO classification. Pathol Res Pract 1992;188:836-46.
Siefert G, Donath K. Morphology of salivary gland diseases. Arch Otorhinolaryngol 1976;213:111-208.
Redondo C, Garcia A, Varquez F. Malignant lymphoepithelial lesion of the parotid gland: Poorly differentiated squamous cell carcinoma with lymphoid stoma. Cancer 1981;48:289-92.
Godwin JT. Benign lymphoepithelial lesion of the parotid gland adenolymphoma, chronic inflammation, lymphoepithelioma, lymphocytic tumour, Mikulicz disease. Cancer 1952;5:1089-103.
Ahuja AT, Richards PS, Wong KT, King AD, Yuen HY, Ching AS, et al
. Kuttner tumor (chronic sclerosing sialadenitis) of the submandibular gland: Sonographic appearances. Ultrasound Med Biol 2003;29:913-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]