Metastatic adenocarcinoma of parotid gland originating from the ampulla of vater: case report and review of the literature.
OBJECTIVE
To report a rare case of metastasis from an adenocarcinoma of the ampulla of Vater to the parotid gland.


METHODS
In February 2004, a 61-year-old male underwent Whipple surgery due to a grade II adenocarcinoma of the ampulla of Vater (stage IB:pT2N0M0). Post surgery, the patient did not receive any adjuvant treatment, but was followed up regularly. Two years post surgery, an abdominal computed tomography (CT) revealed metastatic hepatic lesions. The patient subsequently underwent three lines of chemotherapy without significant response. Two months after chemotherapy (April 2007), the patient complained of a painless lump in the parotid region that was progressing fast. Not long after presentation, the mass caused severe local pain that was hardly managed with opioid analgesics. A head and neck CT depicted a 5 x 4 x 3 cm solid mass that was infiltrating the masseter and pterygoid muscles, the mandible, and parotid gland. Fine needle aspiration showed that the infiltrating mass was due to an adenocarcinoma of the ampulla of Vater. The patient subsequently received palliative radiotherapy (50.4 Gy), achieving a considerable therapeutic response.


CONCLUSIONS
Metastasis of adenocarcinoma of the ampulla of Vater to the parotid gland has not to our knowledge been previously reported. Radiotherapy offers an excellent means of palliation with minimal morbidity.
Spyropoulou
Despina
D
Department of Radiation Oncology, University of Patras Medical School, 265 00, Patras, Greece.
Vassiliou
Vassilios
V
Tzelepi
Vassiliki
V
Kardari
Maria
M
Tsamandas
Athanassios C
AC
Kardamakis
Dimitrios
D
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010307:Parotid Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents