title: Spinal metastasis from acinic cell carcinoma of the parotid gland: a case report.
abstract: BACKGROUND
  Acinic cell carcinoma is the fourth most common tumor of the parotid gland, and spinal metastases are thought to be exceedingly rare. Only two other reported presentations are found in the literature, both presumably secondary to incomplete surgical resections.
  
  
  OBJECTIVE
  To present the first known case of metastasis to the lumbar spine causing vertebral body involvement, after complete resection of the parotid gland.
  
  
  METHODS
  Case report.
  
  
  METHODS
  A case of a patient who presented with low back pain and had imaging studies showing an expansive destructive lesion of the L4 vertebral body. The patient underwent a radical parotidectomy and radiation therapy for dedifferentiated, high-grade acinic cell carcinoma 2 years prior.
  
  
  RESULTS
  The patient underwent anterior L4 corpectomy and strut cage placement and posterior pedicle screw fixation from L2 to L5 on the same day, followed by radiation and oral chemotherapy 3 weeks later. Histopathologic examination confirmed metastatic dedifferentiated acinic cell carcinoma, present in the L4 vertebral body and overlying psoas muscle.
  
  
  CONCLUSIONS
  This case report underscores the importance of careful evaluation of patients presenting with back pain with a history of malignancy. It also calls into question the traditional low-grade classification ascribed to these tumors, given their ability to metastasize after complete excision and adjuvant therapy.
authors.affiliation: Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23320, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Zook
authors.forename: Mladen
authors.initials: M
authors.lastname: Djurasovic
authors.forename: John R
authors.initials: JR
authors.lastname: Dimar
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
mesh_terms: D000368:Aged; D018267:Carcinoma, Acinar Cell / Q000556:secondary / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary