title: Parotid gland metastases of distant primary tumours: A diagnostic challenge.
abstract: OBJECTIVE
  Metastatic disease is common among parotid malignancies. The majority of primary tumours are located in the head and neck, but primary tumours below the clavicle must also be considered, especially in histological types not usually found in primary parotid or skin tumours.
  
  
  METHODS
  We performed 644 consecutive parotidectomies between 1980 and 2012. Benign tumours were found in 555 patients (86%) and malignant tumours in 89 patients (14%).
  
  
  RESULTS
  Of 89 malignant tumours, 39 were metastases (44%). In 5 cases, the primary tumour was located below the clavicle (6% of malignant tumours). A carcinoma of the bronchus was subsequently diagnosed in three patients: one patient had breast carcinoma and one renal cell carcinoma.
  
  
  CONCLUSIONS
  The majority of metastases in the parotid gland arise from primary tumours of the head and neck. In 10-20% of metastases, the primary tumour arises below the clavicle. Parotid metastases can be the first clinical manifestation of a malignant tumour, and can also occur years after curative intent treatment. Histopathology and immunohistochemistry will offer clues to a possible metastatic process and to primary tumour location. Parotidectomy with complete excision of the tumour can be a curative measure or form an essential part of symptom control and should be considered in all but the most moribund patients.
authors.affiliation: Klinik für HNO-Krankheiten und Plastische Operationen, Ruppiner Kliniken, Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany.
authors.forename: Achim M
authors.initials: AM
authors.lastname: Franzen
authors.affiliation: Klinik für HNO-Krankheiten, Borromäus-Hospital, Leer, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Günzel
authors.affiliation: Klinik für HNO-Krankheiten und Plastische Operationen, Ruppiner Kliniken, Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany. Electronic address: a.lieder@ruppiner-kliniken.de.
authors.forename: Anja
authors.initials: A
authors.lastname: Lieder
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D001984:Bronchial Neoplasms / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D007822:Laryngeal Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000473:pathology; D010307:Parotid Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology; D055752:Small Cell Lung Carcinoma / Q000556:secondary* / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Differential diagnosis; Metastasis; Parotid neoplasms; Therapy