Metastatic Neuroendocrine Tumors to Parotid Gland: Where Do They Come From?

Abstract

Background. Metastasis to parotid gland occurs mostly from skin cancers of the head and neck region. Metastatic neuroendocrine tumors to the parotid gland are rare and not well studied so far. In this study, we undertook a retrospective review of secondary neuroendocrine tumors of the parotid diagnosed in our institution. The most common entities, primary tumor locations, their clinical presentations and histopathological features were analyzed. Methods. Cases of secondary neuroendocrine tumors to parotid diagnosed from August 1995 to Jan 2021 were retrieved from our institution's pathology databases, and their clinicopathological features were reviewed. Results. About 29% (120 of 420 cases) of parotid neoplasms were malignant, including 70 cases of parotid primary malignant tumors and 50 cases of metastases to parotid glands. Among metastatic tumors to the parotid glands, squamous cell carcinoma and melanoma of the head and neck region together accounted for about 78% of the cases. Only 11 of 50 metastatic tumors to the parotid were neuroendocrine carcinomas (22%). The most common primaries were poorly differentiated neuroendocrine carcinoma of lung (5 of 11 cases), including 4 cases of small cell carcinoma and one case of large cell neuroendocrine carcinoma. The second most common secondary tumor was Merkel cell carcinoma (4 of 11 cases, 36%) including one case of direct invasion from overlying skin. Medullary carcinoma of the thyroid comprised the rest of the metastases to the parotid (2 of 11 cases, 18%). Conclusion. Our results show that metastatic neuroendocrine carcinomas to the parotid gland account for about 22% of all metastatic tumors to the organ. Lung is the most common primary neuroendocrine carcinoma location. It is not uncommon for metastatic neuroendocrine carcinoma to present as the first sign of systemic clinical manifestation. Merkel cell carcinoma is the second most common entity that metastasizes to parotid, followed by medullary carcinoma of the thyroid.

Top 10 Histological Mimics of Neuroendocrine Carcinoma You Should Not Miss in the Head and Neck

“…NECs outside of the head and neck area occasionally may metastasize to the jaws and major salivary glands [36]. Indeed, metastatic neuroendocrine tumors to the parotid gland accounted for 22% of all metastatic tumors to this organ in a recent case series, and most cases were either pulmonary NECs, Merkel cell carcinomas (MCCs), or MTCs [37]. If not previously known, a hypothetical IHC panel for NEN-UPs metastatic to the salivary glands would therefore need at least TTF1, calcitonin, and CK20, in addition to neuroendocrine markers and Ki-67.…”