Radiographic Thrombus within the External Jugular Vein: Report of a Rare Case and Review of the Literature

Abstract

We are reporting a case of a 91-year-old male with a primary malignancy of the right parotid gland with radiographic thrombus extension within the right external jugular vein. He was treated with palliative radiation therapy to the right parotid mass with a marked clinical response. The rarity of this occurrence as documented in the review of the literature provides for uncertainty with regard to proper management. Radiographic evidence of thrombus in the absence of clinical manifestations, the role of anticoagulation, and the proper radiation target delineation were all challenges encountered in the care of this patient. Our case represents a rare occurrence with unique radiologic findings that has implications for management.

Primary synovial sarcoma of parotid gland with intravenous extension into the heart

“…7,19,20 However, we could find only one case of a 91-year-old male patient with a parotid tumor associated with tumor thrombosis of the right external jugular vein. 21 In our case, the thrombus was in the internal jugular vein extending down to the superior vena cava and subsequently right atrium. Other head and neck tumors have also been reported to invade or grow within the great vessels, among those, paraganglioma was the most common.…”

Primary Parotid Tumor Thrombosis: Immunohistologic Features and Awareness of Metastatic Potential

“…To date, there have been four studies reporting tumor thrombosis associated with a parotid gland tumor [5,[7][8][9]. However, to the best of our knowledge, this is the first reported case of tumor thrombosis of the EJV with subsequent distant pulmonary metastasis.…”

“…Tumor thrombus, also known as intravascular tumor extension, is defined as tumor extension into a vessel [10]. Tumor thrombosis can occur secondary to malignancy via direct compression of the adjacent vasculature leading to venous stasis or via direct tumor extension within the vein [5]. The differentiation of the mechanisms of tumor thrombosis is critical to determine treatment outcomes, as the degree of surgical resection and amount of radiation necessary for treatment differ depending on the exact etiology for certain tumors [5,10].…”

“…Tumor thrombosis can occur secondary to malignancy via direct compression of the adjacent vasculature leading to venous stasis or via direct tumor extension within the vein [5]. The differentiation of the mechanisms of tumor thrombosis is critical to determine treatment outcomes, as the degree of surgical resection and amount of radiation necessary for treatment differ depending on the exact etiology for certain tumors [5,10]. Head and neck cancers (HNC) possess biological factors that are considered high risk for tumor thrombus formation, which include modified thrombosis/fibrinolysis mechanisms, platelet activation, and excessive platelet degranulation and release of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and platelet-derived growth factor (PDGF) [11].…”

“…Due to its rarity, the clinical presentation, management, and complications of MC of the parotid gland have not been well-documented. Tumor thrombosis due to a primary MC of the parotid gland tumor is particularly rare, and to the best of our knowledge, a primary parotid MC with tumor thrombosis has not been previously reported [5]. Here, we present an unusual case of MC of the right parotid gland with tumor thrombosis of the external jugular vein (EJV) with rapid metastatic dissemination in a manner consistent with hematogenous spread following locoregional therapy.…”