Adjuvant Radiation Therapy in Nut Carcinoma of Parotid Gland - Rare Case Scenario

Tumors of salivary glands accounts to 3-4% of all head and neck neoplasms. The most common site of tumors among salivary glands is parotid and it accounts to 70% (Perez and Brady’s principles and practice of radiation oncology/ editors, Edward Halperin et al-6th edition). In parotid gland tumors, both children and adult are the most common malignant subtype and it is Mucoepidermoid carcinoma (MEC) (Perez and Brady’s principles and practice of radiation oncology/ editors, Edward Halperin et al-6th edition). Nuclear protein in testis (NUT) germline carcinomas represents a rare subset of highly aggressive and poorly differentiated epithelial neoplasms. It occurs due to the rearrangement of the NUT gene and it also occur in the aero-digestive tract, particularly in the sinonasal region and mediastinum (50%). It is initially described as mediastinal (midline) malignancy (French et al., 2003; Kubonishi et al., 1991). It affects mainly young adults but the age range varies greatly from the new-born to the elderly. Diagnosis of salivary gland NUT carcinoma is only feasible if NUT Carcinoma is included in the differential diagnosis, NUT IHC and or molecular testing should be performed (NUT Carcinoma of the Salivary Glands, 2018). In this article, we discussed  our experience on treating a case with NUT-associated salivary gland carcinoma of right parotid gland with surgery followed by adjuvant radiotherapy. Patient is on regular follow up and remains free of the disease six months after his initial diagnosis and we concluded IHC for NUT to be done for diagnosis and on controversy, Genetic testing should be done for more accurate diagnosis.