case_images: PMC7345586_01
case_images: (a) Axial plane of CT neck soft tissue with contrast shows a large heterogenous density lesion involving the left parotid gland (red irregular circle) and extending into the overlying subcutaneous tissue. (b) CT chest with contrast, axial plane; bilateral scattered lung nodules of variable size range 2-13 mm (yellow arrows).
case_images: CRIPA2020-5837659.001.jpg
case_images: PMC7345586_01_CRIPA2020-5837659.001.jpg
case_images: fig1
case_images: A computerized tomography (CT) scan of the neck and soft tissue was performed and found to have a large heterogeneous soft tissue density involving both superficial and deep portions of the left parotid gland associated with multiple foci of calcification (Figure 1(a)). Two years later, a follow-up evaluation of the CT chest imaging reveals bilateral scattered lung nodules suggestive of lung metastasis (Figure 1(b)).
case_images: (a) H&E, 4x; an encapsulated tumor with adjacent normal serous parotid gland parenchyma. (b) H&E, 4x; multinodular pattern of the tumor separated by delicate fibrovascular septa. (c) H&E, 20x; cytomorphological features of the dual types of tumor cells with inner ductal epithelial layer and outer neoplastic myoepithelial cells having a clear cytoplasm due to glycogen content. No obvious cytological atypia or necrosis. Scarce mitotic figure. (d) The inner ductal epithelium express cytokeratin 5/6. (e) The outer myoepithelial cells express S-100.
case_images: CRIPA2020-5837659.002.jpg
case_images: PMC7345586_01_CRIPA2020-5837659.002.jpg
case_images: fig2
case_images: The neoplastic nodules are separated by delicate fibrovascular septa and comprise the dual-cell population of inner epithelial cells surrounded by outer myoepithelial cells (Figures 2(a) and 2(b)). The majority of the tumor cells have myoepithelial features with clear cytoplasm or naked nuclei (Figure 2(c)). Immunohistochemistry markers showed diffuse positivity of cytokeratin 5/6 in the epithelial (ductal) component (Figure 2(d)) and immunoreactivity for the S-100 stain in the myoepithelial component (Figure 2(e)).
case_images: (a) FNAB of the left supraclavicular lymph node reveals syncytial clusters of pleomorphic cells exhibiting high N/C ratio, nuclear hyperchromasia, and prominent nucleoli. (b) Cell block of the previous pleomorphic clusters with abundant necrotic background. (c) Cytokeratin 7 immunohistochemical stains the inner ductal epithelium. (d) The outer myoepithelial cells are highlighted by P63.
case_images: CRIPA2020-5837659.003.jpg
case_images: PMC7345586_01_CRIPA2020-5837659.003.jpg
case_images: fig3
case_images: Abundant necrosis in the background (Figure 3(a)) was found. Immunophenotype of those pleomorphic cells is similar to the known left parotid epithelial-myoepithelial carcinoma (Figures 3(b)-3(d)).