- Department of Neurosurgery, General Hospital of Diseases - Guatemalan Institute of Social Security, Guatemala City, Guatemala.
- Department of Neurosurgery, General Hospital of Accidents “Ceibal” - Guatemalan Institute of Social Security, Guatemala City, Guatemala.
- Department of General Surgery, General Hospital of Accidents “Ceibal” - Guatemalan Institute of Social Security, Guatemala City, Guatemala.
- Department of Radiation Oncology, HOPE International, Guatemala City, Guatemala.
- Department of Epidemiology, Integra Cancer Institute, Guatemala City, Guatemala.
Correspondence Address:
Ruy Camilo Gil Rohrmoser, Department of Neurosurgery, General Hospital of Diseases -Guatemalan Institute of Social Security, Guatemala City, Guatemala.
DOI:10.25259/SNI_719_2021
Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Ruy Camilo Gil Rohrmoser1, Manuel Diaz Borras2, Giovanni López Laínez3, Julio Briz Eisen3, Luis Linares Martinez4, Joaquin Barnoya5. Spinal metastasis at the cervicothoracic junction from acinic cell carcinoma of the parotid gland: Case report. 20-Sep-2021;12:474
How to cite this URL: Ruy Camilo Gil Rohrmoser1, Manuel Diaz Borras2, Giovanni López Laínez3, Julio Briz Eisen3, Luis Linares Martinez4, Joaquin Barnoya5. Spinal metastasis at the cervicothoracic junction from acinic cell carcinoma of the parotid gland: Case report. 20-Sep-2021;12:474. Available from: https://surgicalneurologyint.com/surgicalint-articles/11118/
Abstract
Background: Acinic cell carcinoma (ACC) accounts for only 1% of all parotid neoplasms. Spinal metastases of these tumor are extremely rare.
Case Description: A 21-year-old patient had two prior partial resections of an ACC of the parotid gland followed by radiotherapy. Two years later, the patient presented with a 3-month history of cervicothoracic pain. The cervical spine magnetic resonance imaging revealed a pathological vertebral fracture secondary to metastatic infiltration of the D1 and D2 vertebral bodies contributing to spinal cord compression. The patient underwent a two-staged approach to resect the D1/D2 infiltrated vertebral bodies and to stabilize the cervicothoracic junction. The histopathological diagnosis was consistent with metastatic ACC. The patient subsequently received 10 cycles of adjuvant radiotherapy. Six months later, the patient was neurologically intact and radiographically exhibited adequate fusion without new tumor recurrence. At the telemedicine follow-up 35 months postoperatively, the patient was doing well without axial pain or any neurological symptoms.
Conclusion: A 23-year-old patient following circumferential decompression/fusion of a D1/D2 metastatic parotid carcinoma ACC was neurologically symptom free and radiographically stable without evidence of residual/ recurrent tumor.
Keywords: Acinic cell carcinoma, Parotid gland, Parotid neoplasm, Spinal metastases
INTRODUCTION
Acinic cell carcinomas (ACCs) account for only 1% of all parotid neoplasms.[
Metastases of parotid carcinoma/ACCs to the spine are extremely rare; we were only able to identify three such cases. Here, we present a 23-year-old patient with D1/D1 metastatic ACC of the parotid gland that was successfully treated with circumferential decompression/fusion and postoperative radiotherapy.
CASE REPORT
At the age of 19, the patient underwent the partial resection of a malignant left parotid gland tumor diagnosed as ACC. One year later, at the age of 20, the patient required repeated resection of a recurrent parotid lesion. The surgery pathology report stated: recurrent ACC of the parotid gland with surgical margins involve; the patient was next managed with 10 cycles of conformational radiotherapy.
Now, 4 years later, at the age of 23, the patient newly presented with 3 months of cervical pain. Notably, she remained neurologically intact. The thoracic magnetic resonance imaging (MRI) showed a D1/D2 pathological compression fracture with anterior epidural extension of tumor compressing the cord [
Figure 1:
(a) Computerized axial tomography showing pathological fracture at D1 and D2 vertebrae. (b) T2 sequence with fat suppression of magnetic resonance imaging of the cervicothoracic spine showing neoplastic infiltration into D1 and D2 vertebrae, associated to epidural component generating spinal cord compression.
Surgery
The patient had a Spinal Instability Neoplastic Score of 11 points.[
Figure 3:
(a) Final postoperative tomography control showing the corpectomy area at D1 and D2 vertebrae, the 360° cervicothoracic fixation, and the osteosynthesis plate on the sternum manubrium. (b) Postoperative magnetic resonance imaging of T1 and (c) T2 sequences showing adequate spinal decompression and no signs of neoplastic recurrence.
Postoperative status
Neurological function normalized postoperatively, and axial pain significantly decreased. The patient subsequently received 10 radiotherapy cycles centered at the cervicothoracic junction as the pathology report documented an ACC involvement of the resected vertebrae (D1 and D2). Six months later, X-rays confirmed that the construct had remained intact, while the MRI showed adequate cord decompression without signs of local tumor recurrence [
DISCUSSION
ACCs account for 1% of all parotid gland neoplasms.[
Treatment of metastatic acinic parotid cell carcinomas
We identified three prior reports of similar cases treated surgically [
CONCLUSION
Patients with spinal metastases from ACC of the parotid gland contributing to spinal cord compression/instability should undergo circumferential surgical decompression/ fusion plus adjuvant radiotherapy as needed.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Eveson JW, Cawson RA. Salivary gland tumors. A review of 2410, cases with particular reference to histological types, site, age and sex distribution. J Pathol. 1985. 146: 51-8
2. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH. A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the spine oncology study group. Spine. 2010. 35: E1221-9
3. Sangsin A, Murakami H, Shimizu T, Kato S, Tsuchiya H. Four-year survival of a patient with spinal metastatic acinic cell carcinoma after a total en bloc spondylectomy and reconstruction with a frozen tumor-bearing bone graft. Orthopedics. 2018. 41: e727-30
4. Sepúlveda I, Frelinghuysen M, Platin E, Spencer ML, Urra A, Ortega P. Acinic cell carcinoma of the parotid gland: A case report and review of the literature. Case Rep Oncol. 2015. 8: 1-8
5. Spiro RH, Huvos AG, Strong EW. Acinic cell carcinoma of salivary origin. A clinicopathologic study of 67 cases. Cancer. 1978. 41: 924-35
6. Vidyadhara S, Shetty AP, Rajasekaran S. Widespread metastases from acinic cell carcinoma of parotid gland. Singapore Med J. 2007. 48: e13-5
7. Zook JD, Djurasovic M, Dimar JR., Carreon LY. Spinal metastasis from acinic cell carcinoma of the parotid gland: A case report. Spine J. 2012. 12: e7-10