Locally advanced salivary duct carcinoma of the parotid gland
A 35-year old female had presented to the department with a painless lump over the left preauricular region since last 7 months. She also complained of trismus and difficulty in closing the left eyelid. Physical examination showed a 6 × 5cm hard mass in the left preauricular region fixed to the underlying tissues and overlying skin. There were palpable upper cervical lymph nodes. Computed Tomography revealed a large necrotic mass involving the left parotid, infiltrating the masseter muscle and the overlying skin []. Fine needle aspiration cytology was suggestive of carcinoma. A total left radical parotidectomy with enbloc excision of the overlying skin, left modified neck dissection, and reconstruction of the defect with pectoralis major myocutaneous flap (PMMC) were carried out under general anaesthesia. The intra-operative finding was a hard mass involving both the superficial and deep lobe of parotid gland and infiltrating the masseter muscle and the mandibular condyle periosteum. There were multiple cervical lymph nodes at all levels of the left side of neck. Histopathology was suggestive of salivary duct carcinoma involving the parotid gland. Two out of seven nodes dissected were positive histopathologically for SDC. Patient received 60 grays of external beam radiotherapy [EBRT] in thirty fractions. The patient is on regular follow-up since last 8 years and is disease free with no evidence of recurrence or distant metastasis.