Salivary duct carcinoma of parotid gland: a rare malignancy
The following case has been reported in the Annals of Clinical Case Reports. A 58 year-old man with no significant past medical history presented right side parotid mass. Tumor-related symptoms included progressive facial paralysis. Physical examination of patient showed a mass of the right parotid gland which was hard, non-movable and painless on palpation.

Computed Tomography (CT) and MRI examination of neck showed 5 cm sized heterogeneously enhancing mass in right parotid gland and multiple enlarged lymphadenopathy with heterogeneous enhancement in right neck level II to V.

Computed Tomography (CT) of Chest and Positron Emission Tomography (PET-CT) using 2-deoxy-2-[fluorine-18]-fluoro-D-glucose showed no distant metastasis. The needle biopsy proven histology of parotid gland was salivary duct carcinoma. A total right parotidectomy and right neck lymph node dissection was performed. On gross examination, parotid mass was 4.8 cm sized, ill-defined and firm. Microscopic examination showed salivary duct carcinoma extended to dermis of skin. Lymph nodes were infiltrated by the same malignant tumor in right level II, III, IV, V.

All resection margins were free from tumor. He was scheduled for postoperative radiotherapy, consisting of parotid bed and right neck lymph node area with a total dose of 60 Gy in 30 fractions. The radiation therapy was delivered with 6-MV photons using Intensity-Modulated Radiotherapy (IMRT) Technique. There were no recurrences with 12 months of follow-up. At the time of 12 months after completion of treatment, he had severe back pain. A bone scan revealed multiple bone metastases (Figure 2). However, there was no recurrence of parotid and regional lymph nodes.

Lessons learnt:-
• Salivary duct carcinoma is an aggressive and rare disease with poor prognosis. Advanced stage at presentation was common.
• Despite multimodality therapy, the clinical outcome for salivary duct carcinoma is unsatisfactory. The rates of local and distant recurrence are high.

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