PP178: Ductal salivary carcinoma

Abstract

Introduction Ductal carcinoma of salivary glands is an epithelial tumor of high malignancy and poor clinical outcome for its high rate of recurrence, perineural spread, regional and distant metastasis. It occurs more often in the major salivary glands with great predominance in the parotid gland. Its name comes from its pathological and immunohistochemical similarity with the ductal breast carcinoma. Materials and methods We report two cases of ductal salivary carcinoma that underwent surgery at our center in 2012. The first case involved a 78 year old man with submandibular gland ductal carcinoma who presented with a lesion adjacent to Wharton duct. The second case is a woman of 77 years, with a history of ductal carcinoma of the parotid gland, that debuted three years later with of a lytic lesion ipsilateral in the parasymphyseal mandibular area. Results After excluding both distant metastatic disease, we studied the vascularization of tibial–peroneal trunks, underwent surgery by performing a wide resection, and a microsurgical reconstruction with fibular flap. Pathologically confirmed diagnostic of ductal carcinoma with free surgical margins and high-grade of perineural and vascular invasion in both cases. Immunohistochemistry studies performed confirmed negative results for ERB-2 gene amplification. Discussion Ducal carcinoma of the salivary glands is a rare adenocarcinoma generated from the glandular excretory duct cells. Despite his aggressiveness, poor prognosis and unpredictable clinical course, wide excision with ipsilateral cervical lymph node dissection and adjuvant radiotherapy are supported as the treatment of choice for local and regional control of disease. In advanced cases with distant metastases, studies have shown favorable results after treatment with trastuzumab, a monoclonal antibody selective for ERB-2 also expressed in ductal breast carcinoma. Conclusions Salivary duct carcinoma has a low survival rate, which despite surgery with adjuvant radiotherapy offers the best therapeutic weapon, including the possibility of new treatments emerging from the immunohistochemical studies.