PMC3687162_01
(a) Cervical CT showing a 2.8 x 1.7 cm solid poorly defined mass in the superficial lobe of the parotid right gland, (b) Full body CT (abdominal section) ruling out a renal tumor
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F1
Computed tomography (CT) scan showed a 2.8 x 1.7 cm solid poorly defined mass in the superficial lobe of the right parotid gland that hinted in the deep lobe [Figure 1a]. On the suspicion of a CCC, a full body CT was performed to rule out a renal tumor or metastasis, but it failed to show pathological results [Figure 1b].
(a) Preoperative photograph of the tumor, (b) Intra-operative photograph showing the area after modified funcional neck dissection and radical parotidectomy
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F2
Modified functional neck dissection and radical parotidectomy with resection of the facial nerve was performed [Figure 2a and b].
(a) Surgical specimen. Gross photopraph showing a well-circumscribed, grey-white tumor in the parotid parenchyma, (b) Surgical specimen-Cut surface (c) Photomicrograph showing sheets of clear cells separated by hyalinized stroma (H and E, x400), (d) Tumor cells negative for glycogen and mucin (PAS, x400), (e) Carcinoembryonic antigen stain (x200), (f) CD10 inmunoreactivity (x400)
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F3
Histology disclosed a non-encapsulated well defined tumor, though it had some infiltrating areas [Figure 3a and b]. The mass was totally composed of cells with round central nucleus and abundant clear cytoplasm [Figure 3c]. Tumor cells were negative for glycogen and mucin [Figure 3d]. Immunohistochemical stains revealed that the tumor cells were positive for high-molecular-weight cytokeratins, carcinoembryonic antigen (CEA) [Figure 3e] and epithelial membrane antigen (EMA) and were negative for low-molecular-weight cytokeratins (CAM 5.2 and AE3), vimentin, S-100 protein, CK (cytokeratin) 7 and CK20. A posterior immunohistochemical study revealed that the tumor cells were positive for CD 10 (cluster of differentiation) [Figure 3f], which suggested the possibility of metastasis of renal clear cell adenocarcinoma.