PMC8040565_01
T1, fat suppressed, post-contrast coronal and axial MRI images of the right-sided secretory carcinoma, diagnosed in 2009. Arrows indicate the tumor, which appears to be a complex cystic and solid mass in the deep lobe of the parotid gland, sharply defined relative to the surrounding parotid. No regional adenopathy was noted.
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A CT scan showed a non-specific mass in the right parotid gland, and MRI confirmed a complex cystic and solid mass in the deep lobe, which appeared sharply defined relative to the surrounding parotid (Figure 1).
Representative H&E staining of tumor tissue from (a) 2009 and (b) 2016. As originally described by Skalova et al., pathologic features of SC include a lobulated growth pattern with microcystic and glandular spaces displaying abundant eosinophilic homogenous or bubbly secretory material. Top images 200x magnification, bottom images 400x magnification. (c) FISH from the 2016 tumor tissue indicates ETV6 rearrangement at 12p13. This rearrangement is pathognomonic for secretory carcinoma.
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Pathology of the surgical specimen showed an intermediate grade mucoepidermoid carcinoma, 1.8 cm in greatest dimension, with peripheral cystic changes (Figure 2(a)). The pathology department compared the new slides with the tumor from seven years prior, and found that the histologies were the same (Figure 2(b)). This rearrangement was present in the 2016 specimen (Figure 2(c)), but unfortunately the 2009 specimen was decalcified and not suitable for FISH. Regardless, histopathology of the 2009 specimen supported the diagnosis of secretory carcinoma (Figure 2(a)).
T1, fat suppressed, gadolinium-enhanced coronal and axial MRI images of the left-sided secretory carcinoma, diagnosed in 2015. Arrows indicate the tumor, which is located in the superficial lobe of the parotid gland and appears as an enhancing mixed signal. There is mild exophytic extension into adjacent subcutaneous tissues.
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MRI revealed an enhancing mixed signal in the superficial lobe of the parotid gland: a 1 cm mass with mild exophytic extension into adjacent subcutaneous tissues (Figure 3).