Medullary thyroid carcinoma metastatic to the parotid gland

Educational objective At the conclusion of this presentation, the participants should be able to recognize the potential for unusual presentations of metastatic disease in patients with medullary thyroid carcinoma. Objectives Medullary thyroid carcinoma is an aggressive malignancy of the thyroid gland with a propensity for widespread metastasis both at the time of diagnosis and following treatment. Clinicians should be aware of unusual presentations of this malignancy to ensure timely identification of recurrent disease. Methods We present a rare case and review the associated literature. Our patient had a history of familial medullary thyroid cancer previously managed with total thyroidectomy and paratracheal neck dissection. She now presented five years later with a new right parotid mass. Laboratory values showed an elevated calcitonin of 1112 and a CEA of 36. Fine needle aspiration was consistent with metastatic medullary thyroid carcinoma. CT neck confirmed the presence of a right parotid mass but showed no cervical lymphadenopathy. PET, octreotide, and chest CT scans showed no lesions. Results The patient was managed surgically with a superficial parotidectomy and right level II-IV selective neck dissection. Final pathology confirmed a diagnosis of metastatic medullary thyroid carcinoma in the parotid gland; no tumor was present in the contents of the right neck dissection. One year from the time of surgery she remained free of clinical disease. Conclusions To our knowledge this is the second reported case of metastatic medullary thyroid carcinoma to the parotid gland. Knowledge of this malignancy's potential for unusual and aggressive patterns of spread is essential to ensuring early identification of recurrent disease.