Bilateral synchronous salivary gland tumors: report of three cases

Abstract

Background: Bilateral salivary gland tumors, both benign and malignant and synchronous or metachronous are very rare.

Case presentation: Here three cases of synchronous bilateral salivary gland tumors are described and discussed. Recognizing the entity is important for diagnostics and treatment planning. The first patient was a 56-year-old female with a bilateral parotid tumor, a malignant tumor, salivary duct carcinoma on the right side and a benign tumor, pleomorphic adenoma on the left side. The second patient was a 50-year old female with a bilateral benign parotid tumor, a pleomorphic adenoma. The third patient was a 51-year old female with a bilateral malignant tumor, an acinic cell carcinoma. Details on the diagnostic work-up, histopathology and treatment are described and discussed.

Conclusions: In the case of a unilateral salivary gland tumor, especially of the major glands, the contralateral gland is always included in the clinical and radiological (MRI) head and neck evaluation prior to surgery, to detect or exclude possible bilateral occurrence.

Keywords: Acinic cell carcinoma; Pleomorphic adenoma; Salivary duct carcinoma; Salivary gland tumor.

Fig. 1

Patient 1, MR image of bilateral salivary gland tumors in a 56-year old female. A-D show a right sided intraparotid lesion with irregular borders. A) Low signal on T1W (arrow), B) rich contrast enhancement on fat-suppressed TIW, C) low signal on T2W and D) restricted diffusion on the ADC-map, ADC = 1,11 × 10^− 3 mm²/s. E-H Left sided intraparotid lesion in the deep lobe. E) Low signal on T1W (arrow), F) rich contrast enhancement on fat-suppressed TIW, G) mixed signal on T2W (arrow) and H) moderate diffusion restriction on the ADC-map, ADC = 1,42 × 10^− 3 mm²/s

Fig. 2

Patient 1, A. salivary duct carcinoma, H&E; B salivary duct carcinoma, androgen receptor; C,D. pleomorphic adenoma, H&E;

Fig. 3

Patient 2, MR image of bilateral salivary gland tumours in a 50-year old female. A-D Demonstration of bilateral intraparotid lesions in the superficial portions. A) Low signal on T1W (arrows), B) rich, irregular contrast enhancement on fat-suppressed TIW (arrows), C) high signal on fat-suppressed T2W (arrows) and D) restricted diffusion of the left sided lesion on the ADC-map, ADC = 1,14 × 10^− 3 mm²/s

Fig. 4

Patient 2, A and B pleomorphic adenoma on the left side, H&E. Both pleomorphic adenomas had the same morphology

Fig. 5

Patient 3, MR image of bilateral salivary gland tumors in a 51-year old female. A-D Bilateral intraparotid lesions with irregular borders and similar textures on the left side in the deep lobe and on the right side in the superficial lobe (arrows). A) Low signal on T1W, B) heterogeneous contrast enhancement on fat-suppressed TIW, C) mixed signal on T2W and D) restricted diffusion on DWI; the ADC was bilaterally approximately 1,1 × 10^− 3 mm²/s (not shown). E) MR examination 15 months after surgery reveals a small subcutaneous recurrence (arrow) on the right side (fat-suppressed T1W with contrast enhancement)

Fig. 6

Patient 3, A and B. Overview and detail of acinic cell carcinoma on the left side, H&E;. C. Growth in the parotid lymph node on the right side. D. DOG-1 staining Both acinic cell carcinomas had the same morphology