8 Kirklin JW, McDonald JR, Harrington SW, New GB. Parotid tumors, histopathology, clinical behavior and end results. Surg. Gynec Obstet 1951;92:721-33.
Journal of the Royal Society of Medicine Volume 83 March 1990
Endobronchial metastasis from parotid gland tumour
191
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R Breuer MD Pulmonary Unit, Hadassah University Hospital, POB 12000, IL-91120 Jerusalem, Israel
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Keywords: endobronchial metastasis; parotid gland; tumour
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The lungs are the most frequent site for distant metastases from parotid gland neoplasms1. We wish to report on a patient who had adenocarcinoma of the parotid gland with endobronchial metastasis.
Case report A 43-year-old nonsmoking man underwent a right parotidectomy for adenocarcinoma with overlying skin involvement in March 1986. Chest X-ray, barium enema, upper gastrointestinal examinations and liver scan performed before the resection were unremarkable. The patient received radiotherapy to the tumour bed and was followed-up at regular intervals. Head and neck CT scans performed 5 months after the resection failed to demonstrate any evidence of tumour recurrence. The patient did well for 9 months, when he presented with a 5-week history of productive cough and fever unresponsive to antibiotic therapy. Chest X-ray revealed a perihilar mass in the left and a peripheral coin lesion in right lung field (Figure 1). Fiberoptic bronchoscopy was done and showed a protruding shiny friable mucosa in the anterior segment of left upper lobe. No other endobronchial lesions were seen in the rest of the right and left bronchial trees. Biopsies of the abnormal mucosa revealed adenocarcinoma composed of atypical epithelial cells with large nuclei and prominent nucleoli, arranged in alveolar groups, and several mitotic figures. The histology was consistent with a previous primary in the parotid gland. Discussion Pulmonary metastases are found in approximately 30% of all patients who die from malignancy2. Endobronchial metastases are rare. In a retrospective review of 1359 consecutive autopsies, Braman and Whitcomb3 showed metastatic involvement of major airways in only 2% of patients who died of solid tumours of various tissues. The most common extrathoracic tumours associated with metastatic involvement of the endobronchial tree are carcinomas of the breast4-6, kidney3 and colorectum34. Endobronchial metastases from melanoma3'4, seminoma3, sarcomas of various origins4, schwannoma5 and carcinomas of thyroid3, cervix and uterus6, prostate6, adrenal7, penis4, larynx4 and bladder4 have also been reported. We have presented a patient with a chief complaint of productive cough produced by endobronchial metastasis from parotid gland adenocarcinoma. His complaints and the changes on the X-rays were similar to those produced by endobronchial metastases from other primary neoplasms3.
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Figure 1. Photograph of a P-A chest X-ray showing a perihilar infiltrate in the left and a coin lesion in the right lung
Parotid gland neoplasms metastasize to the lung not infrequently. Spiro et all reported 6% incidence of metastases to the lung from histologically heterogenous parotid gland tumours. Cylindromas and adenocarcinomas metastasize to the lung in 29% and 13%, respectively8. The lesions usually have a 'cannon ball' appearance on X-rays. Their growth rate is usually slow, allowing for long-term
survival9"10. Although the majority of endobronchial neoplasms are bronchogenic carcinomas, it is essential to keep in mind that endobronchial tumours may have disseminated from primary neoplasms elsewhere. This may represent the first report of endobronchial metastasis from parotid gland adenocarcinoma. Perhaps now, with the widespread use of fiberoptic bronchoscopy, endobronchial metastases from parotid neoplasms will be recognized more frequently. References 1 Spiro RH, Huvos AG, Strong EW. Cancer of the parotid gland. A clinico-pathologic study of 288 primary cases. Am J Surg 1975;130:452-9 2 Mountain CF. Surgical management of pulmonary metastases. Postgrad Med 1970;48:128-32 3 Braman SS, Whitcomb ME. Endobronchial metastasis. Arch Intern Med 1975;135:543-7 4 Shepherd MP. Endobronchial metastatic disease. Thorax 1982; 37:362-5 5 Amin R. Endobronchial metastasis from malignant schwannoma. Br J Radiol 1984;57:528-30 6 Lalli C, Gogia H, Raju L: Multiple endobronchial metastases from carcinoma of prostrate. Urology 1983;21:164-5 7 McCartney AC. Metastatic adrenal carcinoma masquerading as primary bronchial carcinoma: report of two cases. Thorax 1984;39:315-16 8 Kirklin JW, McDonald JR, Harrington SW, New GB. Parotid tumors, histopathology, clinical behavior and end results. Surg Gynec Obstet 1951;92:721-33 9 Lampe I, Zatzkin H. Pulmonary metastases of pseudoadenomatous basal-cell carcinoma (mucous and salivary gland tumor). Radiology 1949;53:379-85 10 Twardzik BG, Sklaroff DM. Growth analysis of pulmonary metastases from salivary gland tumoms. Am JRoentgenol 1976;123:493-9
(Accepted 1 February 1989)
Meeting reports Drug formularies Keywords: drug formulary; prescribing costs; drug and therapeutic committee
Drug formularies have a long history and are generally perceived as desirable in terms of education
and economy. However, they remain controversial because of the limits they impose on prescribing practice and because it remains unclear whether formularies yield any benefits for patients. The Forum on Clinical Pharmacology and Therapeutics considered these issues at the meeting 'Drug Formularies - the way forward' on 17 March 1989. It soon became apparent that formularies are in
0141-0768/90/ 030191-01/$02.00/0 © 1990 The Royal Society of Medicine
Based on meeting of Forum on Clinical Pharmacology and Therapeutics, 17 March 1989 0141-0768/90/ 030191-04/$02.00/0 © 1990 The Royal Society of Medicine
