Presentation
Lesion in salivary gland on ultrasound.
Patient Data
Exophytic left frontal skin lesion, with deep invasion into the subgaleal fat to the margin of the bone. No convincing evidence of cortical erosion or secondary bone changes. If there is clinical concern, MRI could better evaluate this. Small intraparotid node on the left within the superficial lobe. No cervical lymphadenopathy detected. Marked calcification demonstrated within the internal carotid arteries bilaterally. This could be further assessed with a community ultrasound if clinically indicated.
Case Discussion
MICROSCOPIC DESCRIPTION: 1. Sections show a well-demarcated, thinly encapsulated proliferation of oncocytic cells forming cysts and papillae within a stroma heavily infiltrated by a polymorphous population of bland lymphocytes. The lesion is fully excised. There is no evidence of malignancy. Adjacent salivary gland is unremarkable. 2. Sections show ulcerated sun damaged skin with attached subcutis and deep fascia. There is a poorly differentiated carcinoma extending from the ulcer base as solid sheets that invade subcuticular fat and skeletal muscle. The tumor does not invade through the deep fibrous fascia. Tumor cells are pleomorphic with large nucleoli containing prominent nucleoli and frequent mitotic figures. There is focal keratinization and occasional intercellular bridges. Tumor invades nerves but lymphovascular invasion is not seen. The tumor is well clear of the skin margins. Sections of bone show no evidence of tumor.
DIAGNOSIS:
1. Left parotidectomy: Warthin's tumor, completely excised.
2. Scalp lesion: Poorly differentiated squamous cell carcinoma invading the aponeurotic layer, not involving bone, well clear of skin and soft tissue margins.
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