Case report of a patient with microcystic adnexal carcinoma of the parotid region

Microcystic adnexal carcinomas (MAC) constitute a rare entity of malignant skin tumors of the head and neck region that grow in a locally infiltrative manner but usually do not metastasize. There is a paucity of studies on this entity.

We demonstrate the case of a 52-year-old patient with a MAC of the left parotid region. The patient presented with swelling and itching caudal to the left lobule for three years. There was no paresis of the facial nerve. An MRI already performed off-site and specimen collection showed nonspecific changes. We performed a follow-up MRI, where a size progression of the change in the parotid region, previously diagnosed as a post-inflammatory infiltrate, was revealed. Surgical exploration with deep sampling was therefore performed.

Histologically, a MAC could be detected. According to current studies, tumor resection was indicated. Radical left parotidectomy with ablation of the auricle and partial petrosectomy was performed. Intraoperatively, the tumor presented locally aggressive-destructive and with pronounced nerve sheath infiltration. In a second operation, histological examination during surgery with reconstruction of the facial nerve and defect coverage using a supraclavicular island flap (SCAIF) was performed.

Despite resection R0 of the tumor, the recommendation for adjuvant radiotherapy was made after detailed consultation in the interdisciplinary tumor conference, with the aim to improve local tumor control.

MAC is a locally aggressive tumor with microscopic extension often far beyond what can be clinically appreciated. To date, total microscopic surgical excision has been the procedure of choice. Adjuvant RT may be considered.

Publication History

Article published online:
24 May 2022