„Tubarial salivary glands“ – associated salivary gland carcinoma - A Case Report

Introduction Literature described a previously unnoticed bilateral approximately 4 cm measuring, (sero) mucosal salivary gland structur in the posterolateral nasopharynx draped primarily over the torus tubarius ("tubarial salivary gland"). PSMA-PET/CT visualized prostate-specific membrane antigen (PSMA) positiv tissue specific for major salivary glands. Immunhistochemie revealed predominant mucous acini, negativ amylase staining, presence of multiple draining ducts opening in the dorsolateral pharyngeal wall.

Clinical Aspect In the reported case, a mucoepidermoid tumor was described in the localization of the nasopharynx in 2000. In 2019 the patient presented with a recurrence of the mucoepidermoid carcinoma in the area of the tube ostium. The tumor was already growing into the tympanum via the Eustachian tube. In this case, surgical therapy was not possible. So definitive radiochemotherapy with 66 Gy ad 2.2 Gy single dose, the lymphatic nodes cervical on both sides with 54 Gy ad 2 Gy single dose and cisplatin weekly was performed. Due to tumor progress, salvage re-irradiation with carbon ions C12 total dose 60Gy ad 3Gy single dose was carried out.

Results Mucoepidermoid carcinomas are the most common malignant tumors of the major salivary glands. The described localization in the nasopharynx is atypical.

This case would be an indication that the "tubarial salivary gland", like the other large salivary glands in the head and neck area, can also develop malignant degeneration. The difficult operative accessibility of this localization requires an adaptation of the therapy concept, especially if the standard therapy fails. For such salivary gland tumors, in analogy to prostate carcinoma diagnosis and therapy, PSMA-labeled radionucleotides may be considered for therapy.

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Artikel online veröffentlicht:
13. Mai 2021