(366) Parotid Nodal Metastases from HPV-mediated Oropharyngeal Squamous Cell Carcinoma

Introduction: We encountered three cases of human papilloma virus (HPV)-mediated oropharyngeal squamous cell carcinoma (OPSCC) with parotid nodal metastasis, which has yet to be described in the literature.

Methods: Patients were identified retrospectively based on unanticipated spread to the parotid lymph nodes. A thorough review of articles referencing atypical metastases in OPSCC was conducted in PUBMED.

Results: The first case involved an 82-year-old female with an invasive right parotid mass. Following parotidectomy and neck dissection, immunohistochemistry demonstrated p16 and HPV positivity. Post-operative positron emission tomography (PET) scan identified primary disease of the base of tongue. Secondly, a 65-year-old male with known history of HPV+ OPSCC treated with chemoradiation presented with new-onset cervical lymphadenopathy. PET scan and pathology following salvage neck dissection revealed recurrent, metastatic HPV-mediated disease to the parotid lymph nodes. Lastly, a 47-year-old male with a history of HPV+ OPSCC of the left tonsil treated with radical tonsillectomy and neck dissection presented with a new submandibular mass. Subsequent biopsy and imaging confirmed recurrent disease with metastasis to the parotid gland. All three patients developed distant metastatic disease. Two patients are alive with disease on immunotherapy, and one patient died of his disease.

Conclusions: Although rare, atypical spread to the parotid nodes can occur in HPV-mediated OPSCC, which may be a predictor of aggressive disease.