Epithelial-myoepithelial carcinoma of the parotid: A needle in a haystack of carcinomas

Epithelial Myoepithelial Carcinoma (EMC) is an extremely rare biphasic malignant tumour accounting for less than one percent of all salivary gland neoplasms. EMC is usually seen in the parotid gland but has also been reported in the submandibular gland, minor salivary glands and extraoral sites. It is commonly seen during the sixth and seventh decade of life, occurring more frequently in females. Here, we present the case of a 48-year-old female with a prior history of parotid carcinoma treated by local excision at a hospital two months ago. She presented to our hospital for follow-up. On examination, there was a 3 cm scar near the pre-auricular region with a suture hatch-mark present. Histopathology revealed multiple whitish tissue bits, the largest measuring 1 × 0.8 × 0.5 cm. On microscopy, salivary gland tissue with an infiltrating neoplasm was noted. Magnetic resonance imaging (MRI) revealed no residual disease; however, enlarged lymph nodes were present on the right side, with the largest in level 1B. The patient was taken up for right superficial parotidectomy with excision of the previous scar and right selective neck dissection (Level I–IV). Post-operative histopathology revealed neither residual disease nor involvement of the 32 lymph nodes dissected. Following this, adjuvant radiation therapy was initiated to help sterilize the region. The patient recovered well and has been on regular follow-up for the past two years with no evidence of recurrence. This case highlights the importance of thorough evaluation and multidisciplinary management in rare salivary gland malignancies.