Abordaje quirúrgico del carcinoma adenoide quístico de parótida localmente avanzado con metástasis pulmonar única: Experiencia de un caso en un centro de alta complejidad

Introduction. Adenoid cystic carcinoma is an extremely rare neoplasm, accounting for 1% of head and neck tumors. It is the most common malignant tumor of the major salivary glands. Clinical case. A 44-year-old male presented with a two-year history of trismus, accompanied by difficulty chewing and the appearance of a mass on the left side of the face. Computed tomography revealed an ill-defined mass involving the superficial and deep lobes of the left parotid gland, as well as a solid nodule in the upper lobe of the right lung. Biopsy of the parotid lesion confirmed adenoid cystic carcinoma. Results. The Thoracic Surgery Service performed a lobectomy with curative intent, and pathology reported metastatic involvement by adenoid cystic carcinoma. It was initially staged as a T4bN1M1 (Stage IVC) tumor. However, given the resected solitary pulmonary metastasis, the Head and Neck Surgery team performed a total parotidectomy, mandibulectomy, and modified radical neck dissection on the left side, a procedure completed with a flap for coverage by the Plastic Surgery team. Conclusions. Surgical management is the first-line treatment for parotid neoplasms, aiming to ensure better oncological outcomes and improved survival. Locally advanced parotid tumors require a multidisciplinary approach to ensure complete surgical resection with adequate oncological margins, followed by reconstruction to optimize functional outcomes. In this patient’s case, complete resection of the primary tumor and pulmonary metastasectomy were successfully achieved, resulting in a favorable therapeutic response.