Parotid metastasis as the first presentation of papillary thyroid carcinoma

Parotid metastasis originated from papillary thyroid carcinoma is extremely rare, especially as the first presentation of the disease. We present a 70-year-old man with a history of painless swelling in the right side of the neck. He was evaluated for parotid tumor and histopathologic examination revealed a poorly differentiated carcinoma in the parotid gland with suspicion of thyroid origin. The thyroid was examined and a small nodule was palpable in the right lobe of the thyroid that was found to be dedifferentiated papillary thyroid carcinoma upon total thyroidectomy. He received 5.5GBq of 131I and post-ablation whole body iodine scan showed thyroid remnant, cervical lymph node metastasis, lung and pericardial metastases and pleural effusion. He succumbed to his disease 8 months after diagnosis despite further treatments efforts including chemoradiation.