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Comprehensive management of submandibular salivary duct carcinoma with unilateral axillary lymph node metastasis: a
Ning Zhu1, Guile Zhao2,3, Qi Han2,4
1Department of Oral and Maxillofacial Surgery, Daqing Oil Field General Hospital, Daqing, China.
Background:
Salivary duct carcinoma (SDC) is a rare and aggressive malignancy of the salivary glands, most commonly originating in the parotid gland and less frequently in the submandibular gland. Isolated axillary lymph node metastasis is extremely uncommon, and its clinical characteristics and optimal management remain unclear.
Case Presentation:
A 69-year-old man presented with a painless swelling in the left submandibular region. Imaging revealed a submandibular mass with ipsilateral cervical and axillary lymphadenopathy, without distant metastasis. Fine-needle aspiration cytology (FNA cytology) supported the diagnosis of salivary duct carcinoma. The patient underwent left submandibular gland resection with radical neck and axillary lymph node dissection. Histopathology revealed poorly differentiated SDC with metastatic deposits in both cervical and axillary nodes. Genetic testing identified HER2 (ERBB2) gene amplification. Postoperatively, the patient received four cycles of combination chemotherapy with nab-paclitaxel and trastuzumab, followed by one year of trastuzumab maintenance therapy. The treatment was well tolerated, and imaging follow-up at 3, 6, and 12 months showed no recurrence or distant metastasis.
Conclusion:
Axillary lymph node involvement in submandibular salivary duct carcinoma is extremely rare. To our knowledge, this is the first reported case of isolated unilateral axillary nodal metastasis in the absence of other distant metastases. This case suggests that axillary involvement may represent regional rather than distant spread, and curative surgery remains feasible after comprehensive evaluation. However, this interpretation should be made cautiously because it is based on a single case. Combined chemotherapy and HER2-targeted therapy may achieve favorable short-term outcomes with good tolerability. The accumulation of similar cases is needed to clarify the staging and guide optimal management of such atypical metastases.
