Aggressive metastatic parotid squamous cell carcinoma with pulmonary, cerebral, and hepatic metastases: A radiologic case report

Parotid gland malignancies are rare and represent less than 5% of all head and neck cancers. Squamous cell carcinoma of the parotid gland is an uncommon subtype and is often associated with aggressive clinical behavior. While regional lymphatic spread is common, distant metastases to organs such as the lungs, brain, and liver are rare but indicate advanced disease and poor prognosis. We report a 60-year-old male with primary right parotid squamous cell carcinoma who initially presented with facial nerve paralysis and locally advanced infiltrative disease requiring debulking parotidectomy followed by chemoradiotherapy. Despite multimodal treatment, the patient developed progressive metastatic disease with respiratory symptoms, ocular pain, and worsening clinical status. Computed tomography imaging revealed extensive metastatic involvement including multiple bilateral pulmonary nodules with a dominant left perihilar mass, multiple cerebral metastases demonstrating ring-enhancing lesions with marked surrounding vasogenic edema, pleural metastatic involvement, and multiple hepatic hypodense lesions. An incidental left thyroid lobe nodule was also identified and subsequent fine-needle aspiration cytology confirmed benign colloid goiter. The patient received palliative chemotherapy with carboplatin and paclitaxel alongside supportive therapy. This case highlights the aggressive metastatic potential of parotid squamous cell carcinoma, the possibility of progressive systemic dissemination despite multimodal therapy, and the importance of comprehensive imaging in detecting disease progression and guiding management.