Clear cell carcinoma is a rare form of salivary gland tumor, most commonly affecting the palate and tongue. We present a patient with cervical lymph node metastasis 28 years after treatment for clear cell salivary carcinoma of the soft palate.

A new neck mass was found in a 69-yearold man with a remote history of clear cell salivary carcinoma of the soft palate. Fine-needle aspiration biopsy demonstrated no evidence of malignancy; however, excisional biopsy revealed carcinoma. Neck dissection was performed and final pathologic review demonstrated clear cell salivary carcinoma metastatic to a cervical lymph node.

Clear cell salivary carcinoma may be less indolent than previously believed. Metastases to cervical lymph nodes and distant sites have been reported in one-fourth of patients and can occur many years after treatment. Immunohistochemical staining is a valuable adjunct for differentiating clear cell carcinoma from other neoplasms that demonstrate clear cell components.

This rare case of late neck metastasis after clear cell salivary carcinoma of the soft palate highlights the need for high clinical suspicion of recurrence many years after treatment and indicates the role of neck dissection for diagnosis and treatment in patients with possible nodal spread.