Slow-growing painless lump in the parotid
45-year-old female
§Chief complaint
Painless lump in front of the right ear enlarging over 3 years
§Medical & dental history
- 01No systemic disease, no radiation exposure
- 02Nil relevant
§Clinical examination
- 01Firm, mobile, non-tender 30 mm nodule in the superficial lobe of the right parotid
- 02Facial nerve function intact (House-Brackmann I)
- 03Overlying skin normal, no cervical lymphadenopathy
- 04Stensen duct orifice healthy with clear saliva
§ figuresFigures (2)
Fig. 1Micrograph of Pleomorphic Adenoma of Salivary gland. The section shows a cellular area interspersed with islands of lighter stained bluish myxoid tissue. The cellular area is the epithelial element and is composed of cel
“Pleomorphic Adenoma Salivary gland 10x” · Calicut Medical College · CC BY-SA 4.0 · Wikimedia Commons
Fig. 2Micrograph of a pleomorphic adenoma. Pap stain. See also Image:Adenoid cystic carcinoma cytology.jpg
“Pleomorphic adenoma - cytology” · Nephron · CC BY-SA 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Pleomorphic Adenoma figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Pleomorphic adenoma of the superficial lobe of the right parotid gland
Painless, slow growth over years in a mobile superficial-lobe mass with intact facial nerve function is characteristic. Facial weakness, pain, fixation or rapid growth would shift the diagnosis towards malignancy.
§Investigations
- 01Ultrasound-guided fine needle aspiration cytology — epithelial and myoepithelial cells in a chondromyxoid stroma
- 02MRI — well-defined lobulated lesion, high T2 signal, superficial lobe, no deep extension
- 03Facial nerve function documented pre-operatively
§Treatment plan
- 01Superficial (partial) parotidectomy with facial nerve preservation
- 02Never enucleate — capsular pseudopodia cause recurrence
- 03Counsel about Frey syndrome, facial weakness and sensory loss over the earlobe
§Surgical procedure
- 01Modified Blair incision, skin flap raised
- 02Facial nerve identified at the tragal pointer and tympanomastoid suture, branches dissected
- 03Tumour excised with a cuff of normal gland; nerve monitor used throughout
§Histopathology report
Well-circumscribed encapsulated tumour with epithelial and myoepithelial cells arranged in ducts and sheets within a chondromyxoid stroma. Capsule intact with focal pseudopodia. No malignant change. Pleomorphic adenoma.
§Follow-up & outcome
- 01Transient marginal mandibular weakness recovered by 8 weeks
- 02Mild Frey syndrome managed with topical antiperspirant
- 03No recurrence at 3 years; long-term follow-up planned
§Clinical pearls / learning points
- 01Enucleation of a pleomorphic adenoma has an unacceptably high recurrence rate — always take a cuff of gland.
- 02Long-standing tumours can undergo carcinoma ex pleomorphic adenoma; sudden growth or pain is a red flag.
- 03FNAC is safe in the parotid and does not seed tumour.
§References
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
§Similar cases
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