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.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 3
- L3 · Systematic review — 1
- L6 · Textbook — 3
2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Skálová A, Hyrcza MD, Leivo I. Head and neck pathology · 2022 · 16(1):40-53
Summary of changes to salivary gland tumours in the 5th edition WHO classification of head and neck tumours.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Systematic Reviews & Meta-Analyses
Salzano G, Scocca V, Troise S et al.. Medical sciences (Basel, Switzerland) · 2025 · 13(3)
Comparative review of extracapsular dissection versus superficial parotidectomy outcomes.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
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