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Clinical Challenge
October 2016

Infiltrative Right Parotid Mass With Lymphadenopathy

Author Affiliations
  • 1Texas A&M Health Science Center College of Medicine, Dallas
  • 2Department of Otolaryngology–Head and Neck Surgery, Baylor University Medical Center, Dallas, Texas
  • 3Department of Pathology, Baylor University Medical Center, Dallas, Texas

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Otolaryngol Head Neck Surg. 2016;142(10):1015-1016. doi:10.1001/jamaoto.2015.3959

A man in his 30s from Burma presented with a slow-growing right facial mass after resection 14 years prior. His medical history was significant for atopic dermatitis. He had no previous treatment with radiation or immunosuppressive medications. On examination, he had a surgical scar, an indurated malformed auricle, a superficial right parotid mass infiltrating the overlying skin, and a 1.5-cm postauricular node. Facial nerve function was normal. Postgadolinium magnetic resonance imaging (MRI) showed infiltration into the cartilaginous tissue of the external auditory canal and ipsilateral cervical adenopathy (Figure, A). Serum laboratory test results revealed an eosinophil count of 1109 cells/μL (reference range, 50-350 cells/μL), and an IgE level of 5.44 μg/mL (reference range, <0.27 μg/mL). Flow cytometry was negative for signs of leukemia or lymphoma. Fine-needle aspiration (FNA) revealed a mixed leukocyte population and was negative for malignant neoplasm, necrosis, and granulomatous disease. An excisional biopsy of the postauricular node was performed. Within the lymphoid tissue there was prominent follicular hyperplasia and a diffuse infiltrate of eosinophils (Figure, B). There was an increase in small blood vessels within the germinal centers. While some follicles had well-defined mantle zones, others demonstrated a spectrum of lytic changes accompanied by intrafollicular infiltrates of eosinophils (Figure, C). The stroma was densely fibrotic with perivascular sclerosis (Figure, D).

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