Resident's Page: Pathology Forum
June 1999

Pathologic Quiz Case 1

Author Affiliations



Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

Arch Otolaryngol Head Neck Surg. 1999;125(6):694-697. doi:

The recognition of a parapharyngeal space mass can be challenging because these lesions cause few, if any, symptoms early in their clinical course. Most tumors arising in this site present in a nonspecific fashion, often attaining a large size prior to diagnosis. Masses in the parapharyngeal space most commonly present with displacement of the lateral oropharynx medially and as a palpable contiguous mass beneath the angle of the mandible.1,2 However, owing to their location beneath the ramus of the mandible, the parotid gland, and the sternocleidomastoid muscle, masses in this area generally must be at least 2.5 to 3.0 cm in diameter before a medial bulge of the lateral pharyngeal wall can be seen. Ulceration of the overlying pharyngeal mucosa is usually not present.3 Although most parapharyngeal tumors are clinically silent during their early stages, patients may complain of dyspnea, dysphagia, trismus, or globus as the tumor enlarges.2 Rarely, patients may experience unilateral hearing loss as a result of serous otitis media due to eustachian tube dysfunction.4 Impingement on cranial nerves IX through XII and the cervical sympathetic chain coursing through the parapharyngeal space may lead to corresponding neurological deficits (eg, Vernet syndrome and Horner syndrome).5 The incidence of lymph node involvement ranges from 7% to 16% for acinic cell carcinoma.6,7

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