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Clinical Challenge
August 2016

Unilateral Cystic Parotid Lesion in a Middle-Aged Man

Author Affiliations
  • 1New York University School of Medicine, New York
  • 2Department of Otolaryngology, New York University Medical Center, New York
  • 3Department of Pathology, New York University Medical Center, New York
JAMA Otolaryngol Head Neck Surg. 2016;142(8):797-798. doi:10.1001/jamaoto.2015.3985

A nonsmoking man in his 40s with hypertension and diabetes mellitus type 2 reported a 1-year history of a mass in the region of his left parotid gland that had been steadily increasing in size. There was no associated pain, facial numbness, or weakness. Multiple aspirations of the mass had been performed, which would temporarily decrease the size. On examination, the mass was freely mobile, the facial nerve was intact bilaterally, and there was no palpable lymphadenopathy. Results from fine-needle aspiration 6 months prior to presentation were consistent with a cystic oncocytic neoplasm, and computed tomography revealed a 1.9 × 1.5 × 2.1-cm, well-circumscribed ovoid lesion in the anterior aspect of the superficial lobe of the left parotid gland (Figure, A). A left superficial parotidectomy was performed under general anesthesia with facial nerve dissection and facial nerve monitoring. No complications were encountered. Postoperative pathological analysis revealed a cystic, cribriform, papillary neoplastic growth with low-grade cytologic features and nearly complete myoepithelial rims (Figure, B and C). Calponin and p63 staining were positive in the myoepithelium surrounding the tumor nests (Figure, D), S-100 was positive within the tumor, and the Ki-67 rate was approximately 5%. Extracellular mucin and occasional mucous cells were also noted. Margins were clear, and there was no evidence of perineural spread or lymphovascular invasion. The patient tolerated the procedure well, recovered appropriately, and was free of complications at his first follow-up appointment.

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