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Clinical Challenge
June 2017

Slowly Enlarging Neck Mass

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa
JAMA Otolaryngol Head Neck Surg. 2017;143(6):629-630. doi:10.1001/jamaoto.2016.3707

A white man in his 40s presented with a slowly enlarging, nontender, left-sided neck mass at the angle of the mandible that had been present for 4 years. Fine-needle aspiration was performed twice, each time with inconclusive results. Computed tomography (CT) of the neck showed a heterogeneous mass located immediately adjacent to the tail of the left parotid. No other masses were noted. He underwent a left superficial parotidectomy with en bloc removal of the mass. Pathologic findings revealed a 3.0 × 2.9 × 1.9-cm, encapsulated, tan, soft nodule within the specimen. The nodule had peripheral cystic spaces as well as focal areas of hemorrhage and a 0.5 × 0.4 × 0.4-cm area of calcification within the periphery. The entire tumor was confined within a periparotid lymph node, almost completely replacing it. Histopathologic findings (Figure) showed a mixture of dark, granular, basophilic acinar cells and eosinophilic intercalated ductal cells. The acinar cells contained periodic acid–Schiff–positive, diastase-resistant intracytoplasmic granules, whereas the ductal cells were both fusiform and cuboidal forming small ductlike structures. The neoplasm also exhibited focal areas of hyaline sclerosis without necrosis.