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Clinical Challenge
May 14, 2020

Slow-Growing Painless Parotid Nodule in a Woman in Her 40s

Author Affiliations
  • 1Section of Otorhinolaryngology, Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
  • 2Azienda USL Toscana Centro, Department of Otorhinolaryngology–Head & Neck Surgery, “Nuovo Santo Stefano” Civil Hospital, Prato, Italy
JAMA Otolaryngol Head Neck Surg. 2020;146(7):665-666. doi:10.1001/jamaoto.2020.0675

A 44-year-old woman presented with an asymptomatic enlarging right parotid mass of about 6 years’ duration. She had no prior medical or surgical history and took no medications. Ultrasonography demonstrated a solid and hypoechoic mass, 1.5 × 1.0 × 0.9 cm, in the inferior right parotid gland with minimal vascularity and without extraparotid extension. No lymph node abnormality was observed. Fine-needle aspiration was performed, and the smear was extremely cellular and showed sheets and clusters of bland polygonal epithelial cells admixed with bright pink filamentous matrix. Because of the size and location, extracapsular dissection II was carried out.1 The final pathology of the lesion showed histologic findings compatible with salivary gland carcinoma, with microcystic and papillary architecture (Figure, A and B). Abundant bubbly secretion was present within these microcystic spaces, and this material was positive for periodic acid–Schiff (Figure, C). Immunohistochemically, there was positivity for epithelial membrane antigen, cytokeratin (CK) 7 and CK19, S100 protein, and gross cystic disease fluid protein 15 (GCDFP-15). Stains for gastrointestinal stromal tumors 1 (DOG1) and p63 were negative. The tumor appeared to be contained within the surgical excision margins. There was perineural invasion without evidence of neoplastic emboli in the peritumoral lymphovascular spaces. The patient underwent a right parotidectomy I to IV1 and a level II superselective neck dissection.

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