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Clinical Problem Solving: Pathology
January 18, 2010

Pathology Quiz Case 1

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Otolaryngol Head Neck Surg. 2010;136(1):100. doi:10.1001/archoto.2009.180-a

A 75-year-old man presented with an 8-week history of a right parotid mass. The lesion was associated with ipsilateral otalgia and 1 episode of midfacial twitching. Physical examination revealed a small mass at the angle of the mandible, with facial nerve function grossly intact. Computed tomography revealed a peripherally enhancing, centrally necrotic mass within the deep parotid lobe. Axial T1-weighted magnetic resonance imaging demonstrated a right-sided deep parotid mass measuring 3.3 × 3.4 × 4.6 cm (Figure 1). Ultrasound-guided fine-needle aspiration showed a “few clusters of epithelioid cells with nuclear enlargement and nuclear crowding . . . insufficient for a definite diagnosis.” The patient underwent a right total parotidectomy. The mass was identified in the region of the stylomastoid foramen and completely dissected from the mastoid tip, styloid process, mandible, and main trunk of the facial nerve. Frozen-section analysis revealed a low-grade basaloid neoplasm.