Presentation
Bilateral parotid swelling
Patient Data
Diffuse homogeneous enlargement of both parotid gland is seen, particularly involving the superficial lobes. The adjacent masseter muscles also appear infiltrated.
Lobulated enlargement of right accessory parotid tissue in the right cheek is evident.
There is stranding in the adjacent fat around both parotid glands.
No evidence of calculi within the parotid glands.
Scattered mildly enlarged lymph nodes are seen along both cervical chains.
Evidence of prior paranasal sinus surgery.
Deformity of the medial aspect of both clavicles is thought to be post-traumatic in nature.
Impression:
Findings are highly suspicious for lymphomatous infiltration of both parotid glands and masseter muscles.
Differential diagnosis includes inflammatory conditions including sarcoid and Sjogren's disease. Other conditions such as lymphoepithelial cysts can be seen in HIV-positive patients.
FNA Histology
MICROSCOPIC DESCRIPTION:
The smears are mildly cellular and contain scattered macrophages and lymphoid cells presenting as dispersed cells and small clusters. Also present is a large cluster of epithelioid cells (granuloma) and scattered multinucleate giant cells throughout, in a background of blood. One small salivary gland acinus is included. No malignant cells are identified.
DIAGNOSIS:
FNA Left Parotid: Non-necrotizing granulomatous inflammation. Negative for malignancy. Features favor sarcoidosis.
Case Discussion
Key learning points:
1. Causes of bilateral parotid swelling include: acute and chronic infection including viral parotitis, lymphoma, Sjogren's and sarcoidosis.
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