Adenocystic carcinoma of parotid gland

Case contributed by Dr David Matthews

Presentation

3-4 cm lump below left ear just at angle of mandible.

Patient Data

Age: 45
Gender: Female

US Neck

Ultrasound

Heterogenous hypoechoic lesion within deep parotid. FNA (and subsequent core biopsy) performed. 

CT Neck

CT

Lobulated soft tissue mass within left parotid. This extends into the carotid space and is in contact with the ICA (for 50 % of circumference at level of soft palate) with compression of the IJV. Bony skull base intact. No lymphadenopathy.

MRI Neck

MRI

Diffuse infiltrative lesion in the left neck spanning the posterior aspect of the parotid gland, both superficial and deep lobes, carotid space and posterior cervical space/paravertebral region.

T1 hypointense, T2 mildly hyperintense with fairly uniform moderate enhancement. 

It virtually encases the styloid process and surrounds the posterior belly of digastric extending superiorly to fill the stylomastoid foramen and to the undersurface of the occipitomastoid suture. The internal jugular vein is encased and completely compressed. The mass contacts the internal carotid artery around half of its circumference at the level of the soft palate where the ICA lies medially.

It extends close to the vertebral artery just below the left transverse foramen of the atlas but does not directly contact the vessel. There is no definite pathological intracranial facial nerve enhancement.

Case Discussion

Histopathology: Adenoid cystic carcinoma of parotid gland.

Treatment : Radiotherapy. 

Remember perineural spread.

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