Presentation
Painless swelling of the right parotid region.
Patient Data
There is a lobulated hypoechoic mass of the superficial lobe of the right parotid gland with central echogenic areas and ipsilateral submandibular lymph nodes enlargement.
On MRI sequences this soft tissue mass appears ill-defined measuring 38 x 35 x 24 mm of intermediate signal on T1, low signal on T2 with a central area of high signal on T1 and T2, attenuated on T1 fat sat, invading the platysma muscle and probably the masseter muscle. The postcontrast sequences show a heterogeneous enhancement.
Enlarged right upper cervical lymph node at level II showing heterogeneous enhancement and central necrosis, measuring 18 x 16 mm and 20 x 15 mm, as well as an intraparotid lymph node at the mandibular angle measuring 12 x 10 mm.
Normal appearance of the left parotid and submandibular glands.
Case Discussion
MRI features are most consistent with a malignant tumor of the right parotid gland invading the platysma muscle and probably the masseter muscle with upper cervical metastatic lymphadenopathy, which was pathologically proved as basal cell carcinoma.
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