Presentation
Right cheek swelling associated with pain for 2 weeks.
Patient Data
Large lobulated heterogenous enhancing mass at right buccal space. Multiple areas of low attenuation which may represent collections or necrotic components. Posteriorly, this mass extends into the right masticator space with no clear fat plane to the right masseter muscle. The normal right buccinator muscle is not visualized as it is infiltrated by the mass. Laterally, this mass abuts the subcutaneous tissue and the skin. Medially, it involves the right sided buccal mucosa. The right retromolar trigone and alveolar mucosa do not appear involved.
Another smaller heterogenous enhancing lesion is seen at the buccal mucosa of upper lip. There appears to be an enhancing tract connecting these two lesions. The adjacent upper lip is infiltrated by this lesion.
No abnormal periosteal reaction, lytic lesion or bony erosion.
Bilateral parotid and submandibular glands are normal in configuration. Bilateral carotid artery and IJV are patent. Both parapharyngeal spaces and the fossa of Rosenmüller are clear.
Case Discussion
The right buccal and upper lip heterogenous enhancing lesions are in keeping with a minor salivary gland malignancy. This was biopsy-proven to be a moderately differentiated squamous cell carcinoma.