Presentation
Nodule left cheek. Palpable pea size.
Patient Data
Overlying the left masseter muscle is asymmetric soft tissue density. Within this anteriorly is a discrete hypodense nodule measuring 12 x 6 mm. Possible direct connection to the left parotid gland is seen. No cervical lymphadenopathy. Normal thyroid gland. Pharyngeal contours are normal. Lung apices are clear. No destructive bone lesion.
An initial ultrasound, there is a 13 mm well-circumscribed hypoechoic lesion superficial to the anterior aspect of the left masseter. This appears to arise within the anterior extent of a homogeneously hyperechoic structure consistent with an accessory parotid gland.
- blue arrow indicates the nodule, which on subsequent FNA was a pleomorphic adenoma
- yellow arrow indicates normal accessory parotid gland
- red arrow indicates normal parotid gland
The patient had a FNA of the nodule under ultrasound guidance.
Histopathology:
MICROSCOPIC DESCRIPTION: The smears contain abundant epithelial cells occurring singly, in groups and occasional loose tissue clusters, in a background of scattered myoepithelial cells and abundant chondromyxoid stroma. No malignant cells are identified.
DIAGNOSIS: Pleomorphic adenoma.
Case Discussion
Accessory parotid glands are common, occurring in ~40% of the popualtion. Tumors arising in accessory parotid glands are reported to account for ~5% (range 1-7.7%) of all parotid gland tumors, with pleomorphic adenoma being the most common type.