Recurrent pleomorphic adenoma (CT-guided biopsy)

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient had a history of pleomorphic adenoma resected and presented with pharyngeal swelling.

Patient Data

Age: 50
Gender: Male

MRI

Modality: MRI

There is a mass centered in the right parapharyngeal space with displacement of pterygoid muscles and narrowing of the oropharynx. T2 hyperintensity typical for pleomorphic adenoma is shown.

CT guided biopsy

Modality: CT

CT demonstrates the mass seen on MRI as a hypodense lesion. Contrast delineates vascular structures.

Using an infrazygomatic approach, the lesion was biopsied with a 18G Temno biopsy system (coaxial). The procedure was carried out under general anaesthetic for two reasons: 1. for complete immobility; 2. safety intubation in case of haemorrhage and airway occlusion.

Case Discussion

Pleomorphic adenomas have a delicate pseudocapsule with microscopic extensions beyond, predisposing to recurrence. In this case, the recurrent tumour appears to be expraparotid, extending into the parapharyngeal space.

Recurrence is a risk factor for malignant transformation.

Various biopsy techniques are possible, with an infrazygomatic approach shown here.

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Case Information

rID: 25198
Case created: 12th Oct 2013
Last edited: 14th Jan 2016
System: Head & Neck
Inclusion in quiz mode: Included

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