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

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

CT guided biopsy

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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