Presentation
This patient had a history of pleomorphic adenoma resected and presented with pharyngeal swelling.
Patient Data
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 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 anesthetic for two reasons: 1. for complete immobility; 2. safety intubation in case of hemorrhage and airway occlusion.
Case Discussion
Pleomorphic adenomas have a delicate pseudocapsule with microscopic extensions beyond, predisposing to recurrence. In this case, the recurrent tumor 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.