Nontender Mass Over the Right Parotid Area

Abstract

Aman inhis60spresentedwith a 1-year historyof apalpablepainless mass over the right parotid area. No facial pain, local tenderness, or facial palsy was noted. Physical examination revealed a 2.5 × 2.5-cm, freelymovable, elastic, nontendermassover the right parotid area. A head and neck fat-suppressed, postcontrast T1weighted imagedemonstrateda 1.7-cmmultilocularperipherallyenhancingmass in theanterior superficial lobeof therightparotidgland (Figure,A,arrowhead).Onclinicalandradiologicalgrounds, themost likely diagnosis was thought to be pleomorphic adenoma or Warthin tumor.Right superficial parotidectomywasperformed, and the entire lesion was surgically removedwithout complications. There was no recurrence at the 5-month follow-up. The specimen sent for pathological examination measured 3.6 × 3.0 × 1.5 cmandweighed6.9g.Grossly, therewasagray,wellcircumscribed tumor measuring 1.7 × 1.5 × 1.2 cm within the salivarygland.Onthecutsurface, thereweremultiplecysticspaces filled with light yellow and greasy materials in the tumor. Microscopically, the tumorwascomposedofvarious-sizedcysticepithelialnests of squamoid cells and sebaceous cells, admixedwith some salivary ducts in abackgroundofprominent lymphoid stroma (Figure,Band C).No cell atypia or desmoplastic stromawasnoted.Histiocytic aggregation and multinucleated giant cell reaction were also seen (Figure, D). What is your diagnosis? A B