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Clinical Problem Solving: Pathology |

Pathology Quiz Case 3

Andrew G. Shuman, MD; Marc E. Nelson, MD; Raja Rabah, MD; Marc C. Thorne, MD
Arch Otolaryngol Head Neck Surg. 2011;137(4):412. doi:10.1001/archoto.2011.50-a.
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A healthy 11-year-old girl was referred with a gradually enlarging, asymptomatic facial mass. She had no history of infection, feline scratches, tuberculosis exposure, or prior lesions. A solitary, nontender, nonfluctuant mass was evident between the sternocleidomastoid muscle and the angle of the mandible. The overlying skin was normal. The findings of a complete head and neck examination, including cranial nerves, were otherwise normal.

Computed tomography revealed a 4-cm, hypodense, heterogeneous mass involving the left parotid gland, displacing the retromandibular vein laterally, and extending toward the parapharyngeal and prestyloid spaces, without significant enhancement (Figure 1). The results of fine-needle aspiration were nondiagnostic. A Gram stain and cultures were negative for organisms. The patient underwent a total parotidectomy with facial nerve preservation. A cystic mass in the deep lobe of the parotid gland was excised contiguously, with a solid component extending into the parapharyngeal space.

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