Presentation
Deviation of the oropharynx as seen by the dentist
Patient Data
The typical appearance of a pleomorphic adenoma is demonstrated with a hyperintense signal on T2WI, lobulated contours, a high ADC value, and heterogeneous enhancement.
The lesion is located in the parapharyngeal space, although it would be difficult to determine with certainty that it does not arise from the deep lobe of the parotid gland.
Because these masses do not cause any cosmetic abnormalities or visual lumps, they are often quite large by the time they are seen on imaging studies.
Case Discussion
Histopathology
Macroscopic description: (a) left parapharyngeal mass; an irregular, slightly purple-tinge multi-nodular structure measuring 40 x 33 mm and up to 25 mm.
On sectioning, it is firm, white, slightly semi-translucent, and has a slightly whorled appearance.
There is no obvious neurosis seen; an old hemorrhage was identified.
Microscopic description: (a) sections show salivary gland tissue with a relatively well-circumscribed tumor that includes both epithelial and predominantly stromal elements. The epithelial element consists largely of interconnected tubular structures and, to a lesser degree, glandular structures with an associated myoepithelial layer. The epithelial cells are monomorphous, with rounded nuclei with open chromatin, conspicuous nuclei, and a small amount of ampophilic cytoplasm. The stromal component is rather paucicellular and chondromyxoid. Mitotic activity is not seen. There are no features of atypia or malignancy.
Diagnosis: (a) left parapharyngeal mass; features in keeping with pleomorphic adenoma
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