An Enlarging Parotid Mass in a 9-Year-Old Boy

A 9-year-old boy was referred to the pediatric otolaryngology clinic with a 3-month history of a left-sided neck mass. The mass had been slowly enlarging and he had been experiencing mild intermittent pain, but no additional symptoms were reported. His medical history was significant for several episodes of upper respiratory infection during the previous winter season, and he previously had an adenotonsillectomy several years prior and bilateral ear tubes placed 1 year before presentation. Physical examination showed a mildly tender, nonmobile, left parotid mass near the angle of the mandible with no overlying skin changes or drainage around the mass. There was no lymphadenopathy or other lesions noted in the neck area, and cranial nerve VII was fully intact. Ultrasonography results of the neck showed a left 1.5-cm preauricular nodular mass with internal and marginal vascularity. A neck magnetic resonance imaging study without contrast performed at an outside institution revealed the 1.5-cm heterogeneous intraparotid nodule that was predominantly isotense to glandular tissue on T1 images with vague hypointensity of a small irregular central region, as well as vague hyperintensity on T2 images. He subsequently underwent fine needle aspiration biopsy to assess the lesion, which demonstrated benign-appearing salivary gland tissue and clusters of myoepithelial cells. The mass was continuing to enlarge, and the patient’s pain was increasing in that area, so the decision was made to perform left superficial parotidectomy with preservation of the facial nerve. Intraoperatively, the left parotid mass was noted to be just below the lower branches of the facial nerve. The excised parotid mass was sent to the pathology department for analysis. Gross examination of the specimen demonstrated a 1.6 × 1.5 × 1.1–cm tan-white, well-circumscribed lesion that was partially surrounded by salivary gland parenchyma (Figure, A). Histologic examination of the nodule was performed (Figure, B and C).