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Parotid Mass in an 81-Year-Old Woman

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

An 81-year-old woman presented with a 3-month history of a slow-growing mass in her left cheek. She denied having any symptoms, tenderness, numbness, or facial nerve weakness. Physical examination revealed a mass in the buccinator space that was smooth, was nontender to palpation, and had no overlying cutaneous changes. A contrast-enhanced maxillofacial computed tomography scan demonstrated a 1.8 × 1.8 × 1.9-cm rounded, well-circumscribed lesion at the anterior aspect of the left masticator space (Figure 1). The mass was abutting the parotid duct, which did not appear dilated, and appeared to have a peripheral rim of hyperenhancing soft tissue with a central cystic/necrotic component. Results of ultrasound-guided fine-needle aspiration revealed rare epithelial cells with degenerative changes and inflammatory cells present. Findings from a core biopsy demonstrated a spindle cell neoplasm of uncertain origin. On immunostaining, spindle cells were CK8/18, S100, and SOX10 negative; myosin and smooth muscle actin (SMA) negative; and CD31 negative. However, STAT6 staining was diffusely positive.

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An 81-year-old woman presented with a 3-month history of a slow-growing mass in her left cheek. She denied having any symptoms, tenderness, numbness, or facial nerve weakness. Physical examination revealed a mass in the buccinator space that was smooth, was nontender to palpation, and had no overlying cutaneous changes. A contrast-enhanced maxillofacial computed tomography scan demonstrated a 1.8 × 1.8 × 1.9-cm rounded, well-circumscribed lesion at the anterior aspect of the left masticator space (Figure 1). The mass was abutting the parotid duct, which did not appear dilated, and appeared to have a peripheral rim of hyperenhancing soft tissue with a central cystic/necrotic component. Results of ultrasound-guided fine-needle aspiration revealed rare epithelial cells with degenerative changes and inflammatory cells present. Findings from a core biopsy demonstrated a spindle cell neoplasm of uncertain origin. On immunostaining, spindle cells were CK8/18, S100, and SOX10 negative; myosin and smooth muscle actin (SMA) negative; and CD31 negative. However, STAT6 staining was diffusely positive.

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Article Information

Corresponding Author: Karthik Rajasekaran, MD, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA 19107 (karthik.rajasekaran@pennmedicine.upenn.edu).

Published Online: August 11, 2022. doi:10.1001/jamaoto.2022.2249

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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