Parapharyngeal space pleomorphic adenoma: a case report
Moncef Sellami1,2,&, Slim Charfi2,3
1Department of Otorhinolaryngology-Head and Neck Surgery Habib Bourguiba
University Hospital, Sfax, Tunisia, 2Sfax Medical School, University
of Sfax, Sfax, Tunisia, 3Department of Anatomopathology, Habib Bourguiba
University Hospital, Sfax, Tunisia
Moncef Sellami, Department of Otorhinolaryngology-Head and Neck Surgery Habib Bourguiba University Hospital, Sfax, Tunisia
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Parapharyngeal space masses account for 0.5% of all head and neck neoplasms.
Pleomorphic adenoma arising from the epithelial rests of the salivary tissue
in the parapharyngeal space is rare. Computed tomography (CT) and Magnetic
Resonance Imaging (MRI) allows a precise topographical localization of the
mass and the diagnosis of its nature in the majority of cases. Treatment of
parapharyngeal pleomorphic adenoma is primarily surgical excision. Tumor recurrence
occurs in less than 10% of patients.
We report a case of a 37-year-old man presented with dysphagia and disturbed
sleep during the night since last 6 months. The intraoral examination found
a bulging submucosal mass underneath the right oropharynx crossing the midline
the uvula to the left side.
CT and MRI scan revealed a heterogeneously enhancing tumor in the right parapharyngeal
space measuring 4.5.4 cm and causing luminal narrowing of the oropharynx.
The patient was operated through a transcervical approach to gain entry into
parapharyngeal space without osteotomy of the mandible. The tumor was completely
resected without rupture. The postoperative course was uneventful. Histopathological
examination confirmed the diagnosis of a pleomorphic adenoma.
At the 3 years follow-up the patient was free from disease.
Figure 1: (A) axial computed tomography shows a tumor measuring 4.5.4 cm in the right parapharyngeal space with significant mass effect (arrow); (B) axial T1-weighted MRI shows a heterogeneous, hypointense tumor in the right parapharyngeal space (arrow); (C) axial T2-weighted MRI shows a heterogeneous, hyperintense tumor (arrow); (D) histopathological examination revealed a mixed epithelial and myoepithelial cells in a myxoid stroma consistent with a pleomorphic adenoma (HE x 400)