Dr. Pepe’s Diploma Casebook: Case 37 – SOLVED!

Diploma_casebook_case37

Dear friends,

Presenting images of a 65-year-old asymptomatic woman with left parotid mass.

Possible diagnosis:

1. Benign mixed tumor
2. Non-Hodgkin lymphoma
3. Carcinoma
4. None of the above

Clinical findings: a 65-year-old asymptomatic woman with left parotid mass

Clinical findings: a 65-year-old asymptomatic woman with left parotid mass

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    13 Responses to : Dr. Pepe’s Diploma Casebook: Case 37 – SOLVED!

    1. Albert says:

      T2 hyperintense, enhancing left parotid lesion. It is well defined and with lobulated margins.

      The main differential in a parotid mass would be Pleomorphic adenoma (benign mixed tumor) and Warthin tumor in the benign side and Mucoepidermoid Carcinoma and Cilindroma (adenoid cystic carcinoma in the malignant side. Other possible masses include lymphoma, adenopathies, cystic lymphoepitelial lesions in HIV, mets -melanoma and branchial cleft cyst (1st branchial cleft). Also inflammatory and systemic processes can afect more diffusley theses glands.

      As general features, benign lesions are usually hyperintense in T2 WI and malignant processes tend to be hypointense in T2 WI, anyway that is not always true and some pleomorphic adenomas appear hypointense in T2 and some mucoepidermoid carcinomas appear hyperintense. Cilindroma is usually ill defnied and spiculated and it characteristically spread along cranial nerves. Mucoepidermoid carcinoma tend to be encapsulated, but usually big lesions and is described to affect more freuqnetly the deep lobe of the parotid. Lymphoma can be multifocall and usually does not enahnces this avidly. You have to think in Warthin when you are in front of a cyst-like lesion with enhancing septa and when u are in front of bilateral partoid masses, it is described to have non-lobulated margins ans elipsoidal shape. I wouldn’t consider other processes.

      Summarising, the most probable diagnosis would be for me by far PLEOMORPHIC ADENOMA.

    2. Ricardo Macareno says:

      Well-circumscribed mass is seen hypointense on T1W, hyperintense on FATSAT T2W and gadolinium-enhancing partially. No signs identify tissue infiltration neighborhood or local lymphadenopathy. Clinical data also go for benign (painless mass, no facial nerve involvement).
      The first diagnostic option is benign mixed tumor (pleomorphic adenoma).

    3. genchi bari italia says:

      T. misto od adenoma pleomorfo: agli US ed ECD ha aspetti caratteristici.Perchè non avete mostrato l’esame di primo approccio?

    4. Maria says:

      I agree with the pleomorfic adenoma. But I I would like to ask whether there is an another lesion at the posterior part of the right parotid?!

    5. Yp says:

      Pleomorphic adenoma

    6. Katerina says:

      I agree with Maria. I think that there are two lesions (one in each parotid gland) with the same MR characteristics (well-delineated masses with high signal in T2 and mild enhancement). Therefore, it could be bilateral Wharthin tumors or bilateral parotid lymph node enlargement due to skin, breast or lung carcinoma.

    7. gus says:

      Wharthin tumor – lymphoma
      ADC Maps?

    8. Azat Mikhaylov says:

      papillary cystadenoma lymphomatosum

    9. Pepe says:

      There is no lesion on the right parotid gland. A small lymph node separated from the gland is seen on the right side.

    10. Dr. Pepe says:

      There is no lesion on the right parotid. A small lymph node can be seen posterior to the right parotid.

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