Presentation
Left facial nerve palsy and multiple palpable cervical masses.
Patient Data
Abnormal large mass at the region of the left parotid gland with heterogeneous pattern of enhancement. It infiltrates the left parapharyngeal space, left Eustachian tube, left fossa of Rosenmuller as well as left longus capitis muscle. The lesion extends upwards and infiltrates the left infratemporal fossa and both pterygoid muscles. Evidence of erosion of the left mandibular ramus (bone window).
Enlarged right lateral deep cervical LN (level II) with heterogeneous pattern of enhancement. Multiple enlarged LNs are seen on the left side, the largest (level III) lies just beneath the left sternocleidomastoid muscle with possible involvement of the muscle that appears enlarged and heterogeneous.
Both internal and external carotid arteries are seen traversing the mass. The left internal jugular vein is no further demonstrated above the level of the true vocal cords. Concomitant atrophy of the left masseter muscle is noted as well.
Case Discussion
Biopsy reveals high grade mucoepidermoid carcinoma of the parotid gland.
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