A 25-year-old woman, 21 weeks pregnant, came to the service of oral and maxillofacial surgery for presenting a tumor at the right retroauricular level of 3 months of evolution and rapid growth.
On examination, the lesion was hard and mobile, approximately 5 cm in diameter, painful to palpation, with peritumoral erythema.
The facial nerve was not affected.
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A new needle aspiration biopsy (FNAB) was performed, which indicates the presence of a malignant mesenchymal neoplasm of cells, fusiforms of non-malignant appearance. The pathologist ruled out the possibility of a malignant tumor due to the nositis.
With the clinical data obtained, along with the rapid evolution of the lesion, the anatomopathological study and the realization of an MRI as an imaging test, and consultation with the gynecologic service after the end of pregnancy in our hospital took place.
We performed a preauricular incision, with cervical extension around the tumor, dissecting by planes to locate the main trunk of the facial nerve, which we could respect.
The lesion was resected up to the loop of the mastoid and separated from it. The intervened area was replaced by a free skin graft.
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After surgery, the pregnancy was uneventful for both the mother and the fetus, with no evidence of facial nerve involvement at present, or recurrence of the lesion.
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The definitive pathological diagnosis of the surgical specimen reported that we were in the presence of a mesenchymal neoplasm composed of spindle cells with fibroblastic habit, without nuclear pleomorphism or hyperchromasia, with mitotic index.
Cellular zones with a round pattern are visualized, with frequent multinucleated cells of the osteoclastic type.
The neoplasm is not localized in the deep portion of the parotid gland but is not encapsulated.
The lesion is diagnosed as spindle cell mesenchymal neoplasm fibrofibrofibri compatible with nodular fasciitis.
