case_images: PMC11418345_01
case_images: Contrast CT: (a) enhancing soft tissue involving the left parotid with extension along the left sternocleidomastoid muscle and skin (green arrows); (b) one heterogeneously enhancing nodule over the left neck level II, suspected metastatic lymph node (green arrow); ((c) and (d)) two enhancing nodules (green arrows) over the left parotid gland, suspected metastases or reactive lymph nodes.
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case_images: CT scan showed some heterogeneously enhancing soft tissue involving the inferior pole of the left parotid gland with downward extension along the left sternocleidomastoid muscle (SCM) and regional skin (Figure 1(a) and (b)). Additionally, two enhancing nodules were noted within the left parotid gland, suspected to be metastases or reactive lymph nodes (Figure 1(c) and (d)).
case_images: (a) Left total parotidectomy and neck dissection were performed, and the left facial nerve and its branches (yellow arrows) were well preserved. (b) The sternocleidomastoid muscle rotation flap (yellow arrow) filled the defect after the parotidectomy.
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case_images: Subsequently, she underwent total parotidectomy and neck dissection (Left levels II-Va; Figure 2(a)). A SCM rotation flap was used to fill the resulting space for cosmetic purposes (Figure 2(b)).
case_images: Microscopic examination of the specimen of the parotid gland showed (a) multiple nodules; (b) stromal components containing myxoid areas (green arrow); ((c) and (d)) positive immunohistochemical staining for calponin and CK 14 respectively, indicating myoepithelial cells.
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case_images: Microscopic examination revealed multiple nodules with predominantly myoepithelial cell proliferation, admixed with stromal components containing myxoid areas (Figure 3).
case_images: Microscopic examination of the specimen of the lymph nodes from the left neck level II showed (a) stromal components containing myxoid areas (green arrow); (b) positive PLAG1 immunohistochemical staining suggesting pleomorphic adenoma; (c) positive SOX-10 IHC staining suggesting myoepithelial cells.
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case_images: The lymph node sections from the left neck level II showed scant lymphoid tissue replaced by myoepithelial cells with spindle and focal plasmacytoid features, admixed with stromal components containing myxoid and chondroid areas (Figure 4).