case_images: PMC6920309_01
case_images: Preoperative antero-posterior view.
case_images: gr1.jpg
case_images: PMC6920309_01_gr1.jpg
case_images: fig0005
case_images: The mass itself was not tender, with nodular bosselated outer surface and the surrounding skin was congested in some areas (Fig. 1, Fig. 2).
case_images: CT angiography (antero-posterior view).
case_images: gr3.jpg
case_images: PMC6920309_01_gr3.jpg
case_images: fig0015
case_images: CT angiography was also done and showed that the main arterial supply was from the facial branch of the left external carotid artery, common, external and internal carotid arteries on both sided which were patent and of normal shape (Fig. 3, Fig. 4).
case_images: Inferolateral incision.
case_images: gr5.jpg
case_images: PMC6920309_01_gr5.jpg
case_images: fig0025
case_images: After securing them, we continued the dissection both superiorly and inferiorly in the medial direction to the right side (Fig. 5, Fig. 6).
case_images: Postoperative specimen.
case_images: gr7.jpg
case_images: PMC6920309_01_gr7.jpg
case_images: fig0035
case_images: We were able to remove the tumor completely which weighed 8.1 kg (Fig. 7).
case_images: Covering with Thiersch graft.
case_images: gr8.jpg
case_images: PMC6920309_01_gr8.jpg
case_images: fig0040
case_images: The tumor had a very wide base therefore the defect couldn't be closed primarily and we used a thiersch graft (Fig. 8).
case_images: Pleomorphic adenoma shows alternating.
case_images: gr9.jpg
case_images: PMC6920309_01_gr9.jpg
case_images: fig0045
case_images: These were associated with clear plumpy, rounded epitheloid and plasmacytoid, as well as spindle shaped myoepithelial cells admixed with cartilaginous foci against myxoid background (Fig. 9, Fig. 10, Fig. 11).
case_images: Acinar structures lined by epithelial cells admixed with myo-epithelial cells and myxoid matrix. (H&E. x100).
case_images: gr11.jpg
case_images: PMC6920309_01_gr11.jpg
case_images: fig0055
case_images: These were associated with clear plumpy, rounded epitheloid and plasmacytoid, as well as spindle shaped myoepithelial cells admixed with cartilaginous foci against myxoid background (Fig. 9, Fig. 10, Fig. 11).
case_images: Dystrophic calcification (Hx&E, x400).
case_images: gr12.jpg
case_images: PMC6920309_01_gr12.jpg
case_images: fig0060
case_images: Multiple areas of infarction necrosis were seen with ghosts of cells appearing, admixed with areas of dystrophic calcification (Fig. 12, Fig. 13).
case_images: Nuclear positivity of ki67 in 2% of tumor cells (x40).
case_images: gr14.jpg
case_images: PMC6920309_01_gr14.jpg
case_images: fig0070
case_images: It exhibited nuclear positivity in only about 2% of tumor cells (Fig. 14).