Clinical history and findings
The patient was a 66-year-old Chinese woman who presented in another
hospital 3 years ago with a slowly enlarging left cheek swelling for a
few months. The swelling measured about 3 cm in diameter, hard in
consistency and was situated in the parotid gland on radiological
examination. Partial parotidectomy was done and specimen (S1) was
initially diagnosed as Langerhans cell histiocytosis associated with
benign glandular proliferations focally extending to margin. The
regional lymph node sampled showed reactive changes with increased
Langerhans cells. After 2 years, the patient noticed recurrent cheek
swelling over the same site. Clinical-radiological work-up revealed a
recurrent mass in the parotid gland associated with enlarged regional
lymph nodes. Biopsy of the swelling showed frank carcinoma and was
reported as sclerosing mucoepidermoid carcinoma with eosinophilia. The
patient was then transferred to our hospital for further management.
Radical parotidectomy sacrificing the lower branches of the facial nerve
with reconstruction using the sural nerve, and regional lymph node
dissection were performed. The specimen was subsequently sent for
pathological study. Post-operative external radiotherapy to the neck was
administered and the patient was free from disease 6 months after
operation.