myxofibrosarcoma has been recently described as a distinct histological entity and commonly affects the extremities and trunk of the elderly [ 14 ] . it is , however , rare in the head and neck region , and we are unaware of any reports of this presenting as a parotid mass . we report a case of myxofibrosarcoma presenting as a parotid lump and highlight the clinical course and histological features of this lesion . a 78-year - old female presented with a lump in the right parotid region of a nine - month duration . clinical examination revealed a 4  3  cm mildly tender , mobile mass with normal facial nerve function . an mri scan revealed a 3.8  cm well marginated mass largely confined to the superficial lobe of the parotid and involving the lateral edge of the deep lobe , ( figure 1 ) . fine needle aspiration cytology demonstrated undifferentiated pleomorphic malignant cells with frequent lymphocytes and histiocytes present in the background ( figure 2 ) . a tentative diagnosis of a malignant mesenchymal tumour ( sarcoma ) was made and the patient underwent a total conservative parotidectomy and a selective level i  iii neck dissection . the tumour was directly overlying the main trunk and upper branches of the facial nerve . the final histology was reported as a high - grade epitheloid myxofibrosarcoma of the parotid , with tumour extending to the resection margin and two of the 13 lymph nodes harvested demonstrated metastatic spread ( level ii ) . the patient received postoperative radiotherapy to the parotid bed and neck ( 60 gray/30 fractions ) . the patient was followed up for 18 months with no evidence of local , regional , or distant metastasis , but unfortunately died of motor neurone disease 24 months after initial presentation . the parotid gland ( 60  40  25  mm ) was weighing 28  grams . one pole contains a multinodular tumor nodule ( 36  24  24  mm ) with a gelatinous myxoid cut surface . a second irregular fragment of parotid tissue measuring ( 75  17  15  mm ) was weighing 6.5  grams . the tumour was well circumscribed and had well - defined outer margin with a pseudocapsule in places ( figure 3 ) . it was composed of epitheloid / spindle - shaped pleomorphic tumour cells with abundant eosinophilic cytoplasm showing frequent mitotic figures ( 15 mitosis/10  hpf ) and abnormal mitoses ( figure 4 ) . spaces filled with alcian blue - positive mucin separated cordlike arrangements of cells resulting in a lacelike pattern . in some places , the tumour formed solid sheets with little mucin and in other it was notably arranged along scanty curvilinear capillaries in the myxoid background ( figure 5 ) . the tumor cells were not immunoreactive with cam 5.2 , 34be12 and s100 , mart1 , microphthalmia transcription factor ( mitf ) , and cd34 were negative . taking into account the morphology and immunophenotype , a diagnosis of high - grade epitheloid myxofibrosarcoma was made . two of the eight lymph nodes in level 2 contained metastatic tumour but three lymph nodes in level 3 and the lymph node adjacent to the submandibular salivary gland showed reactive changes only . myxofibrosarcoma , often reported in the past as the myxoid variant of the malignant fibrous histiocytoma , was initially suggested as a distinct histological entity by angervall et al . in 1977   and the lesions do not demonstrate any obvious sex predilection and often affect the elderly , with a mean age of 60 years ( range of 1691  years ) [ 3 , 4 ] . it frequently presents as a slowly enlarging painless mass of weeks to months duration , though 75% of them were less than 18 months duration . it often affects the extremities and trunk , and involvement of the head and neck region ( 2.8% ) is uncommon [ 3 , 4 ] . our case was relatively typical in terms of age and sex , but we are unaware of any previous reports of the lesion affecting the parotid / salivary gland . epitheloid myxofibrosarcoma is a rare variant of myxofibrosarcoma and accounts for less than 3% of myxofibrosarcomas . the definitive diagnosis is often made following thorough histological assessment , often supplemented by ihc , though the cytological features might be suggestive [ 18 ] . cytology often demonstrates large , bizarre , multinucleated giant cells with abundant eosinophilic and well - delineated cytoplasm and irregular - shaped and prominent nuclei . histologically , the lesions demonstrate a broad spectrum of cellularity , pleomorphism , and proliferative activity and exhibit at least a focal area of myxoid matrix . typically , elongated curvilinear capillaries with perivascular tumour cell condensation are seen in the myxoid areas . high - grade tumours demonstrate solid , hyper cellular areas with conspicuous cellular pleomorphism , numerous , often atypical mitosis , and confluent areas of hemorrhage and necrosis . in addition , there is often a heavy inflammatory infiltrate , mainly composed of lymphocytes and plasma cells . the characteristic tumour cells in the myxoid areas stain positively for vimentin , but do not stain for other markers . the mainstay of treatment is excision of the lesion with wide margins , supplemented if necessary by radiotherapy . local recurrence is not uncommon , with a reported frequency of 4561% , with the lesion becoming progressively higher grade with repeated recurrences [ 4 , 9 ] . metastasis occurred in about 23% of cases and often affected the lungs , lymph nodes , and somatic soft tissues [ 4 , 10 , 11 ] various clinicopathologic factors including the status of the surgical margins , grade of tumour , mitotic index and extent of necrosis have all been found to influence the prognosis [ 3 , 4 ] . epitheloid myxofibrosarcoma is considered to be more aggressive than high - grade myxofibrosarcoma with a 70% risk of local recurrence and 50% risk of metastasis . the quality of primary surgery does not only improve local recurrence , but also translates into survival benefit , suggesting that thorough reexcision or adjuvant radiotherapy is warranted for lesions with positive margins [ 4 , 9 ] .
myxofibrosarcoma has been recently described as a distinct histological entity and commonly affects the extremities and trunk of the elderly . 
 it is , however , rare in the head and neck ( 2.8% ) region , and we are unaware of any reports of it presenting as a parotid mass . the epitheloid variant accounts for less than 3% of myxofibrosarcomas . 
 we report a case of a 78/f presenting with an epitheloid myxofibrosarcoma in the parotid gland . 
 the clinical presentation was of a parotid lump of 9-month duration , and the diagnosis was made following thorough histological assessment . 
 we present what we believe to be the first reported case of a ( epitheloid ) myxofibrosarcoma affecting the parotid gland and highlight its diagnostic features and outcome of treatment .