PMC5467284_01
Axial (a) and coronal (b) fat suppressed T2-weighted MR images indicating a large, heterogeneous, lobulated, fusiform, and hyperintense mass in the right parotid region. The multinodular lesion exhibits a target-like appearance due to a peripheral zone of higher intensity. Note the enlarged jugular and spinal accessory lymph nodes.
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Imaging confirmed the presence of the mass and localized the lesion to the superficial lobe of the parotid gland, suggesting a neurofibroma adherent to, and possibly originating from, the intraparotid portion of the facial nerve (Figure 1).
Longitudinal right-side parotid swelling, approximately 3 cm in diameter. The lesion induced serious facial disfigurement and asymmetry (a). Through surgical exploration the lesion was found to be strictly adherent to the main trunk of the facial nerve and longstanding compression had moved the division to temporofacial and cervicofacial branches far more anteriorly than expected. The mass did not, however, originate from the facial nerve, allowing complete resection while preserving neural function (b).
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Intraoperative view also revealed that longstanding compression to the trunk of the facial nerve had moved the division to temporofacial and cervicofacial branches far more anteriorly than expected, thus hampering dissection (Figure 2).
Nodular gray-white soft mass (a) consisting histologically of relatively uniform spindle cells with pointed ends (b), infiltrating the parotid (c), and the hilum of a lymph node (d) ((b) HE x400; (c) HE x100; (d) HE x40).
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Overall, the mass was soft with nodular areas, resembling a "bag of worms." The cut surface of the mass had a gray-white, glistening appearance, without foci of hemorrhage or necrosis (Figure 3(a)). The neoplastic cells were arranged in a fascicular pattern of growth and had a serpentine configuration with elongated nuclei with pointed ends (Figure 3(b)). The neoplasm penetrated the parotic gland thus destructing the normal lobular architecture of the gland (Figure 3(c)). Interestingly, the neoplasm penetrated an intraparotid lymph node through the hilum followed by blood vessels (Figure 3(d)).