PMC8429032_01
Preoperative clinical picture showing the well-defined swelling infra-auricular region.
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On physical examination, the patient had a soft, compressible, nontender, nonfluctuant, nonreducible, nonpulsatile, well-defined mass in the right parotid region measuring 4 x 3 cm extending from the right lobule to 1.5 cm below the angle of the mandible in vertical dimension and 3 cm in front of the lobule in horizontal dimension (Figure 1).
Picture showing ultrasound imaging, suggestive of arteriovenous malformation.
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On ultrasonography, the mass showed multiple pinhead circular calcified foci in it (Figure 2).
Axial cut contrast-enhanced computed tomogram showing a heterogeneously enhancing mass in the superficial lobe of the parotid gland with multiple pin head calcified foci in it.
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Computed tomography reported evidence of a heterogeneously enhancing mass lesion in the superficial lobe of the right parotid gland, and the deep lobe was normal (Figure 3).
Intraoperative picture of dilated, irregular vascular channels replacing the superficial parotid parenchyma.
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Intraoperatively, there was diffuse, dilated vascular channels replacing parotid tissue, with retromandibular vein as the draining vessel to the mass (Figure 4).
(a) Scanner photomicrograph shows thick- and thin-walled blood vessels traversing the parotid parenchyma. Thrombi and calcification are seen within the lumen (H and E x40); (b) low-power photomicrograph shows thrombi in varying stages of organisation. Marked calcification seen in one of the vessels (H and E x100); (c) some of the vascular spaces show organising thrombus with revascularization (H and E x100); and (d) low-power photomicrograph shows luminal as well as focal calcification within the wall (H and E x100).
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The venous calibre vessels showed intraluminal fresh thrombus, which at places showed recanalization and endothelial proliferation, consistent with A-V malformation (Figure 5).
PMC8429032_02
Preoperative clinical picture showing swelling in the left parotid region.
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OPD with complaints of swelling below and in front of the left ear for 1.5 years, which was gradually progressive in nature, painless, and had alteration in size due to external factors and did not relieve with anti-inflammatory drugs. On physical examination, it was a soft, mobile, compressible, nontender, nonreducible, and nonfluctuant mass measuring around 4 x 4 cm in the left parotid region with no bruit on auscultation (Figure 6).
Axial-section T2-weighted MRI sequence showing a well-marginated lesion involving whole of the left parotid gland, hyperintense with lobulated hypointense foci within it.
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MRI showed a well-marginated mass lesion involving whole of the left parotid gland, hyperintense on the T2W sequence with few lobulated hypointense foci within it, closely abutting the left-sided retromandibular vein suggestive of arteriovenous malformation (Figure 7).
(a): Photomicrograph shows large, ectatic, thin-walled anastomosing vascular channels (H and E x40); (b) section shows a thin layer of smooth muscle within the walls of the vascular spaces with adjacent salivary acini (H and E x40); (c) salivary gland acini are seen in between the vascular spaces, with some of them showing fresh thrombi (H and E x40); and (d) organising thrombus with revascularization in a dilated vascular channel (H and E x100).
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