PMC5705891_01
(a) Axial contrast-enhanced CT scan (soft tissue window) showing a well-demarcated mass (arrow) located on the left side in the upper cervical lymph node region (group IIA), with adipose cleavage plane between the mass, the submandibular salivary gland (arrowhead), and the sternocleidomastoid muscle (asterisk). (b) Coronal CT scan reconstruction (soft tissue window) showing a nodular lesion of the left thyroid lobe (asterisk) with peripheral macrocalcifications (arrowhead). A metastatic lymph node in the ipsilateral level IIA region (arrow) was suspected. (c) 3D CT reconstruction showing the left level IIA cervical mass in yellow, the submandibular salivary glands in pink, and the thyroid gland in purple with the left lobe nodule represented in light blue. Arteries are rendered in red and veins in blue.
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fig1
It revealed a 23 x 17 x 25 mm solid nodule with coarse calcifications located in the left thyroid gland and an ipsilateral 24 x 25 x 35 mm well-delineated hypodense mass located in the level IIA lymph node group (Figure 1).
(a) US of thyroid gland (T = trachea) showing the left thyroid nodule, isoechoic to slightly hypoechoic to glandular parenchyma, wide-than-taller shape, hypervascular at color Doppler, with coarse peripheral calcifications (arrowheads). No microcalcifications or perinodular thyroid parenchyma invasion is seen. The thyroid nodule was classified TI-RADS 3 (probably benign nodules, <5% risk of malignancy); however, because of its size, FNAC was performed, showing no signs of malignancy. (b) US of the palpable level IIA lesion revealing a hypoechoic, well-delineated, and polylobulated mass (arrows) in the left anterior neck triangle located along the anterior border of the sternocleidomastoid muscle (asterisk) and submandibular salivary gland (arrowhead). (c) FNAC was performed (original magnification, x25; Papanicolaou (Pap) stain) and revealed tumor epithelial part (arrows) with squamoid epithelial cells (arrowhead, inset in (c), original magnification, x100; Pap stain) and myoepithelial cells (arrow, inset in (c)), thus suggesting the diagnosis of pleomorphic adenoma.
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fig2
The thyroid lesion was slightly hyperechoic to the muscle, hypervascular on color Doppler, with coarse peripheral calcifications, whereas the level IIA lesion was well delineated and solid, being hypoechoic to muscle tissue, homogenous, and hypovascular (Figure 2).
(a) Macroscopic aspect of the level IIA mass after surgical excision: well-delineated white solid lesion with tumor margin smaller than 0.1 cm (red stars). (b) Histopathology (original magnification, x25; HE stain) revealing that the well-delineated tumor (lower part of the picture) is surrounded by a normal serous salivary gland (arrowheads), thus suggesting the diagnosis of pleomorphic adenoma of an ectopic minor salivary gland.
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fig3
Histopathology indicated the level IIA mass to be an encapsulated classic pleomorphic adenoma with a predominant myoepithelial component, surrounded by clusters of normal salivary gland tissue embedded in fatty tissue (Figure 3).