PMC10405830_01
Ultrasound examination detects a hypoechoic uneven mass behind the left parotid gland with a clear boundary (A), and color Doppler flow imaging (CDFI) reveals blood flow signals (B).
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Ultrasound examination detected a hypoechoic uneven mass (8.2*5.6cm in size) behind the left parotid gland with a clear boundary ( Figure 1A ), and color Doppler flow imaging (CDFI) revealed blood flow signals ( Figure 1B ) within the mass.
Axial (A) and coronal (B) CT images reveal locally rough, absorbed, and thinning changes on the left temporal bone (arrowhead). The lesion appears hyperintense with focal hypointense on T2-weighted image (C) with a sharply defined edge, homogenous isointense on unenhanced T1-weighted image (D), and obviously homogenous enhancement on contrast-enhanced T1-weighted images (E, F). Coronal gadolinium-enhanced T1-weighted image (F) demonstrates thickened basicranial dura with a nodule (thick white arrow) on the left middle cranial fossa connecting with a mass in the left parapharyngeal space through the foramen ovale (thin red arrow).
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Unenhanced computed tomography (CT) images of the craniofacial region revealed a homogenous soft tissue mass in the parapharyngeal space without calcification ( Figure 2A ). The left temporal bone revealed locally rough, absorbed, and thinning changes ( Figure 2B ). T1-weighted image ( Figure 2D ), and obviously enhanced after contrast enhancement ( Figure 2E ) in the parapharyngeal space. The tumor size was 8.2cm (left and right) * 3.3cm (front and back) * 6.9cm (up and down). The surrounding structures were compressed by the mass. Coronal MRI image showed that the lesion originated from basicranial dura extending into parapharyngeal space through the left foramen ovale at the skull base ( Figure 2F ).
Histological staining images (A, B) show a spindle cell tumor with scattered psammoma bodies (HE, x100 and x200). Immunohistochemical staining images show that the tumor cells are positive for EMA (C) and PR (D) (x200).
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Histopathology revealed a spindle cell tumor with scattered psammoma bodies ( Figures 3A, B ), suggesting a meningioma. Immunohistochemical results showed CD117 +/-, CD34 +, Beta-catenin ++, smooth-muscle actin (SMA)-, epithelial membrane antigen (EMA)+ ( Figure 3C ), Ki-67 2%, P53 +/-, S-100 +, DOG-1 -, Desmin -, CK(AE1/AE3) -, glial fibrillary acidic protein (GFAP)-, progesterone receptor (PR)++ ( Figure 3D ).
The timeline of diagnosis and treatment.
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The timeline of diagnosis and treatment is shown in  Figure 4 .