A 58-year-old male patient with a history of diabetes and hypertension taking metformin and angiotensin receptor blockers, presented a rapidly growing mass on his right jaw that became stiff within two months associated with recent dysphagia and choking. There was no history of fever. The patient did not report any symptoms associated with impaired function of salivary or lacrimal glands. Physical examination found a huge stiff mass of the right parotid gland that involved also the submandibular region without invading the skin, no facial palsy or trismus were noticed. Also, the patient presented neither a scalp malignancy nor cervical lymphadenopathy. Nasofibroscopic examination of the upper aerodigestive tract has shown a significant bulging of the right lateral pharyngeal wall pushing the larynx to the left side with no compromised vocal folds movement. CT scan (Figs. 1 and 2) disclosed a large, smooth-surfaced, infiltrating mass of the right parotid gland, which invaded the parapharyngeal space and the internal carotid artery. This mass had a heterogeneous opaque shape after intravenous contrast injection. Complete surgical removal was therefore impossible. A biopsy was planted for further management according to the tumor board’s recommendations. Within 5 weeks from the initial consultation, the tumor has completely and spontaneously resolved. The patient presented late to his biopsy appointment due to COVID free circulation restriction as he lived in another city. This remarking event in the course of this patient’s pathology leads us to assume that it could be an atypical form of an auto-immune or inflammatory disease. The biology workup revealed a slightly elevated sedimentation rate with normal blood white cell count. No specific immunoglobulin profile on serum protein electrophoresis was found, auto-immune disease markers were negative, thoracic and abdominal CT scan was uneventful and viral serology was negative. A parotid gland biopsy was performed. Two specimens for pathological examination were collected, they measured approximately 15×6 mm and 20×6mm. They were fixed in 10% formaldehyde and embedded in paraffin for immunopathology study. The microscopic examination (Fig. 3) revealed fibrous tissue between salivary ducts without any atypical or inflammatory cells. In the salivary gland tissue, no mononuclear cells, or lymphocytes, and no evidence of malignancy was observed. The immunopathology study was negative for expressing anaplastic lymphoma kinase-1, CD-68, and muscle-specific actin. These markers are present in a variety of conditions such as anaplastic large cell lymphoma, malignant histiocytosis, histiocytic lymphoma, inflammatory myofibroblastic tumor, adenoid cystic carcinoma myoepithelial component, leiomyosarcoma, malignant fibrous histiocytoma, myoepithelioma, myofibroblastic sarcoma, myofibroblastoma, perivascular epithelioid cell tumors, pleomorphic adenoma, rhabdomyosarcoma, and solitary fibrous tumor. One year after spontaneous disease regression, the patient is clear of any symptoms, auto-immune disease markers and serology still negative at 3 months and six months of follow-up.
CT scan axial view C+ showing a heterogeneous mass of the right parotid gland extended to the submandibular region and uncompressing the vascular axe with an important impact on the aerodigestive tract
CT scan coronal view C+ showing a heterogenous mass of the right parotid region uncompressing the vascular axe with no identified limit regarding the surrounding soft tissue
Biopsy specimen of the parotid gland pathology features on hematoxylin–eosin stain showing normal glandular acini and fibrosis tissue between the salivary duct/400. The arrow points toward a salivary duct and the star mark fibrosis area
The patient’s episodes of care are reported in Fig. 4.
The patient’s episodes of care timeline
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