Parotid or carotid? Misled by site

Area of Science:

• Oncology
• Pathology
• Head and Neck Surgery

Background:

• Salivary gland lesions are common in the infra-auricular region, often leading to initial misdiagnosis.
• Malignant paragangliomas, though rare, can present with varied clinical and cytological findings.
• Accurate diagnosis is crucial for appropriate patient management and treatment planning.

Observation:

• A 64-year-old male presented with a long-standing, painless infra-auricular swelling.
• Fine-needle aspiration cytology (FNAC) suggested a cystic neoplasm of salivary gland, possibly mucoepidermoid carcinoma.
• Radiological findings were characteristic of a carotid body tumor, conflicting with the initial cytological diagnosis.

Findings:

• Histopathological examination revealed metastatic paraganglioma in the right posterior triangle lymph nodes.
• The infra-auricular swelling was an unusual presentation of a malignant paraganglioma.
• The case highlights a diagnostic pitfall where a salivary gland neoplasm was suspected instead of a metastatic paraganglioma.

Implications:

• Clinicians and pathologists must consider rare differentials like paraganglioma in infra-auricular swellings.
• Multimodality diagnostic approaches, including radiology and histopathology, are essential for accurate diagnosis.
• Awareness of such unusual presentations can prevent diagnostic delays and improve patient outcomes.