False Identity: Lymphoid Hyperplasia Imitating a Large Paraganglioma

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Pathology

Background:

• Parapharyngeal space masses pose significant risks due to limited space and proximity to vital structures.
• The differential diagnosis for these masses is extensive, yet benign lymphoid hyperplasia has not been previously documented in this location.

Purpose of the Study:

• To report a unique case of benign lymphoid hyperplasia presenting as a parapharyngeal space mass.
• To review the literature on somatostatin-positive lesions within the parapharyngeal space.

Main Methods:

• A case study involving a 51-year-old male with a parapharyngeal mass was reviewed.
• Methods included audiogram, laryngoscopy, Magnetic Resonance Imaging (MRI), Octreoscan, angiogram, and histopathological examination.
• Literature review on somatostatin-positive parapharyngeal lesions was conducted.

Main Results:

• The patient presented with otalgia, hearing loss, tinnitus, and a paretic true vocal cord.
• MRI revealed a 4.5 cm post-styloid parapharyngeal mass displacing the carotid artery.
• Octreoscan showed significant somatostatin analog uptake, and histopathology confirmed lymphoid hyperplasia.

Conclusions:

• Post-styloid parapharyngeal masses can represent lateral retropharyngeal nodes.
• Octreotide-positive lymphoid hyperplasia in the parapharyngeal space is reported for the first time.
• This case expands the differential diagnosis for parapharyngeal space masses.