Parapharyngeal space meningioma

Area of Science:

• Neuro-oncology
• Head and Neck Surgery
• Radiology

Background:

• Parapharyngeal space (PPS) meningiomas are rare extracranial tumors.
• They can present insidiously, mimicking more common PPS lesions, posing diagnostic challenges.

Observation:

• A 23-year-old female presented with painless, progressive neck swelling and intraoral bulge.
• Imaging demonstrated a left PPS mass encasing the internal carotid artery and compressing the internal jugular vein.
• Biopsy confirmed WHO Grade I meningioma with specific immunohistochemical markers and somatostatin receptor expression.

Findings:

• The meningioma was unresectable due to extensive vascular encasement.
• Peptide receptor radionuclide therapy (PRRT) was administered due to somatostatin receptor positivity.
• PRRT resulted in significant tumor regression.

Implications:

• Meningioma should be considered in the differential diagnosis of PPS masses.
• PRRT is a viable therapeutic option for unresectable, somatostatin receptor-positive meningiomas.
• This case highlights the multidisciplinary approach to managing rare head and neck tumors.