Accessory parotid gland tumors
A 52-year-old female patient presented with a swelling over the left cheek of 2 years duration []. It was insidious in onset and was gradually progressive in size. Patient had recent onset pain in the swelling. The swelling was 3 × 3 cm in size and was situated in the area just below the left zygomatic arch and was above the imaginary line between angle of mouth and tragus. It was hard in consistency, tender with restricted mobility. FNAC done was suggestive of pleomorphic adenoma. The tumor was approached through a modified Blair's incision. The tumor was arising from the region corresponding to the Accessory parotid gland. Zygomatico-temporal division and the buccal branches of the facial nerve were on either side of the tumor and splayed by it []. They were separated from the tumor with difficulty, and excision of the tumor with a superficial parotidectomy was performed. Supraomohyoid neck node dissection was combined with this procedure []. Postoperatively, patient had mild paresis of the buccal and the zygomatic branches of the facial nerve which recovered in 6 months []. The histopathology of the tumor was diffuse small cell type NHL of the accessory parotid gland with circumferential and deep margin involvement with no lymph node foci of tumor []. Immunohistochemistry was CD20 positive and negative for CD3, Cyclin D1, CD5, CD68, MPO, and Tdt. Focal positivity for CD10 and dispersed positivity for CD23 were suggestive of a residual follicular dendritic cell network with identifiable groups of large cells. Hence, a diagnosis of extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma was made. A staging workup with PET-CT, bone marrow aspiration, and biopsy revealed no other foci of tumor. Patient was started on chemotherapy with following regimen. CHOP chemotherapy (1st cycle—Vincristine 2 mg, Cyclophosphamide 1000 mg, Daunorubicin 70 mg, and Prednisolone 16 mg; second and third cycle—Vincristine 1 mg, Cyclophosphamide 500 mg, Daunorubicin 35 mg, and Prednisolone 16 mg). There was complete recovery of facial nerve palsy with no recurrences at 6 months follow-up.