Pleomorphic adenoma of the accessory parotid gland: case report and reappraisal of intraoral extracapsular dissection for management.

Pleomorphic adenoma is the most common tumor of the major and minor salivary glands. Rarely is it found evolving from an ectopic location of major salivary glandular tissue in the mid cheek. A healthy 56-year-old woman presented to our institution with a 20-year duration of a slowly growing right cheek soft tissue mass that was causing facial asymmetry. No significant functional or neurosensory dysfunction was appreciated. Radiologic examination showed a heterogeneous, hyperintense, well-delineated mass within the region of the right buccal fat pad. Fine-needle aspiration biopsy showed benign salivary gland elements consistent with pleomorphic adenoma. The decision was made to perform intraoral extracapsular dissection for removal. Discussion of the clinical assessment and magnetic resonance imaging evaluation with an emphasis on intraoral extracapsular dissection for definitive surgical therapy of longstanding benign salivary gland tumors is emphasized.

Multifocal intraosseous ganglioneuroma.

We report a case of asymptomatic intraosseous ganglioneuroma of the ilium, which was initially misdiagnosed as polyostotic fibrous dysplasia. Our patient presented with multiple asymptomatic skeletal lesions. Despite extensive work-up of our patient to rule out metastatic disease, we were unable to find a primary source; biopsy showed intraosseous ganglioneuroma of the ilium. To the best of our knowledge, we report an exceedingly rare pathologic entity; only 3 cases have been described of intraosseous ganglioneuroma from spontaneous cytomaturation of metastatic neuroblastoma. Knowledge of the natural history of ganglioneuroma is limited, but patients with primary and multifocal disease appear to have benign histologic tumor appearance and excellent prognoses. Similar to previous studies, the rarity of this tumor and its nonspecific radiographic and clinical presentation resulted in the correct diagnosis only after histopathologic analysis. Because intraosseous ganglioneuroma may mimic fibrous dysplasia it should be considered in the differential diagnosis of benignappearing skeletal lesions, particularly if the patient has a history of neuroblastoma.