Alex Palmer

Renoir, "In the Roses"

Case: A 56-year-old woman, Mrs. Rose, visits you, her friendly neighborhood family doc, for her annual physical exam. The patient describes no health problems, but has noticed a little change in skin tone on the left side of her face over the last month or two. Mrs. Rose attributes that to getting a little older and spending too much time in the sun gardening. Social history: denies tobacco use and occasionally has a few glasses of wine, with her husband and friends. Surgical history her second child was delivered by C-section with no significant complications. Your physical exam reveals a slight lump on the left side of her face, which is fixed, but not painful to palpation. Careful examination reveals a slight sagging of the skin. The rest of the exam does not show any significant abnormalities. Differential diagnosis is enlarged lymph node versus a soft tissue tumor.


CT shows poorly enhancing area representing cystic change in the area of the parotid gland.

You call your local surgeon Dr. Ready Cut, who schedules her for surgery.

Pathology receives a total parotidectomy composed of a lobulated pink-tan specimen, including portions of the facial nerve.

Histologic sections reveal a tumor composed of two cell typesí myoepithelial cells and ductal cells in a cribriform pattern.

Immunohistochemical stains: markers for the characteristically dark, small-angulated myoepithelial cells as seen on H&E include myoepithelial markers, such as SMA, CD10. The epithelial component usually marks with keratins such as AE1/3, 1, 5, 7,8,10, 14, 18 and 19.

In tumors that undergo a high-grade transformation, with complete loss of myoepithelial cells are often p53 positive. Genetic testing of the mass shows t(6;9) (q21-24;p13-23).

Treatment: Surgical resection with radiation therapy. Resection showed a light-tan, solid, well-circumscribed but unencapsulated mass.

Alexander Palmer KCUMB '15

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