Sebaceous lymphadenoma of parotid gland: A case report of a unique presentation in an immunocompromised patient

Abstract

Sebaceous lymphadenoma is a rare, benign tumor of the parotid gland accounting for only 0.196% of all adenomas of the parotid gland. Our aim is to present a case of sebaceous lymphadenoma, which has been rapidly enlarging over a period of few months in an immunocompromised patient. This presentation is unusual for a benign salivary gland neoplasm. A 55-year-old female who is a known case of systemic lupus erythromatous, antiphospholipid syndrome, and lupus nephritis, which have been treated by cyclophosphamide, presented with a 2-year complaint of fluctuating painless right parotid swelling, over the last 3 months the swelling started to progressively increasing in size. Physical examination showed a 4 × 3 cm firm, nontender mass in the right parotid gland. The facial nerve was intact and no cervical lymphadenopathy. Fine-needle aspiration cytology (FNAC) revealed marked chronic inflammation and was not helpful for diagnosis. Right superficial parotidectomy was performed without complications and there was no recurrence after 24 months of careful follow-up. In patients presenting with a rapidly enlarging parotid mass associated with an intact facial nerve, the possibility of sebaceous lymphadenoma should be considered as an important differential diagnosis in addition to other benign tumors of the parotid gland. The role of FNAC in this neoplasm is controversial.

Keywords: Diagnosis; FNA cytology; lymphadenoma; pathology; sebaceous lymphadenoma.

Figure 1

Physical examination showed a 4 × 3 cm firm, nontender mass in the right parotid gland

Figure 2

(a) Computerized tomography (axial) showed well-defined oval-shaped heterogeneous and predominantly hypodense lesion arising from the right parotid gland, showing multiple internal small cystic areas. (b) Computerized tomography of the neck with contrast showed a well-defined oval-shaped heterogeneous and predominantly hypodense lesion arising from the right parotid gland and showing several internal small cystic areas with multiple foci of low-density enhancement which is likely due to the presence of fat

Figure 3

Photomicrograph: the sebaceous lymphadenoma shows benign nests and islands of bland sebaceous epithelium (thick arrow) intermixed with a prominent benign lymphoid component (thin arrows). Hematoxylin and eosin stain, original magnification 400×. Fine-needle aspiration cytology (FNAC) revealed marked chronic inflammation with florid histiocytic collections. Right superficial parotidectomy was performed without complications and there was no recurrence after 24 months of careful follow- up