Pleomorphic adenoma of the parotid with lymph node extension: A case report

Pleomorphic adenoma (PA), the most common benign tumor of the salivary glands, typically arises from the parotid gland and is generally slow-growing, painless, and non-invasive. However, rare cases may exhibit aggressive behavior, including local recurrence and spread to regional lymph nodes. This case report presents a 53-year-old woman with a recurrent pleomorphic adenoma of the left parotid gland showing lymph node extension. The patient initially presented in 2021 with a painless mass in the left parotid region and underwent a total parotidectomy with modified radical neck dissection. Histopathological analysis confirmed pleomorphic adenoma with no malignant features. One year later, the mass recurred with associated multiple suspicious lymphadenopathies on imaging, prompting further evaluation. CT scan revealed a heterogeneous solid mass infiltrating adjacent muscles, with bilateral cervical lymph node enlargement. A second total parotidectomy was performed in 2024. Histopathology again confirmed pleomorphic adenoma without malignancy. Postoperative recovery was uneventful, with House-Brackmann grade III facial nerve weakness. This case underscores the potential for PA to recur and spread to regional lymph nodes even in the absence of malignant transformation, possibly due to incomplete excision or tumor seeding during prior interventions such as fine-needle aspiration biopsy (FNAB). Long-term follow-up is essential due to the risk of recurrence and potential progression to carcinoma ex-pleomorphic adenoma. This report highlights the importance of wide excision with clear margins and vigilance for lymphatic spread, even in benign histology, particularly in recurrent cases.