A 53-year-old man presents with a mass located just below the tragus of his right ear. Ultrasound and fine-needle aspiration (FNA) confirm a 2 cm pleomorphic adenoma. What is the most appropriate next step in management?
A. USS-guided core biopsy
B. Radical parotidectomy
C. Superficial parotidectomy
D. Discharge
E. MRI of the region
✅ Correct answer: C. Superficial parotidectomy
📌 Explanation:
A pleomorphic adenoma is the most common benign salivary gland tumor, typically arising from the superficial lobe of the parotid gland. Even though it is benign, it has potential for malignant transformation and local recurrence if not completely excised.
🩺 Management:
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Superficial parotidectomy is the treatment of choice for small, well-circumscribed tumors confined to the superficial lobe.
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It ensures complete tumor excision with preservation of the facial nerve, which runs through the gland.
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Enucleation is avoided due to high recurrence risk.
❌ Why not the others?
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A. USS-guided core biopsy:
Not necessary after FNA has already confirmed the diagnosis. -
B. Radical parotidectomy:
Reserved for malignant tumors or deep lobe involvement with facial nerve infiltration—not for small, benign lesions. -
D. Discharge:
Not appropriate; the tumor needs surgical removal due to its growth potential and risk of malignancy. -
E. MRI of the region:
MRI may be helpful for deep lobe tumors or facial nerve mapping, but not required in a typical superficial 2 cm lesion with clear diagnosis on FNA and US.
🔑 High-Yield Summary:
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Pleomorphic adenoma = Most common benign salivary gland tumor.
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FNA is useful for diagnosis.
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Superficial parotidectomy = Definitive treatment to avoid recurrence/malignancy.
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Avoid simple excision or enucleation.
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