Diagnostic Conundrum and Treatment Dilemma in a Cystic Lesions of Parotid: A Case Report

Diagnostic Conundrum and Treatment Dilemma in a Cystic Lesions of Parotid: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Diagnostic Conundrum and Treatment Dilemma in a Cystic Lesions of Parotid: A Case Report Shambhavi Shukla, Nisha Kumari, Kumar saket, Gunjan Dwivedi, Sunil Goyal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6216977/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cystic lesions of the parotid gland present diagnostic challenges, especially when FNAC is inconclusive. This case highlights the need for a multidisciplinary approach and histopathological confirmation. A 25-year-old male with a recurrent left parotid cyst underwent excision biopsy, confirming a lymphoepithelial cyst. Recurrence after two years revealed a multiloculated cystic mass with solid components. Despite FNAC and sclerotherapy, persistence led to superficial parotidectomy, with final HPE diagnosing intermediate-grade mucoepidermoid carcinoma. Adjuvant radiotherapy was administered, with no recurrence on follow-up. FNAC alone may be insufficient for diagnosis, reinforcing histopathology as the gold standard. Comprehensive evaluation and multidisciplinary management are essential for optimal outcomes in complex parotid lesions. Head & Neck Surgery Cystic lesion Parotid gland Mucoepidermoid carcinoma FNAC Histopathology Superficial parotidectomy Figures Figure 1 INTRODUCTION Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands, accounting for 30–35% of all salivary gland malignancies 1 . The term "mucoepidermoid" was introduced by Stewart and colleagues, describing a distinctive salivary gland tumor consisting of epidermoid and mucus-producing cells, along with intermediate cells exhibiting transitional characteristics 2 . MEC arises most frequently in the parotid gland, followed by the submandibular and minor salivary glands. It is a tumor with diverse histological and cytological features, making diagnosis via FNAC challenging 1 , 3 . Accurate preoperative diagnosis is critical for optimal patient management, including appropriate surgical and adjuvant therapies. We present a case of a recurrent cystic lesion in the left parotid gland initially diagnosed as a benign lymphoepithelial cyst, later confirmed as an intermediate-grade MEC on histopathological examination (HPE). CASE PRESENTATION A 25-year-old male presented with a one-year history of insidious onset and gradually progressive swelling in the left parotid region, associated with mild pain. Examination revealed a solitary non-tender swelling, measuring 2×2 cm, with normal overlying skin. No significant medical, surgical, or family history was noted. In 2019, an ultrasound (USG) of the neck revealed a 1.5×1 cm ill-defined collection in the left parotid. Contrast-enhanced computed tomography (CECT) showed a peripherally enhancing lesion measuring 1.5×0.7×2 cm. FNAC suggested a benign cystic lesion with inflammation. The patient underwent excision biopsy under general anesthesia, and HPE confirmed a lymphoepithelial cyst. In June 2021, the patient presented with recurrence. CECT revealed a multiloculated peripherally enhancing cystic lesion measuring 1×2.3×2.5 cm with an eccentric enhancing solid component. FNAC yielded a pauci-cellular sample with cyst macrophages and polymorphs. Sclerotherapy with Bleomycin (1 mg/kg) and Polidocanol (10 ml/0.5%) was performed, but the swelling persisted. A repeat FNAC and contrast-enhanced MRI revealed a cystic lesion with partial extension into the deep lobe. In December 2021, the patient underwent superficial parotidectomy via a modified Blair’s incision. Final HPE revealed intermediate-grade MEC with perineural invasion. All margins were free, and no lymph nodes were involved. The patient received adjuvant radiotherapy (60 Gy in 30 fractions). Follow-up showed no residual or recurrent disease [Fig. 1]. DISCUSSION FNAC is pivotal in the preliminary assessment of salivary gland lesions but poses challenges in cystic lesions due to sampling errors and the heterogeneous nature of MEC 1 , 4 . MEC often demonstrates overlapping features with other cystic lesions, including mucous retention cysts, benign lymphoepithelial lesions, and Warthin’s tumor 1 , 4 . In our case, FNAC failed to accurately diagnose MEC, emphasizing the importance of HPE for definitive diagnosis. Schmidt et al. reported pooled sensitivity and specificity of 86% and 98%, respectively, for FNAC in parotid gland lesions, though accuracy varied by lesion type. Edwards et al. noted that cystic components in MEC dilute diagnostic cellularity, contributing to misdiagnosis rates exceeding 50% 4 . Despite its limitations, FNAC provides high specificity and positive predictive value (PPV) 5 . However, Shetty and Geethamani highlighted its limitations, including subjective cytological interpretation and sampling errors, particularly in heterogeneous tumors like MEC 6 . Integration of FNAC findings with imaging and HPE improves diagnostic accuracy. CONCLUSIONS Cystic lesions in the parotid gland demand a high index of suspicion. FNAC, while valuable, has inherent limitations. HPE remains the gold standard for definitive diagnosis. A multidisciplinary approach involving surgeons, radiologists, and pathologists is essential for accurate diagnosis and optimal management of complex salivary gland lesions. Declarations We confirm that written informed consent for participation and publication of this case report was obtained from the patient’s legal guardian. Ethics Approval and Consent to Participate: Ethical approval was not needed for this case. Funding This research did not receive specific funding. All resources were provided by the authors’ affiliated institutions. The funding body had no role in the design, data collection, analysis, or manuscript preparation. CARE Checklist The CARE checklist is included as a supplementary document with line and page numbers for each item detailed in the manuscript. References Boahene DKO, Olsen KD, Lewis JE et al (2004) Mucoepidermoid Carcinoma of the Parotid Gland. Arch Otolaryngol Head Neck Surg 130(7):849. 10.1001/archotol.130.7.849 Stewart FW, Foote FW, Becker WF (1945) Muco-epidermoid tumors of salivary glands. Ann Surg 122(5):820–844. 10.1097/00000658-194511000-00005 Schmidt RL, Hall BJ, Wilson AR et al (2011) Diagnostic accuracy of FNAC for parotid gland lesions. Am J Clin Pathol 136(1):45–59. 10.1309/AJCPOIE0CZNAT6SQ Edwards PC, Wasserman P (2005) Evaluation of cystic salivary gland lesions by FNAC. Acta Cytol 49(5):489–494. 10.1159/000326193 Kumar N, Kapila K, Verma K (1991) FNAC of mucoepidermoid carcinoma: A diagnostic problem. Acta Cytol 35(3):357–359 PMID: 2042438 Shetty A, Geethamani V (2016) FNAC in major salivary gland tumors. J Oral Maxillofac Pathol 20(2):224–229. 10.4103/0973-029X.185899 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6216977","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":428166066,"identity":"da66f8de-7eb2-4f30-bedf-be3a7d9b65b4","order_by":0,"name":"Shambhavi Shukla","email":"","orcid":"","institution":"Tata Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Shambhavi","middleName":"","lastName":"Shukla","suffix":""},{"id":428166067,"identity":"69ae4c9b-fdda-48c7-ae7f-78855f9dcf2d","order_by":1,"name":"Nisha Kumari","email":"","orcid":"","institution":"Command Hospital Kolkata","correspondingAuthor":false,"prefix":"","firstName":"Nisha","middleName":"","lastName":"Kumari","suffix":""},{"id":428166068,"identity":"96f5c1f1-f6f6-4845-bf2f-f870389c09cb","order_by":2,"name":"Kumar saket","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYFACNiA2YONhY28AMSyI1HKggk+Gn+cASIsEsVrOyNlIzkgA8YjQIt9+LPHxxzYzHoObz69u+FEgwcDf3p2AV4vBmbTDBgfb0ngMbueU3ewBOkzizNkN+LUwpLdJHGw7BtKSdoMHqMVAIhe/Fvn+5+0/Drb9BzrsTNrNP8RoYbiRdgzofTYeyRnsx24TZYvBjWfJEmcq2Hj4eXLYbssYSPAQ9It8f5rhhwoDNns29uPPbr75YyPH395LwGEIwGMAJolVDgLsD0hRPQpGwSgYBSMIAAAcXElKKwLDPAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-0547-7073","institution":"Tata Medical Centre","correspondingAuthor":true,"prefix":"","firstName":"Kumar","middleName":"","lastName":"saket","suffix":""},{"id":428166069,"identity":"63608897-e911-4755-a72d-1c4dd2398edf","order_by":3,"name":"Gunjan Dwivedi","email":"","orcid":"","institution":"Command Hospital Kolkata","correspondingAuthor":false,"prefix":"","firstName":"Gunjan","middleName":"","lastName":"Dwivedi","suffix":""},{"id":428166070,"identity":"1b8be104-c4d6-434d-8f08-f9be4e272c24","order_by":4,"name":"Sunil Goyal","email":"","orcid":"","institution":"Command Hospital Kolkata","correspondingAuthor":false,"prefix":"","firstName":"Sunil","middleName":"","lastName":"Goyal","suffix":""}],"badges":[],"createdAt":"2025-03-13 06:25:58","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6216977/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6216977/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78657103,"identity":"4140723a-4c27-47c3-a72f-6d865f499815","added_by":"auto","created_at":"2025-03-17 09:38:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2052590,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea:\u003c/strong\u003e H\u0026amp;E stained slide (100×) showing pauci-cellular sample with cyst macrophages and polymorphs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb:\u003c/strong\u003e MRI showing a 1.7×2.3×2.5 cm cystic lesion with partial deep lobe extension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec:\u003c/strong\u003e Intra-operative image during superficial parotidectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed:\u003c/strong\u003e H\u0026amp;E slide (40×) showing hallmark features of MEC with variable-sized cystic spaces.\u003c/p\u003e","description":"","filename":"80269D6307CE495C877FE306725A8941.png","url":"https://assets-eu.researchsquare.com/files/rs-6216977/v1/fa826afbc68a3293667b2496.png"},{"id":78658247,"identity":"28c43bc9-4ced-4401-8623-f41691e55205","added_by":"auto","created_at":"2025-03-17 09:46:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2609673,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6216977/v1/8ec3ed23-4bd3-4caa-b515-3b5cabcc02fc.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eDiagnostic Conundrum and Treatment Dilemma in a Cystic Lesions of Parotid: A Case Report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands, accounting for 30\u0026ndash;35% of all salivary gland malignancies\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The term \"mucoepidermoid\" was introduced by Stewart and colleagues, describing a distinctive salivary gland tumor consisting of epidermoid and mucus-producing cells, along with intermediate cells exhibiting transitional characteristics\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. MEC arises most frequently in the parotid gland, followed by the submandibular and minor salivary glands. It is a tumor with diverse histological and cytological features, making diagnosis via FNAC challenging\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Accurate preoperative diagnosis is critical for optimal patient management, including appropriate surgical and adjuvant therapies. We present a case of a recurrent cystic lesion in the left parotid gland initially diagnosed as a benign lymphoepithelial cyst, later confirmed as an intermediate-grade MEC on histopathological examination (HPE).\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 25-year-old male presented with a one-year history of insidious onset and gradually progressive swelling in the left parotid region, associated with mild pain. Examination revealed a solitary non-tender swelling, measuring 2\u0026times;2 cm, with normal overlying skin. No significant medical, surgical, or family history was noted.\u003c/p\u003e \u003cp\u003eIn 2019, an ultrasound (USG) of the neck revealed a 1.5\u0026times;1 cm ill-defined collection in the left parotid. Contrast-enhanced computed tomography (CECT) showed a peripherally enhancing lesion measuring 1.5\u0026times;0.7\u0026times;2 cm. FNAC suggested a benign cystic lesion with inflammation. The patient underwent excision biopsy under general anesthesia, and HPE confirmed a lymphoepithelial cyst.\u003c/p\u003e \u003cp\u003eIn June 2021, the patient presented with recurrence. CECT revealed a multiloculated peripherally enhancing cystic lesion measuring 1\u0026times;2.3\u0026times;2.5 cm with an eccentric enhancing solid component. FNAC yielded a pauci-cellular sample with cyst macrophages and polymorphs. Sclerotherapy with Bleomycin (1 mg/kg) and Polidocanol (10 ml/0.5%) was performed, but the swelling persisted. A repeat FNAC and contrast-enhanced MRI revealed a cystic lesion with partial extension into the deep lobe.\u003c/p\u003e \u003cp\u003eIn December 2021, the patient underwent superficial parotidectomy via a modified Blair\u0026rsquo;s incision. Final HPE revealed intermediate-grade MEC with perineural invasion. All margins were free, and no lymph nodes were involved. The patient received adjuvant radiotherapy (60 Gy in 30 fractions). Follow-up showed no residual or recurrent disease [Fig.\u0026nbsp;1].\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eFNAC is pivotal in the preliminary assessment of salivary gland lesions but poses challenges in cystic lesions due to sampling errors and the heterogeneous nature of MEC\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. MEC often demonstrates overlapping features with other cystic lesions, including mucous retention cysts, benign lymphoepithelial lesions, and Warthin\u0026rsquo;s tumor\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. In our case, FNAC failed to accurately diagnose MEC, emphasizing the importance of HPE for definitive diagnosis.\u003c/p\u003e \u003cp\u003eSchmidt et al. reported pooled sensitivity and specificity of 86% and 98%, respectively, for FNAC in parotid gland lesions, though accuracy varied by lesion type. Edwards et al. noted that cystic components in MEC dilute diagnostic cellularity, contributing to misdiagnosis rates exceeding 50%\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite its limitations, FNAC provides high specificity and positive predictive value (PPV)\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. However, Shetty and Geethamani highlighted its limitations, including subjective cytological interpretation and sampling errors, particularly in heterogeneous tumors like MEC\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Integration of FNAC findings with imaging and HPE improves diagnostic accuracy.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eCystic lesions in the parotid gland demand a high index of suspicion. FNAC, while valuable, has inherent limitations. HPE remains the gold standard for definitive diagnosis. A multidisciplinary approach involving surgeons, radiologists, and pathologists is essential for accurate diagnosis and optimal management of complex salivary gland lesions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eWe confirm that written informed consent for participation and publication of this case report was obtained from the patient\u0026rsquo;s legal guardian.\u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics Approval and Consent to Participate:\u003c/h2\u003e \u003cp\u003eEthical approval was not needed for this case.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive specific funding. All resources were provided by the authors\u0026rsquo; affiliated institutions. The funding body had no role in the design, data collection, analysis, or manuscript preparation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCARE Checklist\u003c/b\u003e The CARE checklist is included as a supplementary document with line and page numbers for each item detailed in the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBoahene DKO, Olsen KD, Lewis JE et al (2004) Mucoepidermoid Carcinoma of the Parotid Gland. Arch Otolaryngol Head Neck Surg 130(7):849. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archotol.130.7.849\u003c/span\u003e\u003cspan address=\"10.1001/archotol.130.7.849\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStewart FW, Foote FW, Becker WF (1945) Muco-epidermoid tumors of salivary glands. Ann Surg 122(5):820\u0026ndash;844. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00000658-194511000-00005\u003c/span\u003e\u003cspan address=\"10.1097/00000658-194511000-00005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt RL, Hall BJ, Wilson AR et al (2011) Diagnostic accuracy of FNAC for parotid gland lesions. Am J Clin Pathol 136(1):45\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1309/AJCPOIE0CZNAT6SQ\u003c/span\u003e\u003cspan address=\"10.1309/AJCPOIE0CZNAT6SQ\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdwards PC, Wasserman P (2005) Evaluation of cystic salivary gland lesions by FNAC. Acta Cytol 49(5):489\u0026ndash;494. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000326193\u003c/span\u003e\u003cspan address=\"10.1159/000326193\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar N, Kapila K, Verma K (1991) FNAC of mucoepidermoid carcinoma: A diagnostic problem. Acta Cytol 35(3):357\u0026ndash;359 PMID: 2042438\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShetty A, Geethamani V (2016) FNAC in major salivary gland tumors. J Oral Maxillofac Pathol 20(2):224\u0026ndash;229. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0973-029X.185899\u003c/span\u003e\u003cspan address=\"10.4103/0973-029X.185899\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Tata Medical Center","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cystic lesion, Parotid gland, Mucoepidermoid carcinoma, FNAC, Histopathology, Superficial parotidectomy","lastPublishedDoi":"10.21203/rs.3.rs-6216977/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6216977/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCystic lesions of the parotid gland present diagnostic challenges, especially when FNAC is inconclusive. This case highlights the need for a multidisciplinary approach and histopathological confirmation. A 25-year-old male with a recurrent left parotid cyst underwent excision biopsy, confirming a lymphoepithelial cyst. Recurrence after two years revealed a multiloculated cystic mass with solid components. Despite FNAC and sclerotherapy, persistence led to superficial parotidectomy, with final HPE diagnosing intermediate-grade mucoepidermoid carcinoma. Adjuvant radiotherapy was administered, with no recurrence on follow-up. FNAC alone may be insufficient for diagnosis, reinforcing histopathology as the gold standard. Comprehensive evaluation and multidisciplinary management are essential for optimal outcomes in complex parotid lesions.\u003c/p\u003e","manuscriptTitle":"Diagnostic Conundrum and Treatment Dilemma in a Cystic Lesions of Parotid: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-17 09:38:14","doi":"10.21203/rs.3.rs-6216977/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eb7c7c6c-ea98-48cc-8cd3-99e3e50c3b5e","owner":[],"postedDate":"March 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45758744,"name":"Head \u0026 Neck Surgery"}],"tags":[],"updatedAt":"2025-03-17T09:38:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-17 09:38:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6216977","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6216977","identity":"rs-6216977","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}