Adult Parotid Cavernous Hemangioma Coexisting with Pleomorphic Adenoma: A Rare Clinicopathologic Presentation with Superficial Parotidectomy and Facial Nerve Preservation

Abstract

Background: Pleomorphic adenoma (PA) represents the most common benign parotid neoplasm, yet cavernous hemangioma (CH) of the adult parotid gland is exceptionally rare, constituting <0.5% of parotid tumors. The recurrence of this disease remains a surgical challenge. Case: A 36-year-old male presented with a slowly enlarging, lobulated left parotid mass over 5 years. Clinical examination revealed a firm, non-tender, non-fluctuant preauricular swelling without facial nerve involvement. Contrast-enhanced MRI demonstrated a 7.8×5×5.3 cm poorly circumscribed, multilobulated, heterogeneously enhancing mass in the superficial lobe with T1 low-intermediate and T2 high signal intensity, abutting the masseter and tragus without perineural spread. Left submandibular and upper cervical nodes were small and nonspecific. Superficial parotidectomy was performed via modified Blair incision with antegrade facial nerve dissection and en bloc resection. Histopathology revealed biphasic pleomorphic adenoma with coexistent cavernous hemangioma component. Outcome: Complete facial nerve preservation with no transient or permanent dysfunction. Drain removal on postoperative day 2 with uneventful recovery. No recurrence at 18-month clinical follow-up. Clinical Significance: This case illustrates diagnostic and surgical management challenges of an adult parotid vascular tumors masquerading as common benign epithelial tumors. It emphasizes the role of superficial parotidectomy with negative margins in achieving favorable facial nerve outcomes and recurrence while avoiding morbidity from extensive dissection.