Pleomorphic adenoma of the parapharyngeal space: a case report

Tumors of the parapharyngeal space (PPS) are rare, accounting for less than 0.5% of all head and neck neoplasms. Their diagnosis and management remain challenging due to the complex anatomy of this region. Pleomorphic adenoma is an uncommon benign tumor in the PPS and can originate from various structures, most commonly the deep lobe of the parotid gland, but also from ectopic or accessory salivary tissue, and more rarely from minor salivary glands. Magnetic resonance imaging (MRI) is the imaging modality of choice, allowing precise evaluation of the tumor’s extent and its relationships with adjacent structures. We report the case of a 52-year-old French man who presented with a progressive, painless oropharyngeal swelling and mild dysphagia evolving over eight months. MRI with gadolinium enhancement demonstrated a well-defined, well-encapsulated mass in the prestyloid PPS, suggestive of pleomorphic adenoma. Cytological examination supported the diagnosis. The tumor was completely excised through a transoral approach, with careful preservation of the capsule to minimize recurrence risk. Histopathological analysis confirmed pleomorphic adenoma with no evidence of malignant transformation. The postoperative course was uneventful, and no recurrence was observed after one year of follow-up. Pleomorphic adenoma of the PPS is an uncommon entity. When imaging confirms a well-encapsulated benign lesion, the transoral approach offers a safe and minimally invasive surgical option, providing good functional and cosmetic outcomes. Complete excision and regular follow-up are essential to prevent recurrence or potential malignant transformation.