Parotid gland keratocystoma: a rare diagnosis of a neck lump

Abstract

Keratocystoma of the parotid gland is a rare benign tumour, with only a handful of case reports in literature. We report a case of a man in his 70s who presented to the head and neck clinic with a 2-month history of a gradually increasing left neck swelling. Fine-needle aspiration showed contents of an epidermal cyst; however, an MRI showed a solid/cystic mass with a low T2 signal, suggesting increased risk of malignancy. The patient went on to have a left superficial parotidectomy and level IIa supraselective neck dissection. The lesion contained laminated keratin and was lined by squamous epithelium, with nodal extension. Features were those of a keratocystoma; metastatic cystic well-differentiated squamous cell carcinoma was not favoured. This is the first reported case of a parotid keratocystoma with nodal extension of the lesion. This case report demonstrates that surgical excision and clinical monitoring can be a safe management strategy for these benign tumours.