03 August 2023: Articles
Rapidly Enlarging Parotid Mass in a Person Living with HIV: A Case of Multiple Myeloma with Extramedullary Plasmacytoma
Challenging differential diagnosis
Maria G. Novitskaya A , Peter A. DeRosa D , David T. Chen B , Ahmed Khalil B , Omar Harfouch B , Erin E. O’Connor D , Sarah A. Schmalzle A*DOI: 10.12659/AJCR.938431
Am J Case Rep 2023; 24:e938431
Table 1. Differential diagnosis of a parotid mass.
| Type of etiology | Cause of parotid enlargement | Characteristic symptoms and exam findings | Characteristic diagnostic findings |
|---|---|---|---|
| Cough, dyspnea, chest pain, fatigue, malaise, fever, weight loss. Vision changes, dry eyes or mouth, painless salivary gland swelling which may be unifocal or multifocal | Hypercalcemia. Bilateral hilar adenopathy and/or reticular lung opacities. noncaseating granuloma | ||
| Xerosis, xerostomia, dysphagia, bilateral parotid enlargement, submaxillary and sublingual gland swelling | + anti-Rho, anti-La, rheumatoid factor, or antinuclear antibodies, anemia of chronic disease | ||
| Prodrome of fever, malaise, headache, myalgias, anorexia. bilateral parotitis within 48 hours of prodrome | + mumps IgM, mumps virus PCR, leukocytosis or leukopenia, elevated serum amylase | ||
| Fever, malaise, conjunctivitis, myalgia, coryza, pharyngitis, gastroenteritis | Viral culture, antigen assay, or PCR positive for adenovirus. | ||
| Fever, cough, sore throat, myalgia, coryza, nasal congestion, headache | Upper or lower respiratory tract viral PCR + for influenza A H3N2 (strain associated with parotitis) | ||
| Fever. Acute onset of unilateral, firm, erythematous swelling in the parotid area, localized pain, purulent drainage from Stensen’s duct | Leukocytosis, elevated CRP, elevated amylase. Positive gram stain and culture from pus | ||
| Slow-growing painless mass with a propensity for neural involvement | Homogenously enhancing mass, tendency for perineural spread. Basaloid cells encircling hyaline globule, cribriform pattern, typically positive for CD117 | ||
| Slow, painless, cervical lymph node enlargement, similar manifestation to Sjögren’s syndrome | Mixed solid and cystic lesions. Clusters of ductal epithelial cells with lymphocytes, background of lymphoid cells. | ||
| Rapidly growing, painless, jaw mass, predominantly seen in pediatric populations | Osteolytic lesion in maxilla or mandible with adjacent soft tissue component that may involve parotid gland. Elevated LDH and uric acid. Effacement of normal architecture by sheets of atypical lymphoid cells | ||
| Slow-growing painless mass, associated with high-risk multiple myeloma and poor prognosis, more aggressive disease course in HIV population | Non-specific homogeneously enhancing soft tissue mass and/or lymphadenopathy. No anemia, no hypercalcemia, no renal impairment. Clonal plasma cells, | ||
| Weight loss, fever, night sweats. Slow-growing mass, potential rapid expansion, typically advanced at diagnosis | Non-specific variably enhancing mass High-grade neoplasm, large immunoblastic appearing cells, prominent nucleoli | ||
| Fatigue, weight loss, fever, night sweats, symptoms of hyperviscosity. Slow-growing painless mass | Non-specific mass. Anemia, IgM paraproteinemia, cryoglobulinemia,coagulopathy. Abnormal B-cells and plasma cells | ||
| Slow-growing, painless, fixed mass | Low-grade: well-circumscribed mass with cystic component; higher grade tumors: ill-defined with low to intermediate T2 signal. Malignant mass containing epidermoid cells, mucous cells, and “intermediate” cells. Usually positive for “glandular” cytokeratins CK7, CK8, CK18, CK19 | ||
| Slow-growing, painless parotid gland swelling without facial nerve involvement | Well-defined mass with lobulated margins; low T1/high T2 signal and homogeneous enhancement. Proliferation of myoepithelial and epithelial cells | ||
| Slow-growing, painless, well-circumscribed unilateral parotid enlargement. | Well-defined mass in parotid tail; bilateral in 20%. Papillary-cystic structures lined by oncocytic cells | ||
| Weight loss, history of neoplasm of head and neck, breast, kidney, gastrointestinal tract, or prostate | Irregular mass, primary neoplasm found elsewhere in body. Morphology similar to primary neoplasm | ||
| + – positive; PCR – polymerase chain reaction; CRP – C-reactive protein; LDH – lactate dehydrogenase. * Diagnoses that are associated with HIV. | |||