Otolaryngology–Head and Neck Surgery (2007) 136, 672-673
CASE REPORT
Sebaceous adenoma of the parotid gland in a
2-year-old male
Kevin C. Welch, MD, John C. Papadimitriou, MD, Robert Morales, MD,
and Jeffrey S. Wolf, MD, Baltimore, MD
S
ebaceous adenomas of the major salivary glands are
uncommon tumors. Although sebaceous differentiation within the major salivary glands is a frequent histopathologic finding (approximately 20% to 42% of parotid
glands1-3), sebaceous neoplasms of salivary gland origin are
not. A number of publications review the clinical and histologic features of sebaceous neoplasms, however, these
reports focus on adult patients. The finding of these tumors
in a pediatric patient is exceedingly rare.4 We present a case
of a sebaceous adenoma of the parotid in a 2-year-old male.
Our patient is a 2-year-old full-term healthy male who
was referred to the University of Maryland Department of
Otorhinolaryngology with a 1-year history of a progressively
enlarging painless left-sided neck mass. An MRI (Fig 1)
revealed a mildly to moderately enhancing heterogenous
mass that measured 4.7 ⫻ 3.0 ⫻ 5.2 cm in the vicinity of the
left parotid gland. There was no associated lymphadenopathy. Before the referral, he had undergone an open biopsy
that was interpreted as a dermoid tumor. Our review of the
biopsy specimen favored the diagnosis of a sebaceous neoplasm.
Physical examination revealed an otherwise healthy appearing Asian-American male. He had a 5-cm nontender
mass in the location of the left parotid gland. The overlying
skin was normal in appearance with the exception of the
previous biopsy scar. There was no facial nerve weakness
on examination.
A clinical diagnosis of a sebaceous neoplasm was made,
and the patient underwent a left total parotidectomy with
facial nerve preservation. An encapsulated mass that occupied the superficial and deep lobes of the parotid gland was
identified and removed with preservation of the facial nerve.
From the Departments of Otorhinolaryngology (Drs Welch and Wolf);
Pathology (Dr Papadimitriou); and Radiology (Dr Morales); University of
Maryland School of Medicine Baltimore.
Figure 1 Axial T2-weighted MRI demonstrates a well-circumscribed tumor within the region of the left parotid gland. The tumor
has heterogenous signal intensity representative of the sebaceous
components of this type of tumor.
The final pathology report was consistent with a sebaceous adenoma, which is a benign adnexal tumor that is
characterized by abundant islands of sebaceous cells admixed in a fibrous stroma surrounded by cystic and ductlike structures5 (Fig 2). These sebaceous cells are noninvasive and fail to demonstrate any significant pleomorphism
Reprint requests: Kevin C. Welch, MD, Department of Otorhinolaryngology, 16 S. Eutaw St, Suite 500, Baltimore, MD 21201.
E-mail address: [email protected].
0194-5998/$32.00 © 2007 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
doi:10.1016/j.otohns.2006.08.029
Welch et al
Sebaceous adenoma of the parotid gland in a . . .
Figure 2 Sebaceous adenoma under magnification; cystic elements of the lesion are lined by both squamous and sebaceous
cells. The surrounding stroma is fibrotic (original magnification,
⫻200).
or atypia. In a gross examination, sebaceous adenomas
appear well-circumscribed, are pale yellow in color, and are
rubbery to palpation.
The patient had an uneventful postoperative course and
was discharged to home on postoperative day four.
673
sule could be identified in the five specimens. The specimens were otherwise characterized by foreign body reaction, histiocytes, fibrosis, and varying degrees of cyst
formation. Cawson et al5 reviewed the histology of sebaceous adenomas and noted their preponderance of solid
nests of sebaceous glands that were admixed in a fibrous
stroma. They also noted squamous metaplasia in their tissue
samples. Although their report referred to a sebaceous adenoma that occurred in a minor salivary gland, Izutsu et al6
also describe their findings as well-circumscribed and possessing well-differentiated sebaceous units with ductal formation.
The management of sebaceous adenoma consists of excision en toto. With complete excision, recurrence rates
would be very low. There is no information with respect to
the accuracy of fine needle aspiration of these tumors.
CONCLUSION
Sebaceous adenomas are benign tumors that are infrequently encountered in adult patients. We presented an
extremely rare case of a sebaceous adenoma of the parotid
in a pediatric patient. Although other neoplasms are much
more frequently encountered in the pediatric population,
one should maintain sebaceous adenomas in the differential
diagnosis of parotid masses.
DISCUSSION
Sebaceous adenomas are rare in adult patients and have
been reported only once in the pediatric population.4 These
adenomas occur most commonly in the parotid gland; however, they have been reported2,6 in the submandibular, sublingual, and minor salivary glands. The largest compilation
of information on sebaceous neoplasms is provided by
Gnepp and Brannon.2 In their review of the AFIP database,
21 cases of salivary gland sebaceous neoplasms were reported. Five were sebaceous adenomas, nine were sebaceous lymphadenomas, five were sebaceous carcinomas,
and two were sebaceous lymphadenocarcinomas. In their
series, sebaceous adenomas were found in the parotid gland
in three of five cases, the submandibular gland in one case,
and the buccal mucosa in another. All tumors were well
demarcated or circumscribed; however, no consistent cap-
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