Venolymphatic malformation – parotid gland

Vascular malformations (VMs) are a rare clinical entity and even rarer are those originating from the salivary glands. Those arising from the parotid gland are the most reported with the most common subtype being venous or arteriovenous malformation. Here, we report a case of a neck mass which was identified as a venolymphatic VM in the parotid gland. A 14-year-old patient presented with a progressive right-sided facial mass without constitutional symptoms. Ultrasonography of the mass showed a well-defined lobulated parotid mass with few cystic areas and minimal vascularity, thus deducing a differential of either a branchial cyst or a pleomorphic adenoma. Excision of the mass was performed and sent for histopathological diagnosis. The grossly hemorrhagic and congested specimen showed many vascular channels lined by flat endothelium on microscopy. These dilated channels of varying sizes had many red blood cells and proteinaceous fluid. The lesion was also seen infiltrating the normal surrounding structures of the salivary gland tissue. With the rare incidence of VMs occurring anywhere in the body, diagnosing a venolymphatic malformation occurring in the parotid gland was an out of common experience. Better imaging of a mass in the salivary gland using not only ultrasonography but also color Doppler and magnetic resonance imaging can help rule out the rare entities that can sometimes be overlooked and help plan better treatment for the patient.