A 56-year-old female was admitted in the Department of Oral Maxillofacial Head and Neck Oncology Surgery with a history of painless mass of the left posterior region of the parotid gland. The swelling was slowly progressive over a period of 2 months and there were no associated systemic symptoms. Physical examination revealed a parotid mass 1.5 cm × 2 cm × 2 cm in size, firm in consistency, and with no palpable cervical lymph nodes. The preoperative computed tomography (CT) scan depicted a 4.5 cm × 3.4 cm × 3.2 cm sized irregular lobular mass involving the deep lobe of the left parotid gland. Margins were clear, uneven texture, and the compression of the left internal jugular vein with the forward displacement was observed. The cervical lymph nodes were not enlarged []. The coronal CT demonstrated a soft tissue mass that extended up to the left temporal bone []. Parotid gland pleomorphism adenoma or facial nerve neurilemmoma was the clinical differential diagnosis. Following discussion and after obtaining consent from the patient, left partial parotidectomy with conservation of facial nerve was performed under general anesthesia. During the course of the surgery, the tumor was identified with an intact capsule and jugular vein, and the carotid artery was palpated [Figure –].
A 47-year-old Iranian male patient referred to our outpatient clinic in the Imam Khomeini Hospital, Sari, with a palpable and painless mass in his left shoulder.\nThe patient did not complain about pain or weakness in this location. On examination, the mass was small, mobile, firm, and nontender located in the soft tissue of left shoulder. The skin covering the mass was intact, and there was no ecchymosis and even erythema (). The shoulder range of motion had no functional impairment, and the patient was able to do the routine tasks with no neurovascular disturbance. Medically speaking, important clinical signs and symptoms such as fever, weight loss, and respiratory symptoms were not detected.\nThere was no visible fluctuation in this field, and it was estimated 0.5-1 cm in length and width. Tumor consistency was not similar to bone, and it seemed to be a soft tissue mass. The patient denied any history of trauma and also no significant family history was identified. Interestingly, the patient was operated by general surgeon 6 times because of relapses in a way the last one was 1.5 years ago. At the first time, the patient was referred to the outpatient clinic because of gradual mass enlargement. The patient was operated by wrong method as transverse approach in the lateral border of the shoulder ().\nIn the recent recurrence, chest X-ray showed no obvious lung or bone involvement ( and ). Magnetic resonance imaging (MRI) illustrated a small extraskeletal nodular lesion with ring enhancement and no bone involvement at subcutaneous fat on lateral aspect of shoulder measuring about 13 mm which could be due to a recurrence of the previous tumor ( and ). Unfortunately, no previous documentation such as MRI was found. Thus, this caused difficulty for interpretation of the course of the main disease.\nFirst, we decided to operate the tumor as an incisional biopsy because we were not sure about the nature of the lesion. An important note in this approach was limited access to the lesion because of an incorrect previous approach. Pathologic specimen confirmed the diagnosis of chondrosarcoma. Then, he underwent a wide resection of the lesion in the beach-chair position. In surgery, the five dense fibrotic and firm masses measuring from 0.5 to 2 cm and the middle part of deltoid muscle (because of involvement) were excised and sent to pathology ward. Microscopic examination showed infiltrative hypercellular islands of pleomorphic chondrocytes composed of enlarged cells with irregular hyperchromatic nuclei and inconspicuous cytoplasm which was compatible with the diagnosis of chondrosarcoma with free surgical margins ( and ). We should say that the diagnosis was based on the characteristic clinical, radiologic, and pathological criteria; moreover, it was confirmed by immunohistochemistry. Hence, after consulting with the oncologist, radiation therapy was done. We have followed the patient for 6 months after operation, and until now, no recurrence is recognized.