Case Studies
A Rare Case of Chondroma of the Parotid Gland
Gad Murenzi, MD,1 Rachel Kaye, MD,2 Adam Cole, MD,1 Antonio Cajigas, MD,1 Samer Khader, MD,1
Andrew Tassler, MD,2 Tiffany Hebert, MD1*
Lab Med Spring 2014;45:156-160
DOI: 10.1309/LMYQ8IPPVESAXG0R
CLINICAL HISTORY
Patient: A 39-year-old Hispanic woman.
History of Present Illness: The patient had swelling of the left
side of her neck, which she had first noticed 3 to 4 months before
consultation and which did not subside after 2 courses of antibiotics.
She reported no tenderness, dysphagia, odynophagia, dysphonia,
otalgia, fevers, chills, or weight changes.
Past medical history: The patient had a past history of gastroe-
sophageal reflux disease, arthritis (knee and cervical disease), and a
prior abnormal Pap smear result (high grade squamous intraepithelial
lesion). The cervical lesion was treated with a loop electrosurgical
excision procedure (LEEP). Her past surgical history is remarkable
for cholecystectomy and a left breast biopsy with benign results.
Chondroma of the parotid gland is an extremely rare type
of tumor that consists of benign mature cartilage arising
in the parotid gland with no admixture of epithelial and
myoepithelial components. We have found only 4 cases
reported in the literature of purely cartilaginous tumors
arising in the parotid gland. Three of the reported cases
were benign, of which 1 was reported in Germany,1 a
second in Greece,2 and a third in the United Kingdom.3
The fourth was a chondrosarcoma reported in Japan.4
Pleomorphic adenoma is the most common tumor of the
parotid gland and may include cartilaginous differentiation;
herein, we report a case of pure chondroma arising
from the parotid gland with no epithelial or myoepithelial
Abbreviations
FNA, fine needle aspiration; LEEP, loop electrosurgical excision
procedure; CT, computed tomography
Departments of 1Pathology and 2Otorhinolaryngology–Head and
Neck Surgery, Montefiore Medical Center, Albert Einstein College
of Medicine, Bronx, New York
*To whom correspondence should be addressed.
E-mail: thebert@montefiore.org
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Social history: Noncontributory.
Family history: Noncontributory.
Physical exam: The patient harbored a firm, nontender, fully mobile
2- to 3-cm left parotid tail mass without other abnormalities; her facial
nerve function was intact in all branches.
Principle Laboratory Findings: See Image 1, Image 2, Image 3,
Image 4, Image 5, and Image 6.
Keywords: fine needle aspiration, parotid gland, chondroma,
pleomorphic adenoma, soft tissue, salivary gland, extraskeletal
chondroma
components identified. The initial fine needle aspiration
biopsy cytologic results ultimately correlated with the final
histologic diagnosis of parotid chondroma.
Case Report
A 39-year-old female presented to the Department of
Otorhinolaryngology–Head and Neck Surgery at Montefiore
Medical Center (a teaching hospital for the Albert Einstein
College of Medicine, Bronx, NY) with swelling on the
left side of her neck that she first noticed 3 to 4 months
before seeking a medical consultation. The swelling was
first thought to be related to an upper respiratory tract
infection because the patient had a sore throat, sinus/nasal
congestion, and aural fullness; however, the swelling did not
subside after 2 courses of antibiotics. The patient reported
no tenderness, dysphagia, odynophagia, dysphonia,
otalgia, fevers, chills, or weight changes. Her past
medical history included gastroesophageal reflux disease,
arthritis (knee and cervical disease), and an abnormal
Pap smear result in 2002. The clinical interpretation of
the abnormal Pap smear was that the patient had a high-
grade cervical intraepithelial lesion, which prompted a

Image 1
Coronal cut of computed tomography imaging of the head and
neck of the patient, with contrast highlighting rim calcifications
and positioning of lesion within the parotid gland.
Image 2
Axial cut of computed tomography imaging of the head of the
patient, with contrast that highlights rim calcifications.
loop electrosurgical excision procedure (LEEP). Her past
surgical history is remarkable for cholecystectomy and a
left breast biopsy interpreted as benign.
Physical examination revealed a firm, nontender, fully
mobile 2- to 3-cm left parotid tail mass without other
abnormalities; her facial-nerve function was intact in all
branches. Computed tomography (CT) imaging revealed
a 2.1-cm nonenhancing lobular lesion with peripheral
coarse calcification. The lesion involved the superficial
and deep lobes of the parotid gland without parotid duct
dilation (Image 1 and Image 2). Fine needle aspiration
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(FNA) biopsies were collected with a 25-gauge needle and
plunger. We created air-dried smears from the aspirated
material and stained them with Romanowski stain (Diff-
Quick, (Cat#B4132; Siemens AG, Munich, Germany);
we stained alcohol-fixed (95% ethanol) slides with
Papanicolaou stain. The cytology smears demonstrated
a pattern of chondromyxoid matrix with embedded cells
that exhibited a centrally placed nucleus surrounded by
an artifactual lacunar space (Image 3). The cytoplasm
appeared condensed and stained greenish blue. Benign
clusters of salivary gland cells were present, which
confirmed the location of the nodule within the parotid
Case Studies

Image 3
Papanicolaou stain of biopsy material from the parotid gland
of the patient (original magnification ×400). A chondromyxoid
matrix with embedded cells (arrow) is visible, featuring a nucleus
surround by a lacunar halo.

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Image 4
Papanicolaou stain of biopsy material from the parotid gland of
the patient (original magnification ×200). Isolated chondrocyte
(black arrow) with an adjacent cluster of salivary-gland cells (red
arrow) and a background of chondromyxoid matrix.

gland (Image 4). We interpreted the findings of the
FNA cytologic examination as being consistent with an
atypical lesion of uncertain significance. Subsequently
obtained histologic material confirmed that these cells
originated from chondrocytes and correlated the cytologic
findings with the histologic appearance of an extraskeletal
chondroma of the parotid gland.
A parotidectomy was performed and the specimen
was submitted for histopathologic examination.
Intraoperatively, the mass was found to involve the
superficial lobe and extend into the deep lobe of the left
parotid gland at the junction of the posterior belly of the
digastric muscle, the inferior division of the facial nerve,
and the external carotid artery.
On gross examination, we determined that the specimen
measured 3.2 × 2.2 × 2.2 cm and weighed 6 grams.
Sectioning revealed a 2.9 × 2.2 × 2.0 cm circumscribed,
nodular, cartilaginous mass; the entire specimen was
submitted for histologic examination. We fixed the
surgically resected specimen in 10% formalin and
processed it using routine histologic techniques.
We examined hematoxylin-eosin–stained slides and
immunohistochemical stain preparations for S100, Cam
5.2, and vimentin.
Multiple sections of the surgical specimen revealed a
well-circumscribed tumor of mature hyaline cartilage
surrounded by normal parotid gland tissue (Image 5).
There were no epithelial or myoepithelial components in
the tumor, nor any evidence of atypia, mitosis, or invasion
(Image 6). Immunohistochemical stains revealed that the
chondrocytes expressed S100 and vimentin markers, but
were negative for CAM 5.2, which confirmed the absence
of any epithelial component.

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Image 5
Benign mature cartilage surrounded by normal parotid-gland
tissue (on the left-hand side).
Image 6
Higher-power view (original magnification ×20) of unremarkable
chondrocytes.
Discussion
Extraskeletal, or soft tissue, chondromas are rare, benign
cartilaginous tumors that occur in tissue other than bone.
These chondromas are usually found in close proximity to
tendons or joint capsules.5
Strict morphologic criteria are required to diagnose a
parotid chondroma. The entire specimen should be
submitted and sections prepared from multiple levels
should be examined to exclude a pleomorphic adenoma.
A parotid chondroma should be located within the parotid
gland and should be composed purely of cartilage. The
immunohistochemical profile should also reveal negativity
for epithelial and/or myoepithelial cells. The chondrocytes
should test positive for S100 and vimentin. Atypia,
increased mitoses, and necrosis should not be present;
our case fulfilled all of these diagnostic criteria.3 Further,
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the CT imaging results were consistent with a chondroma
because it reveals an iso- or hyperdense soft-tissue mass
with calcifications in 33% to 70% of parotid chondroma
cases.5
Symptoms of extraskeletal chondromas generally occur
due to the mass displacement effect (albeit slowly
expanding) on nearby tissues.5 Since tumors of the parotid
gland have a 5.5% to 25% recurrence rate, and also
have a remote possibility of malignant transformation,
wide local surgical excision is generally recommended;
however, there are no current treatment recommendations
specific for parotid chondromas due to their extreme
rarity.5-7 In our patient, the excised tumor was completely
encapsulated, and the patient has had regular follow-up
to monitor for any recurrence of the disease. Thus far, her
postoperative course has been uneventful and her aural
fullness has resolved. LM
Case Studies

References 6. Chung EB, Enzinger FM. Chondroma of soft parts. Cancer. Apr
1978;41(4):1414-1424.

1. Huppertz M. Rare case of chondroma formation in the parotid region. 7. Kransdorf MJ, Meis JM. From the archives of the AFIP. Extraskeletal
HNO. Apr 1969;17(4):111-112. osseous and cartilaginous tumors of the extremities. Radiographics.
Jul 1993;13(4):853-884.
2. Kostopoulos IS, Daniilidis I, Velegrakis G, Papadimitriou
CS. Chondroma of the parotid gland. Clinical histologic
immunohistochemical findings of a rare case. Laryngorhinootologie.

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May 1993;72(5):261-263.
3. Aslam MB, Haqqani MT. Extraskeletal chondroma of parotid gland.
Histopathology. Mar 2006;48(4):465-467.
4. Maruya S, Kurotaki H, Fujita S, Sariishi T, Shinkawa H, Yagihashi To read this article online, scan
S. Primary chondrosarcoma arising in the parotid gland. ORL J
the QR code, http://labmed.
Otorhinolaryngol Relat Spec. Mar-Apr 2001;63(2):110-113.
ascpjournals.org/content/45/2/156.full.
5. Watanabe F, Saiki T, Ochochi Y. Extraskeletal chondroma of the
preauricular region: a case report and literature review. Case Rep pdf+html
Med. 2012;2012:121743.

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