PAROTID GLAND MALIGNANCY IN PEDIATRICS: MUCOEPIDERMOID CARCINOMA

Matlhatse Phuti Maluleke, Elliot Motloung, Modise Zacharia Koto, Eliyah Aaron Sischy

Faculty of Medicine, Sefako Makgatho Health Science University, Department of Pediatric Surgery,

Ga-Rankuwa

Abstract

Introduction: Salivary gland neoplasms are rare in children and adolescents, with an estimated incidence of ~4% in patients under 20 years of age. Malignant epithelial salivary gland neoplasms are particularly rare, most often presenting around 14 years of age, and with a female predominance. The parotid gland is the most frequently affected anatomical site. Low or intermediate grade mucoepidermoid carcinoma is the most common malignant subtype in this age group, followed by acinic cell carcinoma and adenoid cystic carcinoma, which

together account for up to 80 to 90% of pediatric cases. Compared with adults, firm salivary gland swellings in children should raise a higher index of suspicion for malignancy. Additional concerning features include local pain and facial nerve palsy. Imaging with ultrasonography, magnetic resonance imaging (MRI), and occasionally contrast enhanced computed tomography (CECT) scan are essential for evaluating tumor extent and detecting metastasis. Complete surgical (R₀) resection remains the cornerstone of treatment, with histological grade, perineural invasion, and margin status serving as important prognostic

factors.

Case Report: We describe a 7-year-old girl who presented with a 4- month history of a progressive, painless right parotid gland mass.Presentation at this young age is exceptionally rare, as most pediatric salivary gland malignancies are reported closer to adolescence. Biopsy revealed an invasive neoplasm with squamous and mucinous differentiation, consistent with mucoepidermoid carcinoma. After correlation with radiological findings, the patient underwent a right total parotidectomy with lymph node dissection. Final histology confirmed a low grade mucoepidermoid carcinoma with clear (R₀) resection margins and no evidence of nodal metastasis.

Conclusion: Pediatric salivary gland malignancies are rare but clinically significant, and prompt recognition is essential. Mucoepidermoid carcinoma is the most common malignant variant, and surgical excision provides excellent outcomes when complete (R₀) resection is achieved. This case highlights the unusual occurrence of mucoepidermoid carcinoma in a young child, underlining the importance of maintaining suspicion even at an early age. Only a few cases under the age of 10 have been documented in the literature, further emphasizing the rarity and clinical relevance of this presentation.