Pleomorphic Adenoma of the Soft Palate With Indeterminate Imaging and Nondiagnostic Fine-Needle Aspiration Cytology: A Case Report.

Pleomorphic adenoma is the most common benign salivary gland neoplasm and may arise from the minor salivary glands of the palate. Palatal masses can resemble inflammatory, infectious, or other neoplastic lesions, and fine-needle aspiration cytology (FNAC) may be nondiagnostic. A 35-year-old woman presented with a painless, gradually enlarging swelling of the left soft palate of three months' duration. Examination revealed a smooth, firm, non-tender, non-ulcerated submucosal mass measuring approximately 3 × 2 cm and extending toward the left tonsillar fossa. Contrast-enhanced computed tomography demonstrated a well-circumscribed heterogeneous lesion measuring 2.3 × 2.3 × 2 cm adjacent to the left tonsillar fossa, with peripheral enhancement, a hypoenhancing center, and mass effect on the soft palate and pharyngeal mucosa. An inflammatory or phlegmonous process was considered, although neoplasia could not be excluded. FNAC yielded predominantly hemorrhagic material with scattered plasmacytoid cells and occasional cell clusters and was insufficient for a definitive diagnosis. The lesion was excised in toto through a transoral approach under general anesthesia, and its capsule was grossly intact. Gross examination revealed a well-circumscribed, firm, gray-white nodular specimen measuring 2 × 2 × 2 cm. Histopathological examination confirmed pleomorphic adenoma. No local recurrence was documented at the six-month follow-up. This case emphasizes that salivary gland neoplasia should remain in the differential diagnosis of persistent palatal masses despite inflammatory-appearing imaging and nondiagnostic FNAC, with histopathological examination providing the definitive diagnosis.