Paediatric myofibroma of the parotid gland: a rare masquerade of pleomorphic adenoma.

Paediatric parotid masses are relatively rare clinical entities, with pleomorphic adenoma representing the predominant benign aetiology. We document the clinical trajectory of a male patient in middle childhood presenting with an asymptomatic, progressive left parotid mass. Although preliminary MRI and cytology favoured a diagnosis of pleomorphic adenoma, the patient underwent a left superficial parotidectomy for definitive management. Histopathological assessment unveiled an unencapsulated spindle cell neoplasm characterised by a vague nodular architecture, hyalinised stroma and increased mitotic activity. While the presence of smooth muscle actin and desmin expression raised the possibility of a low-grade sarcoma, the absence of marked pleomorphism, infiltrative margins and specific immunohistochemical markers confirmed a diagnosis of myofibroma, likely the 'atypical' variant. This case underscores the diagnostic complexities associated with rare paediatric mesenchymal tumours of parotid and validates the necessity of precise clinicopathological correlation.