# Parotid Enlargement as a Rare First Site of Manifestation in Extramedullary Acute Lymphoblastic Leukemia: A Case Report

## TL;DR

A 12-year-old boy presented with parotid swelling, later diagnosed with B-cell acute lymphoblastic leukemia, highlighting a rare initial manifestation of the disease.

## Contribution

This case report highlights parotid enlargement as a rare first sign of extramedullary acute lymphoblastic leukemia in children.

## Key findings

- Bilateral parotid enlargement was the initial manifestation of B-cell acute lymphoblastic leukemia in a 12-year-old boy.
- Initial treatment for infection failed to resolve the swelling, leading to further diagnostic evaluation.
- The case underscores the importance of considering leukemia in the differential diagnosis of unexplained parotid enlargement in children.

## Abstract

Parotid neoplasm in children is very rare, and most of these tumors are benign. Parotid enlargement in children is usually caused by infection or inflammation. We report a case of a 12-year-old boy who presented with the initial manifestation of bilateral parotid enlargement. He complained of two weeks of parotid swelling, during which the tumor gradually increased in size as he battled a monthlong on-and-off fever. An intravenous antibiotic was administered, as the first diagnosis was infection. Imaging studies of the swelling displayed features of infection, which was not resolved by the antibiotic. Fine-needle aspiration cytology was initially planned to establish a diagnosis. However, due to other findings in the clinical examination, such as bilateral scrotal swelling with abnormal blood work, the child was referred to other specialists for further assessment. Eventually, he was diagnosed with B-cell acute lymphoblastic leukemia by a hematology team.