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A rare case of a soft tissue myoepithelial tumor in the parapharyngeal space of a 30-year-old female is reported. The patient presented with a left parapharyngeal swelling identified after a history of tonsillectomy for recurrent tonsillitis. Magnetic resonance imaging revealed a 3.5 cm cystic mass initially suspected to be a branchial cyst. Fine needle aspiration was inconclusive, necessitating surgical excision via transoral robotic surgery. The lesion was removed en bloc without complications. Histological examination confirmed a soft tissue myoepithelial tumor with cytologic atypia, low mitotic activity, and no necrosis. Immunohistochemical analysis showed positivity for SOX-10, S-100, CK8/18, and focal E-cadherin and epithelial membrane antigen (EMA) staining, with a low Ki-67 proliferation index. No EWSR1 rearrangement was detected. Postoperative positron emission tomography-computed tomography and thoracic imaging excluded metastatic disease. After multidisciplinary discussion, no adjuvant treatment was administered, and close imaging follow-up was initiated. Two years postoperatively, the patient remains disease-free without recurrence or metastasis. Parapharyngeal space tumors are rare, and myoepithelial tumors in this location pose diagnostic challenges due to their rarity and nonspecific presentation. Transoral robotic surgery proved an effective, minimally invasive treatment option, and regular follow-up is critical due to the uncertain malignant potential of such tumors.
Cite this article as: Lenaerts A, Vorst SVD, Deheneffe S, Nollevaux MC, Delahaut G. Transoral robotic surgery for cystic myoepithelioma of the parapharyngeal space. B-ENT. Published online September 2, 2025. doi: 10.5152/B-ENT.2025.241750