Carotid sinus syndrome as the presenting symptom of cystadenolymphoma

Carotid sinus syndrome is a rare but serious manifestation of head and neck malignancy [1]. Although a number of different types of the syndrome have been proposed by Weiss and Baker [2], it is not always easy to fit a patient into these categories. However, to our knowledge, this is the first report of cystadenolymphoma presenting as recurrent syncopal episodes, and the surgical removal of the tumor resulted in complete amelioration of symptoms and disappearance of electrocardiogram abnormalities.A 45-year-old woman with one-week-old swelling in the left mandibular angle was admitted to our oral and maxillofacial surgery department with the complaints of recurrent episodes of vertigo and consciousness. The vertigos gradually increased in frequency and intensity since they started one month prior her admission. Physical examination revealed a discrete raised, painless mass occupying the left parotid area witch adhered to underlying soft tissue, extending approximately 2 cm in diameter in the sub- and retromandibular regions. There were no restrictions on the cranial nerves supplying this area. No odontogenic cause or any other inflammatory factors could be responsible for the parotid gland swelling. There was no palpable lymphadenopathy in the left neck. Blood pressure was 115/62 mm Hg and the heart rate was 63 beats per minute. Routine laboratory investigations were normal. 24-hour Holter monitoring revealed several episodes of sinus arrest. Ultrasonography showed a well-defined space-occupying lesion of about 31 mm in length and 17 mm in width, which was hypo echoic and located in the deep lobe of the left parotid gland. The rest of the gland showed a homogeneous parenchyma.Computerized tomography (CT) showed a large mass extending into the carotid space and protruding into the parapharyngeal space (Figure 1).A left parotidectomy was performed. The resected gland was a hard mass, which had spread over the bifurcation of the left carotid artery without invading the