From suspicion to surprise: a case of soft palate bulge diagnosed as parapharyngeal space pleomorphic adenoma

Introduction: Parapharyngeal space (PPS) tumors are rare and often present diagnostic challenges due to their deep anatomical location and nonspecific symptoms. Pleomorphic adenomas in this region are very rare, and when unrelated to the parotid gland, they can mimic malignancies. Case Presentation: A 51-year-old male presented with a 9-month history of progressive right-sided soft palate swelling, dysphagia, and hot potato voice. MRI revealed a solid-cystic mass in the prestyloid PPS, radiologically suspicious for malignancy and separate from the parotid gland. The lesion was excised via transoral endoscopic approach. Histopathology confirmed pleomorphic adenoma. Recovery was uneventful, with no recurrence on follow-up. Conclusion: Pleomorphic adenomas of the PPS can mimic malignancy clinically and radiologically. Complete surgical excision via a transoral endoscopic approach can be safe and effective in selected patients. Histopathological confirmation is essential to guide management.