Presentation
Painless left parotid swelling for one year. No change in size.
Patient Data
A sizeable lobulated cystic lesion is seen in the left parotid gland, involving both the superficial as well as the deep lobes. Internal septations and debris with fluid-fluid levels are seen in it. No significant vascularity is seen in it. A small well-defined isoechoic structure with peripheral hypoechoic walls measuring 5 x 12 mm is seen in the superficial lobe of the parotid gland which is likely a lymph node.
Left parotid gland complex lesion measuring approximately 4.5 x 1.5 x 2.0 cm, involving both the superficial and deep lobes. Solid component/septa of the lesion show enhancement on the post-contrast study. No calcifications are seen in it. Few small lymph nodes are seen in both parotid glands. No suspicious focal lesion is seen in the right parotid gland. Submandibular glands are normal. Multiple small sub centimetric lymph nodes are noted in the neck.
Initial FNAC and post-parotidectomy histopathology reports showing Warthin tumour.
Case Discussion
Polymorphic adenoma (PA) is the most common and the Warthin tumour (WT) is the second most common parotid gland tumour. Although these are mostly benign lesions, their biological behaviour differs with PA being relatively aggressive with a malignant tendency and a higher recurrence rate after resection. PA is seen in 30-50 years of age, more commonly in females, and is usually located in the superficial lobe of the parotid gland whereas the WT is usually seen in the middle-aged and elderly men (>50 years of age), associated with smoking and can be bilateral1.
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