Warthin tumour

Case contributed by Dr Bruno Di Muzio

Presentation

Mass noted near the right parotid gland, firm, about 3 cm, posterior to the right mandibular angle. Malignancy?

Patient Data

Age: 75 years
Gender: Male
Ultrasound

US parotid glands

There is a relatively well-defined ovoid mass within the posterior aspects of the right parotid gland, extending into the deep lobe as well, measuring 37 x 24 x 26 mm. It has a heterogeneous solid echotexture with multiple ill-defined hypoechogenic foci (cystic changes?) and demonstrating prominent internal vascularity on colour Doppler. A few small intraparotid lymph nodes are also noted, and they show preserved morphology. The left parotid gland demonstrates two adjacent smaller solid nodular lesions in its superficial lobe that have similar morphology, echotexture, and vascularity compared to the lesion in the right gland.

Conclusion: Although the sonographic appearances are completely nonspecific, multiple solid parotid masses in this epidemiology raises the possibility of Warthin tumours over the other differentials. 

Case Discussion

This patient has also a long-term tobacco smoking history. The presence of bilateral similar lesions in the parotid glands in this age group, also with a history of smoking, make Warthin tumour the most favoured diagnosis. Parotid benign mixed tumour, although being the most common parotid tumour, is felt less likely in this context. The lack of neck lymphadenopathy makes parotid Non-Hodgkin lymphoma also unlikely. 

MACROSCOPIC DESCRIPTION:
FNA attended and two samples were collected. 
1. FNA Right Parotid Gland: 2 passes were made, 2 wet fixed and 2 air-dried slides were made. Needle washings prepared from all passes. Specimen adequacy statement: Adequate.
2. FNA Right Parotid Gland: 3 passes were made, 3 wet fixed and 3 air-dried slides were made. Needle washings prepared from all passes. Specimen adequacy statement: Adequate.

MICROSCOPIC DESCRIPTION:
1. The smears contain groups and sheets of oncocytes, in a background of lymphoid cells, degenerate cells, protein deposit, acellular debris and blood.
2. The smears contain clusters of oncocytes, in a background of reactive lymphoid cells and blood.

DIAGNOSIS:
1. FNA Right Parotid Gland: Warthin tumour.
2. FNA Right Parotid Gland: Suggestive of Warthin tumour.

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Case information

rID: 56206
Published: 19th Oct 2017
Last edited: 22nd Oct 2017
System: Head & Neck
Inclusion in quiz mode: Included

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