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Mass noted near the right parotid gland, firm, about 3 cm, posterior to the right mandibular angle. Malignancy?
US parotid glands
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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 color 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 tumors over the other differentials.
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 tumor the most favored diagnosis. Parotid benign mixed tumor, although being the most common parotid tumor, is felt less likely in this context. The lack of neck lymphadenopathy makes parotid Non-Hodgkin lymphoma also unlikely.
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.
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.
1. FNA Right Parotid Gland: Warthin tumor.
2. FNA Right Parotid Gland: Suggestive of Warthin tumor.