Warthin tumour of the parotid

Case contributed by A.Prof Frank Gaillard

Presentation

Left parotid lump.

Patient Data

Age: 70 years
Gender: Male
Modality: MRI

Rounded mass seen in the retromandibular left parotid tail measuring 1.5 by 1.8 centimetres in axial dimensions and 2.6 centimetres superoinferiorly. There is heterogeneous internal signal including small areas of T1 hyperintensity, and heterogeneous enhancement. There are smaller adjacent nodules in the parotid, measuring 11.5 x 6.2 mm in the left parotid tail and 11.3 x 5.3 mm superiorly in the left parotid. These may be small lymph nodes. No abnormal perineural enhancement.

No right parotid lesions are seen. The right submandibular gland appears atrophic (not shown)

Encephalomalacia is seen at the left temporal pole suggestive of prior trauma. 

Tiny T2 hyperintense nodule subpleural in the left lobe of the thyroid. Mucosal thickening in the left maxillary sinus. 

Conclusion:  

Findings compatible with a left parotid Warthin's tumour. Small adjacent intraparotid nodules likely lymph nodes.

Modality: Ultrasound

Within the left parotid gland there is a large 3.0 x 1.5 x 1.3 cm well- defined hypoechoic lesion. A smaller adjacent similar lesion.  The larger lesion demonstrates mild heterogeneity and internal vascularity. No posterior acoustic shadowing. A core biopsy of this lesion was performed.

Technique:

Informed consent obtained. 1% lignocaine used for local anaesthesia. Under ultrasound guidance a core biopsy was performed with a 20g QuickCore biopsy system. Sample was sent for analysis in formalin. No immediate post procedure complications.

Histology

MICROSCOPIC DESCRIPTION: The sections show a fragmented core biopsy which consists of prominent oncocytic cells with associated benign lymphoid tissue. There is no evidence of malignancy seen.

DIAGNOSIS: Left parotid lesion core biopsy: Features in keeping with a Warthin's tumour.

Case Discussion

 

Key learning points:

1. A heterogenous small parotid lesion <2cm is unlikely to be a pleomorphic adenoma.

2. Warthin tumours are most common in elderly male smokers and can be bilateral.

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Case Information

rID: 26057
Case created: 26th Nov 2013
Last edited: 24th Jul 2016
System: Head & Neck
Inclusion in quiz mode: Included

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