Elsevier

Auris Nasus Larynx

Volume 31, Issue 1, March 2004, Pages 73-78
Auris Nasus Larynx

Case report
Synchronous oncocytoma and Warthin’s tumor in the ipsilateral parotid gland

https://doi.org/10.1016/j.anl.2003.07.008Get rights and content

Abstract

We encountered an 81-year-old Japanese man with oncocytoma of the parotid gland occurring simultaneously with a Warthin’s tumor in the ipsilateral parotid gland. The patient complained of swelling in the right infra-auricular region. Computed tomographic images, magnetic resonance images, and ultrasonography showed two masses in the right parotid gland. Technetium 99 m pertechnetate scintigraphy revealed a high accumulation in both tumors. We performed a superficial lobectomy of the parotid gland. Preoperative diagnosis was multiple Warthin’s tumor, but upon histopathological examination Warthin’s tumor proved to coexist with oncocytoma. In general, the presence of synchronous, major, salivary gland tumors with different histopathology in the ipsilateral parotid gland appears to be unique. This is especially true for the combination of oncocytomas and Warthin’s tumors, which is extremely rare. Only eight cases of this kind coincidence were found in our review of the literature. The similarity of oncocytomas and Warthin’s tumors based on epidemiology, image diagnostics, and histopathology is discussed.

Introduction

The occurrence of parotid gland tumors are relatively frequent among reported head and neck lesions. Usually, these tumors are solitary, although multiple-occurring tumors are occasionally observed. Most multiple parotid tumors are histologically classified as Warthin’s tumors, some are classified as multiple metastatic parotid tumors and others benign tumors that become multiple malignant tumors [1], [2].

The simultaneous occurrence of multiple tumors in the same parotid gland is rare [3]. The coexistence of Warthin’s tumors and oncocytomas is extremely rare, only eight cases were found in our literature review. Here, we describe an interesting case of oncocytoma of the parotid gland occurring simultaneously with a Warthin’s tumor. The clinicopathological relationship between these tumors is also discussed.

Section snippets

Case report

An 81-year-old Japanese man presented with a persistent swelling in the right infra-auricular region without pain, experienced this swelling for two months prior to his visit to our office. Physical examination revealed a 2.0cm×2.5 cm, elastic, soft, mobile mass with a smooth surface in the right parotid gland. There were no palpable cervical lymph nodes and no facial nerve paralysis. Two years before consultation, he had undergone superficial lobectomy of the left parotid gland for Warthin’s

Discussion

The histopathological difference between oncocytomas and Warthin’s tumors is the presence or absence of lymphoid stroma. Although these tumors are readily distinguishable via light microscopy [4], they are difficult to differentiate using conventional imaging techniques. Oncocytomas and Warthin’s tumors have very similar imaging features; thus, they are indistinguishable in standard CT and MR images [5]. For example, unlike with other salivary gland tumors, both oncocytomas and Warthin’s tumors

Conclusion

We encountered a case of synchronous oncocytoma and Warthin’s tumor in the ipsilateral parotid gland. Simultaneous occurrence of these tumors is extremely rare, only eight cases are previously described in the English literature. Preoperative diagnosis on the basis of conventional imaging was difficult to confirm. The present case report underscores the similarities between oncocytomas and Warthin’s tumors.

References (18)

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    MR findings are variable; although, the most common reported MR findings of parotid oncocytoma have been described as hypointense signal intensity on T1 weighted imaging becoming isointense to the parotid on T2 weighted and post contrast fat suppressed T1 weighted images [15]. In rare cases where Warthin's tumor and oncocytoma coexist, one study notes that neither CT nor MRI can distinguish between the tumors [13]. Meanwhile, another study suggests that certain MR features can potentially help distinguish these 2 entities when they occur independently.

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    The coexistence of two different histopathological tumours in the same parotid gland is rare,1–5 and synchronous benign and malignant tumours in the ipsilateral parotid gland even more so.1,4–6

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    Oncocytomas are often present with well-defined borders with the smooth or lobulated contour on CT and MRI [4,5]. They most commonly demonstrate hypointense signal on both T1WI and T2WI compared to the normal parotid gland [1,5–8], isointense signal on STIR images, fat-saturated T2WI, and fat-saturated postcontrast T1WI [5,6]. An oncocytoma is a histologically hypercellular tumor and consists of solid clusters or cords of tightly packed oncocytes separated by thin strands of fibrovascular stroma [3], which is suggested by the low signal intensity on T2WI and low ADC values [8–10].

  • MR imaging of multinodular bilateral oncocytoma of the parotid gland

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    However, biopsy was not performed on all tumors. Oncocytoma and Warthin's tumor have similar imaging features [18] and a case of coexisting of oncocytoma and Warthin's tumor has been reported [17]. The incidence of coexisting oncocytoma and Warthin's tumor is very rare, but the possibility that parotid tumors in our case contained not only oncocytoma but also Warthin's tumor cannot be completely ruled out.

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