Case reportSynchronous oncocytoma and Warthin’s tumor in the ipsilateral parotid gland
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 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)
- et al.
Multiple tumors of the major salivary glands
Am. J. Surg.
(1969) - et al.
Assessment of dynamic MRI of Warthin’s tumors arising as multiple lesions in the parotid glands
Oral. Oncol.
(2002) - et al.
Identification of Warthin’s tumors by scanning of salivary glands
Am. J. Surg.
(1968) - et al.
Oncocytic neoplasms of the parotid gland: a 16-year institutional review
Otolaryngol. Head Neck Surg.
(2002) - et al.
Warthin’s tumor (cystadenolymphoma) of salivary glands. A clinicopathologic investigation of 278 cases
Oral Surg. Oral Med. Oral Pathol.
(1986) - et al.
Rare synchronous parotid tumors of different histologic types
Plast. Reconstr. Surg.
(1983) - et al.
Synchronous tumors arising in a single major salivary gland
Cancer
(1989) - Ellis GL, Auclair PL, Oncocytoma. In: Rosai J, editor. Tumors of the salivary glands. Third ed. Washington, DC: Armed...
- et al.
Fine-needle aspiration of 154 parotid masses with histologic correlation: ten-year experience at the University of Texas M.D. Anderson Cancer Center
Cancer
(1998)
Cited by (24)
Parotid oncocytoma: CT and pathologic correlation of a rare benign parotid tumor
2020, Radiology Case ReportsCitation Excerpt :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.
Synchronous pleomorphic adenoma and oncocytic carcinoma in the ipsilateral parotid gland
2018, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :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
Bilateral parotid oncocytoma with spontaneous intratumoral hemorrhage: A rare hypervascular parotid tumor with ASL perfusion
2016, Clinical ImagingCitation Excerpt :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].
A proposed mechanism for the pathogenesis of multiple primary tumours
2009, Medical HypothesesA rare case of multiple primary benign neoplasm of parotid gland: Oncocytoma and adenolimphoma
2009, Otolaryngologia PolskaMR imaging of multinodular bilateral oncocytoma of the parotid gland
2007, European Journal of Radiology ExtraCitation Excerpt :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.