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Vaknin I, Allon I, Zafrir-Haver S, Abramson A. A Rare Diagnosis of Parotid Gland Follicular Lymphoma Arising in Warthin Tumor: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2086. [PMID: 39768965 PMCID: PMC11679321 DOI: 10.3390/medicina60122086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 11/24/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025]
Abstract
Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. Clinical report: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. Conclusions: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the "wait and see" approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery.
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Affiliation(s)
- Ido Vaknin
- Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel;
| | - Irit Allon
- Institute of Pathology, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Shirley Zafrir-Haver
- Department of Hematology, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Alex Abramson
- Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel;
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Tong HC, Ma S, Chen L, Meng X, Li YC, Li LY, Dong L, Zhang WL, Wildes T, Yang LH, Wang E. Warthin tumor concomitant with mantle cell lymphoma: a case report and review of literature. Diagn Pathol 2024; 19:114. [PMID: 39182117 PMCID: PMC11344329 DOI: 10.1186/s13000-024-01538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Warthin tumor (WT) is the second most common benign tumor in salivary gland. It has a slow growth rate and most frequently occurs in the parotid gland. Most patients present with an incidental finding of a painless mass inferior/anterior to the ear. Besides the epithelial component of the tumor, WT is characteristically associated with lymphoid stroma that is considered benign. While there have been a few reports of malignant transformation of the lymphoid components in WT, cases of WT concomitant with mantle cell lymphoma (MCL) are extremely rare. To the best of our knowledge, two cases have been described in the English literature. Herein, we report a case of WT concomitant with MCL in a 70-year-old female patient, and emphasize the importance of careful examination of lymphoid stroma in WT so that concurrent lymphoma is not missed. PATIENT CONCERNS A 70-year-old Chinese woman with a 40-year history of cigarette smoking presented with a one year history of a right submaxillary mass with recent enlargement. DIAGNOSIS Cervical ultrasound (US) and computed tomography (CT) scans of the neck revealed a well-circumscribed mass in the right parotid with a maximum diameter of 3.1 cm. Surgical resection of the mass was performed. Histopathological examination revealed a characteristic double-layer of neoplastic epithelium with prominent lymphoid stroma, suggesting WT. In addition, morphology and immunohistochemistry studies confirmed the coexistence of MCL. Thereafter, the final diagnosis of this case was WT concomitant with MCL. INTERVENTIONS The patient was staged as stage I after clinical assessment. Due to the slow growth of parotid lesions, close observation was decided with periodic clinical and radiological monitoring. OUTCOMES Currently, the patient demonstrates a stable disease by clinical evaluation. LESSONS To the best of our knowledge, reported cases of WT concomitant with MCL are very rare. This case highlights the importance of a comprehensive assessment of the lymphoid stroma of WT to avoid missed diagnosis of a lymphoma component in a collision tumor.
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Affiliation(s)
- Hai-Chao Tong
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lan Chen
- Department of pathology, Datong County People's Hospital of Qinghai Province, Datong Hui and Tu Autonomous County, China
| | - Xiangyun Meng
- Department of pathology, Datong County People's Hospital of Qinghai Province, Datong Hui and Tu Autonomous County, China
| | - Ying-Chun Li
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Le-Yao Li
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Lingyun Dong
- Department of pathology, Yangzhou maternal and child health hospital, Yangzhou, Jiangsu province, China
| | - Wan-Lin Zhang
- Department of pathology, The Third Medical Centre, Chinese PLA General Hospital, Peking, China
| | - Tyler Wildes
- Department of Pathology, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Lian-He Yang
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
| | - Endi Wang
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abukhiran I, Jasser J, Hoffman HT, Syrbu S. Mantle Cell Lymphoma Involving Major and Minor Salivary Glands With Parotid Sparing. JAMA Otolaryngol Head Neck Surg 2021; 146:309-311. [PMID: 31895458 DOI: 10.1001/jamaoto.2019.4116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Judy Jasser
- University of Iowa Hospitals & Clinics, Iowa City
| | | | - Sergei Syrbu
- University of Iowa Hospitals & Clinics, Iowa City
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Mantsopoulos K, Koch M, Fauck V, Schinz K, Schapher M, Constantinidis J, Rösler W, Iro H. Primary parotid gland lymphoma: pitfalls in the use of ultrasound imaging by a great pretender. Int J Oral Maxillofac Surg 2020; 50:573-578. [PMID: 32938567 DOI: 10.1016/j.ijom.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/23/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to highlight several misleading imaging and clinical aspects of parotid gland lymphoma, taking our personal experience and relevant literature reports into consideration. The records of all patients diagnosed with lymphoma in the parotid gland between 2005 and 2017 were examined retrospectively. Sixty-seven patients were included in this study. The mean age was 61.4 years. The most frequent histological entities were marginal zone B-cell lymphoma (31.3%) and follicular lymphoma (28.4%). The tumour was stage I in 35 cases (52.2%), stage II in 13 cases (19.4%), stage III in 11 cases (16.4%), and stage IV in eight cases (11.9%). B symptoms were seen in only three patients (4.5%). The diagnosis was made after parotidectomy in 51 cases (76.1%), by core needle biopsy in 14 cases (20.9%), and by means of open biopsy in the remaining two cases (3.0%). Parotid gland lymphoma represents a diagnostically challenging, multifaceted entity that can easily mimic both benign and malignant conditions. This entity should be included in the differential diagnosis of almost all types of parotid lesion, as it seems to play the role of a great pretender.
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Affiliation(s)
- K Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - M Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - V Fauck
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - K Schinz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Constantinidis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Thessaloniki, Greece
| | - W Rösler
- Department of Haematology-Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - H Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Alnoor FNU, Gandhi JS, Stein MK, Solares J, Gradowski JF. Prevalence of Lymphoid Neoplasia in a Retrospective Analysis of Warthin Tumor: A Single Institution Experience. Head Neck Pathol 2020; 14:944-950. [PMID: 32328910 PMCID: PMC7669968 DOI: 10.1007/s12105-020-01161-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Warthin tumor is one of the most common benign salivary gland tumors. Overt lymphoma is known to occur in the lymphoid stroma of Warthin tumor. In situ follicular neoplasia is difficult to identify in routine histologic examination of lymphoid tissue and has not been reported in association with Warthin tumor. Our objective is to determine the prevalence of overt malignant lymphoma and in situ follicular neoplasia in Warthin tumor. We conducted a retrospective histological evaluation of 89 sequential Warthin tumor cases with available slides and blocks from the years 2010-2019. Of these, 84 cases were subjected to immunohistochemical testing, while 5 cases had been previously worked up for the suspicion of lymphoma. We identified two additional cases of lymphoid neoplasia associated with Warthin tumor including small lymphocytic lymphoma/chronic lymphocytic leukemia (n = 1) and in situ follicular neoplasia (n = 1) in addition to previously reported case of follicular lymphoma included in this study. The prevalence rate of first-time detected lymphoid neoplasia in Warthin tumor is 3.4%. The prevalence rate of overt lymphoma is 2.2%, while the prevalence of in situ follicular neoplasia is 1.1%. We propose histologic criteria to identify small lymphocytic lymphoma and follicular lymphoma in Warthin tumor. These include a monotonous interfollicular expansion of small lymphocytes and germinal centers composed of a monotonous population of lymphocytes without polarity or tingible body macrophages respectively. It is very important for pathologists to perform a diligent morphological examination and perform immunohistochemistry in suspected cases to identify subtle involvement of Warthin tumor by lymphoma. In patients with involvement of Warthin tumor by in situ follicular neoplasia, concurrent lymphoma in the same tissue and other sites should be considered. Patients without overt lymphoma elsewhere likely have a low risk of progression to follicular lymphoma. The low prevalence of in situ follicular neoplasia in Warthin tumor, combined with the low rate of clinical progression to lymphoma, make routine screening of Warthin tumor for in situ follicular neoplasia unnecessary.
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Affiliation(s)
- F. N. U. Alnoor
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Jatin S. Gandhi
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Matthew K. Stein
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis, TN USA
| | - Jorge Solares
- Department of Pathology and Laboratory Medicine, Methodist University Hospital, Memphis, TN USA
| | - Joel F. Gradowski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA ,Department of Pathology and Laboratory Medicine, Methodist University Hospital, Memphis, TN USA ,Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Methodist University Hospital, 1265 Union Ave, 6th Floor Sherard, Suite 621, Memphis, TN 38104 USA
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Wang CS, Chu X, Yang D, Ren L, Meng NL, Lv XX, Yun T, Cao YS. Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland - immunophenotypic and genetic features: A case report. World J Clin Cases 2019; 7:3895-3903. [PMID: 31799320 PMCID: PMC6887602 DOI: 10.12998/wjcc.v7.i22.3895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/23/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Warthin’s tumor (WT) is composed of several cysts that are lined with tall, bilayered oncocytic columnar cells and lymphoid stroma. Within WT, the two components rarely transform into carcinoma or lymphoma, and when it does, carcinoma is the most common type. Approximately 28 cases of lymphoma with WT have been reported, most of which were non-Hodgkin lymphomas, and only a few cases were Hodgkin lymphomas. In the present report, we studied a case of diffuse large B cell lymphoma (DLBCL) arising from follicular lymphoma (FL) with WT in the parotid gland and its immunophenotypic and genetic features.
CASE SUMMARY A 67-year-old man presented with a slowly enlarging right cheek mass for 12 years, and the mass began to change in size over a 2-mo time period. Over time, the patient felt mild local pain and right cheek discomfort. His medical history included a hepatitis B virus infection for 20 years and 30 years of smoking. Gross examination of the excised specimen showed a gray-red and gray-white appearance and a soft texture lobulated external surface neoplasm that measured 9 cm × 8 cm × 7 cm and was well circumscribed by relative normal parotid gland tissue. In cross section, the cut surfaces of the neoplasm were multicystic and had a homogeneous scaly appearance. A small fluid was discovered in the cyst. Bilateral oxyphilic, cuboidal or polygonal epithelium cells and lymphoid intraparenchymal components were observed. Many medium- to large-sized lymphoid cells were observed diffusely in part of the neoplasm, and a few secondary lymphoid follicles were observed at the center or edge of the neoplasm. Immunohistochemical staining showed that the columnar oncocytic cells were positive for AE1/AE3; neoplastic cells located in coarctate follicular were positive for CD20, Pax-5, bcl-2 and bcl-6; and the adjacent diffusely medium- to large-sized lymphoid cells were positive for Pax-5, bcl-6, CD20, MUM-1, bcl-2 and CD79a. The bcl-6 (3q27) break-apart rearrangement was observed, and an Epstein Barr virus test was negative in the tumor cells. The patient survived 6 months after being diagnosed without any treatment.
CONCLUSION WT-associated lymphoma is a very rare neoplasm in the parotid gland. Most cases are B cell non-Hodgkin lymphomas and involve middle-age and older males. This case highlights the extremely rare association of DLBCL arising from FL with WT and the importance of deliberate evaluation of the WT intraparenchymal stroma. Molecular detection techniques have potential advantages in the diagnosis of lymphoma with WT.
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Affiliation(s)
- Chang-Song Wang
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Xia Chu
- Department of Pathology, 988th Hospital of PLA, Zhengzhou 450042, Henan Province, China
| | - Di Yang
- Department of Pathology, Sanmenxia center Hospital, Sanmenxia 472000, Henan Province, China
| | - Lei Ren
- Department of Pathology, Luoyang First People’s Hospital, Luoyang 471000, Henan Province, China
| | - Nian-Long Meng
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Xue-Xia Lv
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Tian Yun
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Yan-Sha Cao
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
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Pan X, Yu S, Che L, Xu J, Zhou H. Terminal deoxynucleotidyl transferase negative T-cell lymphoblastic lymphoma from heterotopic Warthin's tumor in cervical lymph nodes: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:4167-4170. [PMID: 31933816 PMCID: PMC6949790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
Collision of lymphoma and Warthin's tumor (WT) is extremely uncommon, especially T-cell lymphoma. Here we present a 69-year-old woman who had terminal deoxynucleotidyl transferase (TDT) negative T-cell lymphoblastic lymphoma (T-LBL) from heterotopic Warthin's tumor in cervical lymph nodes, in which only cervical lymph nodes enlarged initially and quickly progressed to systemic lesions.
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Affiliation(s)
- Xubo Pan
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantai 264000, China
| | - Shengqiang Yu
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantai 264000, China
| | - Lisha Che
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantai 264000, China
| | - Junqing Xu
- Department of Hematology, Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantai 264000, China
| | - Huihui Zhou
- Department of Pathology, Affiliated Yantai Yuhuangding Hospital of Qingdao UniversityYantai 264000, China
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Hellquist H, Paiva-Correia A, Vander Poorten V, Quer M, Hernandez-Prera JC, Andreasen S, Zbären P, Skalova A, Rinaldo A, Ferlito A. Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours. Adv Ther 2019; 36:1950-1974. [PMID: 31209701 PMCID: PMC6822986 DOI: 10.1007/s12325-019-01007-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, for several reasons, this has not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour. METHODS A search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically. RESULTS Pleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur. CONCLUSIONS A correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types of basal cell adenoma can occasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.
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Affiliation(s)
- Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Faro, Portugal.
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Centre (ABC), Faro, Portugal.
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
| | - António Paiva-Correia
- Epigenetics and Human Disease Laboratory, Faro, Portugal
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Centre (ABC), Faro, Portugal
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
- Histopathology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
| | - Miquel Quer
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Peter Zbären
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - Alena Skalova
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzeň, Czech Republic
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Incidence of Non-Salivary Gland Neoplasms in Patients with Warthin Tumor: A Study of 73 Cases. Head Neck Pathol 2019; 14:412-418. [PMID: 31228167 PMCID: PMC7235100 DOI: 10.1007/s12105-019-01049-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/15/2019] [Indexed: 01/12/2023]
Abstract
Warthin tumor is the second most common benign parotid neoplasm. Its association with non-salivary gland neoplasms has been sporadically reported. We reviewed clinical records of Warthin tumor diagnosed on aspiration cytology and surgical pathology to determine if there is any association with other extra-salivary gland malignant neoplasms. Computer search was made for all cases of Warthin tumor diagnosed in the parotid gland by aspiration cytology and surgical pathology at our institution between January 2007 and August 2016. Clinical records of all cases were reviewed for any associated malignant neoplasms and any surgical follow up. All available cytology and histologic material was reviewed. Seventy-three patients (mean 66.9, M:F 1.1:1, age range 43 to 87 years) with Warthin tumor were identified. 45 (62%) were diagnosed on aspiration cytology only, 19 (26%) had cytologic diagnosis as well as concordant surgical follow up, and 9 (12%) were diagnosed based on surgical pathology only. Average age for patients with and without secondary malignancy was 70.5-years, and 63.4-years, respectively (p < 0.05). Average pack years for patients with and without secondary malignancy was 45.4, and 39.8, respectively (p > 0.05). Twenty-seven (37.0%) patients harbored a malignant neoplasm. Association of extra salivary gland malignant neoplasms in 37.0% of our cases suggest that the prevalence of secondary non-salivary neoplasms in patients harboring Warthin tumor might have been underestimated. Squamous cell carcinoma was the most commonly associated non-salivary malignant neoplasm. The association of Warthin tumor with smoking plays an important role in this increased rate of malignancy, and this is supported by the fact that smoking is highly associated with head and neck and lung cancers.
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Alnoor F, Gandhi JS, Stein MK, Gradowski JF. Follicular Lymphoma Diagnosed in Warthin Tumor: A Case Report and Review of the Literature. Head Neck Pathol 2019; 14:386-391. [PMID: 31183747 PMCID: PMC7235116 DOI: 10.1007/s12105-019-01045-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/05/2019] [Indexed: 12/24/2022]
Abstract
Warthin tumor is one of the most common benign salivary gland tumors. It is unusual and difficult to diagnose follicular lymphoma within the lymphoid tissue of Warthin tumor. We present a rare case of a 69-year-old man with systemic follicular lymphoma initially diagnosed in a Warthin tumor. Lymphomas occurring within Warthin tumors are rare, however, follicular lymphoma is most commonly reported. Because these patients require further treatment depending on the stage of a disease, it is important for a pathologist to review the histology of Warthin tumors diligently to identify occult lymphomas.
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Affiliation(s)
- Fnu Alnoor
- grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA ,grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 525, Memphis, TN 38163 USA
| | - Jatin S. Gandhi
- grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Matthew K. Stein
- grid.267301.10000 0004 0386 9246Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis, TN USA
| | - Joel F. Gradowski
- grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
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Oral lymphoid lesions: a 47-year clinicopathological study in a Brazilian population. Med Mol Morphol 2018; 52:123-134. [PMID: 30382358 DOI: 10.1007/s00795-018-0210-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/25/2018] [Indexed: 01/25/2023]
Abstract
We performed an epidemiological, clinical and histopathological analysis of oral lymphoid lesions (OLLs) during a 47-year period. Data regarding patient age, sex, duration, location, symptomatology, type of growth, implantation, staining, presence of ulceration and bleeding of all cases were compiled from the clinical data. For the histopathological analyses, all slides stained by H/E were reassessed. During the analyzed period, 14,565 patients with oral and maxillofacial lesions were diagnosed, with 45 cases diagnosed as OLLs. The most prevalent location was the tongue. Females were more affected, and the mean age was 40.8 years. OLLs presented a heterogeneous frequency, with the prevalence of reactive lesions (42.3%) followed by developmental lesions (35.6%). Among the reactive lesions, foreign body granulomas were the most common. Regarding diagnosed neoplasms, malignant represented 13.2% of the cases. The average time of evolution of OLLs in general was of 22.2 months. Regarding the histopathological characteristics, the presence of primary lymphoid follicles was observed in 37.8% of the cases, while inflammatory infiltrates were diffuse in 66.7% and epimyoepithelial islands were observed in 13.3%. Our study concludes that OLLs involves a broad spectrum of lesions that share the presence of the lymphoid component, which can range from indolent to more aggressive behavior.
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Safi M, Sun X, Wang L, Zhang X, Song J, Ameen M. Risk interrelationship among multiple primary tumors: A case report and review of literature. Medicine (Baltimore) 2018; 97:e0289. [PMID: 29642151 PMCID: PMC5908637 DOI: 10.1097/md.0000000000010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Along with advanced management in oncology, great progress has been recently achieved in the studies of multiple primary tumors. Several reports have studied the coexistence between lymphoma and either renal cell carcinoma (RCC) or Warthin tumor. However, the level of coexistence between these cases remains unclear due to the absence of a distinct link between them. PATIENT CONCERNS We present a unique case of multiple primary tumors (lymphoma, RCC, and Warthin tumor) in an 80-year-old man and a review of the literature on the coexistence of RCC with lymphoma and lymphoma with Warthin tumor. DIAGNOSIS With a history of RCC, the patient had a freely movable lump under his left ear, and the pathological report indicated Hodgkin lymphoma and Warthin tumor. INTERVENTION RCC and Warthin tumor of the patient were surgically treated, followed by 2 cycles (14 days per cycle) of Epirubicin 40 mg day 1, Bleomycin 8 mg day 1, Vincristine 2 mg day 1, and Dacarbazine 500 mg day 1. The chemotherapy protocol was then changed to Epirubicin 40 mg day 1, Vincristine 2 mg day 1, and Dacarbazine 500 mg day 1 for 7 cycles. OUTCOMES After the last day of chemotherapy, the patient showed a complete response. LESSONS To the best of our knowledge, this paper is the first to report a case of multiple primary tumors with a complete response. For their early detection, favorable prognosis, and correlation identification, we suggest a transitive relation between these coexisting tumors. Therefore, similar studies should be conducted.
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Affiliation(s)
- Mohammed Safi
- The Second Hospital of Dalian Medical University, Shahekou, China-Dalian
| | - Xiuhua Sun
- The Second Hospital of Dalian Medical University, Shahekou, China-Dalian
| | - Lifen Wang
- The Second Hospital of Dalian Medical University, Shahekou, China-Dalian
| | - Xinwei Zhang
- The Second Hospital of Dalian Medical University, Shahekou, China-Dalian
| | - Jicheng Song
- The Second Hospital of Dalian Medical University, Shahekou, China-Dalian
| | - Mohammed Ameen
- Sino-German Cancer Diagnosis and Treatment Center, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Jawad H, McCarthy P, O'Leary G, Heffron CC. Presentation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma in a Warthin Tumor: Case Report and Literature Review. Int J Surg Pathol 2017; 26:256-260. [PMID: 28978260 DOI: 10.1177/1066896917734371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Warthin tumor is the second most common salivary gland neoplasm. It occurs more commonly in males than in females. Malignant transformation in Warthin tumor is a rare but well-recognized phenomenon; however, the development or presentation of lymphoma in a Warthin tumor is rare. An 80-year-old man presented with painless mass of the right parotid gland of 2 years duration with recent ulceration of the overlying skin and right cervical lymphadenopathy underwent a surgical resection of parotid mass and biopsy of the periglandular lymph nodes. The histological diagnosis was malignant lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, present within the stroma of a Warthin tumor, and also present within the adjacent lymph node. This case is the third reported case describing a collision of Warthin tumor and chronic lymphocytic leukemia/small lymphocytic lymphoma. It also emphasizes the importance of careful examination of the lymphoid stroma of these tumors.
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Affiliation(s)
| | | | - Gerard O'Leary
- 2 South Infirmary Victoria University Hospital, Cork, Ireland
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