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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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Aoki R, Tanaka T. Pathogenesis of Warthin's Tumor: Neoplastic or Non-Neoplastic? Cancers (Basel) 2024; 16:912. [PMID: 38473274 DOI: 10.3390/cancers16050912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Warthin's tumor is the second most frequent neoplasm next to pleomorphic adenoma in the salivary gland, mostly in the parotid gland. The epithelial cells constituting a tumor are characterized by the presence of mitochondria that undergo structural and functional changes, resulting in the development of oncocytes. In addition to containing epithelial cells, Warthin's tumors contain abundant lymphocytes with lymph follicles (germinal centers) that are surrounded by epithelial cells. The pathogenesis of Warthin's tumor is not fully understood, and several hypotheses have been proposed. The risk factors for the development of Warthin's tumor, which predominantly occurs in males, include aging, smoking, and radiation exposure. Recently, it has been reported that chronic inflammation and aging cells promote the growth of Warthin's tumor. Several reports regarding the origin of the tumor have suggested that (1) Warthin's tumor is an IgG4-related disease, (2) epithelial cells that compose Warthin's tumor accumulate mitochondria, and (3) Warthin's tumor is a metaplastic lesion in the lymph nodes. It is possible that the pathogenesis of Warthin's tumor includes mitochondrial metabolic abnormalities, accumulation of aged cells, chronic inflammation, and senescence-associated secretory phenotype (SASP). In this short review, we propose that DNA damage, metabolic dysfunction of mitochondria, senescent cells, SASP, human papillomavirus, and IgG4 may be involved in the development of Warthin's tumor.
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Affiliation(s)
- Ryogo Aoki
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP), Gifu Municipal Hospital, 7-l Kashima-Cho, Gifu City 500-8513, Gifu, Japan
| | - Takuji Tanaka
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP), Gifu Municipal Hospital, 7-l Kashima-Cho, Gifu City 500-8513, Gifu, Japan
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Gutierrez-Alvarez M, Martinez C, Campollo Lopez AP, Fuentes K, Robles Aviña JA. Warthin's Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature. Cureus 2023; 15:e36802. [PMID: 37123704 PMCID: PMC10134961 DOI: 10.7759/cureus.36802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
Parotid gland neoplasms are rare; some benign lesions, such as Warthin's tumor (WT), can present as malignant degeneration to carcinomas or, even rarer, to lymphomas. In the literature, there are fewer than 30 reported cases of primary lymphoma of the parotid gland. We present a case of a 65-year-old male patient with a first diagnosis of WT of the parotid gland who later presented a tumor recurrence and underwent a second surgery, reporting diffuse large B-cell lymphoma of the parotid gland. He underwent a right parotidectomy and chemotherapy, and at his 5-month follow-up, he remains free of recurrence. These tumors may look clinically like benign tumors. However, it is essential to be always alert to detect potentially malignant neoplasms and to emphasize examining the lymphoid component of WT to have an early-stage diagnosis of possible lymphomas and treat them before morbidity and mortality increase.
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Affiliation(s)
| | | | | | | | - Jorge Alberto Robles Aviña
- Surgical Oncology, Medica Sur, Mexico, MEX
- Surgical Oncology, Hospital General Dr. Manuel Gea González, Mexico, MEX
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Pandiar D, Aravind S, Nayanar SK, Babu S. Incipient Warthin tumor of intraparotid lymph node in a patient with squamous cell carcinoma of the external auditory canal: An incidental finding. Natl J Maxillofac Surg 2020; 11:113-116. [PMID: 33041588 PMCID: PMC7518491 DOI: 10.4103/njms.njms_46_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/19/2019] [Accepted: 10/18/2019] [Indexed: 11/11/2022] Open
Abstract
The occurrence of intranodal salivary gland neoplasm is uncommon; squamous cell carcinoma (SCC) of the external auditory canal (EAC) is another rare occurrence. Clinically, SCC of EAC presents with symptoms similar to other benign otologic conditions. A case of Stage I SCC in EAC region is presented here in a 60-year-old male patient with incidental intranodal Warthin tumor along with the histological differential diagnosis. The patient is being followed up. There is no evidence of recurrence 1 year and 11 months after surgery.
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Affiliation(s)
- Deepak Pandiar
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sithara Aravind
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sangeetha K Nayanar
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sajith Babu
- Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India
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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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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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Clinical Application of Real-Time Shear Wave Elastography in Identifying the Histological Components of Parotid Adenolymphoma. Ultrasound Q 2018; 34:47-51. [DOI: 10.1097/ruq.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jun L, Ming Z. Classical Hodgkin lymphoma arising from heterotopic Warthin's tumor in the cervical lymph node: A case report. Oncol Lett 2018; 16:619-622. [PMID: 29928448 DOI: 10.3892/ol.2018.8682] [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: 11/05/2017] [Accepted: 04/17/2018] [Indexed: 12/14/2022] Open
Abstract
Heterotopic Warthin's tumor (WT) arising from the cervical lymph nodes is uncommon and WT presenting concomitantly with classical Hodgkin's lymphoma has only been previously reported three times in English literature. The current study presents an unusual case of classical Hodgkin lymphoma (CHL) involving the heterotopic WT in a 59-year-old male. Histopathologic examination revealied a WT with extensive expansion of mixed-cellularity CHL in a lymph node in the right of the neck. Clinical staging was determined as stage IA disease. The patient received four courses of chemotherapy and local consolidative radiotherapy, no evidence of disseminated lymphoma was observed over the 6-month follow-up. To the best of our knowledge, this is the first well documented collision tumor between CHL and heterotopic WT of the cervical lymph nodes. The present case also expands the anatomical site of malignant lymphomas associated with WT.
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Affiliation(s)
- Li Jun
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhu Ming
- Department of Head and Neck, Zhejiang Tumor Hospital, Hangzhou, Zhejiang 310021, P.R. China
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Xu W, Lu H, Zhu Y, Ruan M, Zhang C, Yang W, Liu S. Warthin's tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population. Int J Oral Maxillofac Surg 2018; 47:913-917. [PMID: 29627151 DOI: 10.1016/j.ijom.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/31/2017] [Accepted: 03/18/2018] [Indexed: 11/16/2022]
Abstract
There is little information in the English-language literature regarding Warthin's tumour (WT) in the eastern-Chinese population. A large retrospective study (1084 primary tumours over a period of 18years) was carried out to investigate the clinicopathological features (patients' gender, age and tumour location) of these tumours in this population. A total of 994 (91.7%) patients were male and 90 (8.3%) were female, with a male/female ratio of 11:1. The mean age was 56.48years (range 20-89years), with a peak incidence in the fifth to seventh decade (82.1%). The favorite primary site of the tumour was the parotid gland (n=1055), followed by intra-/peri-parotid lymph nodes (n=13), upper neck (n=10), submandibular gland (n=4) and upper lip (n=1). Multifocal WTs arose in 9.5% (103 patients) of cases whereas bilateral multifocal WTs were found in 0.65% (seven patients). In 24 (2.2%) patients, WT were found to coexist with other different types of neoplasm synchronously. The most common subtype of metaplasia was the squamous metaplasia (166/250, 66.4%). The usual treatment measure is (bilateral) superficial parotidectomy and the patients should be followed long term, in view of possible metachronous WT, even after prolonged time intervals.
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Affiliation(s)
- W Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - H Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Y Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - M Ruan
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - C Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - W Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - S Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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Mantsopoulos K, Goncalves M, Koch M, Iro H. Extracapsular dissection for warthin tumors despite the risk of ipsilateral metachronous occurrence. Laryngoscope 2018; 128:2521-2524. [DOI: 10.1002/lary.27166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/14/2017] [Accepted: 02/07/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Michael Koch
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Erlangen-Nuremberg; Erlangen Germany
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14
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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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15
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Yu C, Song Z, Xiao Z, Lin Q, Dong X. Mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland: Clinicopathological characteristics and immunophenotypes. Sci Rep 2016; 6:30149. [PMID: 27417276 PMCID: PMC4945913 DOI: 10.1038/srep30149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC), an extremely rare tumor, arises from the epithelial component of preexisting parotid Warthin tumors (WT). Among the 309 cases of surgically resected WTs in Chinese PLA General Hospital and Beijing Shijitan Hospital of Capital Medical University, 5 cases (1.6%) fulfilled the criteria for MECs transformed from WTs. Clinicopathological characteristics of MECs was demonstrated in order to avoid misdiagnosis of this rare type of tumor. All the 5 patients, 3 males and 2 females, presented painless masses in the parotid gland. MECs were located inside or at the edge of WTs, with an obvious transitional zone between WT and MEC. Basal cells of WTs and epidermoid cells of MECs were strongly positive for cytokeratin CK5/6, CK34βE12, and P63; whereas negative for CK7, CK20, and CEA. Mucous cells of MECs were positive for CK7, CEA, as well as periodic acid-Schiff (PAS), whereas negative for CK5/6, CK34βE12, CK20, and P63. MECs patients were followed up for 25–69 months after surgery, presenting no evidence of recurrence or metastasis. Collectively, MECs arising from WT is very rare. The pathological diagnosis was based on histological morphology, especially the transitional zone between WT and MEC.
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Affiliation(s)
- Chunkai Yu
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P. R. China
| | - Zhigang Song
- Department of Pathology, The Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Zhibo Xiao
- Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, P. R. China
| | - Qiushi Lin
- Department of Gastroenterology, Stephenson Cancer Center, Department of Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, USA
| | - Xiaoqun Dong
- Department of Gastroenterology, Stephenson Cancer Center, Department of Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, USA
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16
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Di Napoli A, Mallel G, Bartolazzi A, Cavalieri E, Becelli R, Cippitelli C, Ruco L. Nodular Lymphocyte-Predominant Hodgkin Lymphoma in a Warthin Tumor of the Parotid Gland: A Case Report and Literature Review. Int J Surg Pathol 2016; 23:419-23. [PMID: 26169920 DOI: 10.1177/1066896915582263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hodgkin lymphoma (HL) associated with Warthin tumor (WT) is extremely rare, accounting for only 3 cases of classical HLs. Here, we report for the first time the occurrence of a nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) involving the lymphoid stroma of a WT of the parotid gland. Pathogenesis of WT is controversial, with both a nodal and a parenchymal possible origin. On the other hand, extranodal involvement by HLs is uncommon. In our case, the coexistence of a WT and of a NLPHL within its stroma and in cervical lymph node emphasizes the importance of a careful evaluation of the lymphoid tissue in WT in order to exclude the possibility of an associated lymphoid malignancy.
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Affiliation(s)
| | | | | | | | | | | | - Luigi Ruco
- Sant'Andrea Hospital, Sapienza University, Rome, Italy
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17
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Smółka W, Markowski J, Piotrowska-Seweryn A, Paleń P, Dobrosz Z, Dziubdziela W. Mucoepidermoid carcinoma in Warthin tumor of the parotid gland. Arch Med Sci 2015; 11:691-5. [PMID: 26170867 PMCID: PMC4495166 DOI: 10.5114/aoms.2015.52379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/30/2013] [Accepted: 09/03/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Wojciech Smółka
- Department of Laryngology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jarosław Markowski
- Department of Laryngology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Piotr Paleń
- Department of Histopathology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Zuzanna Dobrosz
- Department of Histopathology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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18
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Wang Y, Zhou J, Zhang Y, Wang L, Liu Y, Fan L, Zhu J, Xu X, Huang G, Li X, Xun W. PRDM1 expression on the epithelial component but not on ectopic lymphoid tissues of Warthin tumour. Oral Dis 2014; 21:432-6. [PMID: 25280345 DOI: 10.1111/odi.12294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/10/2014] [Accepted: 08/27/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the role of PRDM1, a key molecule for modulating the immune cells, in Warthin tumour (WT) pathogenesis. SUBJECTS AND METHODS Forty paraffin-embedded parotid tissues of patients (mean age: 62.08 ± 11.90) with WT were retrieved from the pathology archives of Qindu Hospital from January 2012 to December 2012. The PRDM1 expression was investigated in a cohort of WT by immunohistochemistry. RESULTS PRDM1 was expressed only on the epithelial component but not on ectopic lymphoid tissue of the tumour. Statistically, PRDM1 expression rates between WT glandular epithelial cells (40/40 cases) and the tumour-adjacent tissues (0/9 cases), and WT germinal centres (0/34 cases) and tonsil tissues (10/10 cases) were significantly different (P < 0.001), respectively. CONCLUSIONS The PRDM1 expression appeared to play an essential role in WT pathogenesis. A better understanding of it might give options for revealing possible novel management strategies.
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Affiliation(s)
- Y Wang
- Department of Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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19
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Ozkök G, Taşlı F, Ozsan N, Oztürk R, Postacı H. Diffuse Large B-Cell Lymphoma Arising in Warthin's Tumor: Case Study and Review of the Literature. KOREAN JOURNAL OF PATHOLOGY 2013; 47:579-82. [PMID: 24421853 PMCID: PMC3887162 DOI: 10.4132/koreanjpathol.2013.47.6.579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/15/2012] [Accepted: 09/17/2012] [Indexed: 12/13/2022]
Abstract
Warthin's tumor is the second most common type of salivary gland tumor. Microscopically, Warthin's tumor displays a proliferative epithelial component and lymphoid stroma. Carcinomas arising from the epithelial component are well known, but malignant transformations of the lymphoid stroma are rare. When they do occur, they are most commonly B-cell type non-Hodgkin lymphomas. A 60-year-old male patient underwent surgical resection of a parotid mass. After superficial parotidectomy, microscopic examination indicated that the tumor was of epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components. In addition to the lymphoid follicles with distinct germinal centers, there were large, bizarre and extremely atypical neoplastic cells seen in the lymphoid component. Large neoplastic cells were diffusely CD20 and CD30 positive. The patient was diagnosed with "Warthin's tumor and diffuse large B-cell lymphoma with expression of CD30." The histopathologic and clinical features are discussed along with a review of the literature.
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Affiliation(s)
- Güliz Ozkök
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Funda Taşlı
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Nazan Ozsan
- Department of Pathology, Ege University School of Medicine, Izmir, Turkey
| | - Rafet Oztürk
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Hakan Postacı
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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20
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Singh AP, Tandon A, Chowdhary A, Mujoo S. Adenolymphoma: A probing entity: Case report and review. J Nat Sci Biol Med 2013; 4:492-6. [PMID: 24082763 PMCID: PMC3783811 DOI: 10.4103/0976-9668.116999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Warthin's tumor undoubtedly is the most frequent monomorphic adenoma of the major salivary glands. Clinically, it appears as a slow-growing tumor often fluctuant on palpation due to its cystic nature. The treatment of choice is complete excision with wide tumor-free margins. This article highlights a case of Warthin's tumor of the parotid gland in an elderly male patient along with a review of the literature on the aforementioned pathology.
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Affiliation(s)
- Anand Pratap Singh
- Department of Oral Medicine and Radiology, Rungta College of Dental Sciences and Research, Bhilai-Durg, Chhattisgarh, India
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21
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Laco J, Celakovsky P, Kalfert D, Hornychova H, Rybnikar T, Ryska A. Tumor-to-tumor metastasis: Warthin tumor as a recipient of lung carcinoma and of renal carcinoma - Report of two cases. Pathol Res Pract 2009; 206:458-62. [PMID: 19625134 DOI: 10.1016/j.prp.2009.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 06/02/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
Abstract
Tumor-to-tumor metastasis is an exceedingly rare event with only about 100 cases reported in the English written literature. We report two cases of a 65-year-old man with duplicity of colonic and lung adenocarcinomas who presented with swelling of the left parotid gland, and of a 75-year-old man who presented with swelling of the right parotid gland. Microscopical and immunohistochemical examination showed metastasis of lung carcinoma and of renal carcinoma, respectively, to Warthin tumor as the first clinical manifestation of the malignancy in the latter case. To the best of our knowledge, such a phenomenon has not been reported so far.
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Affiliation(s)
- Jan Laco
- The Fingerland Department of Pathology, Charles University Faculty of Medicine and Faculty Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.
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22
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Giaslakiotis K, Androulaki A, Panagoulias G, Kyrtsonis MC, Lazaris AC, Kanakis DN, Patsouris ES. T cell lymphoblastic lymphoma in parotidectomy for Warthin's tumor: case report and review of the literature. Int J Hematol 2009; 89:359-364. [PMID: 19294485 DOI: 10.1007/s12185-009-0271-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 01/09/2009] [Accepted: 02/09/2009] [Indexed: 12/12/2022]
Abstract
Lymphomas associated with Warthin's tumor (WT) are extremely uncommon and the majorities are of B cell type. We report the simultaneous occurrence of T-cell lymphoblastic lymphoma (T-LBL) and WT in an 81-year-old patient, who presented with fever, night sweats and enlargement of the right parotid gland. The parotidectomy specimen showed a WT with extensive replacement of the lymphoid stroma by T-LBL, but preservation of the oncocytic epithelium. Staging investigations revealed mediastinal and abdominal lymphadenopathy, bilateral pleural effusions and bone marrow infiltration, in keeping with stage IVB disease. The patient received combination chemotherapy treatment but responded poorly, and died three months after diagnosis. To our knowledge, this is the first case report of T-LBL involving WT. The present study indicates that the lymphoid stroma in WT belongs to the systemic lymphoid tissue and can be involved in disseminated lymphoma. It highlights the importance of careful examination of WT's lymphoid stroma for the possible presence of any coexistent malignancy.
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Affiliation(s)
- Konstantinos Giaslakiotis
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, UK
| | - Athina Androulaki
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, GR-11527, Athens, Greece
| | - George Panagoulias
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Hematology, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Christina Kyrtsonis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Hematology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, GR-11527, Athens, Greece
| | - Dimitrios N Kanakis
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, GR-11527, Athens, Greece.
| | - Efstratios S Patsouris
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, GR-11527, Athens, Greece
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