Warthin's tumor with multiple granulomas: A clinicopathologic study of six cases

Cytomorphological findings in diagnosis of Warthin tumor

Background/aim

To define the cytomorphologic findings leading to difficulties in diagnosis of Warthin tumors (WTs).

Materials and methods

Forty-eight histopathologically diagnosed WT patients who had fine needle aspiration cytology preoperatively were reevaluated for defining the presence or absence of lymphocytes, oncocytic cell layer, oncocytic cell papillae, granular debris background, mucoid background, macrophages, polymorphonuclear cells, mast cells, squamous-like cells, atypical vacuolated cytoplasmic cells, and giant cells.

Results

Forty-seven tumors were in the parotid gland and one in the submandibular gland. There were 37 (77%) male and 11 (23%) female patients. Cytopathologically in 36 patients the diagnosis was benign neoplasm (WT); in 6, other benign entities; and in 6, suspicious for malignancy. The main characteristic cytomorphologic features of WTs were as follows: 92% lymphoid cells, 83% oncocytic cell layers, and 67% granular debris background. These percentages were 67%, 17%, and 17% in the benign cytology group and 67%, 50%, and 17% in the suspicious for malignancy group, respectively.

Conclusion

Absence or lack of main features of WTs with or without presence of squamous-like cells, vacuolated cytoplasmic cells, and inflammatory reaction may cause diagnostic dilemma. The presence of the mast cells accompanied by epithelial tissue was striking for WT diagnosis.

Warthin's tumor with necrotizing tuberculous granulomatous inflammation causing severe facial nerve adhesion in parotid gland: A case report and literature review

RATIONALE

Warthin's tumor is the second most common tumor arising from the parotid gland, but it rarely occurs concomitantly with tuberculous granulomatous inflammation with only 13 documented case reports in the English literature.

PATIENT CONCERNS

An 82-year-old woman had a left infraauricular mass for approximately 3 years that had significantly increased in size over the previous 1 month.

DIAGNOSES

A diagnosis of Warthin's tumor was made by ultrasonography (US)-guided core needle biopsy. Pathological examinations of the specimen obtained by total extirpation confirmed that the tumor was superimposed with tuberculous granuloma.

INTERVENTIONS

The core biopsy wound did not heal and there was formation of a skin fistula tract with persistent discharge. During the operation with en bloc resection of the necrotic parotid tumor, adhesion between the branches of the facial nerve was too tight to allow preservation.

OUTCOMES

A diagnosis of necrotic Warthin's tumor superimposed with tuberculous granuloma was made. Due to the high-clinical suspicion of tuberculosis (TB) due to Mycobacterium tuberculosis infection, anti-TB chemotherapy was given.

LESSONS

Poor wound healing from a core biopsy and formation of a skin fistulous tract with persistent discharge should raise concern regarding potential extrapulmonary tuberculous infection. Although very rare, tuberculous granuloma concomitant with Warthin's tumor should be considered in the differential diagnosis of a parotid mass lesion. Adhesion of branches of the facial nerve should be expected, and sacrifice of the nerve may be planned. This consideration can be explained to the patient in preoperative counseling and planning. Anti-TB chemotherapy should be given in cases with a definite pathological report associated with speculative clinical presentation.

Intraductal papilloma arising from the accessory parotid gland: A case report and literature review

RATIONALE

Intraductal papillomas of the accessory parotid glands are extremely rare benign tumors that are most commonly derived from minor salivary glands and are easily misdiagnosed as other diseases. Studying these lesions by pathology and immunohistochemistry can raise awareness of the disease, reduce the rate of misdiagnosis, and provide more precise treatments.

PATIENT CONCERNS

A 35-year-old man first presented to our hospital with a 6-month history of a painless mass on his left parotid gland.

DIAGNOSES

The patient was diagnosed with intraductal papilloma of the accessory parotid gland by pathology and immunohistochemistry.

INTERVENTIONS

The mass was completely resected.

OUTCOMES

After 2 years of postoperative follow-up, the patient recovered well without recurrence.

LESSONS

Intraductal papilloma of the accessory parotid gland is very rare, and can easily be misdiagnosed as sialadenoma papilliferum, inverted ductal papilloma, or papillary cystadenoma, among others. It is necessary to analyze its pathology and immunohistochemistry in comparison with other diseases. Early excision and long-term follow-up are necessary to provide optimal treatment and to better understand the pathological processes of intraductal papilloma.