Parotid mass, Metaplastic Whartin’s Tumor case report
Affiliation(s)
Faculty of Medicine, Department of Otorhinolaryngology, Ufuk University, Ankara, Turkey. Mikro-Pat Pathology Laboratory, Ankara, Turkey.
Faculty of Medicine, Department of Otorhinolaryngology, Ufuk University, Ankara, Turkey. Mikro-Pat Pathology Laboratory, Ankara, Turkey.
ABSTRACT
The Whartin Tumor is the second most frequent tumor of the parotid gland following pleomorphic adenoma. Among the Whartin tumors, Metaplastic Whartin Tumor (MWT) is rare. In case of a MWT, histo-pathological replacement of oncosytic cells by squamous cells, ruptured epidermoid and lymphoe-pithelial cystic areas, a large necrosis area, fibrosis and granuloma formation may be seen. MWT may display similar clinical characteristics as the malign parotid tumor that causes sialadenitis, abscess formation, skin ulceration, and facial paralysis. Although the histopathogenesis of Metaplastic Whartin Tumors is not exactly known, it is postulated that the histo-pathological processes caused by trauma, infection, or radiotherapy have a role in the formation of these tumors. This case study presents a 48-year-old female patient with a complaint of panicula before her left ear persisting for 5 months. Following a superfacial parotidectomy carried out 3 weeks after the fineneedle aspiration biopsy (FNAB), her pathological assessment was found to be in line with Metaplastic Whartin Tumor. Our case study presents the case of a Metaplastic Whartin Tumor case with a review of literature on the subject, accompanied by radiological and histological analyses.
The Whartin Tumor is the second most frequent tumor of the parotid gland following pleomorphic adenoma. Among the Whartin tumors, Metaplastic Whartin Tumor (MWT) is rare. In case of a MWT, histo-pathological replacement of oncosytic cells by squamous cells, ruptured epidermoid and lymphoe-pithelial cystic areas, a large necrosis area, fibrosis and granuloma formation may be seen. MWT may display similar clinical characteristics as the malign parotid tumor that causes sialadenitis, abscess formation, skin ulceration, and facial paralysis. Although the histopathogenesis of Metaplastic Whartin Tumors is not exactly known, it is postulated that the histo-pathological processes caused by trauma, infection, or radiotherapy have a role in the formation of these tumors. This case study presents a 48-year-old female patient with a complaint of panicula before her left ear persisting for 5 months. Following a superfacial parotidectomy carried out 3 weeks after the fineneedle aspiration biopsy (FNAB), her pathological assessment was found to be in line with Metaplastic Whartin Tumor. Our case study presents the case of a Metaplastic Whartin Tumor case with a review of literature on the subject, accompanied by radiological and histological analyses.
Cite this paper
Beriat, G. , Dogan, C. , Akmansu, S. and Ataolu, O. (2012) Parotid mass, Metaplastic Whartin’s Tumor case report. Open Journal of Stomatology, 2, 157-161. doi: 10.4236/ojst.2012.22029.
Beriat, G. , Dogan, C. , Akmansu, S. and Ataolu, O. (2012) Parotid mass, Metaplastic Whartin’s Tumor case report. Open Journal of Stomatology, 2, 157-161. doi: 10.4236/ojst.2012.22029.
References
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(2006) Accuracy of fine needle aspiration cytology and frozen section histopathology for lesions of the major salivary glands. Annals, Academy of Medicine, Singapore, 35, 242-248. [17] Kamal, M.M., Dani, A.A., Kotwal, M.N. and Kherdekar, M.S. (1994) Aspiration cytology of salivary gland lesions advantages and pitfalls. Indian Journal of Pathology and Microbiology, 37, 281-287. [18] Patey, D.H. and Thackray, A.C. (1970) Infected ade- nolymphoma: A new parotid syndrome. British Journal of Surgery, 57, 569-572. doi:10.1002/bjs.1800570805 [19] Kern, S.B. (1988) Necrosis of a Warthin’s tumor following fine needle aspiration. Acta Cytologica, 32, 207-208. [20] Chan, J.K.C., Tang, S.K., Tsang, W.Y.W., Lee, K.C. and Batsakis, J.G. (1996) Histologic changes induced by fine-needle aspiration. Advances in Anatomic Pathology, 3, 71-90. doi:10.1097/00125480-199603000-00001 [21] Choreutaki, T., Scarpellini, F. and Eusebi, V. (1996) Breast cancer necrosis following fine needle aspiration biopsy. 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(1999) Xanthogranulomatous sialadenitis following diagnosis of Warthin’s tumor: A possible complication of fine needle aspiration. Cytopathol, 10, 276-279. doi:10.1046/j.1365-2303.1999.00148.x [28] Dardick, I., Jeans, M.T.D., Sinnott, N.M., Wittkuhn, J.F., Kahn, H.J. and Baumal, R. (1985) Salivary gland components involved in the formation of squamous metaplasia. American Journal of Pathology, 119, 33-43. [29] Brannon, R.B., Fowler, C.B. and Hartman, K.S. (1991) Necrotizing sialometaplasia: A clinicopathologic study of sixty-nine cases and review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, 72, 317- 325. [30] Bolat, F., Kayaselcuk, F., Erkan, A.N., Cagici, C.A., Bal, N. and Tuncer, I. (2004) Epidermoid carcinoma arising in Warthin’s tumor. Pathology & Oncology Research, 10, 240-242. doi:10.1007/BF03033769 [31] Gunduz, M., Yamanaka, N., Hotomi, M., et al. (1999) Squamous cell carcinoma arising in a Warthin’s tumor. Auris Nasus Larynx, 26, 355-360. doi:10.1016/S0385-8146(99)00008-5 [32] Little, J.W. and Rickles, N.H. (1965) Malignant papillary cystadenoma lymphomatosum. Report of a case, with review of the lit-erature. Cancer, 18, 851-856. doi:10.1002/1097-0142(196507)18:7<851::AID-CNCR2820180712>3.0.CO;2-7 [33] Ramzy, I., Rone, R. and Schantz, H.D. (1986) Squamous cells in needle aspirates of subcutaneous lesions: A diagnostic problem. American Journal of Clinical Pathology, 85, 319-324.
[1] Eveson, J.W. and Cawson, R.A. (1989) Infarcted (infected) adenolymphomas. A clinicopathological study of 20 cases. Clinical Otolaryngology, 14, 205-210. doi:10.1111/j.1365-2273.1989.tb00362.x [2] Seifert, G., Bull, H.G. and Donath, K. (1980) Histologic subclassification of the cystadenolymphoma of the parotid gland. Analysis of 275 cases. Virchows Arch A Pathol Anat, 388, 13-38. [3] Seifert, G. (1991) Histological typing of salivary gland tumours. Springer-Verlag, Berlin, 13-14. doi:10.1007/978-3-642-84506-2 [4] Bungaard, N., Eriksen, H.E. and Greisen, O. (1987) Inflamed adenolymphoma with cholesterol granuloma. Journal of Laryngology & Otology, 101, 967-970. [5] DiPalma, S., Simpson, R.W.H., Skálová, A. and Michal, M. (1998) Metaplastic [infarcted] Warthins tumor: A possible consequence of fine needle aspiration biopsy. Arch Anat Cytol Path Clin Exp Path, 46, 433-438. [6] Ryska, A. and Seifert, G. (1999) Adenolymphoma [Warthin’s tumor] with multiple sarcoid-like granulomas. Pathology Research and Practice, 195, 835-839. doi:10.1016/S0344-0338(99)80106-X [7] Abraham, Z., Rozenbaum, M. and Keren, R. (2000) Skin ulcer at the blunt apex of a giant Warthin’s tumor. Journal of Dermatology, 27, 523-528. [8] Chilla, R. and Droese, M. (1993) Das infizierte Zys- tadenolymphom. Ein m?glicher Anla? zur klinischen und zytologischen Fehldiagnose “Karzinom”. HNO, 41, 446- 448. [9] Lesser, R.W. and Spector, I.G. (1985) Facial nerve paralysis associated with Warthin’s tumor. Archives of Otolaryngology—Head & Neck Surgery, 111, 548-549. doi:10.1001/archotol.1985.00800100096016 [10] Newman, L., Loukota, R.A. and Bradley, P.F. (1993) An infarcted Warthin’s tumour presenting with facial weakness. British Journal of Oral and Maxillofacial Surgery, 31, 311-312. doi:10.1016/0266-4356(93)90067-7 [11] Patey, D. and Thackray, A.C. (1970) Infected adenolymphoma: A new parotid syndrome. British Journal of Surgery, 57, 569-572. doi:10.1002/bjs.1800570805 [12] Pinel, J., Narcy, P. and Trotoux, J. (1971) Cystadenolymphomes parotitidiens masques par une surinfection. Ann Otolaryngol Chir Cervicofacial, 88, 283- 286. [13] Seifert, G. (1997) Bilateral mucoepidermoid carcinomas arising in bilateral pre-existing Warthin’s tumours of the parotid gland. European Journal of Cancer, 33, 284-287. [14] Skalova, A., Michal, M. and Nathansky, Z. (1994) Epidermoid carcinoma arising in Warthin’s tumour: A case study. Journal of Oral Pathology & Medicine, 23, 330-333. doi:10.1111/j.1600-0714.1994.tb00070.x [15] Palma, S.Di, Simpson, R.H.W., Skalova, A., Michal, M. (1999) Metaplastic (infarcted) Warthin’s tumour of the parotid gland: A possible consequence of fine needle aspiration biopsy. Histopathology, 35, 432-438. doi:10.1046/j.1365-2559.1999.035005432.x [16] Tan, L.G.L. and Khoo, M.L.C. (2006) Accuracy of fine needle aspiration cytology and frozen section histopathology for lesions of the major salivary glands. Annals, Academy of Medicine, Singapore, 35, 242-248. [17] Kamal, M.M., Dani, A.A., Kotwal, M.N. and Kherdekar, M.S. (1994) Aspiration cytology of salivary gland lesions advantages and pitfalls. Indian Journal of Pathology and Microbiology, 37, 281-287. [18] Patey, D.H. and Thackray, A.C. (1970) Infected ade- nolymphoma: A new parotid syndrome. British Journal of Surgery, 57, 569-572. doi:10.1002/bjs.1800570805 [19] Kern, S.B. (1988) Necrosis of a Warthin’s tumor following fine needle aspiration. Acta Cytologica, 32, 207-208. [20] Chan, J.K.C., Tang, S.K., Tsang, W.Y.W., Lee, K.C. and Batsakis, J.G. (1996) Histologic changes induced by fine-needle aspiration. Advances in Anatomic Pathology, 3, 71-90. doi:10.1097/00125480-199603000-00001 [21] Choreutaki, T., Scarpellini, F. and Eusebi, V. (1996) Breast cancer necrosis following fine needle aspiration biopsy. Tumori, 82, 242-244. [22] Davies, J.D. and Webb, A.J. (1982) Segmental lymphnode infarction after fine needle aspiration. Journal of Clinical Pathology, 35, 855-857. doi:10.1136/jcp.35.8.855 [23] Tsang, W.Y.W. and Chan, J.K.C. (1992) Spectrum of morphologic changes in lymph nodes attributable to fine needle aspiration. Human Pathology, 23, 562-565. doi:10.1016/0046-8177(92)90134-O [24] Kini, S.R. and Miller, J.M. (1986) Infarction of thyroid neoplasms following aspiration biopsy. Acta Cytologica, 30, 591. [25] Kini, S.R. (1996) Post-fine-needle biopsy infarction of thyroid neoplasms: A review of 28 cases. Diagnostic Cytopathology, 15, 211-220. doi:10.1002/(SICI)1097-0339(199609)15:3<211::AID-DC7>3.0.CO;2-J [26] Batsakis, J.G., Sneige, N. and El-Naggar, A.K. (1992) Fine-needle aspiration of salivary glands: Its utility and tissue effects. Annals of Otology, Rhinology and Laryn- gology, 101, 185-188. [27] Stephen, M.R., Matalka, I., Stewart, C.J.R. and Mackenzie, K. (1999) Xanthogranulomatous sialadenitis following diagnosis of Warthin’s tumor: A possible complication of fine needle aspiration. Cytopathol, 10, 276-279. doi:10.1046/j.1365-2303.1999.00148.x [28] Dardick, I., Jeans, M.T.D., Sinnott, N.M., Wittkuhn, J.F., Kahn, H.J. and Baumal, R. (1985) Salivary gland components involved in the formation of squamous metaplasia. American Journal of Pathology, 119, 33-43. [29] Brannon, R.B., Fowler, C.B. and Hartman, K.S. (1991) Necrotizing sialometaplasia: A clinicopathologic study of sixty-nine cases and review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, 72, 317- 325. [30] Bolat, F., Kayaselcuk, F., Erkan, A.N., Cagici, C.A., Bal, N. and Tuncer, I. (2004) Epidermoid carcinoma arising in Warthin’s tumor. Pathology & Oncology Research, 10, 240-242. doi:10.1007/BF03033769 [31] Gunduz, M., Yamanaka, N., Hotomi, M., et al. (1999) Squamous cell carcinoma arising in a Warthin’s tumor. Auris Nasus Larynx, 26, 355-360. doi:10.1016/S0385-8146(99)00008-5 [32] Little, J.W. and Rickles, N.H. (1965) Malignant papillary cystadenoma lymphomatosum. Report of a case, with review of the lit-erature. Cancer, 18, 851-856. doi:10.1002/1097-0142(196507)18:7<851::AID-CNCR2820180712>3.0.CO;2-7 [33] Ramzy, I., Rone, R. and Schantz, H.D. (1986) Squamous cells in needle aspirates of subcutaneous lesions: A diagnostic problem. American Journal of Clinical Pathology, 85, 319-324.