Papillary Cystadenoma Lymphomatosum (Warthin’s Tumour) of Parotic Salivary Glands with Multifocal Manifestation
Authors:
J. Pazdera; V. Zbořil
Authors‘ workplace:
Klinika ústní, čelistní a obličejové chirurgie FN a LF UP, Olomouc
Published in:
Česká stomatologie / Praktické zubní lékařství, ročník 112, 2012, 5, s. 128-134
Category:
Case Report
Overview
Introduction:
Papillary cystadenoma lymphomatosum (Warthin´s tumour) primarily occurs in parotid glands (5–10% of all the parotid salivary tumours) with slight predilection for males and clinical symptoms between the fifth and eighth decades of life. Its clinical manifestation in other locations (e.g. small palatinal salivary glands) is very rare.
This tumour typically presents itself as a doughy cystic-like mass in the inferior part of the parotid gland. It is composed of small cystic spaces with intraluminal projection lined by eosinophillic columnar cells and contains abundant lymphoid tissue in the underlying connective tissue. The tumour is thought to arise within lymph nodes after the entrapment of salivary gland elements in the course of embryonal development. Its growth is believed to arise secondary to chronic inflammation. Warthin´s tumour is benign, with a limited growth potential. Malignant transformation is extremely rare. The treatment of the tumour consists of simple enucleation; to prevent recurrence and avoid the possibility of multicentric growth, superficial parotic lobectomy is sometimes recommended.
Aim:
To point out the multiplicity and/or bilaterality of Warthin´s tumour in the parotid gland tissue and lymphatic nodes.
Material and Method, Results: The authors present their experience with the treatment of a man (64) with a multifocal and bilateral clinical manifestation of the papillary cystadenoma in parotid glands. In 2004, two tumour’s nodes from the area of inferior part of the left part parotid gland were removed. In the course of postoperative checking another tumour in the lower parts of contralateral, right parotid gland was noticed. This tumour was removed eight years after the first surgery; the diagnosis of Warthin´s tumour having been confirmed by a pathologist. After both operations, our patient feels well showing no signs or symptoms of any recurrence.
Conclusion:
Papillary cystadenoma lymphomatosum (Warthin´s tumour) belongs to less common neoplasmas of salivary glands. Owing to the risk of its multicentric or bilateral manifestation in the course of years, careful clinical checking after surgery is necessary. In diagnostically questionable cases ultrasonography or CT (MR) are recommended.
Key words:
papillary cystadenoma lymphomatosum – multifocal manifestation
Sources
1. Baugh, R. F., McClatchey, K. D.: Papillary cystadenoma lymphomatosum syndrome. J. Otolaryngol., roč. 15, 1986, č. 3, s. 166–168.
2. Becelli, R., Morello, R., Renzi G., Dominici C.: Warthin´s tumor of the hard palate. J. Craniofac. Surg., roč. 18, 2007, č. 5, s. 1182–1184.
3. Bond, W. R. Jr., Kincaid, R. S., Schultz, R. L., Morrison, W. V.: Bilateral simultaneous presentation of papillary cystadenoma lymphomatosum. Ear. Nose Throat. J., roč. 60, 1979, č. 2, s. 404–407.
4. Caldwell, E. H., Armiger, W. G., McDonald, H. M.: Malignant transformation of a Warthin tumor. Ann. Plast. Surg., roč, 3, 1979, č. 2, s. 177–181.
5. Cawson, R. A., Gleeson, M. J., Eveson, J. W.: Pathology and surgery of the salivary glands. Oxford, Isis Medical Media Ldt., 1997.
6. Faur, A., Lazar, E., Cornianu, M., Dema, A., Vidita, C. G., Guluscan, A.: Warthin tumor: A curious entity – Case report and review of literature. Rom. J. Morphol. Embryol., 50, 2008, č. 2, s. 269–273.
7. Faur, A., Lazar, E., Cornianu, M., Dema, A., Lazureanu, C., Costi, S., Vidita, C. G.: Malignant transformation of the epithelial componenet in Whartin´s tumor. Rev. Rom. Med. Lab., roč. 17, 2009, 4, s. 51–57.
8. Chen, Y.-H., Liu, P.-J., Yuan, B.-C.: Papillary cystadenoma lymphomatosum syndrome – Case report. J. Otolaryngol. Soc. Rep. China, roč. 33, 1998, č. 4, s. 390–393.
9. Kawatoko, S., Sato, T., Kawabata, Y., Suenaga, K., Morita, Y., Indo, H., Semba, I.: A trial for histopathological subclassification of papillary cystadenoma lymphomatosum by 99Tcm pertechnate in a patient with multiple bilateral lesions of the parotid glands. Dentomaxillofac. Radiol., roč. 4, 2005, roč. 4, s. 218–221.
10. Kim, J., Kim, E-K., Park, C. S., Choi, Y. S., Kim, Y. H., Choi, E. C.: Characteristic sonographic findings of Warthin´s tumor in the parotid gland. J. Clin. Ultrasound., roč. 32, 2004, č. 2, s. 78–81.
11. Mandel, L., Tomkoria, A.: Differentiating HIV-1 parotid cysts: From papillary cystadenoma lymphomatosum. J. Am. Demt. Asspc., roč, 131, 2000, č. 6, s. 772–776.
12. Mardi, K., Sharma, J.: Mucoepidermoid carcinoma arising in Warthin´s tumor. Indian J. Pathol. Microbiol., roč. 50, 2007, č. 2, s. 331–333.
13. Matsuo, M.: Bilateral papillary cystadenoma lymphomatosum (Warthin´s tumor) of the parotid region. Otolaryngology, roč. 54, 1982, č. 9, s. 333–338.
14. Meikle, D., Yarington Jr., C. T.: Synchronous parotid tumors of different histological types in association with metastasizing hypopharyngeal carcinoma. Otolaryngology, roč. 54, 1982, č. 5, s. 333–338.
15. Párraga-Linares, L., Aguirre-Urízar, J.-M., Berini-Aytés, L., Gay-Escoda, C.: Papillary cystadenoma lymphomatosum (Warthin-like) of minor salivary glands. Med. Oral. Patol. Oral. Cir. Bucal., roč. 14, 2009, č. 11, s. 597–600.
16. Raymond, M. R., Yoo, J. H., Godfrey Haethcote, J., Megan McLachlin, C., Lampe, H. B.: Accuracy of fine-needle aspiration biopsy for Warthin´s tumours. J. Otolaryngol., roč. 31, 2002, č. 5, s. 263–270.
17. Regezi, J. A., Sciubba, J. J.: Oral pathology. Clinical pathologic correlations. Philadelphia, W. B. Saunders, 1989.
18. Rydzewski, B., Glówczewska, M., Paprzycki, W.: Warthin´s tumors with atypical location. Otolaryngol. Pol., roč. 52, 1998, 4, s. 495–498.
Labels
Maxillofacial surgery Orthodontics Dental medicineArticle was published in
Czech Dental Journal
2012 Issue 5
Most read in this issue
- Papillary Cystadenoma Lymphomatosum (Warthin’s Tumour) of Parotic Salivary Glands with Multifocal Manifestation
- Tooth agenesis review
- Conservative Treatment of Temporomandibular Joint Disorders
- Cholesterol as an Aetiological Factor of Persistent Asymptomatic Apical Periodontitis