Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour. (17/66)

Warthin tumours (WT) and malignant lymphomas are only rarely associated, and most are examples of involvement of the lymphoid stroma of WT by a disseminated lymphoma. This report describes a case where excision of a parotid mass led to the initial diagnosis of WT and small lymphocytic lymphoma (SLL). The diagnosis of SLL was confirmed by immunohistochemistry and molecular studies. The patient had stage IV A disease and is currently in chemotherapy induced complete remission. This case highlights the extremely rare association of SLL with WT and the importance of evaluation of the WT stroma, where the pale proliferation centres of SLL may mimic germinal centres of reactive lymphoid nodules.  (+info)

Cytological characteristics of acinic cell carcinoma (ACC) diagnosed by fine-needle aspiration biopsy (FNAB). A study of four cases. (18/66)

OBJECTIVE: To present the cytopathological characteristics of acinic cell carcinoma (ACC) as well as its cyto-histological correlation, commenting on the differential diagnostic problems of this entity based on four observations studied using fine-needle aspiration biopsy (FNAB). CLINICAL CASES: Two males of 52 and 53 years of age, one 79 year-old woman and a girl of 12 years of age, who presented tumors located in the parotid area (cases 1, 2 and 4) and at the laterocervical level (case 3). In 3 patients, the FNAB was, together with the image studies, the first diagnostic indication; case 3 corresponding to a puncture of metastatic laterocervical adenopathies in a patient with a history of parotid ACC. CYTOLOGICAL FINDINGS: The cytologic smears revealed abundant tumoral cellularity arranged in small monolayered sheets, forming acinar structures or isolated cells. The abundance of bare nuclei at the background of the smears, and the absence of adipose tissue and ductal epithelium are highlighted. The cells possessed round or oval monomorphic nuclei, few nucleoli and abundant granular or finely vacuolate cytoplasm. DISCUSSION: FNAB provides essential information on the diagnostic-therapeutic management of salivary gland tumors; this methodology is highly sensitive in its diagnostic efficacy. The diagnosis of ACCs frequently presents difficulties, owing to the great cytologic similarity of the tumor cells with the normal acinar component of the salivary gland. The differential diagnosis is considered, fundamentally, with clear cell carcinomas, mucoepidermoid carcinomas, Warthin s tumor, and oncocytomas. Our observations confirm the validity of FNAB in a first diagnostic approximation for those lesions accessible to direct puncture.  (+info)

Ultrasound contrast media in the study of salivary gland tumors. (19/66)

BACKGROUND: The aims of the present study were: to assess standard ultrasound and color-Doppler patterns for the study and characterization of salivary gland tumors; to define the improvement in the color-Doppler ultrasound image after injection of a signal amplifier (Levovist); to compare morphological and vascular aspects of the neoplasm with data obtained during postoperative histopathological analysis. MATERIALS AND METHODS: We used color-Doppler ultrasound before and after injection of the contrast medium to study 56 patients (32 males and 24 females) between the ages of 28 and 77 years old, presenting nodular pathology of the salivary glands. Only patients with less than optimal results of the basic color-Doppler examination (grade of vascularization 0-1) were included in the study. The data were then compared with the final histological results. RESULTS: According to B-mode ultrasonography, all neoplasms were hypoechogenous; 8 showed irregular margins and, of these, 6 were carcinomas. We did not obtain significant data regarding size and echostructure. In 10 cases, we observed the presence of multiple locoregional formations in the lymph nodes. Patients were selected on the basis of unsatisfactory color-Doppler examination results; following injection of the contrast medium, we were able to visualize an increased number of vascular signals in 40 out of 56 patients, compared to the basic examination. This enabled us to better assess the vascular map of the neoplasms, as well as more easily trace the vascular blood flow and perform a better extrapolation of the quantitative and semi-quantitative data. This study demonstrated the importance of the vascular pattern, which is predictive of a malignant lesion when it is high-grade with multiple vascular poles and irregular vascular distribution. Furthermore, certain semi-quantitative parameters proved to be important, particularly the velocity of the systolic peak (SP), the cut-off of which was approximately 25 cm/s. The resistance index (RI) and pulsality index (PI) did not prove significant and showed overlapping values. CONCLUSION: We observed that the contrast medium was useful in characterizing lesions, of the salivary glands by allowing for a more precise vascular map of the lesions, as well as greater diagnostic accuracy in tracing the vascular blood flow and calculating quantitative and semiquantitative data.  (+info)

Papillary cystadenoma lymphomatosum: case report and review of literature. (20/66)

Papillary Cystadenoma Lymphomatosum or Warthin's tumour is a unique neoplasm arising almost exclusively in the parotid salivary gland and is composed of oncocytic epithelium with a prominent lymphoid infiltrate. The tumor is usually asymptomatic and may be associated with varying degrees of pain not necessarily an indication of malignant transformation in the tumour. The tumour is managed easily by surgical excision. This article presents a typical case arising in the right parotid gland of a 73-year-old male with review of literature of this rare tumour.  (+info)

A type II first branchial cleft cyst masquerading as an infected parotid Warthin's tumor. (21/66)

The diagnosis of a parotid mass usually depends on thorough history taking and physical examination. Diagnostic modalities, including ultrasonographic examinations, computed tomography and magnetic resonance images, may also provide substantial information but their accuracy for diagnosis is sometimes questionable, especially in differentiating some rare neoplasms. First branchial cleft cysts (FBCCs) are rare causes of parotid swelling and comprise less than 1% of all branchial anomalies. They are frequently misdiagnosed due to their rarity and unfamiliar clinical signs and symptoms. We present a case of type II FBCC masquerading as an infected parotid Warthin's tumor. We also review the clinical signs and symptoms of FBCCs in order to remind clinicians that this rare branchial anomaly can mimic an infected Warthin's tumor and may be seated in the deep lobe of the parotid gland. By making an accurate pre-operative diagnosis of type II FBCC, we can minimize surgical morbidity and avoid incomplete resection and possible recurrence.  (+info)

Unilocular cystic sebaceous lymphadenoma: a rare tumour. (22/66)

A unique variant of the sebaceous lymphadenoma, so-called unilocular cystic sebaceous lymphadenoma, occurred in a 28-year-old male with a painless swelling in the left parotid region. The recognition of key histological features will readily allow differentiation of this unique neoplasm from its benign and malignant mimics. To our knowledge, out of 21 cases of sebaceous lymphadenoma reported, only 3 unilocular cystic variants have been recorded.  (+info)

Malignant lymphoma arising from heterotopic Warthin's tumor in the neck: case report and review of the literature. (23/66)

Warthin's tumor (WT), so-called adenolymphoma, is a benign salivary gland tumor with both epithelial and lymphoid histological characteristics, so the histogenesis remains unclear. Treatment consists primarily of tumor removal or conservative follow up. Here we present a rare case of malignant lymphoma arising from heterotopic (ectopic) WT. A 102-year-old man presented with a mass in the left side of the neck which was painless but gradually enlarged over 1 month. The mass was 2-3 cm in diameter, and freely moveable below the angle of the mandible. The mass was totally removed. The histological diagnosis was malignant lymphoma, diffuse large B-cell type, arising from heterotopic WT. Postoperative staging examination including chest radiography, bone scan, and computed tomography of the abdomen and pelvis revealed no evidence of dissemination of malignant lymphoma. Malignant transformation within WT is rarer in the lymphoid component than in the epithelial component. Only 16 cases of malignant transformation arising from WT have been reported, including only three cases of non-Hodgkin lymphoma apparently arising from heterotopic WT. Tumor removal or careful follow up is recommended in patients with WT because of the potential risk posed by such malignant transformation.  (+info)

Sebaceous lymphadenoma of the parotid gland: report of two cases and review of the literature. (24/66)

Sebaceous lymphadenoma is an unusual salivary gland neoplasm which is rarely correctly diagnosed pre-operatively in the parotid gland. Two cases of sebaceous lymphadenoma are presented in which, in common with most cases reported in the literature, the correct pre-operative diagnosis was not made. Sebaceous lymphadenoma rarely transforms into a malignant tumour. Fine needle aspiration cytology identifies a benign process in the majority of patients who receive appropriate treatment on this basis. Although an uncommon tumour, it should be taken into consideration in the differential diagnosis of a solitary parotid mass.  (+info)