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 ...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.展开更多
AIM:To present computed tomography(CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy.METHODS:From January 2009 to November 2011,56 patients were col...AIM:To present computed tomography(CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy.METHODS:From January 2009 to November 2011,56 patients were collected through the histopathology and Picture Archiving and Communication Systems records,which revealed 5 basal cell adenoma(BCA),16 pleomorphic adenoma(PA),25 Warthin's tumor(War-T),3 Kimura's disease(KD) and 7 parotid carcinoma(PCa) cases.All the CT images were retrospectively analyzed by two radiologists in consensus,based on their description of morphology(location,number,size,margin and fibrous capsule) and enhancement patterns of masses.In addition,the diagnostic efficiency of diagnostic strategy is tested.RESULTS:War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years;the significant difference was seen in War-T vs PA and BCA vs PA.About 40% of War-Ts presented with bilateral multifocal lesions,a higher ratio than others.Seventy two percent of War-Ts were limited to the superficial lobe,followed by BCA 60% and PA 40%.Vessel facing sign and enlarged lymph nodes were both frequent in War-T,which respectively accounts for 84% and 76% of cases.Rapid contrast enhancement and decreases were unique for War-T.BCA and PA showed obvious delayed enhancement.The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency,with high accuracy,sensitivity and specificity.CONCLUSION:Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data.A diagnostic strategy with high diagnostic efficiency was established.展开更多
Objective： The aim of the study was to investigate CT and MRI findings of parotid Warthin＇s tumors （parotid ad- enolymphomas）. Methods： CT and MRI findings of 14 patients with pathologically-confirmed Warthin＇s ...Objective： The aim of the study was to investigate CT and MRI findings of parotid Warthin＇s tumors （parotid ad- enolymphomas）. Methods： CT and MRI findings of 14 patients with pathologically-confirmed Warthin＇s tumor （10 males and 4 females） were retrospectively analyzed. The average age was 56 years （range 44-77 years）. Twelve patients underwent CT plain scan, of which, 10 received the further enhancement; other 2 patients performed MR plain scan, of which, 1 was enhanced. The disease course ranged from 20 days to 4 years with the average of 22 months. Ten patients had the smoking history （71.4%）. Results： A total of 22 foal were found in all 14 patients, multiple in one parotid gland in 3 patients, single in one parotid gland in 9 patients and single in bilateral glands in 2 patients （one recurred the tumor in the contralateral gland 14 years after the surgery）. Sixteen （72.7%） foci or the main bodies [long diameter of 0.8-5.0 crn with the average of （2.3 ＋ 1.3） crn] were located in the posterior and interior role of the superficial lobe of the parotid gland. The foci were round or oval. The boundary was smooth in 21 （95.5%） loci and blurred in 3 loci which were proved by biopsy to be accompanied with infection. Fourteen foci （77.7%） with uniform density and 4 foci with nonuniform density were found in 12 patients under CT plain. A total of 15 loci in 10 patients were enhanced, 7 （46.7%） on significant enhancement, 5 （33.3%） on moderate enhancement and 3 on slight enhancement. The margin was enhanced slightly in 3 foci. In MR images, the signal of tumor was uniform or nonunifrom, TlWl showed low signal and T2Wl showed moderate or high signal. The envelope displayed signal shadow under plain scan and the enhancement was slightly. Conclusion： For middle or elder males with the smoking history, if they have the foci in the posterior and interior parts of the parotid gland which show clear boundary and significant enhancement, especially for multiple or bilateral foci, parotid Warthin＇s tumor should be considered firstly.展开更多
Warthin’s tumour (WT) is the second most common benign salivary gland tumour of the parotid gland. Several treatments have been proposed. Surgery is considered the treatment of choice. We report a case of an 83-year-...Warthin’s tumour (WT) is the second most common benign salivary gland tumour of the parotid gland. Several treatments have been proposed. Surgery is considered the treatment of choice. We report a case of an 83-year-old woman who was treated using sclerotherapy and discuss the possible benefits of this method. To our knowledge this is the first report on sclerotherapic treatment of WT.展开更多
文摘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.
文摘AIM:To present computed tomography(CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy.METHODS:From January 2009 to November 2011,56 patients were collected through the histopathology and Picture Archiving and Communication Systems records,which revealed 5 basal cell adenoma(BCA),16 pleomorphic adenoma(PA),25 Warthin's tumor(War-T),3 Kimura's disease(KD) and 7 parotid carcinoma(PCa) cases.All the CT images were retrospectively analyzed by two radiologists in consensus,based on their description of morphology(location,number,size,margin and fibrous capsule) and enhancement patterns of masses.In addition,the diagnostic efficiency of diagnostic strategy is tested.RESULTS:War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years;the significant difference was seen in War-T vs PA and BCA vs PA.About 40% of War-Ts presented with bilateral multifocal lesions,a higher ratio than others.Seventy two percent of War-Ts were limited to the superficial lobe,followed by BCA 60% and PA 40%.Vessel facing sign and enlarged lymph nodes were both frequent in War-T,which respectively accounts for 84% and 76% of cases.Rapid contrast enhancement and decreases were unique for War-T.BCA and PA showed obvious delayed enhancement.The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency,with high accuracy,sensitivity and specificity.CONCLUSION:Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data.A diagnostic strategy with high diagnostic efficiency was established.
文摘Objective： The aim of the study was to investigate CT and MRI findings of parotid Warthin＇s tumors （parotid ad- enolymphomas）. Methods： CT and MRI findings of 14 patients with pathologically-confirmed Warthin＇s tumor （10 males and 4 females） were retrospectively analyzed. The average age was 56 years （range 44-77 years）. Twelve patients underwent CT plain scan, of which, 10 received the further enhancement; other 2 patients performed MR plain scan, of which, 1 was enhanced. The disease course ranged from 20 days to 4 years with the average of 22 months. Ten patients had the smoking history （71.4%）. Results： A total of 22 foal were found in all 14 patients, multiple in one parotid gland in 3 patients, single in one parotid gland in 9 patients and single in bilateral glands in 2 patients （one recurred the tumor in the contralateral gland 14 years after the surgery）. Sixteen （72.7%） foci or the main bodies [long diameter of 0.8-5.0 crn with the average of （2.3 ＋ 1.3） crn] were located in the posterior and interior role of the superficial lobe of the parotid gland. The foci were round or oval. The boundary was smooth in 21 （95.5%） loci and blurred in 3 loci which were proved by biopsy to be accompanied with infection. Fourteen foci （77.7%） with uniform density and 4 foci with nonuniform density were found in 12 patients under CT plain. A total of 15 loci in 10 patients were enhanced, 7 （46.7%） on significant enhancement, 5 （33.3%） on moderate enhancement and 3 on slight enhancement. The margin was enhanced slightly in 3 foci. In MR images, the signal of tumor was uniform or nonunifrom, TlWl showed low signal and T2Wl showed moderate or high signal. The envelope displayed signal shadow under plain scan and the enhancement was slightly. Conclusion： For middle or elder males with the smoking history, if they have the foci in the posterior and interior parts of the parotid gland which show clear boundary and significant enhancement, especially for multiple or bilateral foci, parotid Warthin＇s tumor should be considered firstly.
文摘Warthin’s tumour (WT) is the second most common benign salivary gland tumour of the parotid gland. Several treatments have been proposed. Surgery is considered the treatment of choice. We report a case of an 83-year-old woman who was treated using sclerotherapy and discuss the possible benefits of this method. To our knowledge this is the first report on sclerotherapic treatment of WT.
