A Case of Warthin’s Tumor Together with IgG4-Related Sialadenitis

Warthin’s tumor is the second most frequent neoplasm next to pleomorphic adenoma in the salivary gland. The tumor contains the epithelial oncocyte cells with the presence of rich-mitochondria and their surrounding abundant lymphocytes. A relatively new disease entity of IgG4-related disease frequently occurs in the salivary gland. However, the coexistence of Warthin’s tumor and IgG4-related disease is scarcely observed. We have recently experienced a rare case of Warthin’s tumor with IgG4-related sialadenitis. A 51-year-old man presented to our hospital, complaining of a mass with right submandibular tenderness and spontaneous pain. A computed tomography scan of the cervical region revealed a suspicion of lymph node proliferative disease, including malignant lymphoma. Elevated serum levels of IL-2R: 1843 U/ml (reference value 122 - 496 U/ml), IgG: 3430 mg/dl (reference value 861 - 1747 mg/dl), and IgG4: 3140 mg/dl (reference value 11 - 121 mg/dl) were observed. Other laboratory data showed within normal ranges. The cervical tumor was diagnosed as Warthin’s tumor by the findings of fine-needle aspiration cytology and biopsy examination. Immunohistochemistry revealed numerous IgG4- and IgG-positive cells with fibrosis surrounding the epithelial component of Warthin’s tumor, suggesting IgG4-rerated sialadenitis. Finally, we diagnosed the cervical tumor as Warthin tumor with IgG4-related sialadenitis. This is the second report describing a case of Warthin’s tumor with possible involvement of IgG4-related sialadenitis.

Differential Diagnosis of Warthin's Tumor Complicated with Lung Adenocarcinoma by 18F- FDG PET/CT Imaging and Radioisotope Scanning with Tc-99m Pertechnetate:A Case Report and Literature Review

A seventy eight years old male patient underwent a whole body 18F- FDG PET/CT imaging to diagnose the lesion which was showed in the right lung by a chest X ray test and CT scan before. Besides the intense 18F- FDG uptake of the lesion in the right lung, a lesion in the left parotid gland also showed intense 18F- FDG uptake. To evaluate the pathology of the lesion in the left parotid gland, a parotid gland scintigraphy imaging with Tc-99m pertechnetate was done and revealed a Warthin＇s tumor. Later a fine needle aspiration（FNA） confirmed that it was a Warthin＇s tumor.

CT and MRI findings of parotid Warthin’s tumors

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.

The distribution of parotid gland neoplasms in a veteran population

Objective:Salivary gland tumors account for 6%-8%of head and neck neoplasms with the parotid gland as the most common primary site.Pleomorphic adenomas(PA)are considered the most common benign parotid gland neoplasms,followed by Warthin tumors(WT).The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population.Design:Retrospective chart review.Setting:Washington DC Veterans Affairs Medical Center.Participants:Veterans who underwent fine needle aspiration(FNA)for a parotid gland mass from 2000 to 2018 were included.Medical records were reviewed for gender,age,tobacco use,surgery date,and pathology results.Main outcome measures:Changes in the distribution of parotid neoplasms and tobacco use over an 18-year period.Results:Of 141 patients with parotid gland masses,86.5%(n=122)were benign,9.9%(n=14)were malignant,and 3.5%(n=5)were indeterminate.Of benign tumors,WT accounted for the majority at 51.6%,followed by PA at 40.2%.When stratified by decade(2000-2009 and 2010-2018),the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6%to 53.6%,whereas the proportion of PA decreased from 36.8%to 33.3%.The rate of tobacco use was unchanged at approximately 32.0%among our cohort from 2000 to 2018.Conclusion:Among our cohort of veteran patients,WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.