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Vaknin I, Allon I, Zafrir-Haver S, Abramson A. A Rare Diagnosis of Parotid Gland Follicular Lymphoma Arising in Warthin Tumor: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:2086. [PMID: 39768965 PMCID: PMC11679321 DOI: 10.3390/medicina60122086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 11/24/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025]
Abstract
Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. Clinical report: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. Conclusions: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the "wait and see" approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery.
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Affiliation(s)
- Ido Vaknin
- Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel;
| | - Irit Allon
- Institute of Pathology, Barzilai University Medical Center, Ashkelon 7830604, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Shirley Zafrir-Haver
- Department of Hematology, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Alex Abramson
- Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel;
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Tong HC, Ma S, Chen L, Meng X, Li YC, Li LY, Dong L, Zhang WL, Wildes T, Yang LH, Wang E. Warthin tumor concomitant with mantle cell lymphoma: a case report and review of literature. Diagn Pathol 2024; 19:114. [PMID: 39182117 PMCID: PMC11344329 DOI: 10.1186/s13000-024-01538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Warthin tumor (WT) is the second most common benign tumor in salivary gland. It has a slow growth rate and most frequently occurs in the parotid gland. Most patients present with an incidental finding of a painless mass inferior/anterior to the ear. Besides the epithelial component of the tumor, WT is characteristically associated with lymphoid stroma that is considered benign. While there have been a few reports of malignant transformation of the lymphoid components in WT, cases of WT concomitant with mantle cell lymphoma (MCL) are extremely rare. To the best of our knowledge, two cases have been described in the English literature. Herein, we report a case of WT concomitant with MCL in a 70-year-old female patient, and emphasize the importance of careful examination of lymphoid stroma in WT so that concurrent lymphoma is not missed. PATIENT CONCERNS A 70-year-old Chinese woman with a 40-year history of cigarette smoking presented with a one year history of a right submaxillary mass with recent enlargement. DIAGNOSIS Cervical ultrasound (US) and computed tomography (CT) scans of the neck revealed a well-circumscribed mass in the right parotid with a maximum diameter of 3.1 cm. Surgical resection of the mass was performed. Histopathological examination revealed a characteristic double-layer of neoplastic epithelium with prominent lymphoid stroma, suggesting WT. In addition, morphology and immunohistochemistry studies confirmed the coexistence of MCL. Thereafter, the final diagnosis of this case was WT concomitant with MCL. INTERVENTIONS The patient was staged as stage I after clinical assessment. Due to the slow growth of parotid lesions, close observation was decided with periodic clinical and radiological monitoring. OUTCOMES Currently, the patient demonstrates a stable disease by clinical evaluation. LESSONS To the best of our knowledge, reported cases of WT concomitant with MCL are very rare. This case highlights the importance of a comprehensive assessment of the lymphoid stroma of WT to avoid missed diagnosis of a lymphoma component in a collision tumor.
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Affiliation(s)
- Hai-Chao Tong
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lan Chen
- Department of pathology, Datong County People's Hospital of Qinghai Province, Datong Hui and Tu Autonomous County, China
| | - Xiangyun Meng
- Department of pathology, Datong County People's Hospital of Qinghai Province, Datong Hui and Tu Autonomous County, China
| | - Ying-Chun Li
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Le-Yao Li
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Lingyun Dong
- Department of pathology, Yangzhou maternal and child health hospital, Yangzhou, Jiangsu province, China
| | - Wan-Lin Zhang
- Department of pathology, The Third Medical Centre, Chinese PLA General Hospital, Peking, China
| | - Tyler Wildes
- Department of Pathology, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Lian-He Yang
- Department of Pathology, First Hospital and College of Basic Medical Sciences, China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
| | - Endi Wang
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Efficacy of Surgery in Patients with Stage I Primary Parotid Gland Lymphoma: A Population-Based Study. JOURNAL OF ONCOLOGY 2022; 2022:4977600. [DOI: 10.1155/2022/4977600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022]
Abstract
Background. Limited and controversial evidence is available on the efficacy of surgery for patients with stage I primary parotid gland lymphoma. Thus, we aimed to investigate whether surgery can enhance the prognosis of patients with stage I primary parotid gland lymphoma using large sample data. Methods. From 1998 to 2015, we searched the Surveillance, Epidemiology, and End Results (SEER) program database and extracted information regarding patients with stage I primary parotid gland lymphoma; we classified these patients into surgery and nonsurgery groups. We calculated overall survival (OS) and cancer-specific survival (CSS) using Kaplan–Meier curves and log-rank testing. Propensity score matching (PSM) analysis was also used to further account for confounding variables before comparing the OS and CSS again. We used the COX proportional hazard regression model in both multivariate and univariate analyses. Results. We enrolled 918 patients with stage I primary parotid gland lymphoma, among which 656 (71.5%) patients underwent surgery. Before PSM, the surgery group had better OS (hazard ratio (HR) = 0.673, 95% confidence interval (CI): 0.519–0.873, and
) and CSS (HR = 0.595, 95% CI: 0.403–0.879, and
) than the nonsurgery group. After PSM, surgery was still a beneficial factor for OS (HR = 0.569, 95% CI: 0.399–0.810, and
) and CSS (HR = 0.384, 95% CI: 0.220–0.669, and
). Furthermore, in univariate and multivariate analyses, total parotidectomy significantly increased OS (
and
, respectively) and CSS (
and
, respectively). Conclusions. In summary, the prognosis of patients with stage I primary parotid gland lymphoma can be significantly improved by surgery. Moreover, total parotidectomy was a protective factor for OS and CSS before and after PSM analysis, suggesting that surgery acts as a significant component in multimodal therapy for early primary parotid gland lymphoma.
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Alnoor FNU, Gandhi JS, Stein MK, Solares J, Gradowski JF. Prevalence of Lymphoid Neoplasia in a Retrospective Analysis of Warthin Tumor: A Single Institution Experience. Head Neck Pathol 2020; 14:944-950. [PMID: 32328910 PMCID: PMC7669968 DOI: 10.1007/s12105-020-01161-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Warthin tumor is one of the most common benign salivary gland tumors. Overt lymphoma is known to occur in the lymphoid stroma of Warthin tumor. In situ follicular neoplasia is difficult to identify in routine histologic examination of lymphoid tissue and has not been reported in association with Warthin tumor. Our objective is to determine the prevalence of overt malignant lymphoma and in situ follicular neoplasia in Warthin tumor. We conducted a retrospective histological evaluation of 89 sequential Warthin tumor cases with available slides and blocks from the years 2010-2019. Of these, 84 cases were subjected to immunohistochemical testing, while 5 cases had been previously worked up for the suspicion of lymphoma. We identified two additional cases of lymphoid neoplasia associated with Warthin tumor including small lymphocytic lymphoma/chronic lymphocytic leukemia (n = 1) and in situ follicular neoplasia (n = 1) in addition to previously reported case of follicular lymphoma included in this study. The prevalence rate of first-time detected lymphoid neoplasia in Warthin tumor is 3.4%. The prevalence rate of overt lymphoma is 2.2%, while the prevalence of in situ follicular neoplasia is 1.1%. We propose histologic criteria to identify small lymphocytic lymphoma and follicular lymphoma in Warthin tumor. These include a monotonous interfollicular expansion of small lymphocytes and germinal centers composed of a monotonous population of lymphocytes without polarity or tingible body macrophages respectively. It is very important for pathologists to perform a diligent morphological examination and perform immunohistochemistry in suspected cases to identify subtle involvement of Warthin tumor by lymphoma. In patients with involvement of Warthin tumor by in situ follicular neoplasia, concurrent lymphoma in the same tissue and other sites should be considered. Patients without overt lymphoma elsewhere likely have a low risk of progression to follicular lymphoma. The low prevalence of in situ follicular neoplasia in Warthin tumor, combined with the low rate of clinical progression to lymphoma, make routine screening of Warthin tumor for in situ follicular neoplasia unnecessary.
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Affiliation(s)
- F. N. U. Alnoor
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Jatin S. Gandhi
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Matthew K. Stein
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis, TN USA
| | - Jorge Solares
- Department of Pathology and Laboratory Medicine, Methodist University Hospital, Memphis, TN USA
| | - Joel F. Gradowski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA ,Department of Pathology and Laboratory Medicine, Methodist University Hospital, Memphis, TN USA ,Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Methodist University Hospital, 1265 Union Ave, 6th Floor Sherard, Suite 621, Memphis, TN 38104 USA
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5
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Wang CS, Chu X, Yang D, Ren L, Meng NL, Lv XX, Yun T, Cao YS. Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland - immunophenotypic and genetic features: A case report. World J Clin Cases 2019; 7:3895-3903. [PMID: 31799320 PMCID: PMC6887602 DOI: 10.12998/wjcc.v7.i22.3895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/23/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Chang-Song Wang
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Xia Chu
- Department of Pathology, 988th Hospital of PLA, Zhengzhou 450042, Henan Province, China
| | - Di Yang
- Department of Pathology, Sanmenxia center Hospital, Sanmenxia 472000, Henan Province, China
| | - Lei Ren
- Department of Pathology, Luoyang First People’s Hospital, Luoyang 471000, Henan Province, China
| | - Nian-Long Meng
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Xue-Xia Lv
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Tian Yun
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Yan-Sha Cao
- Department of Pathology, 989th Hospital of PLA, Luoyang 471000, Henan Province, China
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Incidence of Non-Salivary Gland Neoplasms in Patients with Warthin Tumor: A Study of 73 Cases. Head Neck Pathol 2019; 14:412-418. [PMID: 31228167 PMCID: PMC7235100 DOI: 10.1007/s12105-019-01049-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/15/2019] [Indexed: 01/12/2023]
Abstract
Warthin tumor is the second most common benign parotid neoplasm. Its association with non-salivary gland neoplasms has been sporadically reported. We reviewed clinical records of Warthin tumor diagnosed on aspiration cytology and surgical pathology to determine if there is any association with other extra-salivary gland malignant neoplasms. Computer search was made for all cases of Warthin tumor diagnosed in the parotid gland by aspiration cytology and surgical pathology at our institution between January 2007 and August 2016. Clinical records of all cases were reviewed for any associated malignant neoplasms and any surgical follow up. All available cytology and histologic material was reviewed. Seventy-three patients (mean 66.9, M:F 1.1:1, age range 43 to 87 years) with Warthin tumor were identified. 45 (62%) were diagnosed on aspiration cytology only, 19 (26%) had cytologic diagnosis as well as concordant surgical follow up, and 9 (12%) were diagnosed based on surgical pathology only. Average age for patients with and without secondary malignancy was 70.5-years, and 63.4-years, respectively (p < 0.05). Average pack years for patients with and without secondary malignancy was 45.4, and 39.8, respectively (p > 0.05). Twenty-seven (37.0%) patients harbored a malignant neoplasm. Association of extra salivary gland malignant neoplasms in 37.0% of our cases suggest that the prevalence of secondary non-salivary neoplasms in patients harboring Warthin tumor might have been underestimated. Squamous cell carcinoma was the most commonly associated non-salivary malignant neoplasm. The association of Warthin tumor with smoking plays an important role in this increased rate of malignancy, and this is supported by the fact that smoking is highly associated with head and neck and lung cancers.
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7
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Alnoor F, Gandhi JS, Stein MK, Gradowski JF. Follicular Lymphoma Diagnosed in Warthin Tumor: A Case Report and Review of the Literature. Head Neck Pathol 2019; 14:386-391. [PMID: 31183747 PMCID: PMC7235116 DOI: 10.1007/s12105-019-01045-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/05/2019] [Indexed: 12/24/2022]
Abstract
Warthin tumor is one of the most common benign salivary gland tumors. It is unusual and difficult to diagnose follicular lymphoma within the lymphoid tissue of Warthin tumor. We present a rare case of a 69-year-old man with systemic follicular lymphoma initially diagnosed in a Warthin tumor. Lymphomas occurring within Warthin tumors are rare, however, follicular lymphoma is most commonly reported. Because these patients require further treatment depending on the stage of a disease, it is important for a pathologist to review the histology of Warthin tumors diligently to identify occult lymphomas.
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Affiliation(s)
- Fnu Alnoor
- grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA ,grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 525, Memphis, TN 38163 USA
| | - Jatin S. Gandhi
- grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
| | - Matthew K. Stein
- grid.267301.10000 0004 0386 9246Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis, TN USA
| | - Joel F. Gradowski
- grid.267301.10000 0004 0386 9246Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN USA
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8
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Sánchez-Romero C, Pontes HAR, Pontes FSC, Rocha AC, Carlos R, Rendón JC, de Almeida OP, Fonseca FP. Acute lymphoblastic leukemia/lymphoma of the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:152-164. [DOI: 10.1016/j.oooo.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 12/13/2022]
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9
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Jun L, Ming Z. Classical Hodgkin lymphoma arising from heterotopic Warthin's tumor in the cervical lymph node: A case report. Oncol Lett 2018; 16:619-622. [PMID: 29928448 DOI: 10.3892/ol.2018.8682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/17/2018] [Indexed: 12/14/2022] Open
Abstract
Heterotopic Warthin's tumor (WT) arising from the cervical lymph nodes is uncommon and WT presenting concomitantly with classical Hodgkin's lymphoma has only been previously reported three times in English literature. The current study presents an unusual case of classical Hodgkin lymphoma (CHL) involving the heterotopic WT in a 59-year-old male. Histopathologic examination revealied a WT with extensive expansion of mixed-cellularity CHL in a lymph node in the right of the neck. Clinical staging was determined as stage IA disease. The patient received four courses of chemotherapy and local consolidative radiotherapy, no evidence of disseminated lymphoma was observed over the 6-month follow-up. To the best of our knowledge, this is the first well documented collision tumor between CHL and heterotopic WT of the cervical lymph nodes. The present case also expands the anatomical site of malignant lymphomas associated with WT.
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Affiliation(s)
- Li Jun
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhu Ming
- Department of Head and Neck, Zhejiang Tumor Hospital, Hangzhou, Zhejiang 310021, P.R. China
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10
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Di Napoli A, Mallel G, Bartolazzi A, Cavalieri E, Becelli R, Cippitelli C, Ruco L. Nodular Lymphocyte-Predominant Hodgkin Lymphoma in a Warthin Tumor of the Parotid Gland: A Case Report and Literature Review. Int J Surg Pathol 2016; 23:419-23. [PMID: 26169920 DOI: 10.1177/1066896915582263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hodgkin lymphoma (HL) associated with Warthin tumor (WT) is extremely rare, accounting for only 3 cases of classical HLs. Here, we report for the first time the occurrence of a nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) involving the lymphoid stroma of a WT of the parotid gland. Pathogenesis of WT is controversial, with both a nodal and a parenchymal possible origin. On the other hand, extranodal involvement by HLs is uncommon. In our case, the coexistence of a WT and of a NLPHL within its stroma and in cervical lymph node emphasizes the importance of a careful evaluation of the lymphoid tissue in WT in order to exclude the possibility of an associated lymphoid malignancy.
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Affiliation(s)
| | | | | | | | | | | | - Luigi Ruco
- Sant'Andrea Hospital, Sapienza University, Rome, Italy
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11
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Arcega RS, Feinstein AJ, Bhuta S, Blackwell KE, Rao NP, Pullarkat ST. An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor. Diagn Pathol 2015; 10:209. [PMID: 26634829 PMCID: PMC4669604 DOI: 10.1186/s13000-015-0444-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/28/2015] [Indexed: 02/07/2023] Open
Abstract
Background Warthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature. Herein, we report an unusual initial presentation of a mantle cell lymphoma involving the lymphoid stroma of a Warthin tumor. Case presentation A seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months. Conclusion To the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case also brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor.
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Affiliation(s)
- Ramir S Arcega
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
| | - Aaron J Feinstein
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA.
| | - Sunita Bhuta
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
| | - Keith E Blackwell
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA.
| | - Nagesh P Rao
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA.
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12
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Boutin AB, Chaput L, Lecointre C, Kerdraon R, Metrard G, Michenet P. [An unexpected Warthin's tumor]. Ann Pathol 2015; 35:270-2. [PMID: 26004309 DOI: 10.1016/j.annpat.2015.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/12/2015] [Accepted: 03/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Anne-Blandine Boutin
- Service d'anatomie et cytologie pathologiques, CHR Orléans, hôpital de La-Source, CS 86709, 45067 Orléans cedex 2, France.
| | - Laura Chaput
- Service d'anatomie et cytologie pathologiques, CHR Orléans, hôpital de La-Source, CS 86709, 45067 Orléans cedex 2, France
| | - Claire Lecointre
- Service d'anatomie et cytologie pathologiques, CHR Orléans, hôpital de La-Source, CS 86709, 45067 Orléans cedex 2, France
| | - Rémy Kerdraon
- Service d'anatomie et cytologie pathologiques, CHR Orléans, hôpital de La-Source, CS 86709, 45067 Orléans cedex 2, France
| | - Gilles Metrard
- Service de médecine nucléaire, CHR Orléans, hôpital de La-Source, CS 86709, 45067 Orléans cedex 2, France
| | - Patrick Michenet
- Service d'anatomie et cytologie pathologiques, CHR Orléans, hôpital de La-Source, CS 86709, 45067 Orléans cedex 2, France
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13
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Liu YQ, Tang QL, Wang LL, Liu QY, Fan S, Li HG. Concomitant lymphocyte-rich classical Hodgkin's lymphoma and Warthin's tumor. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:e117-20. [PMID: 23849380 DOI: 10.1016/j.oooo.2013.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/27/2013] [Accepted: 05/08/2013] [Indexed: 12/28/2022]
Abstract
Lymphomas associated with Warthin's tumor (WT) are extremely rare. Here, we report the simultaneous occurrence of lymphocyte-rich classical Hodgkin's lymphoma (LRCHL) and WT in a 78-year-old patient whose symptoms included an enlargement of the left parotid gland. Upon parotidectomy, the tissue specimen showed a WT with extensive replacement of the lymphoid stroma by small lymphocytes and some scattered Reed-Sternberg cells; however, the oncocytic epithelium was preserved. Further investigation revealed mediastinal and abdominal lymphadenopathy, consistent with stage IVB disease. To our knowledge, this is the first case report of LRCHL associated with WT. The lymphoid stroma in WT is part of the systemic lymphoid tissue and thus may be involved in the dissemination of the lymphoma. This case serves as a reminder that a careful evaluation of the histomorphological and immunohistological features of the lymphoid tissue is required for a WT biopsy.
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Affiliation(s)
- Ye-qing Liu
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, PR China
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Ozkök G, Taşlı F, Ozsan N, Oztürk R, Postacı H. Diffuse Large B-Cell Lymphoma Arising in Warthin's Tumor: Case Study and Review of the Literature. KOREAN JOURNAL OF PATHOLOGY 2013; 47:579-82. [PMID: 24421853 PMCID: PMC3887162 DOI: 10.4132/koreanjpathol.2013.47.6.579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/15/2012] [Accepted: 09/17/2012] [Indexed: 12/13/2022]
Abstract
Warthin's tumor is the second most common type of salivary gland tumor. Microscopically, Warthin's tumor displays a proliferative epithelial component and lymphoid stroma. Carcinomas arising from the epithelial component are well known, but malignant transformations of the lymphoid stroma are rare. When they do occur, they are most commonly B-cell type non-Hodgkin lymphomas. A 60-year-old male patient underwent surgical resection of a parotid mass. After superficial parotidectomy, microscopic examination indicated that the tumor was of epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components. In addition to the lymphoid follicles with distinct germinal centers, there were large, bizarre and extremely atypical neoplastic cells seen in the lymphoid component. Large neoplastic cells were diffusely CD20 and CD30 positive. The patient was diagnosed with "Warthin's tumor and diffuse large B-cell lymphoma with expression of CD30." The histopathologic and clinical features are discussed along with a review of the literature.
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Affiliation(s)
- Güliz Ozkök
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Funda Taşlı
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Nazan Ozsan
- Department of Pathology, Ege University School of Medicine, Izmir, Turkey
| | - Rafet Oztürk
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Hakan Postacı
- Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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