Positron emission tomography in Warthin’s tumor mimicking malignancy impacts the evaluation of head and neck patients

The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland

“…On multiphase CT, WTs demonstrate earlier peak enhancement with washout on delayed phase imaging in contrast to other benign and malignant lesions, which generally demonstrate progressive or stable enhancement on delayed phase imaging . However, some imaging features overlap with malignant lesions: WT may demonstrate restricted diffusion on MRI and are frequently FDG‐avid on PET‐CT …”

“…20 On multiphase CT, WTs demonstrate earlier peak enhancement with washout on delayed phase imaging in contrast to other benign and malignant lesions, which generally demonstrate progressive or stable enhancement on delayed phase imaging. 21 However, some imaging features overlap with malignant lesions: WT may demonstrate restricted diffusion on MRI 22,23 and are frequently FDG-avid on PET-CT. 24 By FNAC, WT is characterized by the presence of three components: oncocytes, a polymorphous population of lymphocytes, and a grungy granular background 25 (Figure 2). While a bilayer of epithelium is appreciated histologically-with basal cells and more columnar oncocytic cells-this may not be as readily apparent cytologically.…”

AHNS series: Do you know your guidelines? Diagnosis and management of salivary gland tumors

“…Positron emission tomography‐CT (PET/CT) has shown some benefit in evaluating for primary and recurrent disease; however, signal avidity is inconsistent in salivary gland tumors and such imaging is not recommended in the NCCN Guidelines. It is noteworthy that some malignant tumors with poor biological behavior such as ACC may not be FDG Fludeoxyglucose (18F)‐avid while benign lesions such as Warthin's tumors often appear hypermetabolic on PET scan . As a result, chest imaging with CT should be performed if clinically indicated, primarily in the setting of advanced high‐grade malignancy as a part of initial staging.…”

“…Of note, 1 SGN that is almost always associated with tobacco use is Warthin's tumor, which is benign. 11 Human papilloma virus (HPV) has been isolated from both benign and malignant salivary gland tumors, however its significance as a risk factor for malignancy is not yet established. [12][13][14][15] In addition, although cutaneous malignancy and oral cavity and oropharyngeal carcinoma are not the topics of this article, salivary gland tumors can arise secondary to cancers in these areas by local invasion or metastases, or due to lymphoma because of the close proximity of lymph nodes to the major salivary glands in the submandibular, buccal, and parotid basins.…”

“…It is noteworthy that some malignant tumors with poor biological behavior such as ACC may not be FDG Fludeoxyglucose (18F)-avid while benign lesions such as Warthin's tumors often appear hypermetabolic on PET scan. 11,35 As a result, chest imaging with CT should be performed if clinically indicated, primarily in the setting of advanced high-grade malignancy as a part of initial staging.…”