Synchronous ipsilateral Warthin tumor encased by a separate mucoepidermoid carcinoma of the parotid gland: A case report and review of the literature

Abstract

Fine-needle aspiration (FNA) is a cost effective and low morbidity procedure in the initial assessment of salivary gland tumors. However, cytological assessment of ipsilateral synchronous tumors (which make up less than 0.3% of all salivary gland neoplasms) may pose diagnostic challenges. Therefore, a wholesome approach, including FNA with clinical and radiological correlation, is of utmost importance. Here, we report a unique case of Warthin tumor encased by a separate high-grade mucoepidermoid carcinoma that was first diagnosed on FNA. Another striking feature seen was the presence of chronic sialadenitis in the surrounding nonneoplastic salivary gland. The presence of two different neoplasms in the background of chronic sialadenitis raises the question of a possible causal relationship. Traditionally, there has been diagnostic difficulty when dealing with synchronous tumors of the salivary gland and the background of chronic sialadenitis may further complicate the diagnosis. FNA is very helpful and can give important cues to the diagnosis.

Multiple synchronous neoplasms in the ipsilateral parotid gland: case series

“…Surgery is indicated for multiple synchronous neoplasms involving the ipsilateral parotid gland (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Complete resection with sufficient safe margins is important (3).…”

“…The majority of parotid neoplasms are benign, unilateral, and single lesion (1)(2)(3)(4). Synchronous neoplasms refer to the development of one or more neoplasms that occur simultaneously but distinct from each other in the parotid gland (2).…”

“…Synchronous neoplasms refer to the development of one or more neoplasms that occur simultaneously but distinct from each other in the parotid gland (2). Therefore, multiple synchronous parotid neoplasms are very rare with a frequency of about 0.7% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Letter to the Editor Mucoepidermoid carcinoma in Warthin tumor of the parotid gland

“…When reporting microscopic findings in Warthin tumor, Srivastava et al . described cystic spaces lined by a double layer of cuboidal to tall columnar, eosinophilic, oncocytic epithelial cells next to stroma composed of abundant lymphoid tissue and another neoplasm with highly atypical, large epidermoid cells acting as MEC [ 29 ]. In our study we report the presence of an epithelial component formed of double-layered oxyphilic tubules in close association with high-grade invasive carcinoma with partially solid, partially tubular appearance.…”

Warthin Tumor with Signet-Ring Cell Features as a Pitfall in Salivary Gland Cytopathology

“…In particular, squamous or mucinous metaplasia changes may overlap with mucoepidermoid carcinoma features [1,2,3]. As WT and MEC may coexist, this distinction is difficult [4,5]. For WT treatment, limited surgery can suffice, whereas mucoepidermoid carcinoma warrants a more radical approach [6].…”