Download PDF
Int Arch Otorhinolaryngol 2014; 18(02): 217-220
DOI: 10.1055/s-0033-1351676
Case Report
Thieme Publicações Ltda Rio de Janeiro, Brazil

Synchronous Bilateral Warthin Tumors: A Case Report

Luiz Augusto Nascimento
1   Department of Otolaryngology Head and Neck Surgery, Hospital Universitário de Brasília (UnB), Brasília/DF, Brazil
,
Julia Alessandra Santos Ferreira
2   Student, Department of Medicine, Universidade Católica de Brasília, Brasília/DF, Brazil
,
Raquel Baptista Pio
2   Student, Department of Medicine, Universidade Católica de Brasília, Brasília/DF, Brazil
,
Gustavo Henrique Soares Takano
3   Master Degree, Department of Medical Pathology, Hospital Universitário de Brasília, Brasília/DF, Brazil
,
Hélcio Luiz Miziara
4   Doctor Degree, Department of Medical Pathology, Universidade Católica de Brasília, Brasília/DF, Brazil
› Author Affiliations
Further Information

Publication History

24 October 2012

18 February 2013

Publication Date:
05 November 2013 (online)

Also available at
   Permissions and Reprints

Abstract

Introduction Warthin tumor is described as papillary cystadenoma lymphomatosum and is the second most common tumor of the parotid glands. Bilateral synchronous incidence is rare, occurring in 7 to 10% of the cases. It is more common in males between 60 and 70 years of age and is closely related to smoking. There is slow growth and the condition is a delimited nodule of regular outlines; it has low rates of malignant progression and recurrence.

Objective Report a case of synchronous bilateral Warthin tumor occurring in an elderly patient, and review incidence and peculiarities of this tumor.

Case Report A 78-year-old man who used to smoke had a history of mild pain in the topography of right parotid three weeks ago. Patient with hypertension, diabetes and a longtime smoker (smoking a pack per day for 32 years) noticed a progressive bulging in the right parotid region for about 2.5 years ago, and noticed another progressive bulging (althought in the left parotid region), for about one year ago. Patient denied fever, redness, skin lesions and pain during this period until last three weeks, when he sought medical attention for a mild pain in the right facial region. The patient underwent cervical magnetic resonance imaging that showed tumor lesions in both parotids. Fine needle aspiration revealed a typical lesion of epithelial oxyphilic cells associated with reactive lymphoid proliferation, suggesting Warthin tumor. The patient underwent two superficial parotidectomies, and the histopathologic result from both tumors of parotid glands showed papillary cystadenoma lymphomatosum.

Conclusion The occurrence of synchronous bilateral Warthin tumor is extremely rare, and anamnesis and physical examination, as well as some complementary examinations, are important means for diagnostic evaluation. Confirmation of the diagnosis can only be obtained through a histopathologic study. A superficial or total parotidectomy is the recommended treatment for the disease.

Keywords

cystadenoma - papillary - salivary glands - neoplasms - multiple primary
 

  • References

  • 1 Ascani G, Pieramici T, Rubini C, Messi M, Balercia P. Synchronous bilateral Warthin's tumours of the parotid glands: a case report. Acta Otorhinolaryngol Ital 2010; 30: 310-312
    Google Scholar
  • 2 Naujoks C, Sproll C, Singh DD , et al. Bilateral multifocal Warthin's tumors in upper neck lymph nodes. Report of a case and brief review of the literature. Head Face Med 2012; 8: 11
    CrossrefGoogle Scholar
  • 3 Viveros ALM, Sánchez MJF. Tumor de Warthin. Anales médicos de la Asociacion del Hospital ABC 2001; 46 (2) 88-91
    Google Scholar
  • 4 Alwan MH, Kirkwood S. Periparotid multifocal Warthin's tumour. ANZ J Surg 2011; 81: 183-184
    CrossrefGoogle Scholar
  • 5 Chedid HM , et al. Tumor de Warthin da glândula parótida: estudo de 70 casos. Rev Col Bras Cir 2011; 38 (2) 090-094
    CrossrefGoogle Scholar
  • 6 Pinkston JA, Cole P. Cigarette smoking and Warthin's tumor. Am J Epidemiol 1996; 144: 183-187
    CrossrefGoogle Scholar
  • 7 Castro GA , et al. Tumor de Warthin de Glândula Parótida. Int Arch Otorhinolaryngol 2004; 8 (2) 3-5
    Google Scholar
  • 8 Lamelas J, Terry Jr JH, Alfonso AE. Warthin's tumor: multicentricity and increasing incidence in women. Am J Surg 1987; 154: 347-351
    CrossrefGoogle Scholar
  • 9 Hilton JM, Phillips JS, Hellquist HB, Premachandra DJ. Multifocal multi-site Warthin tumour. Eur Arch Otorhinolaryngol 2008; 265: 1573-1575
    CrossrefGoogle Scholar
  • 10 Gnepp DR, Schroeder W, Heffner D. Synchronous tumors arising in a single major salivary gland. Cancer 1989; 63: 1219-1224
    CrossrefGoogle Scholar
  • 11 Tveterås K, Kristensen S. Warthin's tumour with bilateral synchronous presentation. Survey of the literature and a new case. J Laryngol Otol 1986; 100: 487-492
    CrossrefGoogle Scholar
  • 12 Gallo O, Bocciolini C. Warthin's tumour associated with autoimmune diseases and tobacco use. Acta Otolaryngol 1997; 117: 623-627
    CrossrefGoogle Scholar
  • 13 Azua-Romeo J , et al. Synchronous salivary gland tumors with regard to two cases. Rev Esp Cir Oral y Maxilofac 2005; 27 (3) 145-149
    Google Scholar
  • 14 Martin H, Ehrlich HE. Papillary cystadenoma lymphomatosum (Warthin's tumor) of the parotid gland. Surg Gynecol Obstet 1944; 79: 611-623
    Google Scholar
  • 15 Brennan PA, Davies B, Poller D , et al. Fine needle aspiration cytology (FNAC) of salivary gland tumours: repeat aspiration provides further information in cases with an unclear initial cytological diagnosis. Br J Oral Maxillofac Surg 2010; 48: 26-29
    CrossrefGoogle Scholar
  • 16 Honda K, Kashima K, Daa T, Yokoyama S. Nakayama I: Clonal analysis of the epithelial component of Warthin's tumor. Hum Pathol 2000; 31: 1377-1380
    CrossrefGoogle Scholar