Poorly differentiated carcinoma arising from adenolymphoma of the parotid gland
© Ferrero et al; licensee BioMed Central Ltd. 2003
Received: 22 October 2002
Accepted: 17 January 2003
Published: 17 January 2003
There is only one previous case report of a poorly differentiated carcinoma arising from an adenolymphoma of the parotid gland (Warthin's tumour). The absence of clinical symptoms, and the aspecificity of the radiological pattern make the diagnosis very difficult.
We here report the case of a 73-year-old man with Warthin's tumour who was brought to our attention because of a swelling in the parotid region.
In this case with an atypical clinical presentation, the intra-operative examination of a frozen section of the parotid mass allowed us to diagnose the malignant tumour correctly and consequently undertake its radical excision.
KeywordsWarthin's tumour malignant adenolymphoma parotid gland salivary gland carcinoma
Adenolymphoma (also called Warthin's tumour: WT) is a benign neoplasm of the salivary glands that almost exclusively occurs in the parotid gland, more often at the inferior pole, and usually affects white men aged 55 years. It has a classical composite histological appearance, with an epithelial component and a lymphoid stroma. The malignant transformation of WT is a very rare event. The lymphoid component may evolve into malignant lymphoma , whereas the epithelial component may develop into mucoepidermoid carcinoma , adenocarcinoma  or squamous cell carcinoma [4–7]. To the best of our knowledge, only Onder  has previously reported a case of poorly differentiated carcinoma of the parotid gland arising from WT.
A 73-year-old man was brought to our attention in January 2001 because of a swelling in the right parotid region, which had appeared three years before but had always been neglected by the patient because of its asymptomatic nature. It had apparently grown more rapidly over the previous two months, and a physical examination revealed the presence of a voluminous mass with a regular border that was mobile on the superficial and deep planes, and did not hurt upon palpation. There were no palpable cervical lymph nodes.
The postoperative course was uneventful. The patient underwent postoperative radiotherapy because of the results of the histological examination. Now, 20 months after surgery, he is well and and has not experienced any recurrence.
Our patient with a poorly differentiated carcinoma arising in WT was asymptomatic and showed no signs, such as the clinical lymph node metastases or facial nerve palsies described by some authors [4, 5]. The cytological results were not reliable as the fine-needle biopsy specimen of the parotid mass suggested Warthin's tumour but was negative for malignant cells. As the epithelial tumour component involved more than 50% of the neoplastic area, the case can be classified as subtype 1 (typical cystoadenolymphoma) according to Seifert et al. .
Our findings confirm the possibility of a malignant transformation of the epithelial component of a WT. It is worth underlining the diagnostic difficulty caused by the absence of clinical symptoms and the non-specific nature of the radiological signs; furthermore, false negative cytology for malignant cells is not a rare occurrence. In order to ensure a correct therapeutic approach, we recommend the use of intra-operative frozen section analysis in order to exclude malignant transformation when dealing with an atypical clinical presentation. Finally, from the histological point of view, we suggest considering a malignant transformation only when the bulk of the carcinoma is inside the WT and the oncocytic epithelial component simultaneously shows a transition zone from a hyperplastic-dysplastic state to malignancy.
List of abbreviations
Written consent was obtained from the patient or their relative for publication of the patient's details.
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- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2482/3/1/prepub
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