Abstract
BackgroundWarthin 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 presentationA 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.ConclusionTo 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.
Highlights
Warthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature
To the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor
The tumor is characterized by an epithelial component composed mainly of tall bilayered oncocytic columnar cells embedded within a lymphoid stroma [1, 2]
Summary
Warthin tumor is the second most common benign tumor of the salivary gland [1]. The tumor is characterized by an epithelial component composed mainly of tall bilayered oncocytic columnar cells embedded within a lymphoid stroma [1, 2]. Karyotype studies detected the characteristic t(11;14)(q13;q32) translocation as part of a complex karyotype, and corroborated by immunohistochemistry studies This case emphasizes the importance of a thorough evaluation of the lymphoid stroma of a Warthin Tumor,. Case presentation A 70 year old otherwise healthy male patient with a 50-pack year smoking history who quit approximately 3 years ago, presented with a slowly enlarging left cheek mass He first noted the lesion approximately 1 year prior to presentation. Microscopic examination revealed an intraparenchymal lesion composed of both epithelial and lymphoid elements encased within a thin fibrous capsule, sharply demarcated from the adjacent uninvolved salivary gland parenchyma (Fig. 3a). FISH analysis with the dual-color dual fusion IGH-CCND1 probes identified dual fusion signals (yellow) confirming the presence of a reciprocal t(11;14)(q13;q32) (Fig. 5e–f) Both karyotype and FISH studies were performed on the tissue mass
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