Abstract
Cystadenolymphomas (Warthin's tumors) are the second most frequent lesions of the parotid gland. Due to their benign clinical behavior, the low rates of recurrence and malignant transformation they were classified as tumor-like lesions. In addition, a polyclonal growth of the epithelial components of the tumor could be detected. Warthin's tumors occur bilateral in 7-10%, whereas a multifocal appearance is extremely rare. Even if the pathogenesis is still unclear a heterotopia of salivary tissue during embryogenesis is the most likely explanation for the origin of these tumors in the upper neck and periparotideal region. Here we present a rare case of bilateral, multifocal, extraglandular Warthin's tumors in lymph nodes of the upper neck and give a brief review of the literature. If a primary malignancy can be excluded by a careful staging procedure prior to the operation an isolated excision of the lesions of the neck is the adequate treatment.
Highlights
Bilateral lesions occur in 7-10% of cases while multifocal lesions and recurrence occur in 2% of cases [4,5]
The origins of Warthin tumors are these epithelial inclusions [2,11,12]. This theory supports the heterotopia of salivary tissue in the upper neck and periparotideal region
The first description of adenolymphoma was done by Hildebrand in 1895 [17] and in 1929 Warthin published a series of so called papillary cystadenoma lymphomatosum leading to the well known term ‘Warthin’s tumor’ [18]
Summary
Cystadenolymphoma is the second most frequent benign tumor of the parotid gland representing 6 to 10% of all tumors of the salivary glands [1]. The origins of Warthin tumors are these epithelial inclusions [2,11,12] This theory supports the heterotopia of salivary tissue in the upper neck and periparotideal region. In 2007, there had already been detected two enlarged lymph nodes of unknown dignity on the left (2.4 cm) and right (1.4 cm) angle of the mandible by ultrasound examination. In the year 2011 ultrasound detected a mass on the left side of 3.5 cm and two masses of 1.5 and 1.6 cm on the right side, respectively Due to their appearance they were classified as suspect lymph nodes. Physical examination in our department showed soft, painless solid masses at the left and right angle of the mandible which were moveable to the skin and the deeper tissue. The patient recovered from the operation very soon and showed no signs of recurrence during follow up so far
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