Warthin tumor with atypical presentation

 

Introduction Warthin Tumor (WT) is a benign parotid gland lesion that primarily affects male smokers between the ages of 50 and 70. In rare instances, it may manifest within cervical lymph nodes, mimicking malignancy

Material We selected three patient case histories from the last year at the ENT Clinic in Augsburg, in which, due to various peculiarities, a WT was not initially suspected. In all three cases, the mass was slow growing, the facial nerve function was preserved and the patients had no associated complaints. The first Patient was 35 years old and presented with an extraglandular growing mass in the mandibular angle. The second one had an enlarging mass in the submandibular gland. The third patient presented with a mass in the level Ib. A CT scan revealed a semi-solid cystic mass in the mandibular angle. Clinical suspicion initially favored a Cancer of Unknown Primary. Due to diagnostic uncertainty in all cases, surgical excision of the lesions was performed, and histopathological examination ultimately confirmed a diagnosis of Warthin's Tumor.

Discussion Most patients with WT are over 50 years of age, have a history of smoking and present with tumors in the parotid gland. However, our first case involved a younger patient with an extraparotid tumor. The second case was atypical due to the tumor's location in the submandibular gland, and the third patient exhibited the typical age and nicotine abuse history, but the tumor was situated in level Ib.

Conclusion When smokers present with cervical lymphadenopathy, it naturally raises suspicion of malignancy. However, it is necessary to consider WT as a differential diagnosis. In cases of diagnostic uncertainty, complete surgical removal of the mass for histological confirmation is imperative.

Publication History

Article published online:
19 April 2024

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