Chae Seoung Wan, Sohn Jin Hee, Shin Hyung Sik, Choi Jae Jin, Kim Yong Bok
Department of Pathology, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, South Korea.
Acta Cytol. 2004 Mar-Apr;48(2):229-33. doi: 10.1159/000326322.
Warthin's tumor may be associated with false positive diagnoses of malignancy on fine needle aspiration. The most common cause of error is markedly atypical squamous metaplasia mimicking metastatic cystic squamous carcinoma. The common location of Warthin's tumors within periparotid nodes may add to the clinical suspicion of metastasis. We report a case of unilateral, multicentric Warthin's tumor arising in periparotid and intraparotid glands, leading to a strong clinical and cytologic suspicion of malignancy.
A 60-year-old female presented with a 3-month history of several enlarged lymph nodes in the right side of the neck. Fine needle aspiration, performed at the right upper neck lymph node, suggested the possibility of metastatic tumor. On computed tomography and ultrasonography there were 4 nodular lesions in the right retromandibular area and lateral aspect of the neck, 1-1.5 cm in diameter. A thyroid scan revealed diffuse enlargement of the thyroid gland and a nodular lesion in the right lobe. Right thyroid lobectomy and modified radical neck dissection, including right superficial parotidectomy, were performed for evaluation of occult malignancy. Histologically we confirmed that the tumor was a synchronous, multicentric Warthin's tumor arising in the parotid gland and intraparotid and paraparotid lymph nodes.
Clinicians and pathologists should consider an extraparotid Warthin's tumor in the differential diagnosis of multiple cervical masses.
沃辛瘤在细针穿刺活检时可能出现恶性肿瘤的假阳性诊断。最常见的误诊原因是显著非典型鳞状化生酷似转移性囊性鳞状细胞癌。沃辛瘤常见于腮腺周围淋巴结，这可能增加临床对转移的怀疑。我们报告一例单侧多中心性沃辛瘤，发生于腮腺周围和腮腺内腺体，导致临床和细胞学上高度怀疑为恶性肿瘤。
一名60岁女性，右侧颈部多个淋巴结肿大3个月。对右上颈部淋巴结进行细针穿刺活检，提示可能为转移性肿瘤。计算机断层扫描和超声检查显示，右下颌后区和颈部外侧有4个结节性病变，直径1 - 1.5厘米。甲状腺扫描显示甲状腺弥漫性肿大，右叶有一个结节性病变。为评估隐匿性恶性肿瘤，行右侧甲状腺叶切除术及改良根治性颈清扫术，包括右侧腮腺浅叶切除术。组织学检查证实，肿瘤为同步多中心性沃辛瘤，发生于腮腺、腮腺内及腮腺旁淋巴结。
临床医生和病理学家在鉴别诊断多个颈部肿块时应考虑腮腺外沃辛瘤。
