Vaknin Ido, Allon Irit, Zafrir-Haver Shirley, Abramson Alex
Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel.
Institute of Pathology, Barzilai University Medical Center, Ashkelon 7830604, Israel.
Medicina (Kaunas). 2024 Dec 19;60(12):2086. doi: 10.3390/medicina60122086.
: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. : A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. : Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the "wait and see" approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery.
沃辛瘤是一种良性唾液腺肿瘤，多见于腮腺。由于诊断方式的改进和卫生系统的现代化，近年来报道的沃辛瘤数量有所增加。沃辛瘤很少转变为恶性肿瘤；在本研究中，我们呈现了英文文献中报道的沃辛瘤内不同类型淋巴瘤的所有病例。在此病例中，我们报告了一例发生于沃辛瘤内的低级别滤泡性淋巴瘤。一名64岁男性因右侧面部肿物逐渐增大就诊于口腔颌面外科诊所。病史包括稳定型心绞痛、高血压、高胆固醇血症、肥胖症以及20年的吸烟史（每年20包）。细针穿刺活检提示沃辛瘤诊断。腮腺增强CT扫描显示一个直径2.9×2.7×4.1 cm的肿物。患者接受了右侧腮腺浅叶切除术。肿物的组织学检查显示在一个已存在的沃辛瘤内发生了低级别滤泡性淋巴瘤。术后PET-CT显示无远处转移，血液学评估期间的骨髓活检证实为1期低级别滤泡性淋巴瘤。患者接受了24 Gy的容积调强弧形放疗至右侧腮腺，并继续进行血液学随访。基于文献回顾，这是少数有充分记录的沃辛瘤内发生低级别滤泡性淋巴瘤的病例之一。该病例突出了对腮腺肿物进行全面评估和诊断的重要性。此外，该病例重新引发了关于沃辛瘤“观察等待”方法合理性的讨论。基于细针穿刺活检的诊断不应被视为最终诊断，因为如果拒绝手术，可能会遗漏一些恶性特征。
