A Rare Case of Benign Synchronous Neoplasm of Parotid Salivary Gland

  • Vijayabasker Mithun Department Of Pathology, Apollo Hospitals, Madurai
  • Usha Rani Karuppusamy Department Of Pathology, Apollo Hospitals, Madurai
  • Nandhini Bala Balasubramanian Department Of Pathology, Apollo Hospitals, Madurai
  • Mahudeswaran Rajan Department Of General Surgery, Apollo Hospitals, Madurai
Keywords: synchronous neoplasm, intranodal warthin’s tumour, pleomorphic adenoma

Abstract

Introduction Salivary gland neoplasms represent 2–6% of all head and neck neoplasms. Salivary gland neoplasms arising from the major salivary glands are predominantly benign. Pleomorphic adenoma is the most common benign neoplasm of the salivary gland, followed by warthin’s tumour. The synchronous occurrence of both of these neoplasms is rarely described. We present a case of unilateral salivary gland neoplasm with two distinct histological lesions, which were found incidentally during gross examination and confirmed microscopically. Case report A 72-year-old man with complaints of left parotid swelling, which progressively increased in size over the past 6 months. Ultrasound imaging studies and FNAC show features of pleomorphic adenoma, for which the patient underwent surgery, and the specimen was sent for histopathological examination. In the gross examination, a tan-brown area measuring 0.6 cm in greatest dimension was noted in the parotid salivary gland, in addition to the encapsulated grey-brown neoplasm. Histologically, the tan-brown lesion was found to be an intranodal warthin’s tumour along with a pleomorphic adenoma. Conclusion Synchronous neoplasm is a rare entity that can easily be missed in clinical, imaging and even in cytological examinations. Proper histopathological examination of the resected specimens helps in identifying the lesions that were left unrecognized even by imaging studies due to their proximity to the existing neoplasm, as in our case. The use of VTIQ in combination with B-mode ultrasound may be beneficial in detecting the nature of the lesion prior to surgery.

References

Alsanie I, Rajab S, Cottom H, et al. Distribution and Frequency of Salivary Gland Tumours: An International Multicenter Study. Head Neck Pathol. 2022;16(4):1043-1054.

Horisk N, Stephenson E, Sayers C, Reid J. Incidental finding of synchronous pleomorphic salivary adenoma and Warthin's tumor within a parotid gland. BMJ Case Rep. 2019;12(4):e228675. Published 2019 Apr 24.

WHO Classification of Tumours Editorial Board. Head and neck tumors. 5th edition. Lyon: International Agency for Research on Cancer; 2022.

Klamminger GG, Issing C, Burck I, Herr C, Endemann E, Stöver T, Wild PJ, Winkelmann R. Uncommon Coexistence of Pleomorphic Adenoma and Warthin's Tumor in a Painfully Swollen Left Parotid Gland: A Surgical Case Report. Am J Case Rep. 2023 Nov 30;24:e940985.

Heine D, Zenk J, Psychogios G. Two case reports of synchronous unilateral pleomorphic adenoma and cystadenolymphoma of the parotid gland with literature review. J Ultrason. 2018;18(75):369-373.

Herce-López J, Salazar-Fernández CI, Mayorga-Jiménez F, Gallana-Alvarez S, Pérez-Sánchez JM. Synchronous unilateral parotid neoplasms. A case report. Med Oral Patol Oral Cir Bucal. 2009;14(2):E90-E92.

Godden DR, Akinmoladan VI, Warren A. Synchronous occurrence of 2 histologically distinct parotid neoplasms. J Oral Maxillofac Surg. 2000;58(6):680-681.

Franzen A, Koegel K. [Synchronous double tumors of the parotid gland]. Laryngorhinootologie. 1996;75(7):437-40.

Yu GY, Ma DQ, Zhang Y, et al. Multiple primary tumours of the parotid gland. Int J Oral Maxillofac Surg. 2004;33(6):531-534.

Ethunandan M, Pratt CA, Morrison A, et al. Multiple synchronous and metachronous neoplasms of the parotid gland: The Chichester experience. Br J Oral Maxillofac Surg. 2006;44(5):397-401

Bień S, Kamiński B, Kopczyński J, Sygut J. The synchroneous tumors of different histopathology in the parotid glands. Otolaryngol Pol. 2006;60:703-8

Zeebregts CJ, Mastboom WJ, van Noort G, van Det RJ. Synchronous tumours of the unilateral parotid gland: rare or undetected? J Craniomaxillofac Surg. 2003;31(1):62-66.

Tanaka S, Tabuchi K, Oikawa K, et al. Synchronous unilateral parotid gland neoplasms of three different histological types. Auris Nasus Larynx. 2007;34(2):263-266.

Lefor AT, Ord RA. Multiple synchronous bilateral Warthin's tumors of the parotid glands with pleomorphic adenoma. Case report and review of the literature. Oral Surg Oral Med Oral Pathol. 1993;

Curry JL, Petruzzelli GJ, McClatchey KD, Lingen MW. Synchronous benign and malignant salivary gland tumors in ipsilateral glands: a report of two cases and a review of literature. Head Neck. 2002;24(3):301-306

Kaleem A, Patel N, Alzahrani S, Hatoum H, Tursun R. Concurrent presence of secretory carcinoma and Warthin's tumor in ipsilateral parotid gland. Oral Oncol. 2020;109:104691.

To EW, Tsang WM, Tse GM. Mucoepidermoid carcinoma expleomorphic adenoma of the submandibular gland. Am J Otolaryngol. 2003;24(4):253-257.

Published
15-04-2024
Section
Case Report