Warthin tumor ct radiology

(2014). doi:10.1102/1470-7330.2007.0008 - Pubmed

7. Bilaterality and multifocality are common.

The following flowchart illustrates the diagnostic approach to Warthin's tumor:

flowchart LR A["Patient presents with parotid mass"] --> B["Imaging studies: CT, MRI, Ultrasound"] B --> C{"Characteristic imaging features?"} C -->|"Yes"| D["Warthin's tumor suspected"] C -->|"No"| E["Further diagnostic workup"] D --> F["Fine-needle aspiration cytology"] F --> G{"Diagnostic?"} G -->|"Yes"| H["Conservative management or surgery"] G -->|"No"| I["Repeat biopsy or other diagnostic tests"]

Diagnosis and Differential Diagnosis

The diagnosis of Warthin's tumor involves a combination of imaging studies and histopathological examination.

Histopathological Features

Histologically, Warthin's tumor is characterized by a bilayered epithelium lining cystic spaces surrounded by a dense lymphoid stroma.

They typically occur in older age (6^th decade) and are twice as common in men (2.2:1) ¹¹.

Risk factors

Patients typically present with painless parotid swelling.

Location

They tend to favor the parotid tail region at the level of the mandibular angle. Minami M, Tanioka H, Oyama K et-al.

The presence of cystic components is a characteristic feature 3.

Role of Ultrasound in Diagnosis

Ultrasound is a valuable tool for assessing salivary gland lesions, including Warthin's tumor. AJNR Am J Neuroradiol.

2007;7(1):52-62. Pubmed citation

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• 1.

  (2022). They are often hypervascular.

• In CT scan, the classic appearance is a well-defined heterogeneous solid cystic lesion within the superficial lobe of parotid/parotid tail, well defined and no calcification Cystic changes appear as intralesional lower attenuation. There is a thin rim of compressed normal salivary acini at periphery.
• Interpretation: Warthin tumour.

Diagnosis: Warthin’s tumour of right parotid gland.

Discussion:

• Whartin tumour is also known as lymphomatous papillary cystadenomas, a benign sharply demarcated tumour of the salivary gland.
• It is lymphoid in origin and most commonly arise from parotid gland tail at the level of mandibular angle
• Warthin’s tumor comprises 4-15% of all salivary gland epithelial tumors and 4-10% (up to 30% according to others) of all parotid tumors.

  Understanding Warthin's tumor is crucial for oral radiologists and clinicians due to its distinct characteristics and implications for diagnosis and treatment.

  Definition and Epidemiology

  Warthin's tumor is a benign neoplasm composed of epithelial and lymphoid components. A rare teratoid of the parotid region.

  Warthin’s tumour of parotid gland

  Case contribution: Dr Radhiana Hassan

  Clinical:

  • A 60 years old man
  • A chronic smoker
  • Complaint of right neck swelling for one year
  • Progressively increase in size. (2005) ISBN: 9781588904140 - Google Books

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  Radiology Key

  
  

  KEY FACTS

  
  

  Imaging

  
  
  

  
  
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    Pleomorphic adenoma

    
    
    
    
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      Most common parotid space tumor (80%)

      
      
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      Well defined, lobulated, solid, hypoechoic

      
      
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      Homogeneous internal echoes with posterior enhancement

      
      
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      Large tumors more heterogeneous from hemorrhage and necrosis

      
      
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      Intratumoral calcification may occur if longstanding

      
      
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      Malignant transformation if untreated

    
    
    
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    Warthin tumor

    
    
    
    
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      Arises in intraparotid lymphoid tissue, 2nd most common benign parotid tumor

      
      
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      Well defined, heterogeneous, hypoechoic

      
      
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      Cystic change, posterior acoustic enhancement

      
      
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      Multiseptated when large

      
      
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      Multicentric in 20%, unilateral or bilateral, malignant change in 1%

    
    
    
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    Malignant parotid tumors

    
    
    
    
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      Include mucoepidermoid carcinoma, adenoid cystic and acinic cell carcinoma, and adenocarcinoma

      
      
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      Ill-defined, irregular border, hypoechoic, necrosis, local invasion, and adenopathy

      
      
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      Internal vascularity

      
      
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      Low-grade tumors may mimic benign tumors

    
    

  
  
  

  Top Differential Diagnoses

  
  
  

  
  
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    Non-Hodgkin lymphoma

    
    
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    Parotid nodal metastasis

  
  
  

  Clinical Issues

  
  
  

  
  
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    Painless or painful cheek mass

    
    
  • •
    

    Facial nerve paralysis

  
  
  

  Scanning Tips

  
  
  

  
  
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    Evaluate for signs of invasion and regional lymphadenopathy

  
  
  
  
  
  
  

  
  

  
  
  

  Longitudinal color Doppler ultrasound of a parotid pleomorphic adenoma is shown.

  Journal of Cancer Research. It is the second most common benign tumor of the parotid gland after pleomorphic adenoma. (2013) Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2000;214 (1): 231-6. They are the most common bilateral or multifocal benign parotid tumors.

  Cancer Imaging. >5 cm) tend to have a higher proportion of cystic content than smaller lesions had and in some cases can be composed almost entirely of cystic material. (2018).