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Abstract Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC). Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC. Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients. Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery. Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.
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RESUMEN Introducción: Los tumores sincrónicos son sumamente raros, la coexistencia de cáncer de colon y apéndice es un fenómeno relativamente inusual, que plantea problemas diagnósticos a la hora de discriminar la naturaleza primaria o metastásica de cada uno de ellos. Este hecho se suscita en la mayor parte de los casos ante adenocarcinomas mucosecretores sincrónicos. Reporte de caso: Presentamos el caso de una paciente femenina de 72 años de edad que ingresó al servicio de emergencia del Hospital Regional Docente Las Mercedes de Chiclayo por sintomatología de dolor abdominal agudo, donde se le realizan estudios imagenológicos con diagnóstico presuntivo de neoplasia maligna de recto, ingresando a sala de operaciones. El resultado anatomopatológico evidenció un diagnóstico de Adenocarcinoma tubular con componente mucinoso en recto- sigmoides de bajo grado de malignidad (moderadamente diferenciado), con invasión hasta tejido adiposo peri rectal adyacente, bordes de invasión infiltrativo e invasión perineural, con margen de resección libre y ganglios linfáticos libres de neoplasia maligna; además de, Adenocarcinoma mucinoso de apéndice moderadamente diferenciado (G2), de localización difusa, la neoplasia invade hasta la muscular propia, margen de resección libres de neoplasia maligna. Conclusión: La importancia de esta categoría es que la frecuencia de neoplasias malignas a nivel apendicular no es alta, y su asociación simultánea con Adenocarcinoma colorrectal las hace aún más insólitas.
ABSTRACT Introduction: Synchronous tumors are extremely rare, the coexistence of colon and appendix cancer is a relatively unusual phenomenon, which poses diagnostic problems when it comes to discriminating the primary or metastatic nature of each of them. This fact occurs in most cases with synchronous mucosecretory adenocarcinomas. Case report: We present the case of a 72- year-old female patient who was admitted to the emergency service of the Las Mercedes Regional Teaching Hospital in Chiclayo due to symptoms of acute abdominal pain, where imaging studies were performed with a presumptive diagnosis of malignant neoplasia of the rectum. operations room. The pathological result shows a diagnosis of tubular adenocarcinoma with a mucinous component in the rectus-sigmoid of a low grade of malignancy (moderately differentiated), with invasion to the adjacent peri-rectal adipose tissue, infiltrative invasion borders and perineural invasion, with a free resection margin and lymph nodes. lymphatics free of malignant neoplasm; In addition to moderately differentiated mucinous adenocarcinoma of the appendix (G2), of diffuse location, the neoplasm invades even the muscularis propria, resection margin free of malignant neoplasia. Conclusion: The importance of this category is that the frequency of malignant neoplasms at the appendicular level is not high, and their simultaneous association with colorectal adenocarcinoma makes them even more unusual
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Objective: To explore the value of radiomics features and machine learning models based on T1WI and IDEAL-T2WI in differential diagnosis of parotid gland pleomorphic adenoma (PA) from adenolymphoma (AL). Methods: Clinical and imaging data of 58 patients with parotid tumors, including 33 with PA and 25 with AL were retrospectively analyzed. Axial T1WI and IDEAL-T2WI were manually segmented, and radiomics features were extracted using the radcloud software. Effective radiomics features were selected with the variance threshold method, SelectKBest and Lasso algorithm. The machine learning models were established by using random forest and Logistic regression algorithm, and the ROC curves were drawn to analyze the diagnostic performance. The ability of T1WI, IDEAL-T2WI and image combination in diagnosis of PA from AL were analyzed. Results: T1WI, IDEAL-T2WI and IDEAL-T2WI combined with T1WI obtained 6, 9 and 12 effective features. The random forest model based on IDEAL-T2WI combined with T1WI sequences had the highest diagnostic performance, with AUC of 0.87 (95%CI[0.59,1.00]) and accuracy of 0.83. Conclusion: Radiomics features and machine learning models based on T1WI and IDEAL-T2WI can provide important references for differentiation of PA and AL.
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Objective: To investigate the value of enhanced CT combined with histogram analysis in differential diagnosis of Warthin tumor and pleomorphic adenoma(PA) of parotid. Methods: Maxillofacial plain and enhanced CT were performed on 37 patients with Warthin tumor (Warthin tumor group) and 28 patients with PA (PA group). CT values of plain, arterial phase (AP) and venous phase (VP) CT of lesions were measured, and the enhanced patterns and pure enhanced values were recorded. Then the parameters of histogram analysis, including the mean, standard deviation (StdDev), minimum (Min), maximum (Max), Median, skewness (Skew) and kurtosis (Kurt) were calculated. The differences of all parameters were compared between groups. ROC curves of parameters being statistically different between groups were drawn for differential diagnosis of Warthin tumor and PA of parotid gland, and the corresponding diagnostic efficacy were analyzed. Results: There were statistically differences of CT values in each phase, AP pure enhanced values and enhanced patterns between groups (all P<0.05), and MeanAP, MinAP, MaxAP, MedianAP, SkewAP, MeanVP, StdDevVP, MinVP, MedianVP and SkewVP also showed significant differences (all P<0.05). AUC and Youden indexes of enhanced pattern, AP pure enhanced value, MeanAP, MinAP, MaxAP, MedianAP and SkewAP were all higher than those of VP histogram parameters in differential diagnosis of PA and Warthin tumor. SkewAP had the highest Youden index (0.71), with AUC of 0.88. The diagnostic efficacy enhanced pattern+SkewAP was the most effective, with AUC, Youden index, sensitivity and specificity of 0.94, 0.80, 83.58% and 96.43%, respectively. Conclusion: Enhanced CT combined with histogram analysis based on AP images were helpful to differential diagnosis of Warthin tumor and polymorphic adenoma of parotid. The diagnosis performance of combined parameters was better than that of single parameter.
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Objective@#To assess the conventional and functional MRI features of parotid Warthin tumor (adenolymphoma) and to investigate the correlation between MRI and clinicopathological features which can provide evidence for clinical diagnosis and treatment.@*Methods@#Sixty-seven patients with parotid Warthin tumor who were treated in the Department of Stomatology, The Fifth Clinical Medical College of Yangzhou University, Changshu No. 2 People′s Hospital from June 2008 to April 2017 were included in this study. The retrospective study evaluated preoperative conventional and functional MRI features and clinicopathological findings of this group of patients. Among 67 patients (65 males, 2 females) with 92 lesions, there were 16 patients with multiple lesions and others with single lesion. Their age was (62.1±8.8) years, ranging from 42 to 84 years. According to pathological features, parotid Warthin tumor were classified into two types. Type Ⅰ was predominantly solid component which included completely solid or solid tumor with some cystic components. Type Ⅱ was predominantly cystic component which was characterized by big cyst with some solid components, and could be divided into capsule-like and scum-like cystic type, based on whether its interface of solid and cystic component was clear or not. On contrast-enhanced MRI, according to whether the lesion showed enhancement or not, solid or cystic component was defined.@*Results@#Seventy-two lesions were located in the lower pole of the parotid gland, of which sixty-eight lesions were located in posterior inferior quadrant. In addition, sixteen lesions were located in the upper pole and four lesions in the middle. Because MRI features were consistent with pathological findings, parotid Warthin tumor were classified into solid (73) and cystic types (19). On T2WI, solid components showed isointense (92), whereas on T1WI cystic components demonstrated hyperintense (90). On contrast enhanced T1WI, solid types showed marginal vasculature sign (73), mild (69) or moderate (4) enhancement, whereas its cystic component showed no enhancement. On contrast enhanced T1WI, cystic types showed ring-like enhancement of cycle-wall and intra-cystic septal linear enhancement, whereas its solid components demonstrated mild enhancement (19). On diffusion weighted imaging, these masses demonstrated hyperintensity and lower apparent diffusion coefficient value indicating restricted diffusion (59/59). On dynamic contrast-enhanced-MRI, the masses showed "wash-out" pattern (28/29) or plateau pattern (1/29).@*Conclusions@#Parotid Warthin tumor mainly occur in the posterior inferior quadrant of parotid gland and mostly in mid-aged or elder men. It has certain characteristics on conventional and function MRI. There is correlation between MRI and clinicopathological findings and it is useful for accurate diagnosis and treatment to understand these features.
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Objective To evaluate the differential diagnostic value of the apparent diffusion coefficient(ADC)for the parotid polymorphic adenoma and adenolymphoma. Methods Totally 31 parotid polymorphic adenoma patients and 20 adenol-ymphoma patients confirmed pathologically had their data on diffusion weighted imaging(DWI)analyzed retrospectively with b set as (0, 1 000 s/mm2). The mean values of ADC were obtained by measuring the solid parts for three times, and the difference between ADC values of the two kinds of tumors were analyzed and compared.SPSS 17.0 software was used for data analysis.Results The parotid polymorphic adenoma had the ADC value being(1.55±0.45)×10-3mm2/s,the parotid adenolym-phoma had the ADC value as(1.01±0.35)×10-3mm2/s,and there was statistical difference between the ADC values of parotid polymorphic adenoma and adenolymphoma(P=0.001).Conclusion ADC value is of great value for the identification of the parotid pleomorphie adenoma and adenolymphoma,and thus can be used for the selection of clinical surgical plans.
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Objective To investigate CT image features of pleomorphic adenoma and adenolymphoma,and to improve the diagno-sis accuracy.Methods CT data of 1 3 cases of pleomorphic adenomas and 9 cases of adenolymphomas confirmed by pathology were retrospectively analyzed and compared.Results All 1 3 cases of pleomorphic adeonoma were solitary lesions,in which 1 1 cases were located in the non posterior inferior quadrant,and 1 1 cases showed persistent or delayed enhancement,with “slowly forward and slowly quit”enhancement performance.In all of the 9 cases of adenolymphoma,3 cases were multiple lesions.In total of 1 3 lesions, 9 lesions were located in the posterior inferior quadrant,and 9 lesions were significantly enhanced in the arterial phase and enhance-ment was decreased in the delayed phase,which showed “quickly forward and quickly quit”.Conclusion CT image features of pleo-morphic adenoma and adenolymphoma are different.Most of lesions can be diagnosed correctly before surgery by using image fea-tures with clinical information.
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Objective To investigate the value of diffusion kurtosis imaging (DKI) in differential diagnosis of parotid gland disease and diagnosis of parotid adenolymphoma (PAL).Methods DKI and DWI data of 57 patients with parotid gland disease were etrospectively analyzed.Totally 57 cases were divided into infectious lesions group (n=10),pleomorphic adenoma group (n=19),PAL group (n=14),other benign parotid tumor group (n=4) and malignant parotid tumor group (n=10).Contralateral normal parotid glands in 19 patients with unilateral parotid gland lesions were treated as control group.The quantitative parameters including kurtosis concerning parameters (K Krad,Kax),diffusivity concerning parameters (D Drad,Dax),fractional anisotropy (FA) and conventional apparent diffusion coefficient (ADC) values were retrospectively reviewed.The binary Logistic regression method was used to confirm parameters with significant difference in diagnosing PAL.And Logistic regression equation was constructed to diagnose PAL.ROC analysis was conducted to evaluate the diagnostic value of the confirmed parameters and the Logistic regression equation.Results Significant difference of the parameters including K Krad,Kax,D Drad,Dax,FA and ADC values were found among different groups (all P＜0.05).ROC analysis demonstrated a higher area under the curve (AUC) for FA+Kax [0.88±0.06 (0.79-0.94)] than Kax[0.80±0.07 (0.70-0.88)] and FA [0.63±0.10 (0.52-0.73)],respectively (both P＜0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 71.43％,95.78％,91.77％,76.92％ and 94.44％.Conclusion DKI showed high diagnostic capacity in differential diagnosis of parotid gland disease.The combination of FA and Kaxcan improve the diagnostic accuracy in diagnosis of PAL.
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Introduction Parotid gland incidentalomas (PGIs) are unexpected hypermetabolic foci in the parotid region that can be found when scanning with whole-body positron emission/computed tomography (PET/CT). These deposits are most commonly due to benign lesions such as Warthin tumor. Objective The aim of this study was to determine the prevalence of PGIs identified in PET/CT scans and to assess the role of smoking in their etiology. Methods We retrospectively reviewed all PET/CT scans performed at our center in search of PGIs and identified smoking status and standardized uptake value (SUVmax) in each case. We also analyzed the database of parotidectomies performed in our department in the previous 10 years and focused on the pathologic diagnosis and the presence or absence of smoking in each case. Results Sixteen cases of PGIs were found in 4,250 PET/CT scans, accounting for 0.4% . The average SUVmax was 6.5 (range 2.8 to 16). Cytology was performed in five patients; it was benign in four cases and inconclusive in one case. Thirteen patients had a history of smoking. Of the parotidectomies performed in our center with a diagnosis of Warthin tumor, we identified a history of smoking in 93.8% of those patients. Conclusions The prevalence of PGIs on PET/CT was similar to that reported by other authors. Warthin tumor is frequently diagnosed among PGIs on PET/CT, and it has a strong relationship with smoking. We suggest that a diagnosis other than Warthin tumor should be considered for PGIs in nonsmokers. .
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Humans , ADAM Proteins/metabolism , Proteolysis , von Willebrand Factor/chemistry , von Willebrand Factor/metabolism , Binding Sites , Calcium/metabolism , Disulfides/chemistry , Disulfides/metabolism , Hydrogen Bonding , Models, Molecular , Mutagenesis, Site-Directed , Protein Binding , Protein Stability , Protein Structure, Tertiary , Protein Isoforms/chemistry , Protein Isoforms/metabolism , von Willebrand Factor/geneticsABSTRACT
Warthin's tumor with skin ulceration is extremely uncommon. We report on a 64-year-old man with Warthin's tumor with skin ulceration in the right parotid gland. The ulceration may have resulted from malignant transformation of either the epithelial or lymphoid component, or, as in very rare cases, an inflammatory process crossing the capsule of the tumor into the adjacent parotid parenchyma and overlying skin. Although Warthin's tumor is a common benign tumor of the parotid area, once ulcerated, it is difficult to make a clinical diagnosis. The gross finding of the case reported herein was close to the malignant form, but because an fine needle aspiration biopsy history existed, the possibility of whether more inflammatory changes might have occurred was considered. Therefore, since complications such as facial nerve injury may arise, extensive surgeries should be avoided.
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Humans , Middle Aged , Adenolymphoma , Biopsy , Biopsy, Fine-Needle , Diagnosis , Facial Nerve Injuries , Parotid Gland , Parotid Neoplasms , Skin , Skin Ulcer , UlcerABSTRACT
OBJECTIVES: The goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings. METHODS: We prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates. RESULTS: Attenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05). CONCLUSION: Salivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy.
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Humans , Adenolymphoma , Adenoma, Pleomorphic , Diagnosis , Parotid Gland , Parotid Neoplasms , Prospective Studies , Recurrence , Salivary Glands , Sensitivity and Specificity , Tomography, Spiral ComputedABSTRACT
Warthin's tumor is the second most common type of salivary gland tumor. Microscopically, Warthin's tumor displays a proliferative epithelial component and lymphoid stroma. Carcinomas arising from the epithelial component are well known, but malignant transformations of the lymphoid stroma are rare. When they do occur, they are most commonly B-cell type non-Hodgkin lymphomas. A 60-year-old male patient underwent surgical resection of a parotid mass. After superficial parotidectomy, microscopic examination indicated that the tumor was of epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components. In addition to the lymphoid follicles with distinct germinal centers, there were large, bizarre and extremely atypical neoplastic cells seen in the lymphoid component. Large neoplastic cells were diffusely CD20 and CD30 positive. The patient was diagnosed with "Warthin's tumor and diffuse large B-cell lymphoma with expression of CD30." The histopathologic and clinical features are discussed along with a review of the literature.
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Humans , Male , Middle Aged , Adenolymphoma , B-Lymphocytes , Germinal Center , Lymphoma, B-Cell , Lymphoma, Non-Hodgkin , Parotid Gland , Salivary GlandsABSTRACT
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Accounting , Adenolymphoma , Anesthesia, General , Biopsy, Fine-Needle , Lymphocytes , Parotid Gland , Parotid Neoplasms , Physical Examination , Salivary GlandsABSTRACT
Initially described in 1929, Warthin's tumor is a benign neoplasm predominantly found in the parotid gland of the salivary glands. Warthin's tumor is synonymous for cystadenoma lymphomatosum, adenolymphoma, and cystadenolymphoma. This tumor usually causes minimal pain, but the patient may complain of tinnitus, pain in the ear, or deafness. The tumor is treated with surgical excision, which is easily performed due to the superficial location of the tumor. In our case, a 69-year-old man visited our clinic primarily complaining of swelling in the left parotid gland area. Computed tomography revealed well-defined margins of the tumor in the superficial lobe of the left parotid gland and heterogeneous contrast enhancement. We performed superficial parotidectomy, with the pathological examination confirming Warthin's tumor. We report a typical case of Warthin's tumor and a literature review.
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Humans , Adenolymphoma , Cystadenoma , Deafness , Ear , Parotid Gland , Salivary Glands , Surgery, Oral , TinnitusABSTRACT
OBJETIVO: Relatar as características clínicas, tratamento e complicações.dos tumores de Warthin. MÉTODOS: Estudo retrospectivo com 70 pacientes submetidos à ressecção de cistoadenoma papilífero linfomatoso,. Variáveis analisadas: idade, sexo, etnia, presença ou não de tabagismo, sítio primário do tumor, tamanho do tumor em centímetros, presença de bilateralidade, tipo de operação, multicentricidade, complicações do tratamento, presença de recidiva no seguimento e tempo de seguimento.. RESULTADOS: Quarenta e quatro pacientes (62,8 por cento) eram do sexo masculino e 26 (37,2 por cento), do sexo feminino, com média etária de 56,7 anos, O tabagismo estava presente em 55 (78,6 por cento) pacientes, (94,3 por cento) dos tumores eram unilaterais e quatro (5,7 por cento) bilaterais, com tamanho médio de 4,1cm ao exame físico. As complicações foram 14 (19 por cento) casos de paresia e/ou paralisia facial, seroma em 10 (13,8 por cento), síndrome de Frey em três (4 por cento), hematoma em dois (2,7 por cento) e infecção de ferida operatória em um (1,5 por cento) caso. CONCLUSÃO: O tumor de Warthin tem maior incidência no sexo masculino, em tabagistas e localização unilateral predominante na glândula parótida. A parotidectomia superficial com preservação do nervo facial mostrou-se eficaz em 100 por cento casos. As complicações encontradas foram paresias ou paralisias transitórias, seroma, síndrome de Frey, hematoma e infecção de ferida operatória.
OBJECTIVE: To report the clinical characteristics, treatment and complication of Warthin tumors. METHODS: we conducted a retrospective study of 70 patients undergoing resection of papillary lymphomatous cystadenoma. Variables: age, sex, ethnicity, presence or absence of smoking, primary site of tumor, tumor size in cm, presence of bilateral tumor, type of operation, multicentricity, treatment complications, recurrence and follow up. RESULTS: Forty-four patients (62.8 percent) were male and 26 (37.2 percent) female, with a mean age of 56.7; smoking was present in 55 (78.6 percent) patients; 66 (94.3 percent) tumors were unilateral and four (5.7 percent) bilateral, with an average size of 4.1 cm on physical examination. The complications were 14 (19 percent) cases of facial paresis and / or paralysis, seroma in 10 (13.8 percent), Frey's syndrome in three (4 percent), hematoma in two (2.7 percent) and wound infection in one (1.5 percent) case. CONCLUSIONS: Warthin tumors have a higher incidence in male smokers and predominantly unilateral location of the parotid gland. Superficial parotidectomy with preservation of facial nerve was effective in 100 percent cases. Complications were transient paresis or paralysis, seroma, Frey syndrome, hematoma and wound infection.