An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor

Abstract

BackgroundWarthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature. Herein, we report an unusual initial presentation of a mantle cell lymphoma involving the lymphoid stroma of a Warthin tumor.Case presentationA seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months.ConclusionTo the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case also brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor.

Risk interrelationship among multiple primary tumors

“…[ 16 ] In 2015, Arcega et al reported an unusual case of mantle cell lymphoma inside the lymphoid tissue of Warthin tumor and confirmed a reciprocal translocation (11; 14) (q13; q32) within the lymphoid tissue of Warthin tumor. [ 14 ] Similar to our case of simultaneous association of Warthin tumor and cervical lymph nodes, Di Napoli et al reported 1 case, like the other 2 of 3 reported cases in the literature, whereas only 1 case of association was reported as an intraparotid lymph node. [ 17 ]…”

“…Smoking has been suggested as the major risk factor of Warthin tumor. [ 14 ] In 1953, the male-to-female ratio was 10:1. This ratio significantly decreased to 1.2:1 in 1996 and was attributed to the increased number of female smokers.…”

“…This ratio significantly decreased to 1.2:1 in 1996 and was attributed to the increased number of female smokers. [ 14 ] Distinct lymphoid components are seen from the lesions of the salivary glands and occur in both types of benign and malignant tumors. [ 15 ] Intraparenchymal nodal tissues are contained within the normal parotid gland.…”

Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland - immunophenotypic and genetic features: A case report

“…We concluded that the most common subtypes of lymphoma were FLs (10 cases)[1-10], followed by Hodgkin’s lymphoma (4 cases)[11-14] and diffuse large B cell lymphoma (6 cases)[4,15-18]. The others were small lymphocytic lymphoma/chronic lymphocytic leukemia (3 cases)[19-21], mantle cell lymphoma (1 case)[22], extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (1 case)[23], Lennert lymphoma (1 case)[24], peripheral T-cell lymphoma (2 cases)[25,26], and T lymphoblastic leukemia/lymphoma (1 case)[27]. In these patients, 4 cases of T-cell lymphoma and 25 cases of B-cell lymphoma were observed.…”

Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours

“…WTs, both in the parotid gland or neighbouring lymph nodes, may occasionally be associated with different lymphoproliferative disorders and some 20 cases have been reported, possibly several of which have been collision tumours. Non-Hodgkin lymphomas are most common [114][115][116], but a few cases of Hodgkin's lymphoma have also been reported [117,118]. A few cases of nodal peripheral T cell lymphoma [119] and MALT-type lymphoma [120] associated with WT have been described.…”