An unusual tumour of the neck

Abstract

SURGICAL REGISTRAR, ROYAL NORTHERN HOSPITALTHE uncommon features presented by a solid tumour removed from the lateral aspect of the neck are believed to be of sufficient interest to warrant the placing of the following case on record.The patient was a man, aged 62 years, who came to the hospital complaining of a swelling behind the angle of his lower jaw. He first noticed it five years previously ; it was painless and was gradually increasing in size.A movable tumour was present, in size a little smaller than a hen's egg. It was firm in consistency, non-fluctuant, and there was no evident fixation to adjacent structures. Under general anaesthesia the tumour was exposed through a transverse incision. It lay beneath the deep cervical fascia, projecting forward from under cover of the sternomastoid, and extending upwards as far as the lower pole of the parotid gland. (No definite attachment, however, to the latter was demonstrated.) It was easily enucleated from its surrounding capsule. The specimen obtained was ovoid in form, and covered by a thin membrane in which a number of bloodvessels were to be seen. Its cut surface was greyish-yellow in colour, with one or two small areas of softening. Microscopically (Figs. 149, 150) there were evident a large number of alveoli, most of them small in size, but a few almost reached the size of small cysts. Each was lined by a well-marked epithelium of very uniform type throughout the section. This was constituted by a double layer of cells, the inner being columnar in form, and the outer cuboidal. Here and there the epithelium projected into the alveoli, forming processes which occasionally showed branching. The cells were non-ciliated. Surrounding these alveoli and extending between them was lymphoid tissue, densely packed and with germinal centres, and around the whole a fibrous capsule was evident. No muscle or cartilage was found in the sections, and no sebaceous gland, hair follicle, or Hassal formations were seen. In 1898, Neissel described the inclusion of parotid tubules in lymphatic glands. The developing salivary buds are at an early stage surrounded by a diffuse mass of lymphoid tissue which gradually becomes collected into nodes, and around these, capsules are eventually formed. During this process certain salivary epithelial tubules may become separated and included within the lymphatic gland. These formations were demonstrated by Neisse in many newly-born infants, and they have also been shown in association with the submaxillary salivary gland. It is from these remnants that a tumour is believed occasionally to arise.During the past twenty-five years there have been described a number of cases bearing a close resemblance to each other. Two cases were described by Albrecht and ArtzY2 who pointed out the striking resemblance of the included epithelium to that of salivary duct. This view is endorsed by G. W. Nich~lson,~ who presents two more examples. Ten cases are reviewed by M~a t t i ,~ and this writer points

Extraparotid Warthin's Tumor

“…8 A clear distinction of the mass from the parotid gland Although Warthin' s tumor has been reported in many extraparotid sites, many of these reports have been poorly substantiated and information regarding their exact relationship to parotid tissue has not been specified.…”

“…There are reports in the English literature as early as 1935 that describe neck masses consistent with EPWT. 8 A clear distinction of the mass from the parotid gland extraparotid sites, many of these reports have been poorly substantiated and information regarding their exact relationship to parotid tissue has not been specified.…”