Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour

Abstract

Warthin tumours (WT) and malignant lymphomas are only rarely associated, and most are examples of involvement of the lymphoid stroma of WT by a disseminated lymphoma. This report describes a case where excision of a parotid mass led to the initial diagnosis of WT and small lymphocytic lymphoma (SLL). The diagnosis of SLL was confirmed by immunohistochemistry and molecular studies. The patient had stage IV A disease and is currently in chemotherapy induced complete remission. This case highlights the extremely rare association of SLL with WT and the importance of evaluation of the WT stroma, where the pale proliferation centres of SLL may mimic germinal centres of reactive lymphoid nodules.

T cell lymphoblastic lymphoma in parotidectomy for Warthin’s tumor: case report and review of the literature

“…The majority of non-NHLs involving WT were follicle-centre lymphomas (12/23 reported cases; 52,2%) [2, 4-8, 11, 12, 14, 15]. Two cases of diffuse large B cell lymphoma [8,19] and two cases of B-small lymphocytic lymphoma [10,18] have been reported. There are only two cases of Hodgkin's lymphoma [9,13], one case of large cell lymphoma [3], one case of mucosa associated lymphoid tissue (MALT) lymphoma [16], one case of mantle cell lymphoma [4] and one case of lymphoma which was not further classified [2].…”

“…Lymphomas associated with WT are extremely rare. A review of the English literature provided 23 cases of WT related to malignant lymphoma (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Considering only the cases with existing data, this association occurred in eighteen males (81,8%) and four females (18,2%), with a mean age of 67 years.…”

“…The coexistence of two separate primary tumors raises the question whether it is coincidental or whether they are pathogenetically related. Saxena et al, suggest that disease localized to the parotid region for a variable period of time before dissemination to be considered in supporting the parotid origin of lymphoma [18]. Most lymphomas associated with WT are nodal-based neoplasms and it is feasible hypothesis that lymphomas in this setting likely represent expression of a nodal based disease [12,15].…”

“…To date, there are 23 reported cases in the English literature of lymphomas associated with WT [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Most cases are B cell lymphomas-namely follicular lymphoma [2, 4-8, 11, 12, 14, 15], small lymphocytic lymphoma [10,18] and diffuse large B-cell lymphoma [8,19]-and are usually associated with generalized disease, which is either present at the time of diagnosis or develops subsequently. The co-existence of WT and T-cell lymphoma is extremely rare [17].…”

Differential diagnosis of Warthin’s tumor complicated with lung adenocarcinoma by 18F- FDG PET/CT imaging and radioisotope scanning with Tc-99m pertechnetate: A case report and literature review

“…The Warthin's tumor what is called adenolymphoma is a benign parotid gland tumor characterized histologically by tall columnar and oncocytic epithelium within a lymphoid tissue stroma [1,2] . WHO and Armed Forces Institute of Pathology designed this entity adenolymphoma, while the use of Warthin's tumor pays homage to Warthin who reported the first two cases in America [1] .…”