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Received date: 26/01/2024 Published date: 07/02/2024 Case Report

Benign Synchronous Parotid Tumors: Case Report and Literature Review

Santivañez Juan José¹, Ramos Alexandra², Javier Baena³, Hakim José Antonio¹

¹Department of Head and Neck Surgery, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
²Universidad de los Andes - Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
³Department of Pathology, Fundación Santa Fe de Bogotá University Hospital - Universidad de los Andes, Bogotá, Colombia

*Corresponding author

*Juan Jose Santivañez, MD, General surgeon, Department of Head and Neck Surgery, Fundación Santa Fe de Bogotá, University Hospital, Carrera 7 No. 117-15, Bogotá, 110111, Colombia.

DOI: 10.55920/JCRMHS.2024.07.001285

ABSTRACT

The parotid gland, one of the three major salivary glands in the body, can host both benign and malignant tumors. The overall incidence of salivary gland tumors is less than 5 per 100,000 population per year, representing 3-4% of all head and neck tumors, 80% of which are located in the parotid gland. The occurrence of benign synchronous parotid neoplasms is considered unusual, particularly those involving histologically distinct types, which are exceptionally rare, accounting for only 0.3% of all tumors. To date, nine cases have been reported of synchronous Warthin’s tumor and oncocytomas. The similarities between these tumors make them indistinguishable using clinical or standard imaging techniques. In this report, we present a case of synchronous Warthin's tumor and oncocytoma identified as a postoperative finding.

Key words: Parotid tumors; Oncocytoma; Warthin’s tumor.

Introduction

The occurrence of benign synchronous parotid neoplasms is considered unusual, particularly those involving histologically distinct types, which are exceptionally rare, accounting for only 0.3% of all tumors (3-5). These tumors exhibit a higher frequency in males (73%) with an average age of 63 years (3). The most frequent synchronous tumors (unilateral or bilateral) are Warthin’s tumors (68%), in association with pleomorphic adenomas (2,4). To date, nine cases have been reported of synchronous Warthin’s tumor and oncocytomas. The similarities between these tumors make them indistinguishable using clinical or standard imaging techniques (6,7). It has been established that surgical excision is the standard of care for most parotid tumors (5,7). In this report, we present a case of synchronous Warthin's tumor and oncocytoma identified as a postoperative finding.

Case Report

81-year-old patient with a one-year history characterized by right-sided cervical pain radiating to the right ear. Additionally, she presents a mobile and painless right parotid mass with no facial mobility alterations. The patient has a history of arterial hypertension and hypothyroidism, with no prior surgeries in the head and neck region, she maintains normal functionality in daily life.

Further investigations, including ultrasound and neck tomography, reveal a 2 cm right parotid nodule with undefined borders (Figure 1). Puncture biopsy confirms an oncocytic neoplasm of right parotid gland. Right parotidectomy is performed without complications, revealing a 2 cm tumor in the parotid tail and another 1 cm tumor in the superficial lobe. The facial nerve trunk and its branches where intact, monitor was used during surgery.

Figure 1: Neck Tomography: The image reveals solid, oval-shaped lesions that are well-defined. These lesions exhibit homogeneous enhancement with the contrast medium in the superficial lobe of the right parotid.

The patient experiences appropriate clinical evolution, with no facial mobility alterations and satisfactory healing. The final pathological report indicates an oncocytic neoplasm of 0.9 cm in the superficial lobe and a Whartin tumor of 1.8 cm in the parotid tail, with negative margins for tumor and the presence of 6 inflammatory nodes (Figure 2)

Figure 2: Histological Characteristics of Tumors. A well-defined margin neoplasm is observed (A, Hematoxylin and Eosin, 100X), composed of cells with eosinophilic granular cytoplasm (B, Hematoxylin and Eosin, 400X), forming trabeculae and acini, corresponding to an oncocytoma. On the other hand, a well-defined edge neoplasm is noted with two-layered oncocytic epithelial cells forming cystic spaces, surrounded by lymphoid stroma with germinal centers, consistent with a Warthin Tumor (C and D) (Hematoxylin and Eosin, 40X and 400X, respectively). No features of malignancy were observed in any of the tumors.

Discussion

The origin and etiology of synchronous parotid neoplasms remain controversial (7). Our presented case, involving a synchronous Warthin's tumor and oncocytoma, exemplifies the diagnostic challenges encountered in preoperative settings. The coexistence of neoplasms with different histologic origins underscores the necessity for advanced imaging techniques and detailed histopathological examination to achieve precise characterization.

Accurate preoperative and intraoperative assessment and management is essential for optimal outcomes in such complex cases. The postoperative identification of synchronous tumors highlights the difficulties in preoperative diagnosis, urging a multidisciplinary approach encompassing clinical, radiological, and histopathological assessments. While advanced imaging modalities like high-resolution ultrasound and magnetic resonance imaging (MRI) facilitate preoperative planning, the definitive diagnosis often relies on histopathological examination post-surgery.

Moreover, our case emphasizes the broader implications of synchronous parotid neoplasms, influencing surgical approach, resection extent, and potential need for adjuvant therapies. The reported challenges underscore the importance of continuous research and collaboration among healthcare professionals to refine diagnostic and treatment strategies for synchronous parotid neoplasms.

Ethical Component: This case report was carried out within the ethical principles for medical research in humans according to the Declaration of Helsinki—59th General Assembly, Seoul, Korea, October 2008. The national regulations of the Ministry of Health and Social Protection of Colombia Resolution 8430 of 1993 regarding Chapter I “Of the ethical aspects of research in human beings” were taken into account. This research is classified within the research category without risk, and with the informed consent of the patient. Authorization for this report was given by the patient and ethical approval is not applicable for this article.

Data Availability: The case information was obtained in an authorized manner by the patient and the treating surgical group.

Funding Statement: There is no funding to report for this paper.

Declaration of Conflicting Interests and grants: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No grants where received.

Data availability statement: I authorize to share our research data in a suitable public repository subject to ethical considerations.

References

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Journal of Clinical Case Reports, Medical Images and Health Sciences (ISSN 2832-1286) is a peer-reviewed journal dedicated to publishing clinical images from all sectors of medicine. The goal of this magazine is to disseminate information about new discoveries and treatments in science and medicine.

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