Usefulness of diffusion-weighted MR imaging for differentiating between Warthin’s tumor and oncocytoma of the parotid gland
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Adenolymphoma
Parotid gland oncocytoma is an uncommon, benign salivary neoplasm composed of mitochondria-rich oncocytes. The purpose of this study was to correlate MR imaging and histopathology of parotid gland oncocytomas and to define the features that may distinguish these neoplasms from other benign and malignant parotid gland tumors. The MR imaging features in 9 patients with a pathologic diagnosis of oncocytoma were retrospectively reviewed. The imaging features were strikingly similar for 8 of the 9 patients. All lesions appeared T1 hypointense but isointense to the native parotid gland on fat-saturated T2 and postcontrast T1 imaging. On MR imaging, parotid gland oncocytomas share specific imaging characteristics that have not been described for benign or malignant parotid gland tumors. Oncocytomas are isointense to native parotid gland on fat-saturated T2 and T1 postcontrast MR images. Preoperative identification of correct histology may help surgical planning.
Histopathology
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The authors report on an isolated case of parotid gland oncocytoma observed in an elderly patient who developed an oxyphilic cell adenoma of the parotid gland. As this conditions is very rare, they describe the clinical features of the case and review the available literature on the disease.
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Reports regarding the imaging findings of parotid gland oncocytoma are limited and prospective definitive diagnosis is difficult. This case series is aimed at furthering the knowledge of imaging for parotid gland oncocytoma.Seven patients with pathologically confirmed parotid gland oncocytoma were identified between January, 2016 and August, 2020. They were subjected to computed tomography, magnetic resonance imaging or ultrasound. Imaging features of lesions were retrospectively analyzed and documented by a senior radiologist.Among the 7 recruited parotid gland oncocytoma patients, 4 were males and 3 were females. They were aged between 47 and 87 years with a median age of 63 years. The range of maximum diameter of the mass was about 1.6-4.5 cm, with the median size being 3.5 cm. All cases were unilateral single masses. Three patients had their parotid gland oncocytoma located in the deep lobe of the parotid gland and 4 patients had their parotid gland oncocytoma located in the superficial lobe. Most lesions exhibited a clear boundary and irregular shapes or lobulated, and contain cystic components. Local pain was the most common clinical manifestation. Most of the lesions exhibited a hypoechoic mass on ultrasound, soft tissue density on computed tomography, iso to hypointense signal on T1 weighted imaging, slightly hypersignal on T2 weighted imaging, while contrast-enhanced computed tomography, magnetic resonance imaging, and ultrasound showed avid enhancement.Parotid gland oncocytomas usually exhibit a clear boundary to surrounding parotid tissue, lobulated or irregular shape and avid enhancement, sometimes accompanied with cystic components. Diagnosis of parotid gland oncocytoma should be considered when these features are encountered in clinical practice.
Lobe
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Parotid gland tumors are usually unilateral, and bilateral parotid gland tumors are rare, Warthin's tumor (adenolymphoma) being the most common. Warthin's tumor is the most common tumor of parotid gland except pleomorphic adenoma. Warthin's tumors in both parotid glands are found in 5 to 10% of all patients with Warthin's tumors in the parotid glands. We present a case with a total of 9 Warthin's tumors in both parotid glands. A 66-year-old male came to our department because of throat discomfort, and bilateral parotid tumors were subsequently revealed. CT-scan and MRI showed 8 solitary lesions in both parotid glands. The masses were removed surgically, with preservation of the facial nerves. There were a total of 3 tumors in the right parotid gland, and 6 in the left parotid gland. The histological diagnosis was Warthin's tumors in both parotid glands. Nine Warthin's tumors in a case are the most numerous ever reported in Japan.
Adenolymphoma
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Oncocytoma is a rare benign salivary gland tumour with an incidence rate about 1-2%. It is located in the parotid gland in 82% of cases. The aging mitochondrial hypothesis could explain the predilection between 70 and 90 years. Clinical and radiological features of the parotid oncocytoma are not different from those of the others parotid benign tumors. We report a case of oncocytoma of the left parotid gland in a 69 years woman in whom fine needle aspiration cytology (FNAC) was for a pleomorphic adenoma. Through this case we highlight the importance of histopathology in the positive diagnosis of parotid oncocytoma as well as in it's differential diagnosis and also the place of FNAC.
Histopathology
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Simultaneous occurrence of multiple tumors in the same parotid gland is rare.We reported a rare case of synchronous oncocytoma and Warthin tumor in the ipsilateral parotid gland.The pathogenesis,clinical presentation,diagnosis and treatment were discussed with review of the literature.
Presentation (obstetrics)
Benign tumor
Pathogenesis
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Tumors of parotid glands are majority benign and commonest of them is Pleomorphic adenoma. Patients commonly presents with a painless swelling in face. Parotid Oncocytoma is a rare parotid tumor with incidence of 0.1-1.5% (rarest of salivary tumor type) of all parotid tumors, and it occurs in 6-8 decade of life. In this case report we will present a case of 75 years old male with painless swelling in parotid gland and diagnosis of Oncocytoma was made.
Benign tumor
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Malignant oncocytoma of the parotid gland occurs relatively rarely. Basing upon the case of 48-years old man, the authors discuss the difficulties of diagnostic, treatment and the course of the disease.
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A multinodular parotid tumor in a 63-year-old man occupied almost the entire gland and was found to represent diffuse oncocytic growth. The literature on salivary gland oncocytoma is reviewed. This case appears to be a unique example of diffuse proliferation of oxyphilic granular cells (oncocytes) virtually replacing the normal parotid acinar structure. There was no evidence of local or distant spread.
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To investigate the imaging manifestations of 16-slice enhanced CT of parotid adenolymphoma in the parotid gland and the corresponding pathology,in order to improve the understanding of the CT imaging manifestations of parotid adenolymphoma in the parotid gland.The enhanced CT characteristics of 34 cases of parotid adenolymphoma in the parotid gland confirmed by histological pathology were retrospectively analyzed.There were totally 86 lesions in 34 cases, of which 12 cases with lesions in bilateral sides and 22 cases with lesions in unilateral side. Sixty-six lesions located behind and below the superficial lobe of the parotid gland. The lesions showed moderate to obvious enhancement at arterial phase, and the cystic region within the lesions showed no enhancement.The relatively specific enhanced MSCT manifestations of parotid adenolymphoma in parotid gland include lesions located behind and below the superficial lobe of parotid gland unilaterally or bilaterally, sometimes exhibited as multiple masses, with clear edge, obvious enhancement and cystic degeneration inside.
Adenolymphoma
Lobe
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