[Adenolymphomas of the parotid gland. (Clinical contribution)].
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Cystadenoma lymphomatosum or Warthin's tumor of the parotid glands appears bilateral in 8-10% of cases, synchronous (rarely), metachronous (frequently) and sometimes with multicentric aspects. After the review of the epidemiological, pathogenetic, clinical, radiographic and histologic data, the authors present two cases of bilateral Warthin's tumor, metachronous (7 years), nodular-isolated in the first one and metachronous (5 years), nodular-multicentric in the second one. The patients after CAT scan and NMR examinations, and a fine needle aspiration biopsy were treated with superficial parotidectomy with preservation of the facial nerve. In our experience the management of patients affected by Warthin's tumors, needs the following steps: CAT scan and NMR examinations to outline multiple and bilateral lesions, fine needle aspiration biopsy, superficial parotidectomy with preservation of the facial nerve, an extended follow-up (10 years after the last surgery).
We studied retrospectively 212 patients with parotid tumors who were treated in our hospital between October 1981 and March 1998. One hundred seventy-two of the tumors were benign, and 40 of them were malignant. The tumors were bilateral in 13 patients. Since 1992, we have treated at least 1 bilateral parotid tumor patient per year, and the number of patients with bilateral parotid tumors has tended to increase. Histologically, adenolymphomas occurred in 11 patients, and there was one occurrence of pleomorphic adenoma and one occurrence of basal cell adenoma. Eighty-five percent of all bilateral parotid tumors were adenolymphomas, and the bilateral parotid tumors comprised twenty percent (11 of 53 patients) of all adenolymphomas that we encountered. Among the 13 patients with bilateral parotid tumors, 1 patient experienced them heterochronously. In 7 of the 13 patients the tumor on the opposite side was found by diagnostic imaging. One patient showed recurrence in both parotid glands 4 years after initial surgery. Comparing bilareral adenolymphomas with unilateral adenolymphomas, there was no significant difference in the age or sex of the patients. Regarding bilateral adenolymphoma, 4 patients showed a solitary tumor on either side, 4 patients showed a solitary tumor on one side and multiple tumors on the other side, and 4 patients showed multiple bilateral tumors. Regarding unilateral adenolymphoma, 38 patients showed solitary tumors and 4 patients showed multiple tumors. Bilateral adenolymphomas were more multicentric than unilateral adenolymphomas. Epstein-Barr virus-encoded RNA (EBER) was detected in 11 of the 12 bilateral adenolymphomas and in 18 of 35 patients with unilateral adenolymphoma, by in situ hybridization. EBER was detected more frequently in the multiple unilateral adenolymphomas than in the solitary unilateral adenolymphomas. Based on our experience, the bilateral parotid tumor is not rare. Care should be taken to observe the other side of the parotid gland with parotid tumors that are suspected adenolymphomas. Imaging may be helpful for the detection of bilateral tumors. A relationship may exist between Epstein-Barr virus and adenolymphoma multicentricity.
INTRODUCTION: Multiple tumours of the parotid gland with the same histological appearance may occur as synchronous unilateral tumours, but bilaterality has also been reported. Synchronous multiple unilateral parotid tumours with different histology remain rare. METHODS: Between January 1988 and May 2002, a total of 341 patients underwent parotidectomy in our department. Medical charts were reviewed retrospectively for synchronous multiple unilateral tumours. RESULTS: Fourteen patients had two or more tumours within the same specimen. The combinations encountered were two to four adenolymphomas (n=9), adenolymphoma plus pleomorphic adenoma (n=3), adenolymphoma plus MALT lymphoma (n=1), and pleomorphic adenoma plus acinic cell carcinoma (n=1). The outcome was clinical freedom from signs of tumour recurrence in any patient (mean follow-up = 51 months). CONCLUSION: Synchronous multiple unilateral parotid tumours usually include two or more adenolymphomas and might occur more often than previously realized. The possibility of a concomitant carcinoma, and the prevention of recurrent tumours, may warrant a more radical surgical excision of the parotid gland, accurate intraoperative examination of the resected specimen, and routine histological evaluation of the entire specimen. Preoperative radiological investigation may further increase the chances of finding multiple parotid tumours.
Bilateral tumors of the same histotype occur rarely in opposite organs. These include hereditary diseases such as retinoblastoma and Wilm's tumor. Bilateral tumors of the same histotype also occur in the parotid glands. A study was performed to determine if there is a possibility that hereditary tumors are included in such cases. Two cases of bilateral parotid tumors, one of pleomorphic adenoma and one of adenolymphoma were reported, and 59 cases reported between 1942 and 1990 with clear times of onset which underwent histological examinations were analyzed. The main histotypes were adenolymphoma in 50.8% (30 cases), pleomorphic adenoma in 27.1% (16 cases), acinic cell tumor in 13.6% (8 cases). Onset of the tumors was simultaneous in 43% of the adenolymphomas. The sex and age at onset showed the same trends as in unilateral cases for each histotype. Among parotid tumors, the percentage of bilateral onset is 1-2%, and when adenolymphomas which show the highest incidence among such tumors were considered from the standpoints of multiplicity, simultaneous onset and the fact that they are benign, the possibility that hereditary diseases are included in the aforementioned 43% was suggested.
A peroxidase-antiperoxidase technique for S-100 protein has been applied to 68 salivary glands. These included 17 pleomorphic adenomas, seven adenoid cystic carcinomas, 23 adenolymphomas and a number of other neoplasms. In addition, five specimens of myoepithelial sialadenitis ('benign lymphoepithelial lesion') and five normal parotid glands were included. Consistent results were obtained, myoepithelial cells and cells in myxoid and chondroid areas in pleomorphic adenomas staining intensely. In adenoid cystic carcinoma, on the other hand, there was no staining. The adenolymphomas possessed intensely S-100 protein-positive cells in the interfollicular lymphoid areas; these were probably interdigitating reticulum cells. In addition, branching structures, probably corresponding to Langerhans' cells, were observed in the epithelium of adenolymphomas.
Warthin's tumor (adenolymphoma) is a monomorphous adenoma of the salivary glands well characterized histologically. Its clinical evolution is almost invariably benign, the malignant change being extremely unusual. We present the case of a 67 year-old man with a right retromandibular tumor which has evolved over a two year period, with peripheral involvement of V, VI and VII cranial nerves on the same side, and direct invasion of intracranial structures. The biopsy revealed a classic adenolymphoma which shows foci of well differentiated adenocarcinoma. Transitional areas between benign and malignant epithelium were evident. In addition, histological findings support the hypothesis of the origin of adenolymphoma from epithelial ducts trapped in the regional lymphatic tissue.