Benign Synchronous Parotid Tumors: Case Report and Literature Review by Juan Jose Santivañez in Journal of Clinical Case Reports, Medical Images and Health Sciences

Benign Synchronous Parotid Tumors: Case Report and Literature Review by Juan Jose Santivañez in Journal of Clinical Case Reports, Medical Images and Health Sciences

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.  

Introduction:

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 (1). According to the histological classification published by WHO in 2005, 10 types of benign and 24 types of malignant tumors of the salivary glands can be distinguished (2). 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. 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)

Key Words: Parotid tumors, Oncocytoma, Warthin’s tumor. 

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 highresolution 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.

For more information: jcrmhs

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