Uncommon Coexistence of Pleomorphic Adenoma and Warthin’s Tumor in a Painfully Swollen Left Parotid Gland: A Surgical Case Report

Patient: Female, 54-year-old Final Diagnosis: Synchronous benign pleomorphic adenoma and Warthin’s tumor Symptoms: Progressive and painful swelling of the left parotid gland for the last six months with a marked increase in size in recent weeks Clinical Procedure: Surgery Specialty: Pathology OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Benign pleomorphic adenoma is the most common primary tumor of the salivary glands and mainly arises in the parotid gland. Warthin’s tumor, or papillary cystadenoma lymphomatosum, represents <30% of benign parotid tumors. The simultaneous occurrence of multiple parotid tumors is rarely described – depending on the corresponding histology (different/identical), the time of their occurrence (synchronous/metachronous), as well as their location (unilateral/bilateral), multiple parotid tumors can be further sub-classified. CASE REPORT: We describe the case of a 54-year-old female patient with progressive and painful swelling of the left parotid gland for the last 6 months. During extra-oral examination, a bulging, displaceable mass of approximately 3 cm was determined. A subsequent MRI (magnetic resonance imaging) examination revealed a multifocal lesion but failed to provide a decisive clue as to the tumor entity of the lesion, and a lateral (superficial) parotidectomy was performed. Postoperative histomorphological interpretation allowed the final pathological diagnosis of synchronous, unilateral occurrence of a pleomorphic adenoma as well as a Warthin’s tumor. CONCLUSIONS: This report presents a rare case of synchronous unilateral parotid tumors and supports that benign pleomorphic adenoma and Warthin’s tumor are the most common associations. Since clinical examination, MRI imaging, and even cytological assessment could be misleading in the detection of synchronous ipsilateral multiple parotid gland tumors, our report also highlights the importance of timely and accurate diagnosis with histo-pathology to plan surgery and to exclude malignant transformation, which is a rare but important association with both types of primary salivary gland tumor.