Читать книгу Salivary Gland Pathology - Группа авторов - Страница 112

1 Warthin tumors should be suspected when patients present with multicentric unilateral and/or bilateral tumors of the parotid glands.

2 Staging the performance of the bilateral superficial parotidectomies is prudent to avoid the possibility of bilateral facial nerve palsies if bilateral surgery was performed synchronously and postoperative facial nerve weaknesses were noted bilaterally.

3 Repeat CT scanning in staged parotid surgeries permits the assessment of interval growth of masses prior to the second parotid surgery. The increased growth of the mass in this case increased the pretest probability of a neoplastic process, and specifically a Warthin tumor.

Figure 2.85. The patient demonstrates obvious left facial swelling in the region of the parotid gland (a–c). Axial (d), coronal (e), and sagittal (f) views demonstrate two tumors in the superficial lobe of the left parotid gland. Additionally, an enhancing but smaller tumor is noted in the right parotid gland (g). Synchronous, bilateral Warthin tumors are the suspected diagnoses. The patient underwent left superficial parotidectomy via a modified Blair incision (h). The skin flap is elevated anteriorly, superficial to the parotid capsule (i). The main trunk of the facial nerve and its peripheral branches are identified as the specimen is elevated (j). The specimen is delivered and inspected on its lateral (k) and medial surfaces (l). Final pathology identifies Warthin tumors of the left parotid gland (m). The resultant tissue bed and dissected facial nerve are noted (n). The patient is noted at five months postoperatively (o–q). A repeat CT scan is obtained and axial (r), coronal (s), and sagittal (t) images identify a larger tumor of the right parotid gland than was noted at the time of the patient's original presentation. He underwent a right superficial parotidectomy via a modified Blair incision (u). The specimen is elevated off the identified and preserved facial nerve (v). The specimen is delivered (w) and the resultant tissue bed is noted (x). Final pathology confirmed the clinical suspicion of Warthin tumor of the right parotid gland (y). (m = Hematoxylin and eosin, original magnification × 100; y = Hematoxylin and eosin, original magnification × 100).