Diffuse Large B-Cell Lymphoma Arising in Warthin's Tumor: Case Study and Review of the Literature
A 60-year-old male patient was referred to an otorhinolaryngology clinic due to a lump on the left side of his jaw, which had grown in 2 months. Ultrasound sonography test examination revealed a cystic mass that was 24×17 mm in size with smooth contours. Multiple echogenic and reactive lymph nodes with partially visible hila were visualized in the neighboring upper jugular chain, with the largest being 16×10 mm in size. Following a neck magnetic resonance imaging and a preliminary diagnosis of WT, a left superficial parotidectomy was conducted. The patient had a history of smoking, hypertension, and coronary artery disease.\nLeft superficial parotidectomy materials were sent for pathologic examination in two pieces, which were 5×3.2×2 cm and 4.5×3×1.2 cm in size. Cross section analysis showed an off white-yellowish, well-contoured nodular tumor with a bleeding center of 4×2.5×2.2 cm. Microscopic examination indicated that the tumor had epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components (). In addition to the lymphoid follicles with distinct germinal centers, infiltration of large neoplastic cells with bizarre and extremely atypical morphology was seen in the lymphoid component (, ). The large neoplastic lymphoid cells constituted more than 50% percent of the lymphoid component.\nImmunohistochemical examination showed that neoplastic cells expressed strong positivity for CD20 (), CD79a, CD30 (), leukocyte common antigen, IgG, CD138, MUM1, and focal positivity for kappa. Staining for lambda, IgM, IgA, CD3, CD5, CD10, CD15, CD56, epithelial membrane antigen, Bcl2, Bcl6, cyclinD1, S100, pancytokeratin, cytokeratin 20, human melanoma black 45, actin, and desmin were negative. Latent Epstein-Barr virus (EBV) was shown to be negative in tumor cells by using EBV-encoded RNA chromogenic in situ hybridization. Due to these findings, the patient was diagnosed with "WT and CD30 positive diffuse large B-cell lymphoma in the parotid gland."\nFollowing the lymphoma diagnosis, a full body screen was performed. Results indicated lymphadenopathies of a pathologic size in the inguinal and iliac regions. In addition to these findings, the left suprarenal gland showed two nodular mass lesions, which were assessed as likely adenomas; however, this preliminary diagnosis was not confirmed by histopathology. Bone marrow biopsy revealed a normocellular bone marrow with no lymphoma involvement.\nThe patient was stage 3A and received six courses of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. During 6-month follow-up, the patient was free of disease.