Adenolymphoma: A probing entity: Case report and review
A 65-year-old male patient visited the Department of Oral Medicine, with the chief complaint of swelling below the left ear lobe since six years. Swelling was insidious in onset and gradually increasing up to its present size. Medical and family history was non-contributory. Patient was a known smoker since the past 25 years and there was no history of alcohol consumption.\nOn examination, the lesion extended from the left ear lobule to the lower border of the ramus of the mandible superoinferiorly and also extended behind the left ear []. It was approximately 5 cm in greatest dimensions; smooth contoured, was firm in consistency and had well-defined borders. There were no surface markings and the temperature of the swelling was not elevated. It was midly tender on palpation.\nIntraoral examination revealed normal mucosa and orifices of the parotid gland. Stimulation of the parotid glands yielded normal salivary flow with normal consistency, quantity and color. Other intraoral findings were non-contributory. On aspiration, a clear fluid, light brown in color but viscous in consistency was obtained.\nBased on the history and clinical examination, a provisional diagnosis of Warthin's tumor was given. A differential diagnosis of pleomorphic adenoma, a low-grade parotid malignancy, lipoma and neurofibroma arising in the salivary gland were included. The investigatory workup included complete hemogram, extra-oral radiograph, ultrasonography, computed tomography and excisional biopsy of the lesion.\nRoutine hematological investigation values were found to be within normal limits. The orthopantomogram revealed no abnormalities. Ultrasonographic finding showed a well-defined hypoechoic mass in the lower pole of the left parotid gland. The mass measured about 4.34 × 2.49 × 3.39 cm []. The rest of the parotid gland parenchyma was normal and there was no evidence of ductal dilatation. Computed tomography examination revealed a rounded and well-defined cystic lesion involving the superficial lobe of the left parotid gland [].\nLater, excisional biopsy of the lesion was planned using partial parotidectomy as the technique of choice []. The tissue obtained was fixed in 10% of neutral buffered formalin, and processed routinely. The sections stained with Hematoxylin and Eosin revealed cystic spaces lined by a papillary epithelial proliferation which was bilayered. The cells of the epithelial lining appeared intensely eosinophilic. At the core of papillary projections a variable amount of lymphoid tissue with mature lymphocytes was observed [].\nThe patient did not present with any post-surgical complications. The patient is under regular follow-up to check recurrences, if any.