{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T18:41:26Z","timestamp":1763059286411,"version":"build-2065373602"},"reference-count":57,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. Clinical report: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 \u00d7 2.7 \u00d7 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. Conclusions: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the \u201cwait and see\u201d approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery.<\/jats:p>","DOI":"10.3390\/medicina60122086","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T10:54:20Z","timestamp":1734605660000},"page":"2086","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Rare Diagnosis of Parotid Gland Follicular Lymphoma Arising in Warthin Tumor: Case Report and Literature Review"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1916-9571","authenticated-orcid":false,"given":"Ido","family":"Vaknin","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irit","family":"Allon","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Barzilai University Medical Center, Ashkelon 7830604, Israel"},{"name":"Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirley","family":"Zafrir-Haver","sequence":"additional","affiliation":[{"name":"Department of Hematology, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6265-1106","authenticated-orcid":false,"given":"Alex","family":"Abramson","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery Department, Barzilai University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"key":"ref_1","unstructured":"El-Naggar, A.K., Takata, J.K.C.C., Grandis, J.R., Takata, T., and Slootweg, P.J. (2017). WHO Classification of Head and Neck Tumours, International Agency for Research on Cancer. [4th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s12105-022-01459-0","article-title":"Distribution and Frequency of Salivary Gland Tumours: An International Multicenter Study","volume":"16","author":"Alsanie","year":"2022","journal-title":"Head Neck Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Quer, M., Hernandez-Prera, J.C., Silver, C.E., Casasayas, M., Simo, R., Vander Poorten, V., Guntinas-Lichius, O., Bradley, P.J., Tong-Ng, W., and Rodrigo, J.P. (2021). Current trends and controversies in the management of warthin tumor of the parotid gland. Diagnostics, 11.","DOI":"10.3390\/diagnostics11081467"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1007\/s12325-019-01007-3","article-title":"Analysis of the clinical relevance of histological classification of benign epithelial salivary gland tumours","volume":"36","author":"Hellquist","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sk\u00e1lov\u00e1, A., Bishop, J.A., Mehotra, R., and Thompson, L.D.R. (2022). Introduction. WHO Classification of Head and Neck Tumours, IARC.","DOI":"10.2307\/jj.5425971.3"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1007\/s12105-020-01215-2","article-title":"Low molecular weight cytokeratin immunohistochemistry reveals that most salivary gland Warthin tumors and lymphadenomas arise in intraparotid lymph nodes","volume":"15","author":"Bishop","year":"2021","journal-title":"Head Neck Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s00428-005-1276-5","article-title":"Tissue that has lost its track: Warthin\u2019s tumour","volume":"446","author":"Teymoortash","year":"2005","journal-title":"Virchows Archiv"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/s41572-019-0132-x","article-title":"Follicular lymphoma","volume":"5","author":"Carbone","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/ejh.13271","article-title":"Diagnosis and management of follicular lymphoma: A comprehensive review","volume":"103","author":"Dada","year":"2019","journal-title":"Eur. J. Haematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1002\/ajh.26737","article-title":"Follicular lymphoma: 2023 update on diagnosis and management","volume":"97","author":"Jacobsen","year":"2022","journal-title":"Am. J. Hematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3324\/haematol.2021.278717","article-title":"Prospects in the management of patients with follicular lymphoma beyond first-line therapy","volume":"107","author":"Qualls","year":"2022","journal-title":"Haematologica"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S1470-2045(14)70027-0","article-title":"Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: An open-label randomised phase 3 trial","volume":"15","author":"Ardeshna","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/S0140-6736(03)14110-4","article-title":"British National Lymphoma Investigation. Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: A randomised controlled trial","volume":"362","author":"Ardeshna","year":"2003","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1182\/blood-2003-12-4434","article-title":"Follicular lymphoma international prognostic index","volume":"104","author":"Roy","year":"2004","journal-title":"Blood"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1200\/JCO.1997.15.3.1110","article-title":"Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: A randomized study from the Groupe d\u2019Etude des Lymphomes Folliculaires. Groupe d\u2019Etude des Lymphomes de l\u2019Adulte","volume":"15","author":"Brice","year":"1997","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/S0344-0338(86)80158-3","article-title":"Hodgkin\u2019s disease occurring in a Warthin\u2019s tumor: First case report","volume":"181","author":"Melato","year":"1986","journal-title":"Pathol. Res. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/j.1365-2559.1993.tb00121.x","article-title":"A case of Warthin\u2019s tumour with coexistent Hodgkin\u2019s disease","volume":"22","author":"Badve","year":"1993","journal-title":"Histopathology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1111\/j.1752-248X.2010.01066.x","article-title":"Collision Hodgkin lymphoma and Warthin tumour. Report of a case and review of the literature","volume":"2","author":"Cozzolino","year":"2009","journal-title":"Oral Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1016\/j.oooo.2013.05.004","article-title":"Concomitant lymphocyte-rich classical Hodgkin\u2019s lymphoma and Warthin\u2019s tumor","volume":"116","author":"Liu","year":"2013","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1177\/1066896915582263","article-title":"Nodular lymphocyte-predominant Hodgkin lymphoma in a Warthin tumor of the parotid gland: A case report and literature review","volume":"23","author":"Mallel","year":"2015","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_21","first-page":"619","article-title":"Classical Hodgkin lymphoma arising from heterotopic Warthin\u2019s tumor in the cervical lymph node: A case report","volume":"16","author":"Jun","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e0289","DOI":"10.1097\/MD.0000000000010289","article-title":"Risk interrelationship among multiple primary tumors: A case report and review of literature","volume":"97","author":"Safi","year":"2018","journal-title":"Medicine"},{"key":"ref_23","first-page":"307","article-title":"Malignant lymphomas involving the salivary glands","volume":"14","author":"Colby","year":"1979","journal-title":"Pathol. Annu."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/BF00430674","article-title":"Histologic subclassification of the cystadenolymphoma of the parotid gland: Analysis of 275 cases","volume":"388","author":"Seifert","year":"1980","journal-title":"Virchows Archiv A"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2948","DOI":"10.1002\/1097-0142(19821215)50:12<2948::AID-CNCR2820501240>3.0.CO;2-B","article-title":"Malignant lymphoma in a warthin\u2019s tumor report of a case","volume":"50","author":"Miller","year":"1982","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/path.1711460303","article-title":"Non-Hodgkin\u2019s lymphoma arising in adenolymphoma\u2014A report of two cases","volume":"146","author":"Banik","year":"1985","journal-title":"J. Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S0046-8177(85)80238-0","article-title":"Lymphoma arising in an adenolymphoma","volume":"16","author":"Hall","year":"1985","journal-title":"Hum. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/BF00705302","article-title":"Germinal center derived malignant lymphoma in cystadenolymphoma","volume":"408","author":"Griesser","year":"1986","journal-title":"Virchows Archiv A"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/0046-8177(90)90182-5","article-title":"Malignant lymphoma involving a Warthin\u2019s tumor: A case with immunophenotypic and gene rearrangement analysis","volume":"21","author":"Medeiros","year":"1990","journal-title":"Hum. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1177\/030089169007600212","article-title":"Follicular non Hodgkin\u2019s lymphoma in adenolymphoma: Report of a case","volume":"76","author":"Giardini","year":"1990","journal-title":"Tumori J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1177\/014556139307200408","article-title":"Warthin\u2019s tumor-associated neoplasms: Report of two cases and review of the literature","volume":"72","author":"Shikhani","year":"1993","journal-title":"Ear Nose Throat J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1309\/MJH0-RQGX-U128-VFC6","article-title":"Follicle center lymphoma and Warthin tumor involving the same anatomic site: Report of two cases and review of the literature","volume":"113","author":"Park","year":"2000","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"59","DOI":"10.25100\/cm.v47i1.1842","article-title":"Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma","volume":"47","author":"Romero","year":"2016","journal-title":"Colomb. M\u00e9d."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1007\/s12105-019-01045-x","article-title":"Follicular lymphoma diagnosed in warthin tumor: A case report and review of the literature","volume":"14","author":"Alnoor","year":"2020","journal-title":"Head Neck Pathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1007\/s12105-020-01161-z","article-title":"Prevalence of lymphoid neoplasia in a retrospective analysis of Warthin tumor: A single institution experience","volume":"14","author":"Alnoor","year":"2020","journal-title":"Head Neck Pathol."},{"key":"ref_36","first-page":"345","article-title":"Warthin\u2019s tumor with Sjogren\u2019s syndrome and non-Hodgkin\u2019s lymphoma","volume":"58","author":"Reiner","year":"1979","journal-title":"Ear Nose Throat J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1620\/tjem.212.199","article-title":"Malignant lymphoma arising from heterotopic Warthin\u2019s tumor in the neck: Case report and review of the literature","volume":"212","author":"Gorai","year":"2007","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"579","DOI":"10.4132\/KoreanJPathol.2013.47.6.579","article-title":"Diffuse large B-cell lymphoma arising in Warthin\u2019s tumor: Case study and review of the literature","volume":"47","year":"2013","journal-title":"Korean J. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/pin.12325","article-title":"EBV-positive diffuse large B-cell lymphoma of the elderly involving Warthin tumor","volume":"65","author":"Chu","year":"2015","journal-title":"Pathol. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3895","DOI":"10.12998\/wjcc.v7.i22.3895","article-title":"Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin\u2019s tumor of the parotid gland-immunophenotypic and genetic features: A case report","volume":"7","author":"Wang","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_41","first-page":"e36802","article-title":"Warthin\u2019s Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature","volume":"15","author":"Martinez","year":"2023","journal-title":"Cureus"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/ajcp\/91.3.341","article-title":"Warthin\u2019s tumor with malignant lymphoma: DNA analysis of paraffin-embedded tissue","volume":"91","author":"Bunker","year":"1989","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1136\/jcp.2004.019760","article-title":"Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour","volume":"58","author":"Saxena","year":"2005","journal-title":"J. Clin. Pathol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/1066896917734371","article-title":"Presentation of chronic lymphocytic leukemia\/small lymphocytic lymphoma in a Warthin tumor: Case report and literature review","volume":"26","author":"Jawad","year":"2018","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s13000-015-0444-4","article-title":"An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor","volume":"10","author":"Arcega","year":"2015","journal-title":"Diagn. Pathol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/00016480310015263","article-title":"MALT-type lymphoma and Warthin\u2019s tumour presenting in the same parotid gland","volume":"124","author":"Marioni","year":"2004","journal-title":"Acta Oto-Laryngol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1365-2559.2005.02079.x","article-title":"Nodal peripheral T-cell lymphoma associated with Warthin\u2019s tumour","volume":"47","author":"Pescarmona","year":"2005","journal-title":"Histopathology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s12185-009-0271-z","article-title":"T cell lymphoblastic lymphoma in parotidectomy for Warthin\u2019s tumor: Case report and review of the literature","volume":"89","author":"Giaslakiotis","year":"2009","journal-title":"Int. J. Hematol."},{"key":"ref_49","first-page":"4167","article-title":"Terminal deoxynucleotidyl transferase negative T-cell lymphoblastic lymphoma from heterotopic Warthin\u2019s tumor in cervical lymph nodes: A case report and review of literature","volume":"12","author":"Pan","year":"2019","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1007\/s00405-018-5092-3","article-title":"Increased incidence of Warthin tumours of the parotid gland: A 42-year evaluation","volume":"275","author":"Franzen","year":"2018","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1288\/00005537-197706000-00001","article-title":"Tumors of the major salivary glands","volume":"87","author":"Skolnik","year":"1977","journal-title":"Laryngoscope"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1007\/s12070-020-01981-z","article-title":"Parotid Gland Tumors: A Multicenter Analysis of 1020 Cases. Increasing Incidence of Warthin\u2019s Tumor","volume":"74","author":"Saravakos","year":"2022","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_53","first-page":"110","article-title":"Malignant papillary cystadenoma lymphomatosum","volume":"69","author":"Ruebner","year":"1960","journal-title":"Arch. PathoJ."},{"key":"ref_54","first-page":"41","article-title":"Pathogenesis of Warthin\u2019s tumors","volume":"8","author":"Kuzenko","year":"2016","journal-title":"Interv. Med. Appl. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1007\/s00405-019-05493-7","article-title":"The growth rate and the positive prediction of needle biopsy of clinically diagnosed Warthin\u2019s tumor","volume":"276","author":"Seok","year":"2019","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.oooo.2013.10.013","article-title":"Parotid lymphoma: A review of clinical presentation and management","volume":"118","author":"Shum","year":"2014","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/lary.24837","article-title":"Evolution and changing trends in surgery for benign parotid tumors","volume":"125","author":"Mantsopoulos","year":"2015","journal-title":"Laryngoscope"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/12\/2086\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:55:50Z","timestamp":1760115350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/12\/2086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,19]]},"references-count":57,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["medicina60122086"],"URL":"https:\/\/doi.org\/10.3390\/medicina60122086","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,12,19]]}}}