Author(s)
Ryan C. Borek, MD
Adam C. Kaufman, MD
Laurie A. Loevner, MD
Michael D. Feldman, MD
Bert W. O'Malley, MD
Christopher H. Rassekh, MD
Affiliation(s)
University of Pennsylvania
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the diagnostic dilemma and further workup of a PET positive parotid mass in a patient with known head and neck cancer. Objectives: Warthin's tumors have high affinity for FDG mimicking malignancy. This can result in a false positive diagnosis of parotid or neck cancer, which can be particularly confusing in smokers with known squamous cell carcinoma of the upper aerodigestive tract. Further workup including fine needle aspiration and/or technecium-99 scintigraphy is reliable for clarifying the diagnosis. We present a case of an exceptional patient with carcinoma of the tongue and bilateral cervical metastasis who also had a positive FNA in a contralateral parotid mass. Study Design: Case report. Methods: A 62 year old male smoker presented with a p16+ ventral tongue carcinoma and clinically positive ipsilateral cervical metastases. Contralateral nodal metastasis and parotid mass were identified on PET/CT scan. FNA of the parotid was interpreted as carcinoma. Results: The patient underwent a hemiglossectomy and neck dissection. The parotid mass appeared to be oval shaped and well encapsulated. A local excision of the mass was performed and frozen section pathology confirmed Warthin's tumor. Conclusions: Warthin's tumors with PET/CT positivity can present a diagnostic dilemma in patients with known head/neck malignancy. This unusual case of additional false positive FNA was potentially even more confusing but was managed conservatively. A false positive needle biopsy was suspected and parotidectomy was avoided in this setting. Understanding this presentation can minimize morbidity of a benign disease and not delay treatment of a malignant condition.