Ultrasonographic Identification of the Parotid Cystadenolymphoma (Warthin’s Tumor) by Oral and Maxillofacial Surgeons: Supplement to the Matsuda and Colleagues’ Classification

Abstract

Warthin’s tumor (WT), which is also known as papillary cystadenoma lymphomatosum, monomorphic parotid adenoma, adenolymphoma, cystadenolymphoma, and branchiogenic adenoma, is to be differentiated (in surgical practice) from other parotid masses. The purposes of our retrospective case series study are: (1) to describe ultrasound morphology (sonomorphology) of the WT in patients referred to our hospital, (2) based on the presented cases to propose a supplement to the Matsuda and colleagues’ classification (2017) of anechoic area patterns of the WT, and (3) to expand the knowledge of oral and maxillofacial surgeons for the preoperative ultrasonographic verification of the WT and for choosing the most appropriate surgical technique. Over three years, 5 patients (mean age, 65.4 years) with parotid WT had been examined with gray-scale, color, and power Doppler ultrasonography. Cystic components are visualized in all five WT cases but in different proportions. Case 1 and 4 showed the presence of septations. According to Matsuda and colleagues’ (2017) classification of anechoic area patterns, in our cases the US patterns of the WTs belong only to Group 3 (i.e., with large anechoic areas) (n = 4) and Group 4 (multiple and sponge-like anechoic areas) (n = 1). Moreover, based on the presented five cases, we offer an addition to the classification of Japanese authors. In conclusion, our supplement to Matsuda and colleagues’ classification of anechoic area patterns of the WT can help surgeons around the globe to be more accurate in preoperative verification of cystadenolymphoma. This case series illustrate the growing importance of ultrasonography in the professional life of oral and maxillofacial and head and neck surgeons. Based on the cystic structure of this benign tumor and the ultrasound appearance presented in our case series, we propose to continue using the term “cystadenolymphoma” with a purpose to emphasize the tumor`s structure.