RECURRENT WARTHIN TUMOR PRESENTING WITH SYNCHRONOUS, BILATERAL PAROTID AND MULTI-CENTRIC UPPER NECK INVOLVEMENT.

Background: Warthin tumor is the second most common benign salivary tumor. This case highlights a patient who underwent local excision of a solitary Warthin tumor from the peri-parotid area. He subsequently presented with recurrent, multi-centric disease with bilateral parotid and cervical lymph node involvement. Case Report: A 45 year old, tobacco-using male was referred for a right head and neck mass. Exam revealed a mobile, painless mass near the angle of the jaw. Nasofibroscopic exam revealed a non-obstructive nasopharyngeal mass. CT confirmed an ovoid mass inferior to the right parotid gland. Fine-needle aspiration (FNA) was non-diagnostic. Deep biopsies and local excision of the right neck mass were performed. Nasopharyngeal biopsies were negative; the neck mass was consistent with Warthin tumor. The patient returned approximately 4 years later with a right pre-auricular mass and right upper neck lymphadenopathy. Diagnostic work-up, including ultrasound-guided FNA, revealed bilateral parotid gland Warthin tumor. The patient was symptomatic from the right-sided disease and not the left. Consequently, he elected right parotidectomy and excision of the right upper neck lymph nodes and clinical follow-up of the left mass. Upon pathologic review, there was Warthin tumor present in the parotidectomy and right lymph node specimens.