Warthin ’s tumor mimicking metastasis from lung cancer

A 63-year-old man was referred to us for evaluation of an asymptomatic mass in the left lower lung. Three weeks earlier, he had inadvertently found a painless swelling on his left neck, for which he had been recommended to have a physical screening, and during which the lung mass had been detected. He was a heavy smoker without any significant medical history. Physical examination was unremarkable other than a well-circumscribed lymph node measuring 2.1 cm  × 1.4 cm in the upper left neck. Positron emission tomography/computed tomography (PET/CT) demonstrated 18F-fluorodeoxyglucose (FDG) significant uptake in the mass (SUVmax11.7) and the upper cervical lymph node (SUVmax7.8), suggesting a possibility of lung cancer with metastasis (Figure  1). Considering that disseminated neoplasms have the characteristic pattern of multiple foci of FDG accumulation, we decide to further investigate the cervical lymphadenopathy. However, ultrasound-guided fine-needle aspiration cytology of the node turned out to be a Warthin ’s tumor, ruling out the possibility that the mass had metastasized to the left cervical lymph node and changing the diagnosis of the tumor from Stage IIIb to Stage Ib. Subsequently, he underwent left lower lobectomy, and pathological examination was consistent with squamous cell carcinoma, with n o nodal involvement. One year later, the patient remains well, with no evidence of recurrence, and the Warthin’s tumor is unchanged.
Source: QJM - Category: Internal Medicine Source Type: research