Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges

Ali Mızrak

doi:10.18614/dehm.1723469

Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges

Abstract

Multiple synchronous tumors can be observed in the parotid gland, either unilaterally or bilaterally. When tumors of two distinct histological types occur together, they may present as collision tumors and can appear radiologically and clinically as a single mass. These cases often present challenges in preoperative diagnosis, both radiologically and cytologically. A 46-year-old male patient presented to the Ear, Nose, and Throat (ENT) department with swelling in the neck. Ultrasonographic examination revealed a cystic neoplasm measuring 32 × 30 mm in diameter in the parotid gland. Fine needle aspiration (FNA) cytology reported "Neoplasm - Benign, Warthin tumor" and the patient underwent superficial parotidectomy. The final pathological diagnosis was mucoepidermoid carcinoma with an adjacent Warthin tumor. The preoperative diagnosis of parotid masses containing tumors of two different histological types can be challenging. Careful consideration is necessary to avoid misdiagnosis, particularly in cases of collision tumors, where the presentation may mimic a single neoplasm.

Keywords

Supporting Institution

None

Ethical Statement

According to institutional and national guidelines, ethical approval was not necessary for this case report/study

References

1. Yu GY, Ma DQ, Zhang Y, Peng X, Cai ZG, Gao Y, Chen Y. Multiple primary tumours of the parotid gland. Int J Oral Maxillofac Surg. 2004 Sep;33(6):531-4. .
2. Park KS, Jang HB, Lee DH, Lee JK, Lim SC. Multiple synchronous neoplasms in the ipsilateral parotid gland: case series. Ann Palliat Med. 2022 Aug;11(8):2641-2645.
3. Ochal-Choińska A, Bruzgielewicz A, Osuch-Wójcikiewicz E. Synchronous multiple unilateral parotid gland tumors of benign and malignant histological types: case report and literature review. Braz J Otorhinolaryngol. 2019 May-Jun;85(3):388-392.
4. Xu W, Lu H, Zhu Y, Ruan M, Zhang C, Yang W, Liu S. Warthin's tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population. Int J Oral Maxillofac Surg. 2018 Jul;47(7):913-917.
5. Sayar H, Öztarakçi H, Sayar Ç, Ağirbaş Ş. Adenocarcinoma arising in warthin tumor of the parotid gland. Turk Patoloji Derg. 2012;28(3):278-81.
6. Bulut AŞ, Albayrak A, Kulaçoğlu S. Synchronous salivary duct carcinoma and Warthin's tumour in the same parotid gland: Cytological features and differential diagnosis. Cytopathology. 2019 Sep;30(5):545-548.
7. Kaur J, Mannan R, Duggal P, Bhasin TS, Manjari M. Fine needle aspiration diagnosis of ipsilateral synchronous neoplasm - mucoepidermoid carcinoma with warthin tumor in parotid gland. Gulf J Oncolog. 2012 Jan;(11):75-8. PMID: 22227551.
8. Srivastava S, Nadelman C. Synchronous ipsilateral Warthin tumor encased by a separate mucoepidermoid carcinoma of the parotid gland: a case report and review of the literature. Diagn Cytopathol. 2010 Jul;38(7):533-7.

9. Williamson JD, Simmons BH, el-Naggar A, Medeiros LJ. Mucoepidermoid carcinoma involving Warthin tumor. A report of five cases and review of the literature. Am J Clin Pathol. 2000 Oct;114(4):564-70.
10. Zhang D, Liao X, Tang Y, Meyer RG, VAN Dyke DL, Liu X, Islam MN, Lai J. Warthin-like mucoepidermoid carcinoma of the parotid gland: Unusual morphology and diagnostic pitfalls. Anticancer Res. 2019 Jun;39(6):3213-3217.
11. Basak K, Mericoz CA, Firat P. Warthin-like mucoepidermoid carcinoma: A morphological spectrum - a report of 3 cases with histological and cytological findings and review of the literature. Acta Cytol. 2022;66(3):244-252.
12. Hang JF, Shum CH, Ali SZ, Bishop JA. Cytological features of the Warthin-like variant of salivary mucoepidermoid carcinoma. Diagn Cytopathol. 2017 Dec;45(12):1132-1136.
13. Salehi S, Maleki Z. Diagnostic challenges and problem cases in salivary gland cytology: A 20-year experience. Cancer Cytopathol. 2018 Feb;126(2):101-111.
14. Torous VF, Faquin WC. The Milan System classification of Warthin tumor: A large institutional study of 124 cases highlighting cytologic features that limit definitive interpretation. Cancer Cytopathol. 2022 Sep;130(9):714-725.
15. Saxena A, Memauri B, Hasegawa W. Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour. J Clin Pathol. 2005 Mar;58(3):331-3
16. Di Napoli A, Mallel G, Bartolazzi A, Cavalieri E, Becelli R, Cippitelli C, Ruco L. Nodular lymphocyte-predominant hodgkin lymphoma in a Warthin tumor of the parotid gland: A case report and literature review. Int J Surg Pathol. 2015 Aug;23(5):419-23.

Details

Primary Language

English

Subjects

Pathology

Journal Section

Case Report

Authors

Ali Mızrak ^*
0000-0002-1096-1660
Türkiye

Publication Date

October 26, 2026

Submission Date

June 20, 2025

Acceptance Date

August 19, 2026

Published in Issue

Year 2026 Volume: 40 Number: 4

DOI

https://doi.org/10.18614/dehm.1723469

IZ

https://izlik.org/JA88JS56NH

Cite

RIS / Bibtex

APA

Mızrak, A. (2026). Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges. Developments and Experiments in Health and Medicine, 40(4), 542-548. https://doi.org/10.18614/dehm.1723469

AMA

1.Mızrak A. Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges. Dev Exp Health Med. 2026;40(4):542-548. doi:10.18614/dehm.1723469

Chicago

Mızrak, Ali. 2026. “Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges”. Developments and Experiments in Health and Medicine 40 (4): 542-48. https://doi.org/10.18614/dehm.1723469.

EndNote

Mızrak A (October 1, 2026) Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges. Developments and Experiments in Health and Medicine 40 4 542–548.

IEEE

[1]A. Mızrak, “Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges”, Dev Exp Health Med, vol. 40, no. 4, pp. 542–548, Oct. 2026, doi: 10.18614/dehm.1723469.

ISNAD

Mızrak, Ali. “Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges”. Developments and Experiments in Health and Medicine 40/4 (October 1, 2026): 542-548. https://doi.org/10.18614/dehm.1723469.

JAMA

1.Mızrak A. Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges. Dev Exp Health Med. 2026;40:542–548.

MLA

Mızrak, Ali. “Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges”. Developments and Experiments in Health and Medicine, vol. 40, no. 4, Oct. 2026, pp. 542-8, doi:10.18614/dehm.1723469.

Vancouver

1.Ali Mızrak. Synchronous Warthin Tumor and Mucoepidermoid Carcinoma: A Case Report and Cytological Challenges. Dev Exp Health Med. 2026 Oct. 1;40(4):542-8. doi:10.18614/dehm.1723469