Concurrent Presence of Sjogren's Syndrome, Warthin Tumor, and MALT Lymphoma in a Parotid Gland and Hashimoto's Thyroiditis

Kim Ho-Su; Ryeal Hahm Jong; Sik Jung Tae; Kyoung Kim Soo; Kim Sungsu; Young Kim Kyong; Hwa Jung Jung

doi:10.11106/jkta.2013.6.2.126

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Ho-Su, Jong, Tae, Soo, Sungsu, Kyong, and Jung: Concurrent Presence of Sjogren's Syndrome, Warthin Tumor, and MALT Lymphoma in a Parotid Gland and Hashimoto's Thyroiditis

Original Article

J Korean Thyroid Assoc 2013;6(2):126-130.

Published online: 3 May 2013

DOI: https://doi.org/10.11106/jkta.2013.6.2.126

Concurrent Presence of Sjogren's Syndrome, Warthin Tumor, and MALT Lymphoma in a Parotid Gland and Hashimoto's Thyroiditis

Kim Ho-Su, Ryeal Hahm Jong, Sik Jung Tae, Kyoung Kim Soo, Kim Sungsu, Young Kim Kyong, Hwa Jung Jung

¹Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

²Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea

Address reprint requests to Jung Hwa Jung, MD, Department of Internal Medicine, Gyeongsang National University School of Medicine, 90 Chilam-dong, Jinju 660-702, Korea Tel: 82-55-750-8060, Fax: 82-55-758-9122, E-mail: jhring@daum.net

Received 6 March 2013 Accepted 5 August 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 54-year-old female patient was referred due to a mass in the left salivary gland. A neck CT was performed and surgery was agreed due to a suspected Warthin tumor. The patient was also diagnosed with Sjogren's syndrome and Hashimoto's thyroiditis and treated. Warthin tumor and extranodal marginal zone B-cell lymphoma were also diagnosed after parotidectomy. The coexistence of the two autoimmune diseases, Hashimoto's thyroiditis and Sjogren's syndrome, has been reported, as has the coexistence of Warthin tumor and malignant tumor within a single salivary gland. However, these four diseases have not previously been reported in an individual patient. The authors treated a patient who was first diagnosed with Sjogren's syndrome and Hashimoto's thyroiditis, and subsequently also with Warthin tumor and extranodal marginal zone B-cell lymphoma after superficial parotidectomy. Therefore, this case is reported together with a related literature review.

Keywords: Hashimoto's thyroiditis, Sjogren's syndrome, Warthin tumor, MALT lymphoma

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Fig. 1.

Neck CT scan shows multiple masses with internal cystic changes and focal calcification in both parotid glands.

Fig. 2.

Microscopic findings. (A, B) Warthin tumor. The tumor is composed of a mixture of ductal epithelium and a lymphoid stroma (H&E stain, X40, X100). (C, D) MALT lymphoma. (C) Histological examination of surgical specimens shows diffuse proliferation of atypical small lymphocytes in the mucosa and submucosal layer (H&E stain, X40). (D) Infiltrative lymphocytes are seen within the glandular epithelium (lymphoepithelial lesion) and the gland structures are disrupted in a high power filed (H&E stain, X200).

Fig. 3.

(A) Coronal PET image shows a focal hot lesion on a right neck level II node and an incidental finding of thyroiditis. (B, C) Transaxial PET and fused PET/CT images show a hypermetabolic lesion on right parotid area (SUVmax=5.94).

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