Warthin tumor in a patient with a long-term smoking history: a clinical case report

Relevance. The diagnosis of salivary gland neoplasms remains one of the most challenging problems in oral and maxillofacial surgery because of the marked histological diversity of these tumors and the lack of pathognomonic clinical features at early stages. This issue is further aggravated by the increasing incidence of salivary gland tumors. Among benign salivary gland neoplasms, Warthin tumor (adenolymphoma) consistently ranks second in frequency. The present clinical case highlights long-term tobacco smoking as an important modifiable risk factor for the development of this tumor.

Description of a clinical case. A 57-year-old man presented with a slowly enlarging mass on the right lateral aspect of the neck, which he had first noticed approximately three years earlier. His medical history was notable for long-term tobacco smoking for more than 20 years, with a consumption of one pack of cigarettes per day. Physical examination revealed a painless, firm-elastic mass measuring approximately 4 × 3 × 6 cm and mobile relative to the surrounding tissues. Comprehensive evaluation, including neck ultrasonography and contrast-enhanced magnetic resonance imaging, identified a well-circumscribed lesion closely adjacent to the inferior pole of the parotid gland. The diagnosis was established by core needle biopsy. Histological examination of the biopsy specimen revealed cystadenoma with characteristic lymphoid stroma. The patient underwent radical surgical excision of the tumor. The postoperative course was uneventful, and the wound healed by primary intention. Gross examination demonstrated a cystic tumor enclosed by a fibrous capsule. Microscopic examination showed that the cystic cavity was lined by bilayered oncocytic epithelium forming branching papillary projections into the cyst lumen. Dense lymphoid infiltrates with well-formed germinal centers were identified within the fibrous wall of the tumor. Final histopathological examination of the surgical specimen confirmed the diagnosis of Warthin tumor. The histological findings were consistent with the classic microscopic features of Warthin tumor.

Conclusion. This clinical case illustrates the classic presentation and clinical course of Warthin tumor. It underscores the importance of a comprehensive diagnostic approach integrating modern imaging modalities with mandatory morphologic verification, which remains the gold standard for confirming such lesions. The case also highlights the well-established association between long-term tobacco smoking and the development of this tumor, emphasizing the need for thorough history taking and active patient counseling on smoking cessation for both primary prevention and reduction of recurrence risk.

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