Concluded Case

A 11 year old boy presented with a soft, nontender, gradually increasing, irregular and both nodular and somewhat cystic upon palpation, compressible, swelling involving the right parotid gland for the last 3 years of size 3.5 cm × 2.5 cm × 4.5 cm at the time of presentation with normal Stensen's duct and facial nerve function. What is the probable diagnosis and what are the differential diagnosis? what investigations you will like to order for? How do you manage the case?

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Concluded answer

It is a growth...Neoplastic..classically in the Paraotic=near the ear...for 3+ years..likely benign..parotid related ..originating from (Fibrous?lymphoid?vascular?or glandular). As already DrAshok Leel has made it easy by his opinion of Warthin Tumor) very likely. Which is well described entity.Condition may be of more lymhatic origion? Hence also called Adeno cystolymphomatosis. With other systemic symptoms it is more likely warthins unless it is disproved by Histopathology or other means.D/Ds are too many but more like theorotical. Compressibility is a feature of vascular (Hemangioma/lyphangioma)but does not rule out warthins.Lack of systemic problems Like dry eye/mouth/joint pains may be against autoimmune disorders like sjogrens Infectious and non infectious causes of lymphnode(TB,Catscratch D)anomalies like Hemangioma/cystic hygroma/are easily eliminated.Only serious contenders are Warthins ,remotely sjogrens..How many know Venus Williams had diagnosis of Sjogrens!!Anyway simple Ultrasound/FIne needle biopsy with or without MRI may prove diagnosis.Not the least our Friendly surgical opinion.

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It is a growth...Neoplastic..classically in the Paraotic=near the ear...for 3+ years..likely benign..parotid related ..originating from (Fibrous?lymphoid?vascular?or glandular). As already DrAshok Leel has made it easy by his opinion of Warthin Tumor) very likely. Which is well described entity.Condition may be of more lymhatic origion? Hence also called Adeno cystolymphomatosis. With other systemic symptoms it is more likely warthins unless it is disproved by Histopathology or other means.D/Ds are too many but more like theorotical. Compressibility is a feature of vascular (Hemangioma/lyphangioma)but does not rule out warthins.Lack of systemic problems Like dry eye/mouth/joint pains may be against autoimmune disorders like sjogrens Infectious and non infectious causes of lymphnode(TB,Catscratch D)anomalies like Hemangioma/cystic hygroma/are easily eliminated.Only serious contenders are Warthins ,remotely sjogrens..How many know Venus Williams had diagnosis of Sjogrens!!Anyway simple Ultrasound/FIne needle biopsy with or without MRI may prove diagnosis.Not the least our Friendly surgical opinion.

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Mixed parotid tumour. Adenolympoma. Extracapsular excision.

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Mixed parotid tumor d/dAdenolymphoma. Extracapsular excesion orcomplete parotidectomy

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DDs : Warthin’s Tumor.Branchial Cyst.*Vascular lesion (Hemangioma/Lymphangioma).*Lymphatic Cyst. Advised FNAC & Excision Bx.

Appears to be a salivary gland tumour arising from parotid.Adv FNAC.D/D Branchial cyst

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3 years a big duration... Best is to advise fnac... Possibilities are many but the best is to advise fnac, get the instant diagnosis and treat specifically

DD * Warthin's tumor * Brachial cyst. * Sialocoele CT Head and neck, FNAC , Surgical intervention as per diagnosis.

Thanks Dr Dommeti Durga prasad
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Dermoid cyst. Excisional biopsy. HPE.

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Warthin tumor . Usg of the swelling .

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DD Warthin s tumor Branchial cyst Sialocele Infected lymph node

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