Synchronous bilateral parapharyngeal Warthin tumours without demonstrable parotid continuity: a case report and narrative literature review.

OBJECTIVE

Warthin tumour most often arises in the parotid gland. Parapharyngeal space (PPS) involvement is uncommon and usually represents extension from the deep lobe, although apparently separate extraparotid lesions have been described. We report synchronous bilateral prestyloid PPS Warthin tumours with no demonstrable radiological or intraoperative continuity with either parotid gland and review the relevant literature.

CASE PRESENTATION: A 59-year-old man undergoing staging for tongue squamous cell carcinoma (SCC) was found incidentally to have bilateral prestyloid PPS masses on contrast-enhanced computed tomography. Neither lesion was clinically apparent or symptomatic. Each was separated from the corresponding deep parotid lobe by a preserved circumferential fat plane. The patient underwent hemiglossectomy, selective neck dissection and transcervical excision of both PPS lesions during the same operation. Histopathological examination confirmed completely encapsulated Warthin tumours with adjacent benign serous salivary gland tissue and no residual lymph node architecture. The PPS tumours were synchronous but anatomically and histopathologically unrelated to the tongue SCC.

CONCLUSION

The distinctive feature of this case is the synchronous bilateral occurrence of PPS Warthin tumours with bilateral radiological and operative separation from the parotid glands. The findings are compatible with, but do not conclusively establish, origin from heterotopic salivary tissue. Recognition of this pattern may improve the assessment of prestyloid PPS masses and facilitate surgical planning.