title: An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor.
abstract: BACKGROUND
  Warthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature. Herein, we report an unusual initial presentation of a mantle cell lymphoma involving the lymphoid stroma of a Warthin tumor.
  
  
  METHODS
  A seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case also brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor.
authors.affiliation: Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA. rarcega@mednet.ucla.edu.
authors.forename: Ramir S
authors.initials: RS
authors.lastname: Arcega
authors.affiliation: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA. AFeinstein@mednet.ucla.edu.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Feinstein
authors.affiliation: Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA. sbhuta@mednet.ucla.edu.
authors.forename: Sunita
authors.initials: S
authors.lastname: Bhuta
authors.affiliation: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, USA. KBlackwell@mednet.ucla.edu.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Blackwell
authors.affiliation: Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA. NRao@mednet.ucla.edu.
authors.forename: Nagesh P
authors.initials: NP
authors.lastname: Rao
authors.affiliation: Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, UCLA Path & Lab Med, AL-134 CHS, BOX 951732, Los Angeles, CA, 90095-1732, USA. SPullarkat@mednet.ucla.edu.
authors.forename: Sheeja T
authors.initials: ST
authors.lastname: Pullarkat
mesh_terms: D000235:Adenolymphoma / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D010307:Parotid Neoplasms / Q000175:diagnosis / Q000473:pathology*; D014057:Tomography, X-Ray Computed