0:01

This is a case of a patient who had a

0:04

Warthin's tumor on the left side.

0:07

As you can see in the center image

0:09

with the T1-weighted sequence,

0:11

you have a mass that is in close approximation to

0:15

the parotid gland which was aspirated

0:18

as Warthin's tumor.

0:20

We are at the angle of the mandible here and

0:25

we see the mass as a well-defined lesion.

0:27

If we look on the T2-weighted scan,

0:30

we see it has some of that characteristic

0:32

heterogeneity of bright signal intensity,

0:34

as well as lower signal intensity within it.

0:38

What's interesting in this case is that on the

0:41

contralateral side, you see a similar lesion

0:46

which is just on the edge of the posterior

0:49

border of the parotid gland.

0:51

And we see this as this heterogeneous lesion

0:55

on the T2-weighted scan as well.

0:58

In this case,

0:59

what I would recommend you do is look in multiple

1:01

planes of imaging to ensure that this is indeed an

1:06

intrinsic parotid mass as opposed

1:09

to an extraparotid lesion.

1:11

So when we look on the sagittal scan,

1:15

what we're looking for is the border

1:17

of the mass with the lesion.

1:20

And I think I'm going to have to

1:22

get my cross-referencing out,

1:23

which I think is...

1:26

On the coronal post-gadolinium enhanced scan,

1:29

you can see that this mass is intimately associated

1:33

with the parotid gland on the left side. And on the

1:37

right side is closely opposed again to the

1:41

parotid tissue. Here's the lesion,

1:43

here's the normal parotid tissue.

1:46

Well,

1:46

the interesting phenomenon here is that Warthin's

1:49

tumors are one of the tumors that may be found in

1:54

extraparotid lymph nodes outside the

1:58

parotid gland themselves. Now,

1:59

the vast majority occur within the parotid gland,

2:03

but you may see Warthin's tissue within adjacent

2:07

periparotid lymph nodes. That might be separate from

2:11

an intrinsic parotid Warthin's tumor and be a

2:15

separate phenomenon, or it can occur in conjunction

2:18

with an intraparotid Warthin's tumor.

2:21

So in addition to having multiplicity

2:23

within the parotid gland,

2:25

you may have multiplicity of lesions both within

2:28

the parotid gland and outside the parotid gland.

2:33

I want to refer you also again to the ADC values

2:37

here, which are low in signal intensity,

2:40

therefore lower numbers.

2:42

Again, potentially overlapping with the malignancies

2:47

of the parotid gland.