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. 2018 Mar 28;61(1):33-39.
doi: 10.33160/yam.2018.03.005. eCollection 2018 Mar.

Vanishing Parotid Tumors on MR Imaging

Eiji Matsusue  1 , Yoshio Fujihara  1 , Eiken Matsuda  2 , Yusuke Tokuyasu  3 , Shu Nakamoto  3 , Kazuhiko Nakamura  1 , Toshihide Ogawa  4
Affiliations

Vanishing Parotid Tumors on MR Imaging

Eiji Matsusue et al. Yonago Acta Med. .

Abstract

Background: Of all parotid gland tumors, only oncocytoma has been reported to appear isointense to the parotid gland, namely vanishing, on fat-saturated T2 and T1 postcontrast gadolinium-enhanced magnetic resonance imaging (MRI). The purpose of this study was to evaluate vanishing of parotid tumors on conventional MRI with and/or without postcontrast gadolinium-enhancement and on diffusion weighted imaging (DWI).

Methods: In 8 of 51 patients, ten parotid gland tumors had homogeneously enhanced lesions and were retrospectively analysed. Comparisons of signal intensity between those parotid tumors and parotid glands and evaluations of vanishing were performed on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fat-suppressed T2WI (FS-T2WI), postcontrast gadolinium-enhanced T1WI (CE-T1WI) and fat-suppressed CE-T1WI (FS-CE-T1WI), DWI as well as apparent diffusion coefficient (ADC).

Results: Ten parotid gland tumors consisted of five Warthin tumors, two pleomorphic adenomas, two parotid carcinomas (small cell carcinoma and adenoid cystic carcinoma) and one oncocytoma. All tumors showed hypointensity on T1WI and hyperintensity on DWI. Nine of ten tumors showed vanishing on the other MR sequences. All Warthin tumors showed vanishing on FS-T2WI, FS-CE-T1WI and the ADC map. One oncocytoma showed vanishing on FS-T2WI and the ADC map and hyperintensity on FS-CE-T1WI. All pleomorphic adenomas showed vanishing on T2WI and CE-T1WI. One adenoid cystic carcinoma showed vanishing only on CE-T1WI.

Conclusion: Vanishing of parotid tumors can be observed not only on FS-T2WI and FS-CE-T1WI but also on T2WI, CE-T1WI and ADC mapping.

Keywords: Warthin tumor; magnetic resonance imaging; oncocytoma; parotid tumor; vanishing.

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Figures

Fig. 1.
Fig. 1.
Warthin tumor of the right parotid gland in a 56-year-old man (case 3). A: T1WI shows a well-defined hypointense mass in the right parotid gland. B: FS-T2WI shows the mass is isointense (arrow) compared to the parotid gland. C: FS-CE-T1WI shows the mass is isointense (arrow) compared to the parotid gland. D: ADC mapping shows the mass is isointense (arrow) compared to the parotid gland. The ADC value of the mass was 0.84 × 10-3 mm2/sec. E: High-power view showing proliferation of the glandular epithelium with oncocytic cytoplasm (left) and lymphoid stroma (right) (hematoxylin-eosin, scale bar = 25 μm). ADC, apparent diffusion coefficient; FS-CE-T1WI, fat-suppressed postcontrast gadolinium-enhanced T1-weighted imaging; FS-T2WI, fat-suppressed T2-weighted imaging; T1WI, T1-weighted imaging.
Fig. 2.
Fig. 2.
Oncocytoma of the right parotid gland in a 75-year-old woman (case 4). A: T1WI shows a well-defined hypointense mass in the right parotid gland. B: FS-T2WI shows the mass is isointense (arrow) compared to the parotid gland. C: FS-CE-T1WI shows the mass is hyperintense compared to the parotid gland. D: ADC mapping shows the mass is isointense (arrow) compared to the parotid gland. The ADC value of the mass was 1.09 × 10-3 mm2/sec. E: High-power view showing oncocytic cells with granular and abundant cytoplasm and thin fibrovascular stroma (hematoxylin-eosin, scale bar = 25 μm). ADC, apparent diffusion coefficient; FS-CE-T1WI, fat-suppressed postcontrast gadolinium-enhanced T1-weighted imaging; FS-T2WI, fat-suppressed T2-weighted imaging; T1WI, T1-weighted imaging.
Fig. 3.
Fig. 3.
Pleomorphic adenoma of the right parotid gland in a 42-year-old man (case 6). A: T1WI shows a well-defined hypointense mass in the right parotid gland. B: T2WI shows the mass is isointense (arrow) compared to the parotid gland. C: CE-T1WI shows the mass is isointense (arrow) compared to the parotid gland. D: FS-T2WI shows the mass is hyperintense compared to the parotid gland. E: High-power view showing the epithelial component forming sheets (lower left) and a mesenchymal myxoid component (upper right) (hematoxylin-eosin, scale bar = 25 μm). ADC, apparent diffusion coefficient; FS-CE-T1WI, fat-suppressed postcontrast gadolinium-enhanced T1-weighted imaging; FS-T2WI, fat-suppressed T2-weighted imaging; T1WI, T1-weighted imaging.
Fig. 4.
Fig. 4.
Adenoid cystic carcinoma of the right parotid gland in a 61-year-old woman (Case 8). A: T1WI shows a well-defined hypointense mass in the right parotid gland. B: T2WI shows the mass is hypointense compared to the parotid gland. C: CE-T1WI shows the mass is isointense (arrow) compared to the parotid gland. D: FS-T2WI shows the mass is hyperintense compared to the parotid gland. E: High-power view showing nests of biphasic cells with cylindromatous microcystic spaces filled with hyaline or mucoid material (hematoxylin-eosin, scale bar = 25 μm). ADC, Apparent diffusion coefficient; FS-CE-T1WI, fat-suppressed postcontrast gadolinium-enhanced T1-weighted imaging; FS-T2WI, fat-suppressed T2-weighted imaging; T1WI, T1-weighted imaging.
See this image and copyright information in PMC

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