Neck masses secondary to heterotopic salivary gland tissue: a 25-year experience.

Objectives: The aim of this study is to review salivary tumors arising from heterotopic salivary inclusions in the periparotid and cervical lymph nodal tissues over a 25-year span.

Methods: A retrospective chart review revealed 24 patients with asymptomatic neck masses treated between 1976 and 2001, whose pathology demonstrated heterotopic salivary tissue or neoplasms arising from heterotopic salivary tissue.

Results: Nine cases were benign periparotid lymph nodes with heterotopic salivary inclusions, 3 of which had multimodal involvement. Fifteen cases of heterotopic salivary tumors were identified. The benign tumors were predominantly Warthin's tumor (8) with 1 pleomorphic adenoma. Malignant tumors included mucoepidermoid (3), acinic cell (2), and adenocarcinoma (1). Patients were treated by a superficial parotidectomy, neck dissection, or simple excision depending on site and preoperative workup. Adjuvant radiation therapy was included for high-grade malignancies. Among the 15 tumor patients, follow-up ranged from 1 month to 17 years. Nine patients are alive and disease-free, 5 are deceased, and 1 was lost to follow-up.

Conclusions: Heterotopic salivary tissue in periparotid and upper cervical nodes is a more common occurrence than historically recognized. Tumorigenic changes arise from heterotopic nodal inclusions, and although infrequent, should be considered in the differential diagnosis for isolated neck/periparotid masses and parotid Warthin's tumor. Suggested management, after a thorough clinical exam/needle aspiration biopsy, includes an imaging survey of the parotid gland and neck lymphatics with an appropriate resection to include a simple excision, parotidectomy, neck dissection, and/or irradiation as indicated. Isolated low-grade malignant lesions/benign lesions are adequately managed by excision or parotidectomy alone. High-grade malignant lesions require more extended surgery with possible irradiation.