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43 yo lady complaining of a nodule of the left parotid gland. The nodule increased in size steadily for the last 4 months. On physical examination the nodule was firm, fixed to the parotid gland. No other complaint reported, and the rest of the physical exam was negative.

A frozen section revealed an atypical lympho-epithelial lesion. Superficial parotidectomy performed.

                         

        

At low power, a mixed pattern of lymphoid proliferation and epithelial clustering is noted. More obvious on higher magnification.

              

 Giemsa stain view.   Another area of the same lesion with higher magnifications.

Mixture of lymphoid cells, varying in size, with high mitotic activity.

    

Intrication of the lymphoid infiltrate and the epithelial clusters. Higher power on the lymphoid component, Giemsa stain.                                                             

   

Serologic workout for systemic diseases was negative

 

Immunohistochemistry            

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Cytokeratin, Lympho-epithelial lesions, and monocytoid lymphoid infiltrate.

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The first area observed on HE, after IHC for T marker (CD3) disclosing clear areas.

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The second area observed on HE, CD3.

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The large cells express mainly the B cell marker (CD20),with a high proliferative rate, Ki67 (MIB1)

 

Sections from the surrounding parotid tissue

 

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Chronic inflammatory changes. Mainly lymphoid infiltrate with follicles and glandular atrophy .

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PAS stain. Area of heavier lymphoid infiltrate. Epimyoepithelial islands featuring a myoepithelial sialadenitis. High power on previous fields with a cytokeratin marker disclosing the epithelial component in the myoepithelial island.

 

Diagnosis:

MALT-Lymphoma of the parotid gland with large B-cell component consistent a higher grade transformation.

Appropriate evaluation of other MALT sites is recommended (see references, 0)

No clinical findings favored a Mikulicz disease or Sjgren's syndrome. Sections disclose chronic parotidis and myoepithelial sialadenitis in the surrounding parotid tissue. No helicobacter was found in the ducts or acini.