Technetium-99m pertechnetate salivary gland imaging: its role in the diagnosis of Warthin's tumor.

A 74-yr-oldmalecomplainedof painlessswellingin the right parotid area which started several months ago. There was no associated numbness in the area, and he denied facialweakness. Essentially, the masswas asymptomatic. His past medical history wasunremarkable andhehadnopriorsurgery. Hewasnotonany medications. He denied allergies. He had smoked tobacco, two packs a day for 55 yr and quit 6 yr prior to the current medical problem.He didnotdrinkalcohol. Physicalexaminationrevealeda well developedman in no acute distress. He had no head and neck abnormalities except for a right-sided 2 x 3-cm parotid mass. A fine needle aspiration was performedduring the initial visit. An MRI scanrevealeda largerightparotidmass,measuring 3 cminitsgreatest dimensionwithintheinferioraspect ofthegland. Two otherincidentalfindingswere alsonoted.The firstwas a rightcerebellopontine angletumor,andthesecondwastwo en hancinglesionswithinthecerebellum, bothsuspicious for meta static disease. Fine needle aspiration cytology of the parotid mass revealednormalparotidaciniandafewoncocytic ellsassociated with numerouslymphoid cells, consistentwith Warthin's tumor. No evidenceof malignancywas found.Becauseof the incidental detectionof massesin the head, it was decidedto initiatea workupto locatea primarytumor. In addition,a radionuclide scan to assess the nature of the parotid mass and to confirm its benign nature was also scheduled. A radionuclidescanof the parotidglandwas performedfollow ing the intravenousadministrationof [@Tc]pertechnetate (Fig. 1). A SPEC!' scan of the head was also obtainedas part of this examination.The imagerevealedan areaof increasedfocal up takeintherightparotidgland,consistent withthepatient'sknown Warthin's tumor. No posterior fossa uptakewas noted. A chest x-rayrevealeda rightupperlobemass,suggesting carcinomaof thelungandchronicobstructivepulmonarydisease. At thispoint, thepatientwasreferredfor definitivetherapyfor metastatic ar