Purpose: Painless parotid recurrent swelling of the salivary gland could be due to chronic obstructive sialadenitis as wellasa manifestation of Sjögren’s syndrome. Both are radiographically diagnosed using Sialo-Cone Beam Computed Tomography(CBCT). Sjögren’s syndrome has been closely associated with an increased risk of lymphoma, specifically Marginal Zone B-cell lymphoma, mostly arising in the parotid gland.
Material & Methods: A 75-year old woman was referred for sialo-CBCT due to recurrent unpainful swellings of the left parotid gland in the last 15 years which has recently become persistent.The patient medical background was significant for HTN, osteoporosis and hypercholesterolemia.Radiological findings were compatible with Sjögren’s syndrome with secondary chronic obstructive sialadenitis. Furthermore, a non-filling region, suspected of Space Occupying Lesion (SOL), was detected while reviewing the examination in a multiplanar reconstruction (MPR) mode. The region was provisionally diagnosed as extra-nodal lymphoma. Further evaluation included Magnetic Resonance Imaging (MRI), Fine Needle Aspiration Biopsy (FNAB) and Core Needle Biopsy (CNB).
Results: MRI findings were non-specific, FNAB showed many scattered lymphatic cells, plasma cells and few histiocytes which required further evaluation. CNB led to the final histological diagnosis of Marginal Zone B cell lymphoma. The patient was referred to an oncologist for definitive treatment planning which included PET scanning with 18-fluoro-deoxyglucose (FDG/PET).
Conclusions: This case shows the management of SOL suspected in parotid Sialo-CBCT scans. Definite diagnosis of marginal zone B-cell lymphoma was made by CNB. When searching for radiographic findings that indicative of SOL, Sialo-CBCT volumetric scan should be reviewed using MPR.
