1. Differential diagnosis BMT-Whartin
Parotid Mass
Differential diagnosis BMT-Whartin

2. Annual Incidence salivary gland tumoUrs
0,4-13,5 cases per population
Malignant: 0,4-2,6 cases per population
64-80% parotid gland
Benign: 54-79%
Malignant parotid: 15-32%
Pleomorphic adenoma 50% of all benign
Whartin tumour second
Mucoepidermöid carcinoma most common malignant

4. Pleomorphic adenoma(BMT)
WHARTIN TUMOUR
all ages (mean 46)
slight female predominance
no site predominance
solitary mass (<1% multifocal)
dystrofic calcification may be present
small BMT (<2 cm): sharply marginated ovoid with uniform enhancement
large BMT(>2 cm): lobulated with heterogeneous enhancement
“peer shaped” when arising in deep lobe
all ages (mean 62), rare before 40
male predominance
strong link with smoking
“Adult male smoker”
lower pole predominance
20% multicentric (syn-of metachronous)
does not calcify
parenchymal heterogeneity (cystic component 30%)

5. CT
BMT
Whartin

6. MRI
BMT
Whartin T1
T1 ce T2
T1 ce T2

7. Deep lobe BMT
MRI T1 T2
T1 ce
Large symptomatic mass arising from deep lobe of parotid: almost always BMT!!

8. When to suspect malignacy?
Gradual onset facial nerve paresis
Heterogeneous inflitrating mass with poorly defined margins
Perineural tumor spread (adenocystic carcinoma)
Adjacent invaded lymph node (muco-epidermoïd carcinoma)