Gray-scale and color Doppler ultrasonographic features of pleomorphic adenoma and Warthin's tumor in major salivary glands

Published:February 02, 2009DOI:


      Our aim was to assess the specific ultrasonic characteristics of pleomorphic adenoma and Warthin's tumor in major salivary glands.


      We retrospectively reviewed and analyzed the ultrasonographic (US) features of 19 pleomorphic adenomas in 16 patients and 29 Warthin's tumors in 20 patients. The features included tumor size, echotexture, boundary, and shape on gray-scale US imaging and grading and distribution of tumor vascularity on color Doppler ultrasound (CDU).


      All lesions were hypoechoic, and only 22.9% had a homogeneous echotexture. Most of the tumors (87.5%) were ≥10 mm, and 93.8% were well defined. On CDU, 91.7% had intermediate (+ and ++) grades of vascularity. Only two of 29 Warthin's tumors had the highest grade of vascularity (+++). Predominantly central blood flow was present in 58.6% of Warthin's tumors and 42.1% of pleomorphic adenomas. Lobulated margin (shape) was noted in 84.2% of pleomorphic adenomas and 51.7% of Warthin's tumors (P<.05). Anechoic cystic components were present in 13 (44.8%) of 29 Warthin's tumors and in only one pleomorphic adenoma (1/19, 5.3%) (P<.01).


      Most pleomorphic adenomas were lobulated. Internal anechoic cystic components were absent from pleomorphic adenomas but present in some Warthin's tumors. The grading and distribution of blood flow signals on CDU provided only limited additional diagnostic information for distinguishing pleomorphic adenomas from Warthin's tumors. Gray-scale ultrasonography is a useful method for evaluating and distinguishing pleomorphic adenomas from Warthin's tumors.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ansari MH
        Salivary gland tumors in an Iranian population: a retrospective study of 130 cases.
        J Oral Maxillofac Surg. 2007; 65: 2187-2194
        • Zajkowski P
        • Jakubowski W
        • Białek EJ
        • Wysocki M
        • Osmólski A
        • Serafin-Król M
        Pleomorphic adenoma and adenolymphoma in ultrasonography.
        Eur J Ultrasound. 2000; 12: 23-29
        • Bradley MJ
        • Durham LH
        • Lancer JM
        The role of colour flow Doppler in the investigation of the salivary gland tumour.
        Clin Radiol. 2000; 55: 759-762
        • Seven H
        • Caliş AB
        • Başak T
        • Senvar A
        Multifocal synchronous Warthin's tumor: a case report.
        Am J Otolaryngol. 1999; 20: 346-349
        • Kim J
        • Kim EK
        • Park CS
        • Choi YS
        • Kim YH
        • Choi EC
        Characteristic sonographic findings of Warthin's tumor in the parotid gland.
        J Clin Ultrasound. 2004; 32: 78-81
        • Rodriguez KH
        • Vargas S
        • Robson C
        • Perez-Atayde A
        • Shamberger R
        • McGill TJ
        • Healy GB
        • Rahbar R
        Pleomorphic adenoma of the parotid gland in children.
        Int J Pediatr Otorhinolaryngol. 2007; 71: 1717-1723
        • Hamilton BE
        • Salzman KL
        • Wiggins RH
        • Harnsberger HR
        Earring lesions of the parotid tail.
        AJNR Am J Neuroradiol. 2003; 24: 1757-1764
        • Wittich GR
        • Scheible WF
        • Hajek PC
        Ultrasonography of the salivary glands.
        Radiol Clin North Am. 1985; 23: 29-37
        • Shimizu M
        • Ussmüller J
        • Hartwein J
        • Donath K
        • Kinukawa N
        Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 226-233
        • Yasumoto M
        • Yoshimura R
        • Sunaba K
        • Shibuya H
        Sonographic appearance of malignant lymphoma of the salivary glands.
        J Clin Ultrasound. 2001; 29: 491-498
        • Gritzmann N
        Sonography of the salivary glands.
        AJR Am J Roentgenol. 1989; 153: 161-166
        • Martinoli C
        • Derchi LE
        • Solbiati L
        • Rizzatto G
        • Silvestri E
        • Giannoni M
        Color Doppler sonography of salivary glands.
        AJR Am J Roentgenol. 1994; 163: 933-941
        • Yuan WH
        • Chiou HJ
        • Chou YH
        • Hsu HC
        • Tiu CM
        • Cheng CY
        • Lee CH
        Gray-scale and color Doppler ultrasonographic manifestations of papillary thyroid carcinoma: analysis of 51 cases.
        Clin Imaging. 2006; 30: 394-401
        • Howlett DC
        High resolution ultrasound assessment of the parotid gland.
        Br J Radiol. 2003; 76: 271-277
        • Ishii J
        • Nagasawa H
        • Wadamori T
        • Yamashiro M
        • Ishikawa II
        • Yamada T
        • Miyakura T
        • Amagasa T
        Ultrasonography in the diagnosis of palatal tumors.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87: 39-43
        • Kim EK
        • Park CS
        • Chung WY
        • Oh KK
        • Kim DI
        • Lee JT
        • Yoo HS
        New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid.
        AJR Am J Roentgenol. 2002; 178: 687-691
        • Taylor GA
        • Perlman EJ
        • Scherer LR
        • Gearhart JP
        • Leventhal BG
        • Wiley J
        Vascularity of tumors in children: evaluation with color Doppler imaging.
        AJR Am J Roentgenol. 1991; 157: 1267-1271