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Castleman disease is an extremely rare benign lymphoproliferative disorder of unknown etiology. It affects the lymphatic chain in anybody region, although the commonest site is the mediastinum. The head and neck region is the second most common site; however, the salivary glands are rarely affected. We report a case of a 29-year-old Asian lady who presented with a 2-year history of an enlarging left parotid mass. Histopathology of the excisional biopsy confirmed the diagnosis of Castleman disease.

Ectopic salivary tissue is commonly found in intraparotid and periparotid lymph nodes. Warthin tumor is the most common tumor arising in ectopic salivary gland tissue and in intraparotid lymph nodes. Although rare, neoplastic transformation of the ectopic salivary tissues is conceivable and other types of salivary gland neoplasms arising in intraparotid lymph nodes have been reported. Herein we report a rare case of a 32-year-old Kuwaiti male who presented with a mass in the right parotid gland. A preoperative fine needle aspiration suggested Warthin tumor. The patient underwent a superficial parotidectomy. The specimen showed a mass within the parotid parenchyma abutting the deep margin. Hematoxylin and Eosin stained sections of the lesion showed solid islands and cysts composed of epidermoid cells, mucus cells, and intermixed smaller “intermediate” cells within an intraparotid lymph node. The tumor was seen infiltrating the parotid parenchyma at the deep margin. Metastasis from distant sites was ruled out clinically, and the diagnosis rendered was MEC, low-grade, arising from ectopic salivary tissue in an intraparotid lymph node. Such cases are extremely rare and the presence of malignancies within lymph nodes may pose a diagnostic pitfall, which can affect patient management.

Kimura disease is a rare, benign, chronic inflammatory swelling of the subcutaneous tissue, lymph nodes, and glandular tissue. Characteristic features of the disease include, but not limited to, painless subcutaneous head and neck swelling, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Herein, we report a rare case of Kimura disease manifesting as synchronous bilateral parotid swelling of 12 years duration in a 33-year-old Middle-Eastern man. To our knowledge only few cases have been reported in the literature involving bilateral parotid glands, and this is the first case to be reported in the Middle East.