A 64-year-old male presented with a large right parotid region swelling that had been present for approximately 7 years, with progressive increase in size over time. Bilateral thyroid lobes were also palpable on examination. The swelling was not associated with pain, fever, or other constitutional symptoms. His past medical history was significant for hypertension and diabetes mellitus. Past surgical history and family history were unremarkable. The patient reported an allergy to contrast media.

Ultrasound examination of the neck and thyroid demonstrated an enlarged right parotid gland containing a large complex cystic mass measuring 82 × 39 × 44 mm, with solid components and hypervascular mural nodules, consistent with a salivary gland mass. The thyroid gland was enlarged, with the right lobe measuring 77 × 33 × 32 mm, the left lobe measuring 70 × 44 × 50 mm, and an isthmus thickness of 8 mm. The gland showed heterogeneous echotexture with multiple well-defined nodules of variable sizes. The largest nodules measured 29 × 26 × 25 mm in the right lobe (TI-RADS 3) and 44 × 36 × 30 mm in the left lobe (TI-RADS 3). Mildly increased vascularity and macrocalcifications within some nodules were noted. The overall appearance was suggestive of multinodular goiter (MNG) with mild left-sided retrosternal extension. No significant cervical lymphadenopathy was identified. The left parotid and both submandibular glands were normal in appearance, with no focal lesions detected.

Fine-needle aspiration cytology (FNAC) of the right parotid gland nodule demonstrated a neoplasm favoring benign (Milan System category IVA). The cytological features were suggestive of an oncocytic salivary gland neoplasm, favoring Warthin tumor. The aspirate showed a hypercellular smear composed of numerous sheets of bland epithelial cells with abundant oncocytic cytoplasm and well-defined cell borders in an eosinophilic background containing inflammatory cells, predominantly lymphocytes and macrophages. No cytological features of malignancy were identified.

The patient underwent right total parotidectomy under general anesthesia. The patient was put in the supine position with neck extension. A lazy S incision was made over the right neck, and the parotid gland was exposed. A total parotidectomy was performed with careful dissection and preservation of the facial nerve and all its branches. Hemostasis was achieved, and a corrugated drain was inserted. The wound was then closed in layers in anatomical layers using appropriate sutures. The patient tolerated the procedure well and was transferred to recovery in stable condition.

Histopathological examination of the right total parotidectomy specimen revealed a Warthin tumor. Grossly, the specimen showed a well-circumscribed 9 cm cystic mass with scattered solid tan areas. Microscopically, the lesion demonstrated a well-demarcated cystic tumor with pushing borders, composed of papillary structures lined by a bilayered epithelium with abundant eosinophilic cytoplasm, accompanied by prominent lymphoid stroma with lymphoid follicles and active germinal centers, consistent with Warthin tumor. The surrounding salivary gland tissue was unremarkable, with benign reactive lymph nodes identified.

The patient's postoperative recovery was uneventful. He remained clinically stable with satisfactory wound healing and no evidence of postoperative bleeding, infection, or facial nerve dysfunction. The facial nerve function was preserved postoperatively, and the surgical site showed good healing. The drain was managed appropriately and removed as indicated. Follow-up visits were arranged for ongoing surveillance and further management.