Warthin’s Tumor Benign

“The people are great.  The care is great.  This school is great.  I have always recommended the dental school to anyone who needs good oral health care.  But I’m doing that even more now following the way my student dentist, Jody, took good care of me,” says William Ruber.

For four years, Ruber has traveled from his home in Brooklyn, Michigan, to Ann Arbor to receive dental care at the University of Michigan School of Dentistry.  A former chairman of United Auto Workers Local 600, Ruber, now retired, worked for more than 35 years at the Ford River Rouge complex in Dearborn.

Since June 2011, fourth-year dental student Jody Atzmon has been Ruber’s “student dentist.”

When Ruber returned to the School of Dentistry in November 2011 for an appointment with Atzmon.  Both thought the visit would be routine.  It was not. 

During an extra oral examination, Atzmon detected “something unusual” on the left side of Ruber’s neck.  “It was a small, hard lump, roughly dime-size in diameter that felt like an enlarged lymph node but only on one side of his neck,” Atzmon said. 

Atzmon discussed her findings with Ruber and the clinical faculty members she was working with.  They agreed more investigation was needed.  Before leaving the School’s clinic, “I urged Bill to have his medical doctor check his lump and let me know the results,” Atzmon said.

When he returned home, Ruber told his wife, Bobbi, what his student dentist discovered.  “I wasn’t too concerned, nor was my wife, because the lump was small,” he said.  A short time later, Ruber followed up Atzmon’s recommendation and visited his physician who referred him to a specialist.

Lump Grows

Atzmon said when Ruber returned to the School of Dentistry for a follow-up appointment in December, the lump was still present.  But it was larger.  Concerned about its growth, she again consulted with School of Dentistry faculty members who advised Atzmon to urge Ruber to have the lump re-evaluated.  An aspiration biopsy was conducted in January.  The results were negative.

But the feeling of relief disappeared when Ruber returned to the School of Dentistry in February 2012 for another appointment with Atzmon.  The lump was still there, but “it had grown to a rather large size in a short period of time.  Now I was even more concerned,” she said.  

Ruber said Atzmon told him the lump “was about the size of a quarter.  I was even more concerned when she said the lump was growing rapidly.”  A short time later, Ruber made an appointment with a surgeon to have the lump removed.

Ruber said he and his wife “were on pins and needles” after the surgery as they waited for the pathology report.

Diagnosis: Benign Warthin’s Tumor

The report revealed the lump in Ruber’s neck was a Warthin’s tumor, a benign salivary gland tumor that is frequently found in men 60 years of age and older, especially those who smoke.

Relieved the tumor was benign, Ruber praised his student dentist for her vigilance.  “I am so glad Jody applied what she learned in the classroom to help me in the clinic.  She may have saved my life,” he said.

Atzmon said this was the first patient she has treated with a Warthin’s tumor.  “I’m thankful it was benign and that it was found early,” she said. 

Oral Exams Important

Ironically, Atzmon says since treating Ruber, she has discovered other lesions in three patients where biopsies have been necessary.

An extra-oral head and neck examination is standard for all patients, both new and returning, who are treated at the School of Dentistry.  “I cannot stress enough the importance of doing oral cancer screenings on all patients because this can save a life,” she says. 

Atzmon says with the classroom education and clinical training she and other dental students have received at the School of Dentistry, “I was able to recognize these growths, give my patients vital information, and recommend appropriate follow-up care with their physicians.”

Ruber agrees.  “I’m very thankful that Jody was so thorough.  Her education and training gave me and my family a sense of security knowing the School’s student dentists are always looking for anything unusual when they treat their patients,” he says.  “Because Jody was prepared, my benign tumor was detected early enough so something could be done.”

Dr. Paul Edwards, a specialist in oral and maxillofacial pathology, and a full-time clinical professor in the Department of Periodontics and Oral Medicine, also praised Atzmon and was relieved the tumor was not malignant.

“Fortunately, the type of tumor Mr. Ruber had was benign.  But the only way to know for sure is to have a biopsy performed since many neoplasms (tumors) in this area turn out to be malignant,” Edwards said.  “Jody did a terrific job identifying the lesion and then emphasizing to Mr. Ruber the importance of talking to his physician about follow up treatment.  It’s extremely gratifying to see our students practicing what they are learning here at the School of Dentistry and that they are so conscientious.”

Ruber praised his student dentist.  “Jody will be a great dentist wherever she goes after dental school,” he said.  Asked about her future plans, Atzmon says she hopes to participate in a pediatric dentistry residency when she graduates next June.