Warthin's tumor: a review indicating no male predominance

There is probably no other head and neck group of tumors as those found in the parotid gland that constitute such a diversity of growths, both benign and malignant. Warthin's or papillary cystadenoma lymphomatosum is the second most common benign tumor of the parotid gland. One universally held clinical characteristic of this tumor is its high male ratio. Because of a high frequency of female Warthin's tumor seen at Geisinger Medical Center, a review of all primary parotid gland tumors from 1971 to 1981 was carried out. Sixty-two cases out of 204 primary neoplasms were classified as Warthin's. There was no significant difference in the number of male and female cases with 32 males and 30 females. The clinical characteristics of Warthin's tumor and this unusually high female occurrence are discussed.     

Synchronous unilateral parotid gland neoplasms of three different histological types

A 67-year-old male with three synchronous tumors in the unilateral parotid gland is reported. Postoperative histological examinations confirmed the presence of three synchronous primary tumors, specifically pleomorphic adenoma, Warthin's tumor and salivary duct carcinoma, in the right parotid gland. To our knowledge, this is the first case report describing three different histological types in the unilateral parotid gland.     

Synchronous oncocytoma and Warthin's tumor in the ipsilateral parotid gland

We encountered an 81-year-old Japanese man with oncocytoma of the parotid gland occurring simultaneously with a Warthin's tumor in the ipsilateral parotid gland. The patient complained of swelling in the right infra-auricular region. Computed tomographic images, magnetic resonance images, and ultrasonography showed two masses in the right parotid gland. Technetium 99m pertechnetate scintigraphy revealed a high accumulation in both tumors. We performed a superficial lobectomy of the parotid gland. Preoperative diagnosis was multiple Warthin's tumor, but upon histopathological examination Warthin's tumor proved to coexist with oncocytoma. In general, the presence of synchronous, major, salivary gland tumors with different histopathology in the ipsilateral parotid gland appears to be unique. This is especially true for the combination of oncocytomas and Warthin's tumors, which is extremely rare. Only eight cases of this kind coincidence were found in our review of the literature. The similarity of oncocytomas and Warthin's tumors based on epidemiology, image diagnostics, and histopathology is discussed.     

Warthin's tumor of the parotid gland. Epidemiological and clinical analysis of 127 cases

The aim of this study was a review of 127 patients treated for Warthin's tumor of parotid gland during 15-years period 1988-2003 in Pomeranian Voivodeship of Poland. The age-standardised incidence rate of this tumor was 0.32/100,000. There were 73.2% males and 26.8% females. Age ranged at presentation from 18 to 88 years (average 59.8+/-11.6). Workers from cities over 100,000 inhabitants, with technical education constituted the largest group. Almost 70% of the patients were smokers. Most frequently patients reported slow enlargement of tumor (55.9%), presence of tumor (24.4%) and rapid tumor enlargement (7.1%). Average duration of symptoms was 27 months. The average size of the tumor was 36+/-19 mm. More than half of tumors had less than 30 mm in diameter. After histopathological assessment the average size of tumor was 21+/-17 mm and the tumors less than 30 mm in diameter were 73.1%. There were 2.4% of bilateral neoplasms. Pre-operative cytological examination was not correlated with histopathological examination in less than half of cases (39.5%). All patients were treated surgically and in 81.9% the parotidectomy was performed. The most common localization of the tumor (52.4%) was lower pole of parotid gland. There were also stated 12.4% multifocal neoplasms and 3.8% tumors arising extraglandularly. The main complication after surgical treatment was temporary or permanent facial nerve palsy (10.8%). In 1 case the residual tumor was observed which required reoperation. In time of postoperative observation up to 15 years 1 case (0.9%) of recurrence which required surgical intervention. We noted an increase in number of Warthin's tumor in the analysed period of time.     

Surgical procedure for Warthin's tumor in the parotid gland

Warthin's tumor is benign and exclusively involves the parotid gland but may, however, often show multifocal and/or bilateral growth. The aim of this study was to evaluate the surgical procedure for removal of this tumor. Sixty patients with Warthin's tumor in the parotid gland who presented at the Kansai Medical University Hospital from 1990 to 1999 were the subjects of the present study. The surgical procedures were as follows. We performed enucleation for tumors in the deep lobe. Tumors in the superficial lobe were resected with partial parotidectomy, and an enucleative procedure was also performed at the bottom of the tumor where the tumor capsule directly touched the facial nerve. No recurrence was observed in all sixty cases including cases of rupture of the capsule before or during surgery. Therefore, we recommend that enucleation is a useful choice as a surgical procedure for the removal of Warthin's tumor after accurate detection of the tumors using MRI. The overall incidences of temporary and permanent facial nerve palsy were 19.7% and 0%, respectively. The incidence of palsy increased after surgery for multiple tumors or deep lobe tumors. These findings indicate that more careful consideration for preservation of the facial nerve should be given in such cases and that simultaneous surgery for such tumors in the bilateral parotid glands should be avoided to prevent bilateral facial nerve palsy.     

Multiple tumors of the parotid gland.

Multiple tumors in a single major salivary gland are rare. Recently a patient with an acinic cell carcinoma and a Warthin's tumor in the same parotid gland was surgically treated at the Toronto General Hospital. A review of the world literature failed to reveal any report of this combination of tumors in the same gland.     

Radiological findings of adenolymphoma (Warthin''s tumor)

The radiological findings of adenolymphomas (Warthin's tumor) treated in six hospitals between 1985 and 1994 were compared with the operative and histological findings and the usefulness of the radiological examinations was evaluated. The total number of patients was 72. The mean age was 61.8 years; 61 were males and 11 were females. All tumors developed in the parotid gland. Tc-99m-pertechnetate salivary gland scanning was performed in 13 patients and an increased uptake of the isotope was observed in only six patients. Even if Tc-99m-pertechnetate salivary gland scanning does not reveal intense accumulation, this tumor should not be ruled out. By computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI), the margin of all tumors was evident; however, the contents of the tumor varied. The contents and multiplicity of the tumors were well demonstrated by MRI, which was found to be the most accurate imaging modality.     

Evaluation of RI scintiscanning to parotid gland tumors

We retrospectively evaluated preoperative radioisotope (RI) scintiscans in 275 patients (283 glands) with parotid tumors who undergoing surgery between 1987 and 2000. Technetium-99m-pertechnetate (Tc) scintigraphy was conducted on 201 glands. Oncocytoma and Warthin's tumor showed a high positive rate. In evaluating Warthin's tumor with Tc scintigraphy, sensitivity was 75% and specificity 88%; above the age of 40 years, specificity exceeded 90%. Gallium-67-citrate (Ga) scintigraphy was conducted on 207 glands. Malignant parotid tumors showed high positivity (85%), but the specificity of positive findings was quite low (38%) because 44% of benign pleomorphic adenoma, which occupied major material, showed Ga-positive findings. Ga-negative findings indicated high probability (95%) of benign tumors. Thus, Tc scintigraphy is effective in diagnosing Warthin's tumor, while Ga scintigraphy is effective in diagnosing benign tumors.     

Syncronized Warthin's tumor in bilateral parotid gland and nasopharynx

Warthin's tumor is a benign salivary gland tumor of the parotid gland. Although bilateral or multicentric involvement of the parotid gland is common, extraparotid involvement is seen rarely. The nasopharynx is an unusual region for extraparotid involvement. In this article, we present a 52-year-old male case with a synchronized Warthin's tumor in the bilateral parotid gland and nasopharynx, and we discuss the clinical management of the disease.     

Synchronous benign and malignant tumors in the ipsilateral parotid gland

Synchronous benign and malignant tumors in the ipsilateral salivary glands are extremely rare. We report a unique case of synchronous unilateral parotid tumors in a 71-year-old man. The main parotid lesion was preoperatively suggested to be adenocarcinoma by fine needle aspiration cytology. A coexisting Warthin's tumor was also diagnosed on microscopic examination of total parotidectomy specimens. We describe this case of rare synchronous salivary gland tumors exhibiting both benign and malignant components with a review of the literature.     

Bilateral Warthin's tumor of the parotid gland

Three cases of bilateral Warthin's tumor (adenolymphoma) of the parotid gland in patients treated in the ENT Department, Medical University of Gdańsk were presented. They were stated 3.3% of all Whartin's tumors in our institution. In two cases the contralateral tumor developed after 2.5 and 15 years and in one case arised synchronically. Our three patients were males, 50-65 years old, cigarette smokers more than 25 years. All of the patients were treated surgically--conservative parotidectomy was performed. We did not observe the complications and reccurence of the disease. Opinions on the diagnostic and therapeutic methods in that disease reported in Polish and foreign references are discussed.     

First report of parotid gland metastasis in multiple enchondromatosis with secondary CHOSA (G-III)

Chondrosarcomas constitute the second-most-frequent malignant bone tumors, representing about 10% of all malignant bone tumors. The most frequent localizations comprise the trunk, pelvis and limbs. Metastatic disease usually occurs in the lung; metastases to other localizations are seen occasionally. Manifestation in the head and neck area, either as primary tumor or metastasis, is very rare. A case of parotid gland metastasis in multiple enchondromatosis secondary chondrosarcoma (CHOSA) G-III of the left femoral bone is presented. A 79-year-old male patient reported to our clinic with a rapidly progressing mass in the left parotid gland. A superficial parotidectomy was performed and the entire tumor resected. Histopathological examination revealed nodular infiltration of the parotid by chondrosarcoma consistent with metastatic disease. Review of the literature shows that this is the first report of such a case. Received: 3 July 2001 / Accepted: 26 September 2001     

Squamous cell carcinoma arising in a Warthin's tumor.

Warthin's tumor is a well-defined salivary gland neoplasm consisting of epithelial and lymphoid components. However, malignant transformation is extremely rare. Such a patient who developed squamous cell carcinoma within a Warthin's tumor of the parotid gland is described and possible pathogenesis is discussed.     

Detection of Epstein-Barr virus DNA in salivary gland tumors]

To evaluate the relations between salivary gland tumors and Epstein-Barr virus (EBV), the levels of EBV-related antibodies were examined, and detection of EBV nuclear antigen (EBNA) and EBVDNA in tumor tissue was attempted by the anti-complement immunofluorescence technique and polymerase chain reaction, respectively. The mean VCA-IgG antibody level was increased to 925 (80-2560) in Warthin's tumor, 496 (40-2560) in mucoepidermoid tumor, and 206 (40-640) in pleomorphic adenoma. The positive rate of EA-IgG was high in Warthin's and mucoepidermoid tumors. VCA-IgA antibody was positive in 2 of the 7 cases of Warthin's tumor. EA-IgA antibody was negative in all cases. EBVDNA was detected in 7 of the 7 cases of Warthin's tumor, 3 of the 5 cases of mucoepidermoid tumor, and 2 of the 26 cases of pleomorphic adenoma. A relationship between Warthin's tumor and EBV was suggested by the 100% detection rate of the viral DNA.     

Multiple bilateral synchronous Warthin's tumors: a case report and review of the literature

Warthin's tumor is a relatively uncommon and biologically fascinating neoplasm of salivary glands. Bilateral simultaneous parotid Warthin's tumors have been reported previously, as have multiple unilateral tumors. However, an extensive search of the English and non-English medical literature revealed only two previous reports of multiple bilateral Warthin's tumor presenting simultaneously. We report a third case, and review the unique embryological origin and biological characteristics of this entity.     

Synchronous extra-parotid Warthin's tumour

Warthin's tumour (also known as adenolymphoma or papillary cystadenoma lymphomatosum) is benign and accounts for 12 per cent of all neoplasms of the parotid gland. A case of extra-parotid Warthin's tumour occurring synchronously in a peri-parotid lymph node is described. This is not a metastatic phenomenon and occurs as a result of salivary gland inclusions of local lymph nodes during the embryological development of the parotid. Extra-parotid Warthin's tumour should be regarded as a benign incidental finding and the prognosis is excellent.     

Unilocular cystic sebaceous lymphadenoma of the parotid gland

A unique variant of the sebaceous lymphadenoma, so-called unilocular cystic sebaceous lymphadenoma or lymphoepithelial cyst with sebaceous differentiation, occurred in the parotid gland of a 38-year-old man. Morphologic evidence to support the lymph node-salivary gland inclusion derivation of this tumor is presented and its taxonomic relationship to the parotid lymphoepithelial cyst and Warthin's tumor is discussed.     

A pseudo-malignant Warthin's tumor presenting with facial nerve paralysis

Facial nerve paralysis, in association with a parotid mass, is generally considered pathognomonic of malignancy. However, nine cases of paralysis with benign tumors have been reported: four in association with a pleomorphic adenoma, three with a Warthin's tumor and one with an oncocytoma. The details of these cases are described and an additional case of Warthin's tumor causing a facial paralysis is reported. In all four cases of Warthin's tumor the pathology is similar, with inflammation, fibrosis and necrosis, especially in areas surrounding branches of the facial nerve. In view of the 10 cases reviewed herein, it is suggested that the pathology be confirmed at the time of surgery and every effort made to preserve facial nerve function.     

Ischaemic necrosis and facial palsy in Warthin's tumour of the parotid gland.

A 72-year-old patient with a Warthin's tumor of the right parotid gland developed massive necrosis of the tumour associated with temporary facial palsy with subsequent macroscopic tumour disappearance.     

Primary carcinoid tumor of the parotid gland: A case report and review of the literature

Salivary gland tumors account for 3 to 6% of all head and neck neoplasms in adults. Some 70 to 85% of these lesions are found in the parotid. Carcinoid tumors, which represent a distinct and relatively uncommon subset of neuroendocrine tumors, are most commonly found in the gastrointestinal tract, although in rare cases they are known to occur in extragastrointestinal locations, including the larynx, middle ear and pancreas. Malignancies of the parotid gland are uncommon (approximately 25% of parotid neoplasms), and to the best of our knowledge, a primary carcinoid tumor of the parotid has not been previously described in the literature. Reports of parotid carcinoid tumors during the past 30 years have described the presence of nonparotid primary carcinoid tumors (usually gastrointestinal) that had been diagnosed and treated several years prior to the presentation of the parotid lesion. Under such circumstances, the parotid lesion may be assumed to have been a metastatic rather than a primary carcinoid. This report documents what we believe is the first case of a primary carcinoid tumor of the parotid gland. We detail the clinical, surgical, radiologic, immunologic, and histochemical findings associated with its diagnosis, and we describe our management of this case. Although a primary carcinoid in this location is exquisitely rare, knowledge of such lesions is important because their management is substantially different from that of other parotid tumors. In particular, it is important to differentiate them from metastatic tumors from other sites.