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 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. A high incidence and no sex predominance in central Pennsylvania.

Papillary cystadenolymphoma, or Warthin's tumor, is a monomorphic adenoma found in salivary glands. It nearly always occurs in the parotid gland, and is reported to occur in 5% to 14% of all parotid tumors according to most studies. The tumor has a universally accepted male predominance, with an increasing incidence in females having been reported over the last four decades. A review of all primary parotid gland tumors seen at York (Pa) Hospital for the last 10 years was performed. Warthin's tumor was diagnosed histologically in 42 (30%) of 138 primary parotid gland tumors, with no significant sex predominance identified (22 men, 20 women). A significantly higher percentage of all parotid gland tumors, and especially Warthin's tumor, was associated with smoking in both males and females.     

Limited parotidectomy: the role of extracapsular dissection in parotid gland neoplasms

OBJECTIVE: Surgical techniques for parotid gland neoplasm removal have been shaped over the years by the importance of the gland's relationship with the facial nerve, histologic behavior of parotid tumors, and recurrence rates from specific techniques. Parotidectomy with facial nerve dissection has become the procedure of choice in removal of parotid gland neoplasms because of the resulting low recurrence rate. However, these more comprehensive dissections can cause significant postoperative complications, some cosmetically devastating. We propose that a more limited dissection yields a similar low recurrence rate but with less risk of complications. STUDY DESIGN: Retrospective case series. METHODS: A retrospective review of the clinical outcomes and pathology of 27 patients who underwent extracapsular dissection for parotid gland neoplasms. RESULTS: All tumors were located in the superficial lobe of the parotid gland and size of the masses ranged from 4.0 to 1.0 cm (mean 2.4 cm) in diameter. Pathology of the parotid tumors consisted of 11 pleomorphic adenomas, six Warthin's tumors, six benign epithelial cysts, one sarcoid lesion, two lymphoid hyperplasia, and one Kaposi's sarcoma. There were no cases of capsular rupture. There was no temporary or permanent facial paralysis and no incidence of Frey's syndrome. One patient developed a sialocele, which was aspirated and resolved after 3 months. There were no recurrences with follow-up times between 5 months and 6 years (mean 41 mo). CONCLUSION: We advocate extracapsular dissection for benign parotid neoplasms because of the acceptable recurrence rates with limited complications as compared to superficial parotidectomy.     

Benign and malignant neoplasms of the parotid gland: incidence and histology in the Danish County of Funen

The present series is comprised of 155 patients from the county of Funen who were operated on for tumors of the parotid gland during the 5-year period, 1978 to 1982. Fifteen cases were malignant, 116 were benign, while no neoplasms were found in 24 cases. The incidence was calculated as 5.8 parotid neoplasms per year per 100,000 inhabitants. Computation of age standardized incidence rates adjusted to European and World Standard populations has been performed. It is stated that the county of Funen is a well-defined area and the series can be regarded to be representative of a certain geographical area. The histological classification was carried out according to the rules of the World Health Organization (WHO) and revealed a remarkably high occurrence of Warthin's tumors, i.e., 27.5%.     

Synchronous parotid tumors of different histological types in association with metastasizing hypopharyngeal carcinoma

At operation for metastasizing carcinoma of the piriform sinus a patient was found to have two separate parotid tumors, one a pleomorphic adenoma and the other a papillary cystadenoma lymphomatosum (Warthin's tumor). These tumors presented as palpable masses on the same side as a lymph node involved with carcinoma. Synchronous parotid tumors of different types are rare; previous reports in the literature show that this combination of pleomorphic adenoma and Warthin's tumor is the most common. We have found no previous report of multiple parotid neoplasms in a patient with coexistent squamous carcinoma of the head and neck.     

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.     

Neoplasms of the parotid gland in northern Poland, 1991–2000: an epidemiologic study

A review of patients treated for malignant and benign parotid tumors in a 10-year period (1991–2000) in the Pomeranian County of Poland revealed 417 new cases. The age-standardized incidence rate was 0.23 and 1.35 per 100,000 inhabitants for malignant and benign tumors, respectively. The following data were collected: age, sex, place of living, education, job, smoking, symptoms, duration of symptoms at the time of diagnosis, result of histopathological tumor examination, tumor size, TNM staging and distant metastases. The results were divided into two parts: malignant neoplasms and benign neoplasms. The most common malignant neoplasms were carcinomas (96.8%), and among them the most numerous were mucoepidermoid carcinoma (22.2%), carcinoma in pleomorphic adenoma (20.6%) and adenoid cystic carcinoma (15.9%). The most common benign neoplasms were adenomas (95.5%), most frequently pleomorphic adenoma (65.5%) and adenolymphoma (24.0%), but rarely basal cell adenoma (4.2%). We also observed a steady increase in the number of benign parotid tumors in the examined period of time.     

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.     

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.     

腮腺良性肿瘤拉曼光谱特征及诊断模型研究

目的 研究腮腺良性肿瘤拉曼光谱(Raman spectra)特征,并结合统计学方法建立诊断分类模型.方法 收集腮腺正常组织、腮腺多形性腺瘤和Warthin瘤组织样本各20例,以785 nm波长近红外激发光对样本进行拉曼光谱扫描,分析不同组织光谱的特征,应用主成分分析法(principle component analy...     

Epithelial salivary gland tumors in children and adolescents. Analysis of 80 cases (Salivary Gland Register 1965-1984)

In the Salivary Gland Register (University of Hamburg), 9883 cases were recorded from 1965 to 1984. Among these cases there were 3,326 neoplasms, of which 3,017 were epithelial in origin. In this latter group, 80 neoplasms arose in children and adolescents. Among these 80 persons, there was a slight predominance of females; 57 tumors (71%) were localized in the parotid gland, and only 6 (8%) in the submandibular gland. The incidence of the tumor types was different in children and adolescents as compared to the incidence in adults: monomorphic adenomas were virtually absent in children (only 1 patient), and benign tumors were also less common (65%). The incidence of mucoepidermoid tumors was remarkable (12 cases, 15%). Acinic cell tumors occurred more frequently (5 cases, 6%). The neoplasms have been analyzed histologically. Two very rare tumors, a monomorphic salivary duct adenoma and an embryonal carcinoma, were also studied by electron microscopy and immunohistochemistry.     

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.     

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.     

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.     

The distribution of parotid gland neoplasms in a veteran population

ObjectiveSalivary gland tumors account for 6%–8% of head and neck neoplasms with the parotid gland as the most common primary site. Pleomorphic adenomas (PA) are considered the most common benign parotid gland neoplasms, followed by Warthin tumors (WT). The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population.DesignRetrospective chart review.SettingWashington DC Veterans Affairs Medical Center.ParticipantsVeterans who underwent fine needle aspiration (FNA) for a parotid gland mass from 2000 to 2018 were included. Medical records were reviewed for gender, age, tobacco use, surgery date, and pathology results.Main outcome measuresChanges in the distribution of parotid neoplasms and tobacco use over an 18-year period.ResultsOf 141 patients with parotid gland masses, 86.5% (n = 122) were benign, 9.9% (n = 14) were malignant, and 3.5% (n = 5) were indeterminate. Of benign tumors, WT accounted for the majority at 51.6%, followed by PA at 40.2%. When stratified by decade (2000–2009 and 2010–2018), the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6% to 53.6%, whereas the proportion of PA decreased from 36.8% to 33.3%. The rate of tobacco use was unchanged at approximately 32.0% among our cohort from 2000 to 2018.ConclusionAmong our cohort of veteran patients, WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.     

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.     

Parotid gland mucoepidermoid carcinoma in a 4-year-old child

Salivary gland tumors account for less than 5% of the head and neck neoplasms. Among them, mucoepidermoid carcinoma is the most common malignant salivary gland tumor. About 45% of mucoepidermoid carcinomas occur in the parotid gland, and appear around the fifth decade of life, being unusual in children under 10 years. We report a case of a parotid mass arising in a 4-year-old female, who had no lateral adenopathy. After histological examination, the diagnosis was of a low-grade mucoepidermoid carcinoma of the parotid gland. Three years after surgery no recurrence was observed. As a conclusion, although rare, the presence of a parotid mass with progressive growth in children could correspond to a neoplasm.     

Neck masses secondary to heterotopic salivary gland tissue: a 25-year experience

OBJECTIVES: The aim of this study is to review salivary tumors arising from heterotopic salivary inclusions in the periparotid and cervical lymph nodal tissues over a 25-year span. METHODS: A retrospective chart review revealed 24 patients with asymptomatic neck masses treated between 1976 and 2001, whose pathology demonstrated heterotopic salivary tissue or neoplasms arising from heterotopic salivary tissue. RESULTS: Nine cases were benign periparotid lymph nodes with heterotopic salivary inclusions, 3 of which had multimodal involvement. Fifteen cases of heterotopic salivary tumors were identified. The benign tumors were predominantly Warthin's tumor (8) with 1 pleomorphic adenoma. Malignant tumors included mucoepidermoid (3), acinic cell (2), and adenocarcinoma (1). Patients were treated by a superficial parotidectomy, neck dissection, or simple excision depending on site and preoperative workup. Adjuvant radiation therapy was included for high-grade malignancies. Among the 15 tumor patients, follow-up ranged from 1 month to 17 years. Nine patients are alive and disease-free, 5 are deceased, and 1 was lost to follow-up. CONCLUSIONS: Heterotopic salivary tissue in periparotid and upper cervical nodes is a more common occurrence than historically recognized. Tumorigenic changes arise from heterotopic nodal inclusions, and although infrequent, should be considered in the differential diagnosis for isolated neck/periparotid masses and parotid Warthin's tumor. Suggested management, after a thorough clinical exam/needle aspiration biopsy, includes an imaging survey of the parotid gland and neck lymphatics with an appropriate resection to include a simple excision, parotidectomy, neck dissection, and/or irradiation as indicated. Isolated low-grade malignant lesions/benign lesions are adequately managed by excision or parotidectomy alone. High-grade malignant lesions require more extended surgery with possible irradiation.     

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.