Warthin’s Tumor

Warthin’s Tumor Warthin’s tumor is second most common benign salivary gland tumor and is exceeded in number only by the pleomorphic adenoma. This tumor is also commonly referred to as Adenolymphoma, or Papillary cystadenoma lymphomatosum.

Case presentation A 50 year old Saudi male patient came to our department with a bilateral swelling of his parotid glands of one year duration. He indicated that the swelling was painless, slow growing, with no obvious precipitating event before it’s occurrence.

Relevant medical history He was a Type-II diabetic patient, who received regular oral hypoglycemic drugs. He was a heavy Smoker, with H/O smoking for the past 30 years.

Clinical examination A painless discrete, soft to firm swelling was found in the lower pole of the parotid gland next to the angle of the mandible on both the sides. Swelling on the right side measured about 3.5 x 3 cm, and the one on the left side was about 3cm x 2.5cm.

C.T.Scan examination C.T. Scan with contrast examination showed two well defined round hyperdense solid looking nodules in the superficial compartment of both the right and left parotid glands.

Nuclear medicine examination The tumor in relation to the right and left parotid glands scanned “hot” with technetium 99m pertechnetate.

F.N.A.C. examination A fine needle aspiration biopsy(F.N.A.C) of the tumor provided a diagnosis of Warthin’s tumor.

Surgery Under General anesthesia bilateral superficial parotidectomies was performed. Tumor was completely excised with no damage to the facial nerve on both sides.

Histopathology Tumor specimen from both the right and left parotid glands revealed a identical and classical, microscopic picture of warthin’s tumor.

Warthin’s Tumor DISCUSSION

Warthin’s Tumor -Features Warthin’s tumor occurs almost exclusively in the vicinity of the parotid. Occurrence in the first three decades is unusual.

Warthin’s Tumor- Features It has a characteristic lymphoid component. It is located in the parotid and periparotid lymph nodes in 99% of cases. A Male preponderance of 1.5: 1.

Warthins Tumor - Features Bilateral involvement that may or may not be simultaneous in 10% of cases. Unilateral multi-focal involvement. Higher prevalence in whites than in other races.

Warthin’s Tumor - Features It is multifocal in 12% of cases. Most common location is the inferior pole of the superficial lobe of the parotid, next to the angle of the mandible.

Smoking - a possible cause? Although the tumor is still common in men than in women, there is a dramatic decrease in male prevalence from a high of 8: 1 in the 1950’s to a low of 1.5: 1 in the 1980’s. The cause for this striking increase in women is now suggested to be associated with the increased prevalence of smoking in women.

Smoking - a possible cause? There are suggestions that tobacco smoke, by irritating ductal epithelium, may initiate the development of this tumor.

Aids in diagnosis Preoperative diagnosis has been greatly aided by scanning of the parotid gland with technetium pertecnetate. Tumors that appear as hot spots are almost always warthin’s tumor or oncocytoma’s. Most other neoplasms show either normal uptake or appear as cold nodule.

Recurrence after surgery Although it is a completely benign tumor, recurrences have been explained by incomplete excision and multicentricity.

Is malignant transformation possible? A few reports of malignant transformation of warthin’s tumor have been published.

Treatment The treatment of choice consists of surgical excision, obtaining adequate normal tissue at the margins. A superficial parotidectomy is performed whenever the multicentric tumor is found in the superficial lobes of the parotid gland.

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