Warthin Tumor


What is Warthin Tumor?

The origin of Warthin Tumors usually arises from the terminal end of the parotid gland. The largest salivary glands in our body is parotid gland and positioned at the front of the ears. In detail anatomy we can explain the location of parotid gland as interior part of the each cheek mucous line and at the top of the jaws. Warthin tumor is covered with double layered epithelial tissue.

It has been estimated that almost 10 percent of parotid gland originated tumor is Warthin Tumor; whereas 70 percent of bilateral salivary gland tumors are Warthin Tumors. Smokers have the higher risk to develop Warthin Tumours. Usual onset of this type of tumor occurs after 40 years of age1,2,3.

Warthin tumor images


Symptoms

Almost 5 to 14 percent of the Warthin Tumors affected individuals have bilateral and 12 to 20 percent of affected persons have the multicentric disease.

Warthin tumor location


The symptoms of Warthin Tumors are included painless, firm bump at the tail of the parotid gland. In the case of negligence or without medical care the size of the bump gradually increases over a time period.

The excessive swelling can cause face movement difficulty (facial nerve palsy). In addition, some patients may also have symptoms like hoarseness, swallowing difficulty, or weight loss.


Occasionally, some patients may also experience pain, heaviness in the mouth and mass become rapidly growing3,4.

Predominance

Warthin Tumor is the second most common type of benign parotid tumor, which develop as bilateral (in both the side) or multifocal means multiple origins benign parotid tumor. The incidence is common in an elderly patient usually after 60 years of age. Males have higher tendency to develop Warthin Tumor than females1,3.

Causes

The reason behind the development of Warthin Tumor is unknown. But it is expected d that smoking increases the risk of Warthin Tumor. It is also assumed that autoimmune disease or exposure to the radiation increase the risk of Warthin Tumor progression3.

Diagnosis

The clinical presentation analysis is important for the diagnosis of Warthin Tumor. After finding of positive sign and symptoms and patient smoking or radiation exposure history support the findings, then for confirmation, the following tests are conducted including:

Ptyalogram

This is also known as sialogram, is a type of X-Ray conducted on the salivary gland.

MRI

Usually, two types of MRI process can be applied in the diagnosis of Warthin Tumor.


  • Standard MRI, which provides the images of multifocal laceration and definite margins. These are classic findings of MRI in the case of Warthin Tumor.
  • Dynamic MRI is a highly specific test, which has maximum sensitivity for Warthin tumor and has the ability to differentiate the Warthin Tumor from other parotid gland malignancy.

Warthin tumor pics mri scan

CT scan and Ultrasound

These are other imaging tools also additionally used to diagnose the Warthin Tumor.

Fine-needle aspiration

This is also a type of biopsy used for tissue sampling and plays an important role in the identification of Warthin Tumor cells.

Salivary gland biopsy

This is an invasive procedure used to collect the sample of tissue from Warthin Tumor cells and tested under a microscope for determining the presence of malignant tissue3,4.

Treatment

Surgical intervention is the only option for treatment of Warthin Tumor cells. Surgery is applied for removing the tumor completely. Usually, the method applied in surgical intervention is medically termed as superficial parotidectomy.

Another applied surgical method is total parotidectomy. However, after surgery close monitoring of the patient is required for over a time, because during this time doctor observe further mass formation on the parotid gland.

Rarely additional therapy like chemotherapy or radiation therapy required to prescribed, although the nature of the Warthin Tumor is benign 3,4,5.

Prognosis

The surgical treatment prognosis is good in case of the Warthin tumor, Because surgical intervention provides curative outcome, as the nature of the tumor is benign. There is very minimum risk (only 2%) for recurrence of the condition3.

Complications

There are two main complications associated with surgical intervention of the parotid gland, which includes facial nerve dysfunction and Frey’s syndrome.

Temporary or permanent, facial nerve dysfunction often reported as immediately after the surgical intervention of the parotid gland. Frey’s syndrome can occur at the later phase of the surgical intervention of the parotid gland5.

References

  1. A.Prof Frank Gaillard. Warthin Tumor. https://radiopaedia.org/articles/warthin-tumour
  2. Adriana Handra-Luca. Salivary glands, Epithelial / myoepithelial tumors/ Warthin’s tumor. PathologyOutlines.com. http://pathologyoutlines.com/topic/salivaryglandswarthin.html
  3. Warthin Tumor. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/8569/warthin-tumor
  4. Robert L. Hatch, Sejal Shah. Warthin Tumor: A Common, Benign Tumor Presenting as a Highly Suspicious Mass. J Am Board Fam Med July-August 2005 vol. 18 no. 4 320-322. Retrieved from http://www.jabfm.org/content/18/4/320.full
  5. T.C. CHULAM, A.L. NORONHA FRANCISCO, J. GONCALVES FILHO, C.A. PINTO ALVES, L.P. KOWALSKI. Warthin’s tumour of the parotid gland: our experience. Acta Otorhinolaryngol Ital. 2013 Dec; 33(6): 393–397. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870448/

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