1
|
Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland. Diagnostics (Basel) 2021; 11:diagnostics11081467. [PMID: 34441400 PMCID: PMC8391156 DOI: 10.3390/diagnostics11081467] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.
Collapse
|
2
|
Shen LF, Chen YL, Zhou SH. Three unusual parapharyngeal space masses resected via the endoscopy-assisted transoral approach: case series and literature review. J Int Med Res 2020; 48:300060520936068. [PMID: 32865073 PMCID: PMC7469745 DOI: 10.1177/0300060520936068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tumors of the parapharyngeal space (PPS) are rare, most originate from salivary and neurogenic tissues, and most are benign. However, there are some rarer masses in the PPS, with just a few published reports in the literature worldwide, and we may not consider them in the differential diagnosis of PPS neoplasms. We report three cases of rare masses in the PPS: Warthin’s tumor, branchial cleft cyst, and carcinoma ex pleomorphic adenoma. The three patients were admitted to our department with complaints of painless swelling in the lower side of the right face or a long history of snoring; diagnoses were confirmed histopathologically. An endoscopy-assisted transoral approach was used that allowed wide visibility for safe resection and resulted in a short hospitalization time and good functional and cosmetic outcomes. All patients have been followed to the current time, and there have been no recurrences. The transoral endoscopy-assisted approach appears to be safe, effective, and less invasive for excision of masses in the PPS.
Collapse
Affiliation(s)
- Li-Fang Shen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
| | - Ya-Lian Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, China
| |
Collapse
|
3
|
Hellquist H, Paiva-Correia A, Vander Poorten V, Quer M, Hernandez-Prera JC, Andreasen S, Zbären P, Skalova A, Rinaldo A, Ferlito A. Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours. Adv Ther 2019; 36:1950-1974. [PMID: 31209701 PMCID: PMC6822986 DOI: 10.1007/s12325-019-01007-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, for several reasons, this has not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour. METHODS A search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically. RESULTS Pleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur. CONCLUSIONS A correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types of basal cell adenoma can occasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.
Collapse
Affiliation(s)
- Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Faro, Portugal.
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Centre (ABC), Faro, Portugal.
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
| | - António Paiva-Correia
- Epigenetics and Human Disease Laboratory, Faro, Portugal
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Centre (ABC), Faro, Portugal
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
- Histopathology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
| | - Miquel Quer
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Peter Zbären
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - Alena Skalova
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzeň, Czech Republic
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
4
|
Quer M, Vander Poorten V, Takes RP, Silver CE, Boedeker CC, de Bree R, Rinaldo A, Sanabria A, Shaha AR, Pujol A, Zbären P, Ferlito A. Surgical options in benign parotid tumors: a proposal for classification. Eur Arch Otorhinolaryngol 2017. [DOI: 10.1007/s00405-017-4650-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Kadletz L, Grasl S, Grasl MC, Perisanidis C, Erovic BM. Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience. Head Neck 2016; 39:356-360. [DOI: 10.1002/hed.24598] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lorenz Kadletz
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Matthäus C. Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Christos Perisanidis
- Department of Maxillofacial Surgery; Medical University of Vienna; Vienna Austria
| | - Boban M. Erovic
- Department of Otorhinolaryngology and Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| |
Collapse
|
6
|
Schwalje AT, Uzelac A, Ryan WR. Growth rate characteristics of Warthin's tumours of the parotid gland. Int J Oral Maxillofac Surg 2015; 44:1474-9. [PMID: 26314235 DOI: 10.1016/j.ijom.2015.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate growth characteristics of parotid gland Warthin's tumours. The medical records of 134 patients who had a cytological or histopathological diagnosis of Warthin's tumour between 1997 and 2013, at a single tertiary care centre, were reviewed retrospectively. Thirteen of these patients underwent observation with 30 serial computed tomography or magnetic resonance imaging scans of the head and neck, with 24 Warthin's lesions identified. The mean length of time between scans was 882 days, and mean initial and final sizes per lesion were 3.9 cm(3) and 5.6 cm(3), respectively. Average growth of these lesions was 8% per year (95% confidence interval -27% to 43%; range -148% to 460%; median -8%), and was highly variable (standard deviation 96%). Age over 75 years was associated with slower growth (P=0.03), but gender, smoking status, multifocality, bilaterality versus unilaterality, and initial size did not correlate with the growth rate. Warthin's tumours appear to have an approximate average doubling time of 9 years, but can have a wide range of growth rates, with many cases showing a reduction in size. Either conservative management or surgical resection could be supported by these data, depending on the current size of the tumour, appearance, symptoms, and the age, health, and wishes of the patient.
Collapse
Affiliation(s)
- A T Schwalje
- School of Medicine, University of California - San Francisco, San Francisco, CA, USA
| | - A Uzelac
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, USA
| | - W R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, CA, USA.
| |
Collapse
|
8
|
Mukherji S, Sheth S. Warthin's Tumor of Bilateral Parotid Glands: A Case Report. J Maxillofac Oral Surg 2012; 11:483-6. [PMID: 24293945 PMCID: PMC3485471 DOI: 10.1007/s12663-010-0099-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 10/15/2010] [Indexed: 10/18/2022] Open
Abstract
Bilateral Warthin's tumours of parotid constitute a small proportion of all salivary gland tumours. We present a case report of surgical management of a prototype case.
Collapse
Affiliation(s)
- Srijon Mukherji
- Calcutta Institute of Maxillofacial Surgery & Research, 200, Rajdanga, Nabapally, Kolkata, 700 078 India
| | - Sunit Sheth
- Calcutta Institute of Maxillofacial Surgery & Research, 200, Rajdanga, Nabapally, Kolkata, 700 078 India
| |
Collapse
|
9
|
Abstract
Warthin tumor is the second most frequently seen benign tumor of the salivary glands and is generally located in the parotid gland. Although extraparotideal manifestations in the small salivary glands are rare, the occurrence of cystic lesions in the area of the nasopharynx, eyelid, oral cavity or vestibular folds should include the Warthin tumor in the differential diagnosis. The therapy of choice is complete surgical tumor resection.
Collapse
|