Therapeutic Experience of 189 Patients with Warthin's Tumor of the Parotid Gland

Abstract

We investigated the clinical characteristics and preoperative diagnosis rate of Warthin's tumor (WT) of the parotid gland. The subjects were 189 patients who underwent surgery at the Department of Otolaryngology, Head and Neck Surgery in Osaka Medical College between September 1999 and April 2017. We compared the date of the189 patients with 466 cases of pleomorphic adenoma (PA) of the parotid gland seen during the same period. Among the 189 patients with WT, there were 163 males and 26 females, with a median age of 62 years. The sites of origin of the tumors in the parotid gland were distributed as follows: superficial lobe, 64 cases; deep lobe, 14 cases; and lower pole, 111 cases. The median maximum diameter of the tumor was 30 mm. The median operative time and the median operative blood loss were 120 minutes and 20 mL, respectively. The diagnosis had been made accurately prior to the surgery in 72% of the patients, by the fine needle aspiration cytology. Postoperative facial nerve dysfunction occurred in 39 cases (20.6%); however, it was transient in all cases. The transient facial nerve dysfunction recovered within 2 months in 50% of all cases, within 6 months in 90%, and within 1 year in 100% of cases. The features that were especially frequently encountered in the cases with postoperative facial dysfunction were origin of the tumor in the deep lobe of the parotid and large size of the tumor; furthermore, these cases also required a longer operative time. As compared with PA, WT occurred more often in male patients. WTs occurred more often in the lower pole and they were larger in size. The operative blood loss was greater. There were no significant differences with regards to the incidence of postoperative facial nerve dysfunction and the operative time.

Keywords

Warthin's tumor - parotid tumor - facial nerve dysfunction - fine needle aspiration cytology

• References

• 1 Spiro RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg 1986; 8 (03) 177-184
• 2 Chung YF, Khoo ML, Heng MK, Hong GS, Soo KC. Epidemiology of Warthin's tumour of the parotid gland in an Asian population. Br J Surg 1999; 86 (05) 661-664
• 3 El-Naggar AK, Chan JK, Grandis JR, et al. Tumours of salivary glands. In: World Health Organization Classification of Tumours. Lyon, France: IARC Press; 2017:160-202
• 4 Eveson JW, Cawson RA. Warthin's tumor (cystadenolymphoma) of salivary glands. A clinicopathologic investigation of 278 cases. Oral Surg Oral Med Oral Pathol 1986; 61 (03) 256-262
• 5 Fitzpatrick PJ, Black KM. Salivary gland tumors. J Otolaryngol 1985; 14 (05) 296-300
• 6 Kawata R, Terada T, Lee K, Higashino M, Ichihara S. [Surgical management for benign parotid tumors: review of a 16-year experience with 633 patients]. Nippon Jibiinkoka Gakkai Kaiho 2016; 119 (03) 196-203
• 7 Tsuji Y, Kawata R, Yoshimura K. , et al. Clinical study on 54 cases of Warthin's tumor of the parotid gland. Journal of Japan Society of Head & Neck Surgery 2006; 78: 777-781
• 8 Ichihara T, Kawata R, Higashino M, Terada T, Haginomori S. A more appropriate clinical classification of benign parotid tumors: investigation of 425 cases. Acta Otolaryngol 2014; 134 (11) 1185-1191
• 9 Lamelas J, Terry Jr JH, Alfonso AE. Warthin's tumor: multicentricity and increasing incidence in women. Am J Surg 1987; 154 (04) 347-351
• 10 Hughes JH, Volk EE, Wilbur DC. ; Cytopathology Resource Committee, College of American Pathologists. Pitfalls in salivary gland fine-needle aspiration cytology: lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2005; 129 (01) 26-31
• 11 Murata Y, Yamada I, Umehara I, Okada N, Shibuya H. Diagnostic accuracy of technetium-99m-pertechnetate scintigraphy with lemon juice stimulation to evaluate Warthin's tumor. J Nucl Med 1998; 39 (01) 43-46