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.
Thank You