Current controversies in the management of Warthin tumour

Abstract

Warthin tumour is the second most common benign neoplasm of the parotid gland. It has a low rate of growth and exhibits malignant transformation in 0.3% of cases. Although its aggressiveness has not been a concern, surgical resection remains the most common treatment modality. This entails the risk of a general anaesthetic and those pertaining to the procedure itself, most notably permanent facial nerve damage. This has led some authors to use conservative management, albeit rarely. There are those who condemn such a policy despite the encouraging results reported thus far. To understand the rationale underpinning non-operative management, it is imperative that one has a comprehensive understanding of the pathogenesis, clinical presentation and diagnosis of Warthin tumour. The aim of this review therefore is to detail these elements and clarify the current controversies in managing this lesion.

The incidence of Warthin tumours and pleomorphic adenomas in the parotid gland over a 25‐year period

“…Surprisingly, a similar analysis in the UK population from 1997 to 2007 could not reveal the changed ratio of WT, compared to PA . A recent study on primary parotid tumours in New Zealand showed a WT percentage of 24% within the last 15 years . Of note, in none of these studies, a true incidence of WT or PA was measured, as only selected materials (surgical cases) were used.…”

Squamous Cell Carcinoma Arising in Warthin’s Tumour: A Case Report

“…The cytological appearance of Warthin's tumour is characterized by cellular debris which is mixed with lymphocytes and oncocytes [6]. This is not a consistent finding.…”

“…This creates a significant diagnostic challenge because the squamous element in particular, is common to squamous cell carcinoma and mucoepidermoid carcinoma [7]. The sensitivity, specificity and the diagnostic accuracy of FNAC in diagnosing Warthin's tumour ranges from 74% to 100% [6].…”

Warthin’s Tumour of Parotid Gland: Post-Surgical Evaluation of Follow-up and Treatment

“…WT erkeklerde kadınlara (erkek kadın oranı 4:1) oranla daha sık görülmekle beraber, yaşamın altıncı ve yedinci dekatlarında daha sık görülmektedir (5) . WT çift taraflı tutulum yatkınlı-ğı olup, genellikle yüzeyel lobu tutmaktadır (6) . Tedavide de tutulan anatomik bölgeye göre fasiyal sinirin korunduğu parsiyel, totale yakın ve total parotidektomi yöntemlerinden biri uygulanmaktadır (7) .…”