Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland

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.

Value of T2-weighted-based radiomics model in distinguishing Warthin tumor from pleomorphic adenoma of the parotid

“…Although PA is benign, the recurrence rate is 1-4%; malignant potential may occur in 2-40% of neglected longstanding PAs [2]. In WT, if the diagnosis can be ascertained without surgery, only observation or local treatment is required, especially in older people or those with poor health status [3]. Consequently, the accurate differentiation of PA from WT is essential.…”

Perfil Clínico e Histopatológico das Neoplasias Benignas das Glândulas Salivares em Pacientes Diagnosticados em Serviço de Referência do Estado do Amazonas

“…Não raramente, as lesões podem ser múltiplas. A superfície de corte é amarronzada, lisa ou lobulada com múltiplos espaços císticos contendo um fluido viscoso marrom a verde, tendo pico de ocorrência na sexta década de vida, associado ao tabagismo 35 . Dos aspectos microscópicos, observouse que o adenoma pleomórfico foi composto por células mioepiteliais, apresentando arranjo variado, podendo ser dispostos em cordões, ilhas e ninhos celulares, com componentes adjacentes associados, tais como ductos contendo em seu lúmen coágulo eosinofílico amorfo, recoberto por uma camada capsular fibrosada bem delimitada.…”

Usefulness of MRI-based radiomic features for distinguishing Warthin tumor from pleomorphic adenoma: performance assessment using T2-weighted and post-contrast T1-weighted MR images

“…The accuracy of the diagnosis is based on three steps: clinical data, imaging, and cytology evaluation. When there is discordance regarding WT diagnosis, surgery should be performed to reach the final diagnosis by histopathological examination of the resected specimen [2] .…”

“…In fact, PA can grow , recur easily after surgery, and is associated with a small, but not negligible risk of malignant transformation [1] . In addition, although superficial or partial parotidectomy has long been the most common treatment for WT, in recent years active surveillance has been proposed as an alternative or first choice approach to preserve patients from risk of transient or permanent facial nerve damage, bleeding, and other surgery complications [2] , [3] .…”

“…Fine needle aspiration cytology (FNAC) is considered the gold standard for parotid tumor diagnosis, yet it has some limitations (such as tumor location in the deep parotid lobe) and shows highly variable levels of diagnostic accuracy. In this context, variant mucoepidermoid carcinoma (so-called Warthin-like mucoepidermoid carcinoma) may be particularly problematic, highlighting the need for a reliable preoperative differential diagnosis against WT [2] .…”