Abstract
Warthin tumor is the second most common benign parotid neoplasm. Its association with non-salivary gland neoplasms has been sporadically reported. We reviewed clinical records of Warthin tumor diagnosed on aspiration cytology and surgical pathology to determine if there is any association with other extra-salivary gland malignant neoplasms. Computer search was made for all cases of Warthin tumor diagnosed in the parotid gland by aspiration cytology and surgical pathology at our institution between January 2007 and August 2016. Clinical records of all cases were reviewed for any associated malignant neoplasms and any surgical follow up. All available cytology and histologic material was reviewed. Seventy-three patients (mean 66.9, M:F 1.1:1, age range 43 to 87 years) with Warthin tumor were identified. 45 (62%) were diagnosed on aspiration cytology only, 19 (26%) had cytologic diagnosis as well as concordant surgical follow up, and 9 (12%) were diagnosed based on surgical pathology only. Average age for patients with and without secondary malignancy was 70.5-years, and 63.4-years, respectively (p < 0.05). Average pack years for patients with and without secondary malignancy was 45.4, and 39.8, respectively (p > 0.05). Twenty-seven (37.0%) patients harbored a malignant neoplasm. Association of extra salivary gland malignant neoplasms in 37.0% of our cases suggest that the prevalence of secondary non-salivary neoplasms in patients harboring Warthin tumor might have been underestimated. Squamous cell carcinoma was the most commonly associated non-salivary malignant neoplasm. The association of Warthin tumor with smoking plays an important role in this increased rate of malignancy, and this is supported by the fact that smoking is highly associated with head and neck and lung cancers.
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References
Wenig BM. Atlas of head and neck pathology. Amsterdam: Elsevier Health Sciences; 2015.
Nisa L, Landis BN, Salmina C, Ailianou A, Karamitopoulou E, Giger R. Warthin’s tumor of the larynx: a very rare case and systematic review of the literature. J Otolaryngol Head Neck Surg. 2015;44(1):16.
Yoo GH, Eisele DW, Driben JS, Johns ME, Askin FB. Warthin’s tumor: a 40-year experience at the Johns Hopkins hospital. Laryngoscope. 1994;104(7):799–803.
Struthers MA, William HL, Parkhill EM. Papillary cystadenoma of the maxillary paranasal sinus (atypical Warthin tumor). AMA Archiv Otolaryngol. 1954;59(2):241–4.
Fahmy S. Adenolymphoma of the tonsillar fossa. J Laryngol Otol. 1973;87(7):675–9.
Thompson LD, Bishop JA. Head and neck pathology E-book: a volume in the series: foundations in diagnostic pathology. Amsterdam: Elsevier Health Sciences; 2017.
Kadletz L, Grasl S, Perisanidis C, Grasl MC, Erovic BM. Rising incidences of Warthin’s tumors may be linked to obesity: a single-institutional experience. Eur Archiv Oto-Rhino-Laryngol 2019;276:1–6.
Maiorano E, Muzio LL, Favia G, Piattelli A. Warthin’s tumour: a study of 78 cases with emphasis on bilaterality, multifocality and association with other malignancies. Oral Oncol. 2002;38(1):35–40.
Seifert G, Bull H, Donath K. Histologic subclassification of the cystadenolymphoma of the parotid gland. Virchows Archiv A. 1980;388(1):13–38.
Naumaan A, Ghai R, Gattuso P. Warthin’s tumor of the parotid gland: a simple lesion with complex clinical implications; a clinical pathologic review. Lab Investig. 2017;97:330A.
Xu W, Lu H, Zhu Y, Ruan M, Zhang C, Yang W, et al. Warthin’s tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population. Int J Oral Maxillofac Surg. 2018;47(7):913–7.
Badve S, Evans G, Mady S, Coppen M, Sloane J. A case of Warthin’s tumour with coexistent Hodgkin’s disease. Histopathology. 1993;22(3):280–1.
Bunker ML, Locker J. Warthin’s tumor with malignant lymphoma DNA analysis of paraffin-embedded tissue. Am J Clin Pathol. 1989;91(3):341–4.
Park C, Manning JT Jr, Battifora H, Medeiros LJ. Follicle center lymphoma and Warthin tumor involving the same anatomic site: report of two cases and review of the literature. Am J Clin Pathol. 2000;113(1):113–9.
Medeiros LJ, Rizzi R, Lardelli P, Jaffe ES. Malignant lymphoma involving a Warthin’s tumor: a case with immunophenotypic and gene rearrangement analysis. Hum Pathol. 1990;21(9):974–7.
Banik S, Howell J, Wright D. Non-Hodgkin’s lymphoma arising in adenolymphoma—a report of two cases. J. Pathol. 1985;146(3):167–77.
Damjanov I, Sneff E, Delerme A. Squamous cell carcinoma arising in Warthin’s tumor of the parotid gland: a light, electron microscopic, and immunohistochemical study. Oral Surg Oral Med Oral Pathol. 1983;55(3):286–90.
Gunduz M, Yamanaka N, Hotomi M, Kuki K, Yokoyama M, Nakamine H. Squamous cell carcinoma arising in a Warthin’s tumor. Auris Nasus Larynx. 1999;26(3):355–60.
Skálová A, Michal M, Nathanský Z. Epidermoid carcinoma arising in Warthin’s tumour: a case study. J Oral Pathol Med. 1994;23(7):330–3.
Dreyer T, Battmann A, Silberzahn J, Glanz H, Schulz A. Unusual differentiation of a combination tumor of the parotid gland: a case report. Pathol Res Pract. 1993;189(5):577–81.
Gorai S, Numata T, Kawada S, Nakano M, Tamaru J, Kobayashi T. Malignant lymphoma arising from heterotopic Warthin’s tumor in the neck: case report and review of the literature. Tohoku J Exp Med. 2007;212(2):199–205.
Hall G, Tesluk H, Baron S. Lymphoma arising in an adenolymphoma. Hum Pathol. 1985;16(4):424–7.
Saxena A, Memauri B, Hasegawa W. Initial diagnosis of small lymphocytic lymphoma in parotidectomy for Warthin tumour, a rare collision tumour. J Clin Pathol. 2005;58(3):331–3.
Giaslakiotis K, Androulaki A, Panagoulias G, Kyrtsonis M, Lazaris AC, Kanakis DN, et al. T cell lymphoblastic lymphoma in parotidectomy for Warthin’s tumor: case report and review of the literature. Int J Hematol. 2009;89(3):359–64.
Arcega RS, Feinstein AJ, Bhuta S, Blackwell KE, Rao NP, Pullarkat ST. An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor. Diagn Pathol. 2015;10(1):209.
Agaimy A, Wild V, Märkl B, Wachter DL, Hartmann A, Rosenwald A, et al. Intraparotid classical and nodular lymphocyte-predominant hodgkin lymphoma. Am J Surg Pathol. 2015;39(9):1206–12.
Fornelli A, Eusebi V, Pasquinelli G, Quattrone P, Rosai J. Merkel cell carcinoma of the parotid gland associated with Warthin tumour: report of two cases. Histopathology. 2001;39(4):342–6.
Di Napoli A, Mallel G, Bartolazzi A, Cavalieri E, Becelli R, Cippitelli C, et al. Nodular lymphocyte-predominant Hodgkin lymphoma in a Warthin tumor of the parotid gland: a case report and literature review. Int J Surg Pathol. 2015;23(5):419–23.
Iizuka T, Kohgo T, Amemiya A, Notani K, Totsuka Y, Fukuda H, et al. A case of adenolymphoma of parotid gland associated with squamous cell carcinoma of the floor of the mouth. Jpn J Oral Maxillofac Surg. 1986;32(8):1498–504.
Allevi F, Biglioli F. Squamous carcinoma arising in a parotid Warthin’s tumour. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr2014-207870.
Cozzolino I, Zeppa P, Cuccuru A, Picardi M, Vetrani A, Palombini L. Collision Hodgkin lymphoma and Warthin tumour. Report of a case and review of the literature. Oral Surg. 2009;2(4):188–92.
Meikle D, Yarington CT. Synchronous parotid tumors of different histological types in association with metastasizing hypopharyngeal carcinoma. J Laryngol Otol. 1985;99(12):1261–7.
Iannaccone PR. Multiple primary tumors. Four distinct head and neck tumors. Arch Pathol. 1975;99(5):270–2.
Volmer J. Multiple unilateral tumors of the salivary parotid gland. Zentralbl Allg Pathol. 1982;126(3–4):327–34.
Hall G, Tesluk H, Baron S. Lymphoma arising in an adenolymphoma. Hum Pathol. 1985;16(4):424–7.
Lederman M. Adenolymphoma of the parotid salivary gland. Br J Radiol. 1943;16(192):383–5.
de la Pava S, Knutson GH, Mukhtar F, Pickren JW. Squamous cell carcinoma arising in Warthin’s tumor of the parotid gland. First case report. Cancer. 1965;18(6):790–4.
Little JW, Rickles NH. Malignant papillary cystadenoma lymphomatosum. Report of a case, with a review of the literature. Cancer. 1965;18(7):851–6.
Baker M, Yuzon D, Baker BH. Squamous cell carcinoma arising in benign adenolymphoma (Warthin’s tumor) of the parotid gland. J Surg Oncol. 1980;15(1):7–10.
Mcclatchey KD, Appelblantt NH, Langin JL. Carcinoma in papillary cystadenoma lymphomatosum (Warthin’s tumor). Laryngoscope. 1982;92(1):98–9.
Bolat F, Kayaselcuk F, Erkan AN, Cagici CA, Bal N, Tuncer I. Epidermoid carcinoma arising in Warthin’s tumor. Pathol Oncol Res. 2004;10(4):240–2.
Sharma M, Saxena S, Agrawal U. Squamous cell carcinoma arising in unilateral Warthin’s tumor of parotid gland. J Oral Maxillof Pathol. 2008;12(2):82.
Sheahan P, Hafidh M, Toner M, Timon C. Unexpected findings in neck dissection for squamous cell carcinoma: incidence and implications. Head Neck. 2005;27(1):28–35.
Lesser RW, Spector JG. Facial nerve palsy associated with Warthin’s tumor. Archiv Otolaryngol. 1985;111(8):548–9.
Miller R, Yanagihara ET, Dubrow AA, Lukes RJ. Malignant lymphoma in a warthin’s tumor report of a case. Cancer. 1982;50(12):2948–50.
Melato M, Falconieri G, Fanin R, Baccarani M. Hodgkin’s disease occurring in a Warthin’s tumor: first case report. Pathol Res Pract. 1986;181(5):615–8.
White CK, Williams KA, Rodriguez-Figueroa J, Langer CJ. Warthin’s tumors and their relationship to lung cancer. Cancer Invest. 2015;33(1):1–5.
Zorlu E, Atasoy P, Günal N, Dural K, Özpolat B. Current thoracic surgery. 2018.
Haberal MA, Akar E, Dikis OS. Metastatic lung cancer associated with Warthin’s tumour. Niger J Clin Pract. 2019;22(4):585–7.
Snyderman C, Johnson JT, Barnes EL. Extraparotid Warthin’s tumor. Otolaryngol Head Neck Surg. 1986;94(2):169–75.
Cardoso SV, do Nascimento Souza KC, de Faria PR, Lima RA, Nascimento MF, Eisenberg AL. Warthin’s tumor at the Brazilian National Cancer Institute: additional evidence of homogeneous sex prevalence and association with other neoplasms. ORL J Otorhinolaryngol Relat Spec. 2008;70(6):339–43.
The American Cancer Society medical and editorial content team. Health Risks of Smoking Tobacco. https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/health-risks-of-smoking-tobacco.html. Accessed 20 May 2019.
Samet JM, Wiggins CL, Humble CG, Pathak DR. Cigarette Smoking and Lung Cancer in New Mexico1-3. Am Rev Respir Dis. 1988;137:1110–3.
Jethwa AR, Khariwala SS. Tobacco-related carcinogenesis in head and neck cancer. Cancer Metastasis Rev. 2017;36(3):411–23.
Bothe C, Fernandez A, Garcia J, Lopez M, León X, Quer M, et al. Parotid incidentaloma identified by positron emission/computed tomography: when to consider diagnoses other than warthin tumor. Int Archiv Otorhinolaryngol. 2015;19(02):112–5.
Thomas R, Sharma N, Burke C, Maxwell D, Howlett DC. Parotid incidentaloma detected during thoracic PET imaging: how should these lesions be managed? Br J Hosp Med (2005). 2010;71(5):292–3.
Klijanienko J, Petras S, De Bosschere L, Paulmier B, Le Tourneau C, Rodriguez J. False-positive FDG PET/CT uptake in Warthin tumor in head and neck oncological patients confirmed by a fine needle aspiration. Diagn Cytopathol. 2012;40(3):282–4.
Basu S, Houseni M, Alavi A. Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun. 2008;29(4):367–73.
Teymoortash A, Werner J. Tissue that has lost its track: Warthin’s tumour. Virchows Arch. 2005;446(6):585–8.
Cope W, Naugler C, Taylor S, Trites J, Hart R, Bullock M. The association of warthin tumor with salivary ductal inclusions in intra and periparotid lymph nodes. Head Neck Pathol. 2014;8(1):73–6.
Honda K, Kashima K, Daa T, Yokoyama S, Nakayama I. Clonal analysis of the epithelial component of Warthin’s tumor. Hum Pathol. 2000;31(11):1377–80.
Lewis PD, Baxter P, Paul Griffiths A, Parry JM, Skibinski DO. Detection of damage to the mitochondrial genome in the oncocytic cells of Warthin’s tumour. J. Pathol. 2000;191(3):274–81.
Martins C, Fonseca I, Roque L, Soares J. Cytogenetic characterisation of Warthin’s tumour. Oral Oncol. 1997;33(5):344–7.
Takezawa K, Jackson C, Gnepp DR, King TC. Molecular characterization of Warthin tumor. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 1998;85(5):569–75.
Fehr A, Röser K, Belge G, Löning T, Bullerdiek J. A closer look at Warthin tumors and the t (11; 19). Cancer Genet Cytogenet. 2008;180(2):135–9.
Franzen AM, Franzen CK, Guenzel T, Lieder A. Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation. Eur Arch Otorhinolaryngol. 2018;275(10):2593–8.
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Zaccarini, D.J., Khurana, K.K. Incidence of Non-Salivary Gland Neoplasms in Patients with Warthin Tumor: A Study of 73 Cases. Head and Neck Pathol 14, 412–418 (2020). https://doi.org/10.1007/s12105-019-01049-7
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DOI: https://doi.org/10.1007/s12105-019-01049-7