What is the diagnosis and treatment of Warthin tumor (Adenolymphoma)?

From the Guidelines

Warthin tumor should be managed with surgical excision, usually through a superficial parotidectomy, as it has an excellent prognosis with low recurrence rates. This approach is recommended due to the limitations of imaging modalities such as FDG-PET/CT in distinguishing benign from malignant tumors, as benign tumors like Warthin tumor can present with increased FDG uptake 1. The use of FDG-PET/CT is not recommended for the initial staging of salivary gland tumors like Warthin tumor, unless there is a high suspicion of high-grade malignancy or distant metastases 1.

Key Considerations

• Warthin tumor is a benign salivary gland tumor that primarily affects the parotid gland, occurring most frequently in older adults, particularly men with a history of smoking.
• Diagnosis involves clinical examination, imaging studies such as ultrasound or CT scan, and fine-needle aspiration cytology.
• The tumor has a characteristic histological appearance with lymphoid stroma and epithelial components arranged in a papillary pattern.
• While Warthin tumors are benign and rarely undergo malignant transformation, proper evaluation and surgical management are recommended to confirm the diagnosis and alleviate any cosmetic concerns or discomfort.

Management

• Surgical excision, usually through a superficial parotidectomy, is the recommended treatment for Warthin tumor.
• Patients should be counseled that smoking cessation may reduce the risk of developing additional tumors, as there is a strong association between tobacco use and Warthin tumor development.
• The role of FDG-PET/CT is limited in the management of Warthin tumor, but it may be useful in the staging of high-grade malignancies or detection of distant metastases 1.

From the Research

Characteristics of Warthin Tumor

• Warthin tumor is a benign tumor that primarily affects the parotid gland, but can also occur in minor salivary glands 2, 3.
• It is the second most common benign salivary gland tumor, accounting for 4% to 13% of all salivary gland tumors 3.
• Warthin tumor can be synchronous, metachronous, multifocal, bilateral, or unilateral, which complicates diagnosis and management 2.

Surgical Management

• Surgical procedures for Warthin tumor include enucleation, partial parotidectomy, and extracapsular dissection 4, 5, 6.
• Enucleation is a useful choice for tumors in the deep lobe, while partial parotidectomy is recommended for tumors in the superficial lobe 4.
• The extent of surgery is a controversial topic, with a current trend towards minimizing resection using partial parotidectomies and extracapsular dissections when possible 5.

Non-Surgical Management

• Active surveillance is often suggested as the first approach for Warthin tumor, with surgery being considered if the tumor progresses and/or causes clinical complaints 5.
• Non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases, but their role needs to be defined in future studies 5.

Complications and Recurrence

• The overall incidence of temporary and permanent facial nerve palsy after surgery for Warthin tumor is 19.7% and 0%, respectively 4.
• Recurrence of Warthin tumor is rare, with no recurrence observed in 60 cases studied 4.
• The incidence of palsy increases after surgery for multiple tumors or deep lobe tumors, highlighting the need for careful consideration of facial nerve preservation in these cases 4.