Change in Warthin's tumor incidence: a 20-year joinpoint trend analysis

PURPOSE

The incidence of Warthin's tumor (WT) has increased worldwide. In this study, we aimed to evaluate the incidence of WT in our hospital, which provides health care for an extremely large population.

METHODS

We retrospectively evaluated 573 patients, comprising 345 males and 228 females, who all experienced parotid tumor for the past 20 years. Patients with WT that were operated in the last 20 years were evaluated according to the number of patients per year to determine the annual WT increase trend.

RESULTS

In the distribution of WT over the years of surgery, the ratio of WT to all tumors irregularly changed. Furthermore, the total number of parotidectomies per year increased in time. We investigated whether WT had any increasing trend over the years. The annual percentage change (APC) of WT was calculated, and according to the segmented regression analysis, the APC was insignificant (APC = 4.3, 95% CI = - 3.6-12.9, P = 0.300).

CONCLUSION

The incidence of WT has increased across the world. However, in our study, no significant APC was observed according to the segmented regression analysis.

Adenolymphoma of the Parotid Gland

In the period 1928–1968 in a series of 355 benign and malignant tumors of the parotid observed at the National Cancer Institute in Milan there were 36 cases of adenolymphoma. The clinical, morbid anatomy and histogenetic features of these cases are described. On the strength of the following findings: normal salivary tissue enclosed within an intraparotid lymph node, the association of a mixed tumor and an adenolymphoma in the same gland, the bilaterality of the tumor in 2 cases and the functional activity demonstrated with 131I, the salivary origin of adenolymphoma is argued. As to treatment, given the biological characteristics of the tumor, enucleation/resection would seem to be the operation of choice. For various reasons, however, including the difficulty of a precise preoperative diagnosis, total parotidectomy, sparing the 7th cranial nerves, is more often performed.

Incidental finding of upper lip Warthin tumor

AIM

This report shows an incidental finding of Warthin tumor in upper lip mucosa during hospitalization for a biting lesion of cheek mucosa MATERIALS AND METHODS: A 32-year-old male affected by a biting lesion of cheek mucosa was presented at Maxillo- Facial Unit of Federico II University. Clinical examination showed as an incidental finding a solid mass in the superficial layer of upper lip mucosa. We performed mini-invasive surgical treatment to obtain a radical excision of the cheek lesion at the same time as excision of Warthin tumor.

RESULTS

a follow up of 12 months was performed. The complete healing of the two wounds was achieved, with no recurrence of any of the pathologies.

DISCUSSION

The location of this Warthin tumor of minor salivary glands is very unusual. The role of imaging in diagnosis of Warthin tumor of minor salivary glands is to define localization, shape and dimension, contour, malignant features, nodal involvement. The role of fine needle aspiration cytology (FNAC) is critical in the diagnosis and therapy of minor salivary gland tumors. The surgical treatment in patients affected by Warthin tumour of minor salivary glands is local excision with a wide tumor free margin to prevent potential recurrence.

CONCLUSIONS

Warthin tumor of minor salivary glands is a rare disease. We report a singular case of Warthin tumor localized in the upper lip mucosa, found as an incidental finding during a recovery for a biting lesion of cheek mucosa.

KEY WORDS

Incidental finding, Minor salivary glands, Warthin tumor.

Demographics of benign parotid tumours: Warthin's tumour versus other benign salivary tumours

CONCLUSION

Some variation from the 'classical' clinical picture for Warthin's tumours is evident in these patients. A predilection for the parotid tail and a propensity for multiplicity has been confirmed.

OBJECTIVES

This study sought to analyse demographic and clinical features of a Warthin's patient population.

METHODS

Retrospective review of patients presenting with a benign parotid tumour. The group of Warthin's tumours was compared with the group of patients with other benign parotid tumours.

RESULTS

Of 170 primary parotid tumours, 41 (24%) were Warthin's tumour. Mean age of Warthins patients was significantly older (60 years vs 48 years, p = 0.001) and male gender more prevalent (61% vs 33%, p = 0.015) than in other benign tumours. Most (86%) Warthin's tumours were found in the parotid tail, compared with 61% of other benign tumours (p = 0.002). There was no significant ethnic predilection for Warthin's tumours. Bilaterality (30%) and multiplicity (27%) were common. Significance of gender differences disappeared with logistic regression analysis.

Epidemiology and pathology of parotid tumors five-year retrospective study

AIM

To retrospectively analyze the epidemiological, clinical and pathological data of parotid tumors.

MATERIAL AND METHODS

Reassessment of the histologic diagnosis of parotid tumor in the patients admitted to the Oral and Maxillofacial Surgery Unit of the Iasi "Sf. Spiridon" University Emergency Hospital during 2009-2013. Data on gender, age, place of residence, location, size, surgical procedure type and histopatological type were recorded.

RESULTS

The risk of developing pleomorphic adenonma is 7.40 times higher in women and 4.08 times higher before the age of 50 years. The risk of Warthin tumor is 16.47 times higher in male patients and 3.58 times higher in urban patients. People older than 50 years have a 7.14 times higher risk of developing malignancy and rural people have a 2.41 times higher risk of developing cancer. Diabetes, obesity and systemic hypertension were not important risk factors in our study.

CONCLUSIONS

According to this study age and the place of residence could be important predictors for parotid gland tumors. Since in Romania there are few epidemiological data regarding the parotid gland pathology, further cohort studies are needed for a better understanding of their clinical and pathological behavior.

Using time-dependent covariate analysis to elucidate the relation of smoking history to Warthin's tumor risk

The authors aimed to elucidate the relation of the time-dependent smoking history parameters--age at smoking initiation and smoking intensity, duration, and latency--to the risk of Warthin's tumor, a benign tumor of the salivary gland for which cigarette smoking is a strong risk factor. They studied 117 cases of Warthin's tumor and 336 matched controls included in an Israeli nationwide case-control study of parotid gland tumors conducted from 2002 to 2003 by using the Cox regression model with time-dependent covariates, with age as the time axis. When current age and smoking duration were included in the statistical model, the authors show that the coefficient of a latency variable does not represent latency as such, but a balancing of the effects of age at initiation and time since cessation. They found a strong positive linear effect of duration of smoking, together with a positive nonlinear effect of intensity that levels off at higher intensities, and a negative effect of latency from 25 years onward. The latter finding implies that the effect of time since cessation dominates the effect of age at initiation, with risk decreasing sharply after smoking cessation. The relation of smoking variables to Warthin's tumor agrees with the patterns reported for lung cancer.

[Salivary gland tumors in the County of Funen, 1984-2003]

INTRODUCTION

The objective of this study is to estimate the incidence of major salivary gland tumors in a geographically well-defined area (the County of Funen, Denmark) and to analyse the demographic data and distribution of histological types.

MATERIALS AND METHODS

Patients with salivary gland tumors were identified through a search on pathology and diagnosis codes in the period 1984-2003, which initially resulted in a group of 951 patients. Of these a total of 682 patients (72%) fulfilled the criteria for inclusion.

RESULTS

The incidence of major salivary gland tumors for the County of Funen is calculated to 7.3 per 100,000 residents per year. The material consisted of 372 females (55%) and 310 males (45%), with a median age of 56 years. Pleomorphic adenoma (55%) was the most common type, followed by adenolymphoma (29%). 90% of the tumors were found in the parotid gland - 93% benign and 7% malignant. 10% were located in the submandibular gland - 73% benign and 27% malignant. Only one neoplasm was located in the sublingual gland and it was malignant (100%). The older group harboured significantly more malignant neoplasms (12%) than the younger group (7%). The occurrence of pleomorphic adenomas among females (66%) was higher than among males (43%), on the other hand more adenolymphomas were found in males (43%) than in females (17%).

CONCLUSION

The incidence of major salivary gland tumors in the County of Funen is calculated to 7.3 per 100,000 inhabitants per year which is equivalent to 383 new cases in Denmark per year.

The range and demographics of salivary gland tumours diagnosed in a UK population

Salivary gland tumours are relatively rare and comprise a diverse range of neoplasms. The aim of this study was to determine the range and demographics of all histologically diagnosed salivary tumours in a European population. All entries for salivary gland tumours from 1974 to 2005 inclusive were retrieved and analysed for each diagnosis including number of specimens, male:female ratio and age range. These data were then analysed for the distribution of benign and malignant salivary tumours in major and minor salivary glands. 58,880 specimens were received; of these, 741 cases (1.3% of all specimens) were diagnosed as salivary gland tumours with a male to female ratio of 0.7:1. There were 481 (64.9%) benign and 260 (35.1%) malignant neoplasms, with the most common tumours being pleomorphic adenoma and mucoepidermoid carcinoma, respectively. Our study provides demographic data on a large series of salivary gland tumours in a European population. Accurate diagnosis is essential as salivary lesions have diverse clinical and prognostic outcomes. This study has confirmed that some tumours have a predilection for certain sites and that the risk of malignant disease is also greater at specific sites within the oral cavity.

[An evaluation of parotid gland masses]

OBJECTIVES

We retrospectively evaluated patients who underwent surgery for parotid gland masses.

PATIENTS AND METHODS

A total of 50 patients (25 females, 25 males; mean age 48.5 years; range 18 to 76 years) who underwent surgery for parotid gland masses were evaluated with regard to age, sex, preoperative diagnostic methods, histopathologic diagnoses, and surgical techniques.

RESULTS

Preoperative diagnostic studies included ultrasonography, fine-needle aspiration biopsy, computed tomography, and magnetic resonance imaging. Histopathological diagnoses were benign in 33 patients (66%), malignant in nine patients (18%), and tumor-like pathologies in eight patients (16%), the most common being pleomorphic adenoma (n=28, 56%), Warthin's tumor (n=4, 8%), and squamous cell carcinoma (n=4, 8%). Superficial and total parotidectomies were performed in 40 (80%) and 10 (20%) patients, respectively. Nine patients with malignant tumors also had neck dissection and postoperative radiotherapy. Mortality occurred in one patient with metastasis to the parotid gland. One patient with lipoma developed recurrence two years after surgery. Follow-up was five years in 28 patients (56%), three years in 12 patients (24%), and two years in five patients (10%). Complete and transient facial paralysis developed in 10 patients and five patients following total and superficial parotidectomy, respectively.

CONCLUSION

Superficial parotidectomy is the minimal surgery for parotid gland masses. If the deep lobe of the gland is involved, total parotidectomy should be performed with preservation of the facial nerve. In malignant tumors, neck dissection and postoperative radiotherapy should be added.

High risk for bilateral Warthin tumor in heavy smokers--review of 185 cases

CONCLUSIONS

We identified smoking as a significant risk factor for multilocular Warthin tumor development. Therefore, we recommend taking history of smoking into account when making the decisions for surgical strategy.

OBJECTIVES

Warthin tumor is a common benign neoplasm of the parotid gland. Risk factors for multilocular development have not been defined.

PATIENTS AND METHODS

A total of 185 consecutive patients treated for Warthin tumor were included. Charts were reviewed for symptoms, risk factors, and diagnostic and surgical procedures. Patients were followed for facial function and recurrence. Risk factors were evaluated.

RESULTS

Overall, in 203 parotid operations, a lateral parotidectomy (77%) was performed in most cases; 94% were primary surgery and 6% were revision surgery. In 89% of patients swelling was the only symptom. Bilateral Warthin tumor was seen in 17% of patients. Of these cases synchronous and metachronous bilateral tumors were observed in 61% and 39%, respectively. The median time period for second contralateral tumor development was 7 years. Postoperative transient facial dysfunction was observed in 31%, which recovered within 3 months in all cases. Evaluation of risk factors revealed that 89% of the subjects were smokers and 66% were heavy smokers. The risk for bilateral Warthin tumors correlated significantly with the amount of nicotine intake (p=0.003).

Parotid surgery: review of 107 tumors (1990-2002)

Tumors of the parotid gland are uncommon. We performed a retrospective study to analyze the clinical, diagnostic, and therapeutic features of a group of patients. We reviewed the clinical and the surgical records of a series of 109 patients who were recommended for surgery because of parotid tumors by the Plastic and Reconstructive Service of São João Hospital, Portugal, between 1990 and 2002. The following parameters were evaluated: age, sex, gland afflicted, symptoms, and duration of symptoms, diagnostic procedures, treatment methods, follow-up, and recurrences. Pleomorphic adenoma was the most common tumor (63.5%). In the majority of cases, fine-needle aspiration cytology was used. Swelling was the most frequent clinical finding. In 68.2%, superficial parotidectomy was performed. There were five cases of permanent facial palsy, and 10 patients developed Frey's syndrome. Recurrent disease was seen in six patients. For the majority of tumors, superficial parotidectomy is an effective treatment with acceptable morbidity.

Salivary gland tumors in a Brazilian population: a retrospective study of 496 cases

Salivary gland tumors are uncommon and the microscopical features can be complex. Epidemiological data of these tumors in the various parts of the world can be helpful for a better understanding of its biology and clinical characteristics. In this study, 496 epithelial and mesenchymal tumors of major and minor salivary glands diagnosed at Londrina Cancer Institute during the period from 1972 to 2001 were reviewed. Out of all cases, 335 (67.5%) were classified as benign and 161 (32.5%) as malignant. The majority of the cases occurred in the parotid gland (67.7%), followed by the minor salivary glands (22.8%) and submandibular gland (9.5%). Among the minor salivary gland tumors, the palate was the most frequent location (67%). The tumors affected more commonly adult patients with peak incidence between 40 and 50 years of age and with a slightly predominance in females. Pleomorphic adenoma was the most frequent tumor representing 54.2% of all cases, followed by mucoepidermoid carcinoma (13.5%), Warthin's tumor (8.5%) and adenoid cystic carcinoma (7.9%).

[Adenolymphoma of parotid gland--analysis of 75 cases]

The authors present a clinical analysis of the group of 75 patients, who was treated in Department of Otolaryngology in the years 1986-2000 and who was diagnosed as adenolymphoma. The frequency of incidence of Warthin's tumour is 17,6% of all 426 cases of parotid gland's tumours. In 72 cases (96%) the tumour was localized in the superficial part, only in 3 cases (4%)--in the deep part of the gland. In one patient we observed recurrence of adenolymphoma. In one case adenolymphoma coexisted with carcinoma planoepitheliale of parotid gland.

[Warthin's tumor of the parotid gland. Epidemiological and clinical analysis of 127 cases]

The aim of this study was a review of 127 patients treated for Warthin's tumor of parotid gland during 15-years period 1988-2003 in Pomeranian Voivodeship of Poland. The age-standardised incidence rate of this tumor was 0.32/100,000. There were 73.2% males and 26.8% females. Age ranged at presentation from 18 to 88 years (average 59.8+/-11.6). Workers from cities over 100,000 inhabitants, with technical education constituted the largest group. Almost 70% of the patients were smokers. Most frequently patients reported slow enlargement of tumor (55.9%), presence of tumor (24.4%) and rapid tumor enlargement (7.1%). Average duration of symptoms was 27 months. The average size of the tumor was 36+/-19 mm. More than half of tumors had less than 30 mm in diameter. After histopathological assessment the average size of tumor was 21+/-17 mm and the tumors less than 30 mm in diameter were 73.1%. There were 2.4% of bilateral neoplasms. Pre-operative cytological examination was not correlated with histopathological examination in less than half of cases (39.5%). All patients were treated surgically and in 81.9% the parotidectomy was performed. The most common localization of the tumor (52.4%) was lower pole of parotid gland. There were also stated 12.4% multifocal neoplasms and 3.8% tumors arising extraglandularly. The main complication after surgical treatment was temporary or permanent facial nerve palsy (10.8%). In 1 case the residual tumor was observed which required reoperation. In time of postoperative observation up to 15 years 1 case (0.9%) of recurrence which required surgical intervention. We noted an increase in number of Warthin's tumor in the analysed period of time.

Pattern of salivary gland tumors in Ethiopia and non-western countries

Report from various parts of the world indicate that there are differences in the total incidence of salivary gland tumors as well as in the frequency of particular histologic types and in the frequency with which major and minor salivary glands are involved; Moreover reports from African series have suggested a pattern of presentation that significantly differs from that of western countries. The purpose of this study is to clarify knowledge of salivary gland tumors in Ethiopia on the light of the experience gained form African and western countries. The study was based on the biopsy material collected in the Department of Pathology, Addis Ababa University (AAU), over a period of ten years from 1990-1999 inclusive. This study confirmed that patterns of salivary gland tumors in Ethiopia closely follow the pattern seen in other African countries. Of all salivary gland tumors, parotid gland accounts for 43.2% submandibular gland for 25% and the rest of all minor salivary glands contribute for 31.9%. Out of 176 tumors, 117 were reported to be benign and 59 were malignant. Plemorphic Adenoma forms 58.5% of all tumors. Since "Variations" are of great interest in the geographical study of diseases, discrepancies observed in the two worlds of Africa and western countries are discussed. We recommend that any future plan should stand from the observed disparity between the two worlds and address the problem through better methodology to draw firm conclusion.

Salivary gland tumors in a Brazilian population: a retrospective study of 124 cases

Salivary gland tumors constitute a highly heterogeneous histopathologic group. There are few epidemiological studies of large series of benign and malignant salivary gland tumors in Brazil.

MATERIAL AND METHODS

Hospital records of 124 patients with salivary gland tumors diagnosed from January 1993 to December 1999 were reviewed. The patients were analyzed according to gender, age, size, location, and histopathology of the tumor.

RESULTS AND CONCLUSIONS

Patients with benign and malignant tumors presented with a mean age of 47.7 and 48.8 years, respectively. The frequency of benign tumors was 80% (n = 99) and malignant tumors 20% (n = 25). Tumors were localized in the parotid gland 71% (n = 88), in the submandibular gland 24% (n = 30), and in the minor salivary glands 5% (n = 6). The most common benign tumors were pleomorphic adenoma in 84% (n = 84) and Warthin's tumor in 13% (n = 13). Among malignant tumors, mucoepidermoid carcinoma was the most common in 52% (n = 13), adenoid cystic carcinoma occurred in 20% (n = 5), and carcinoma ex pleomorphic adenoma was detected in 12% (n = 3).

Salivary gland tumours treated in the stomatological clinics in Bratislava

During the period of 1951-1996 a group of 1021 patients (484 men and 537 women, mean age 53 years, range 2-87 years) with salivary gland tumours were analysed retrospectively. The mean follow-up period was 8 years (range 10 months-25 years). The frequency of benign tumours was 74% (n = 755) and malignant tumours 26% (n = 266). Lesions were sited in the parotid gland 83% (n = 847), in the submandibular gland 10.8% (n = 110), in the sublingual gland 3.2% (n = 33) and in the minor salivary glands 3% (n = 31). The most common benign tumours were pleomorphic adenoma in 53.9% (n = 550) and Warthin's tumour 9.7% (n = 99). Of the malignancies, the adenoid cystic carcinoma was most common (6.4% of cases, n = 65) and mucoepidermoid carcinoma occurred in 5.2% (n = 53). The predominant therapy was surgery alone or in combination with postoperative radiotherapy in 93.7% (957 cases), radiotherapy alone after fine needle aspiration biopsy for 4.7%, and 19 patients remained untreated.

[Clinical study of bilateral parotid tumors]

We studied retrospectively 212 patients with parotid tumors who were treated in our hospital between October 1981 and March 1998. One hundred seventy-two of the tumors were benign, and 40 of them were malignant. The tumors were bilateral in 13 patients. Since 1992, we have treated at least 1 bilateral parotid tumor patient per year, and the number of patients with bilateral parotid tumors has tended to increase. Histologically, adenolymphomas occurred in 11 patients, and there was one occurrence of pleomorphic adenoma and one occurrence of basal cell adenoma. Eighty-five percent of all bilateral parotid tumors were adenolymphomas, and the bilateral parotid tumors comprised twenty percent (11 of 53 patients) of all adenolymphomas that we encountered. Among the 13 patients with bilateral parotid tumors, 1 patient experienced them heterochronously. In 7 of the 13 patients the tumor on the opposite side was found by diagnostic imaging. One patient showed recurrence in both parotid glands 4 years after initial surgery. Comparing bilareral adenolymphomas with unilateral adenolymphomas, there was no significant difference in the age or sex of the patients. Regarding bilateral adenolymphoma, 4 patients showed a solitary tumor on either side, 4 patients showed a solitary tumor on one side and multiple tumors on the other side, and 4 patients showed multiple bilateral tumors. Regarding unilateral adenolymphoma, 38 patients showed solitary tumors and 4 patients showed multiple tumors. Bilateral adenolymphomas were more multicentric than unilateral adenolymphomas. Epstein-Barr virus-encoded RNA (EBER) was detected in 11 of the 12 bilateral adenolymphomas and in 18 of 35 patients with unilateral adenolymphoma, by in situ hybridization. EBER was detected more frequently in the multiple unilateral adenolymphomas than in the solitary unilateral adenolymphomas. Based on our experience, the bilateral parotid tumor is not rare. Care should be taken to observe the other side of the parotid gland with parotid tumors that are suspected adenolymphomas. Imaging may be helpful for the detection of bilateral tumors. A relationship may exist between Epstein-Barr virus and adenolymphoma multicentricity.

Incidence rates of salivary gland tumors: results from a population-based study

Salivary gland tumors are uncommon, and their epidemiology has not been well described. We conducted a descriptive epidemiologic study of parotid, submaxillary, and sublingual gland tumors newly diagnosed in Jefferson County, Alabama, hospitals from 1968 to 1989. Incidence rates were estimated with a population-based subset of cases diagnosed during the years 1979 to 1980, 1983 to 1984, or 1987 to 1988. Among 248 incident cases, 84.3% were benign and 15.7% were malignant. Eighty-six percent of cases arose in the parotid gland, and 14% arose in the submaxillary gland. No sublingual gland tumor was identified. The benign mixed tumor was the most frequent tumor (65.6%), followed by Warthin's tumor (29.2%). Mucoepidermoid carcinoma was the most frequent malignant tumor (51.3%). The average annual age-adjusted incidence rate per 100,000 was 4.7 for benign tumors and 0.9 for malignant tumors. Incidence rates for both benign and malignant tumors increased with age until ages 65 to 74 years and then declined. Benign mixed tumors occurred more frequently in female patients, whereas Warthin's tumors and malignant tumors occurred more frequently in male patients (P < 0.05). Warthin's tumor was rare in black patients (P < 0.001). We conclude that salivary gland tumors are an uncommon but epidemiologically diverse group of tumors. Their causes are also likely to differ.

[Clinical study of parotid tumors: a 20 year statistical analysis of 633 cases]

During the 20 years from 1977 to 1996, 633 cases underwent excisions of parotid tumors (539 benign and 94 malignant) in the department of Otolaryngology of Kansai Medical University. The incidence of Warthin's tumors in the years from (1987 to 1996) was higher than that in the years from 1977 to 1986. On the other hand, the incidence of mucoepidermoid carcinomas was less than in previous reports. Tumors accompanied with spontaneous pain or facial nerve palsy and with invasion to both lobes frequently indicated malignancy. Facial nerve palsy caused by either benign or malignant tumors before operation showed no improvement after surgery. The incidences of facial nerve palsy (1.0% in benign, and 18.3% in malignant) and Frey's syndrome (17.8% in benign, and 18.3% in malignant) after surgery were lower than those in other reports of both benign and malignant tumors. Five-year mortality was 76.1%. All deaths that occurred five years after operation involved highly grade malignant tumors.

[Benign neoplasms in the parotid gland in the county of Copenhagen 1986-1995]

In a ten year period from 1986-95 433 patients were submitted to operation due to benign tumours in the parotid gland in Copenhagen County. In this study we made a retrospective analysis of the surgical outcome. The incidence was calculated to be 6.8 benign tumours in the parotid gland per 100,000 persons per year. The histological distribution showed a frequency of 54% pleomorphic adenomas, 28% adenolymphomas and 18% other tumours. In the observation period there was a 3% recurrence rate in our material, most frequently the pleomorphic adenoma. The risk of permanent damage to the facial nerve was 1% for severe injury and 3% for affection of the ramus marginalis. Frey's syndrome was present in 50% of the patients, moreover the syndrome was observed many years after surgery. The frequency rate reached its highest level about five years postoperatively.

Results of the surgical management and histopathological evaluation of 88 parotid gland Warthin's tumours

With the introduction of parotidectomy after identification of the facial nerve the recurrence rates for benign tumours has declined rapidly. Subsequently, attention was focused on other sequelae of parotid surgery. To reduce the specific surgical morbidity, several modifications of parotidectomy have been implemented. This study compares the results of the different surgical techniques with regard to the histopathological findings and recurrence rate for Warthin's tumour of the parotid gland. Eighty-eight primary surgical parotid procedures were performed on 85 patients for a Warthin's tumour. The surgical procedures included 52 'partial' superficial parotidectomies, 22 'standard' superficial parotidectomies, 12 partial superficial/deep lobe parotidectomies, and two 'selective' deep lobe parotidectomies. No patient developed a recurrence or experienced permanent facial nerve paresis/paralysis, the median follow-up being 93 months. Histopathological examination revealed a multifocal origin in 23% (20/88) of the surgical specimens. Partial parotidectomy is an effective treatment for Warthin's tumour. There is no need for extended follow-up.

Warthin's tumour associated with autoimmune diseases and tobacco use

To better clarify the possible role of immune mechanisms in the pathogenesis of Warthin's tumour (WT), we performed a retrospective study of patients with WT surgically treated at the Institute of Otolaryngology Head and Neck Surgery, University of Florence, during a 25-year period; looking for a possible association with autoimmune pathologies. The retrospective analysis of clinical records of 140 WT patients compared with those of 380 patients with pleomorphic adenoma revealed a higher incidence of autoimmune disorders, particularly organ-specific disease (i.e. insulin-dependent diabetes mellitus, Hashimoto's thyroiditis, autoimmune hyperthyroidism and hypothyroidism) in WT patients than in pleomorphic adenoma (PA) patients (23% vs 3%; R.R.: 8.69; p < 0.0001). Moreover, we demonstrate a positive smoking history in 87% of WT patients compared to only 38% of PA subjects (p < 0.001). Because of the well-known possible association among multiple immune disorders, our data support the hypothesis of an immune pathogenesis of WT and also suggest the possible role of tobacco smoke in facilitating such immune reactions responsible for the lympho-epithelial coexistence of WT.

ABO blood groups and salivary gland tumors (Alabama, United States)

Studies of associations between various diseases and the ABO blood groups have shown elevated relative risks for some categories of disease. A strong association between salivary gland tumors and blood group A has been reported, but studies are few and have yielded contradictory results. To investigate this association, we conducted an epidemiologic study of salivary gland tumors diagnosed in Jefferson Country, Alabama (United States), 1968-89. All tumors were histologically confirmed. Blood group information was obtained for 200 individuals with salivary gland tumors, and the distribution of ABO and Rh blood type for cases was compared with that of 52,118 healthy blood donors from the same geographic area. The 38.5 percent of salivary gland tumors in cases with blood group A was similar to the 39.0 percent observed for controls (P = 0.95). No differences were observed when benign and malignant tumors were considered separately, nor for any of the major histologic types of tumor. The distribution of Rh factor among cases and controls also did not differ significantly (P = 0.08).

Cigarette smoking and Warthin's tumor

The etiology of Warthin's tumor, a benign parotid gland tumor, is unknown. Recent evidence suggests a possible relation with cigarette smoking as well as increasing incidence. We reviewed the medical record of subjects with a major salivary gland tumor newly diagnosed in Jefferson County, Alabama, from 1968 to 1989, and identified 149 Warthin's tumors. The 533 cases with other major salivary gland tumors were used as controls. The analysis showed that 96% of Warthin's tumors occurred in whites. The relative incidence of Warthin's tumor among smokers versus nonsmokers was 7.6 for men (95 percent confidence interval 3.2-18.3; p < 0.001) and 17.4 for women (95 percent confidence interval 6.5-54.7; p < 0.001). Smokers of both sexes with Warthin's tumor smoked more heavily than did those with other salivary gland tumors (p < 0.001). From 1968 through 1988, Warthin's tumors steadily increased in number and as a proportion of salivary gland tumors (males, p = 0.003; females, p = 0.008). We also observed a significant increase in the incidence rate for Warthin's tumor (p = 0.041) but not for other salivary gland tumors. We conclude that Warthin's tumor is strongly associated with cigarette smoking and that the incidence rate is increasing. The disease is rare in blacks.

[Adenolymphoma of the salivary glands. The anatomicoclinical, epidemiological and therapeutic aspects of 76 cases]

A series of 76 cases of adenolymphoma (Warthin's tumor) of the salivary glands is presented with emphasis on its epidemiological, clinico-pathological and therapeutic features; together with the analysis of the clinical records and of the epidemiological data, this study has reevaluated the histopathological features of the 76 cases of Warthin's tumor on hematoxylin-eosin stained slides. On these bases, the authors underline the frequent multifocality and/or bilaterality of Warthin's tumor (11.3% of cases), its frequent association with tumors of other sites (11.3% of cases), the prevalence in males (M:F ratio = 24:1) and in adults (mean age: 57 years) of this type of tumor. Furthermore, this study confirms the parotid gland as the elective site for Warthin's tumor and the possibility to categorize this entity into four different histological types. The latter finding should be kept in mind especially when fine needle aspiration (FNA) is used as a preoperative diagnostic procedure for Warthin's tumor to avoid misleading diagnosis and overtreatment. From the analysis of the results the authors underline the need for a complex and multidisciplinary approach to the diagnosis of Warthin's tumor in order to allow conservative surgery with preservation of the facial nerve.

Tumors of the parotid gland: MR imaging characteristics of various histologic types

OBJECTIVE

The purpose of this investigation was to study the MR imaging characteristics of various histologic types of parotid gland tumors in order to determine if MR findings can be used to categorize these tumors.

MATERIAL AND METHODS

We retrospectively studied the MR images and pathologic findings in 20 patients with a variety of tumors of the parotid gland. Fat-suppressed T1-weighted images, T2-weighted images, and contrast-enhanced fat-suppressed T1-weighted images were acquired with a 1.5-T MR imager and an anterior neck coil.

RESULTS

Carcinomas (n = 5) were characterized by infiltration into the muscles along the surface of the mandible and by contrast enhancement. Warthin's tumors (n = 4) showed areas of different signal intensity on T2-weighted images and did not enhance after injection of contrast material. Pleomorphic adenomas (n = 11) showed enhancement after injection of contrast material but did not infiltrate the muscles.

CONCLUSION

Our findings suggest that MR characteristics are helpful in categorizing parotid gland tumors according to histologic type.

Warthin's tumor: a 40-year experience at The Johns Hopkins Hospital

Warthin's tumor previously has been thought to occur much more commonly in men than in women and rarely in African Americans. One hundred thirty-two cases of Warthin's tumor treated at The Johns Hopkins Hospital from 1952 to 1992 were retrospectively reviewed. There were 90 (68%) men and 42 (32%) women, with an overall man-to-woman ratio of 2.2:1. The number and percentage of women with Warthin's tumor increased over each consecutive decade: 1952 to 1962, 5 (21%); 1963 to 1972, 6 (29%); 1973 to 1982, 11 (31%); and 1983 to 1992, 20 (39%). A positive smoking history was found in 88% of the men and in 89% of the women with a Warthin's tumor. Eleven (8%) African Americans and 1 (0.75%) Asian American were diagnosed to have a Warthin's tumor. Also, the incidence of African Americans with a Warthin's tumor increased over each decade: 0 (0%), 1 (4.8%), 2 (5.5%), and 8 (16%). This study's results indicate a progressive increase in the occurrence of this tumor in women and in African Americans and a higher overall incidence in African Americans than previously reported.

[Benign tumors of epithelial origin of the salivary glands. The authors' own experience and cases]

Following a review of the most recent literature on benign tumours of the salivary glands of epithelial origin, the paper illustrates an up-to-date classification of these tumours in anatomical and pathological terms. The author's personal clinical experience in 50 cases of major and minor salivary glands operated during the period between 1985 and 1991.

Smoking as an etiologic factor in the development of Warthin's tumor of the parotid gland

In order to further examine a preliminary association between smoking and the subsequent development of Warthin's tumor, a case-control study was undertaken between the years 1980 and 1989. Consecutive patients with Warthin's tumor served as cases, and consecutive patients with pleomorphic adenomas served as controls. A positive history of smoking was defined as a patient with greater than a 10-pack year history. There were 28 cases and 69 controls (ratio: 1:2.5). The number of male to female patients with Warthin's tumor and pleomorphic adenoma was 22 to 6 (3.7:1) and 22 to 47 (1:2.1), respectively. The mean age at presentation with Warthin's tumor or pleomorphic adenoma was 60.7 years and 40.7 years, respectively. In those patients for whom a definite smoking history was known (93 patients), an odds ratio of 8.1 (p < 0.001) was calculated. In order to exclude sex as a possible confounder, the odds ratio in males only was 6.4 (p = 0.007). In order to exclude age as a possible confounder, the odds ratio in all patients over 45 years (48 patients) was 11.2 (p < 0.001). In summary, smokers have eight times the risk of developing a Warthin's tumor than nonsmokers. This case-control study suggests that smoking may be one of the etiologic factors associated with this benign salivary gland tumor.

Warthin's tumor. A high incidence and no sex predominance in central Pennsylvania

Papillary cystadenolymphoma, or Warthin's tumor, is a monomorphic adenoma found in salivary glands. It nearly always occurs in the parotid gland, and is reported to occur in 5% to 14% of all parotid tumors according to most studies. The tumor has a universally accepted male predominance, with an increasing incidence in females having been reported over the last four decades. A review of all primary parotid gland tumors seen at York (Pa) Hospital for the last 10 years was performed. Warthin's tumor was diagnosed histologically in 42 (30%) of 138 primary parotid gland tumors, with no significant sex predominance identified (22 men, 20 women). A significantly higher percentage of all parotid gland tumors, and especially Warthin's tumor, was associated with smoking in both males and females.

[Primary tumors of the parotid. An anatomicoclinical review]

It was studied 54 cases of tumors of parotid treated in the Hospital Universitario of Granada from 1978 to 1989. It was also studied the patient age and sex, the year and month of disease arise, the tumors stages at diagnosis, the different treatments followed and the histological classification. Finally the results are discussed.

Bilateral Warthin's tumors in a Chinese--literature review and case report

Warthin's tumor is an unusual benign salivary gland tumor. It is predominantly found in Caucasians and is rare in non-Caucasians. The chief affected area of the tumor is the parotid gland. Of all salivary gland neoplasms, Warthin's tumor is the only lesion which is truly multicentric so it may have a second primary lesion, not a recurrence. The peak incidence is in the sixth decade of life. In sexual distribution, there is a male predominance but the incidence of female is progressively increasing. According to Lemelas's study, the increase in female incidence may relate to the increasing population of cigarette smoking of women. Bilateral parotid gland involvement is uncommon. The chief treatment of the tumor is surgical excision. The surgical methods include enucleation, superficial parotidectomy, total parotidectomy. It is very important to protect the facial nerves from injury during surgery. In this paper, we report a case of bilateral metachronous Warthin's tumors with cystic degeneration of parotid glands in a Chinese. Other than literature review and case report, four different methods to protect facial nerves from injury were briefly described.

Warthin's tumour in Jamaica. Incidence, electron microscopy and immunoenzyme studies

Warthin's tumour has traditionally had a strong male association, and has been said to be rare in Blacks. Current studies describe a new trend; a rise in females, strongly linked to cigarette smoking. The tumour has eosinophilic epithelial cells packed with distinctive mitochondria, and a lymphoid stroma. Immunological investigations have demonstrated polyclonal B cells, T cells and macrophages. Views differ as to whether B or T cells predominate. Between 1958 and 1989, the Jamaica Cancer Registry recorded 491 benign and malignant salivary gland tumours. There were 18 cases of Warthin's tumour (3.7%), with a male: female ratio of 5:1. The low proportion of females is similar to the trend for female lung cancer in Kingston & St. Andrew. A case of Warthin's tumour was studied by light and electron microscopy and immunoenzyme methods. The epithelial cells contained numerous mitochondria with stacked cristae, as previously described. Similar morphology occurs in oncocytic tumours; riboflavin-deficient rats and mice; rats given non-lethal doses of hypoglycin; dogs treated with annatto extracts; and hibernating or starving frogs. The mitochondrial changes may be an adaptive response. The immunoenzyme studies utilized newly available monoclonal antibodies: UCHL1, L26, 4KB5, MT1 and LN2. The reaction patterns indicate a distribution of B and T cells in a manner expected in a lymph node. The interaction between mitochondrial changes, adaptive metabolic pathways, the immune cells and tobacco raises some interesting questions.

[Primary and secondary neoplasms of the salivary glands in the province of Trieste (1977-1986). Histopathological review and epidemiological picture of 151 cases]

The authors carried out a histopathological and epidemiological study on 151 cases of primary and secondary neoplasms of the salivary glands. The parotid gland was involved in 117 cases (78.5%). The tumours were malignant in 20% (30 cases) of the lesions. The most common neoplasms were pleomorphic adenoma (74 cases) and adenolymphoma (35 cases). The occurrence of the latter were, for both sexes, directly correlated to the age of the subjects. The malignant neoplasms were also in direct relation to age. In 7 patients pleomorphic adenoma recurred (11.3%) and in 3 of these the tumour showed a carcinomatous change. The world standardized incidence of malignant forms in the province of Trieste was slightly lower than that for other countries with a similar socio-economic and demographic situation.

Warthin's tumor: multicentricity and increasing incidence in women

Warthin's tumors comprised 14 percent of all parotid tumors operated on. The average patient age in our series was 57.2 years. Eighty-seven percent of the tumors occurred in the parotid tail. The rest were in the deep lobe, or in an extraparotid location. Fifteen patients had multifocal tumors. The maximum number of tumor foci in one patient was six. A significant increase in the female incidence was noted with a 1.5:1 male-to-female ratio as compared with the previous male dominant ratio of 8:1. Eighty-two percent of the female patients in our group were smokers. We correlated a very high incidence of cigarette smoking in our series when compared with age-matched groups in both sexes within the general population. Since it is estimated that one of eight patients with Warthin's tumor will have multifocal disease, we suggest wider exposure and more meticulous operative exploration to avoid overlooked synchronous tumor foci and subsequent recurrence.

Warthin's tumor: a review indicating no male predominance

There is probably no other head and neck group of tumors as those found in the parotid gland that constitute such a diversity of growths, both benign and malignant. Warthin's or papillary cystadenoma lymphomatosum is the second most common benign tumor of the parotid gland. One universally held clinical characteristic of this tumor is its high male ratio. Because of a high frequency of female Warthin's tumor seen at Geisinger Medical Center, a review of all primary parotid gland tumors from 1971 to 1981 was carried out. Sixty-two cases out of 204 primary neoplasms were classified as Warthin's. There was no significant difference in the number of male and female cases with 32 males and 30 females. The clinical characteristics of Warthin's tumor and this unusually high female occurrence are discussed.

Incidence of salivary gland neoplasms in Greenland with special reference to an anaplastic carcinoma

Forty-two salivary gland neoplasms were diagnosed in Greenland 1955--1974. Twenty-five cases were malignant of which 92 per cent were an undifferentiated carcinoma, histologically identical to malignant lymphoepithelial lesion. Age adjusted incidence rates for salivary gland carcinomas 1965--1974 were among the highest on record, significantly higher than in Denmark. Prognosis was poor with a 5-year determinate survival rate of 14 per cent. The majority of previously reported malignant lymphoepithelial lesions of salivary glands have occurred in Arctic dwellers in Alaska and Northern Canda. Virus infection and/or dietary deficiencies may be etiological factors. In the present study secondary nasopharyngeal carcinoma could not always be excluded.

Warthin's tumor. Report of a case and survey of 205 salivary neoplasms

A case of Warthin's tumor with an unusual sialographic appearance is reported. The extensive pooling of the contrast media within the tumor was probably the result of communication of the cystic spaces of the tumor with the ductal system of the parotid gland. This case stimulated a re-examination of the incidence of this tumor, with a study of 205 major salivary gland tumors from pathology reports in the files of Hartford Hospital which is affiliated with the University of Connecticut Health Center in Farmington, Connecticut.

Papillary cystadenoma lymphomatosum (Warthin's tumor) in patients in a general hospital over a 24-year period

One hundred thirty-seven Warthin's tumors from 120 patients seen during a 23 1/2 year period were studied as two groups. The first group consisted of 32 tumors removed by the otolaryngology department. Material from these cases was re-examined microscopically for evidence of tumor occurrence within lymph nodes located inside and outside the parotid gland. This group of 32 tumors was also studied as part of the second group, 105 additional lesions removed by the surgery department. Data on patient age, sex, and race, as well as tumor multiplicity, location, and size were incorporated into a single statistical analysis. Seventy-two percent of the tumors in the first group were intranodal in location. Second primary Warthin's tumors occurred in 13 (11%) of the patients. Eight occult tumors were identified, and their importance is discussed. A single Negro, a man, was found among 118 patients. The observed frequency of the tumor was twentyfold less than expected among the Negro population.

Salivary gland tumours in Malaya

Images