Extraparotid Warthin Tumors Imitating Metastasis of Oral Cancers

Abstract

Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC). Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC. Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients. Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery. Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.

Synchronous occurrence of oral squamous cell carcinoma and Warthin’s tumor: systematic review and case report

“…However, other information, such as drinking habits or body mass index, was rarely provided. There does not appear to be a clear link between the two diseases other than the risk factor of tobacco abuse and the high frequency among oral tumors 13 - 15 . In our study, 11 of 19 patients were smokers, but there was no clear evidence that this caused the co-occurrence of the two diseases.…”

“…Of the 19 patients, WT in 6 mimicked metastatic nodes where the patients underwent ipsilateral modified RND or SND that extended beyond level I-III. However, pathological examination determined no nodal metastasis, indicating that the extended neck dissection had been unnecessary 4 , 11 , 15 . For example, in Sato et al 11 , a patient exhibited nodal swelling suggestive of metastasis from maxillary cancer, but the swelling did not subside after radiotherapy.…”

“…Due to these limitations, fine needle aspiration biopsy (FNAB) was recommended by three authors of the articles we reviewed 6 , 8 , 15 and was performed before surgery in one reported study 6 . FNAB is widely used as a diagnostic method for differential diagnosis of head and neck tumors due to its simplicity, safety, and cost-effectiveness 19 .…”

“…Twelve eligible articles were identified with 18 cases of synchronous occurrence of oSCC and WT in the head and neck, and the following information was extracted and summarized in Table 1 4 - 15 : first author, publication year, demographic information, alcohol and smoking history, tumor sites, treatment, and survival. Our case was added for analysis.…”