Incidence of Non-Salivary Gland Neoplasms in Patients with Warthin Tumor: A Study of 73 Cases

Zaccarini, Daniel J.; Khurana, Kamal K.

doi:10.1007/s12105-019-01049-7

Cited by 7 publications

(5 citation statements)

References 59 publications

(31 reference statements)

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“…Several studies have failed to detect clonality of the tumor cells, and a non-neoplastic (metaplastic) process involving salivary inclusions within intraparotid lymph nodes has been postulated as a pathogenetic explanation of WTs [ 10 , 11 ]. The metaplastic theory has been linked to the effect of chronic cigarette smoking, a factor that has also been proposed to explain the striking historical male predominance and the higher frequency of associated head and neck squamous cell carcinoma in patients with WTs [ 12 ]. Irrespective of the exact etiology, damage to mitochondrial DNA, possibly resulting from chronic nicotine abuse, and mitochondrial abnormalities including mitochondrial enzyme dysregulations seem to play a role in the morphogenesis of WTs [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

KRAS codon 12 mutations characterize a subset of de novo proliferating “metaplastic” Warthin tumors

et al. 2023

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Warthin tumor (WT; synonym: cystadenolymphoma) represents one of the most frequent salivary gland tumors with a frequency equaling or even outnumbering that of pleomorphic adenomas in some series. Histologically, the tumor displays tall columnar oncocytic cells, arranged into two cell-thick layers lining variably cystic glands within an organoid lymphoid stroma. Tumors with exuberant squamous metaplasia in response to FNA-induced or other types of tissue injury/infarction have been referred to as “metaplastic WTs.” However, the same terminology was used for tumors with variable mucinous cell and solid or stratified epidermoid proliferations (occasionally mimicking mucoepidermoid carcinoma), although the “metaplasia concept” has never been proven for the latter. We herein investigated 22 WTs showing prominent mucoepidermoid-like or solid oncocytoma-like proliferations without prior FNA or histological evidence of infarction/ trauma using the TruSight Tumor 15 gene panel and KRAS pyrosequencing. As a control, we tested 11 conventional WTs. No statistically significant differences were observed between the two subcohorts regarding patient’s age and tumor size. Six of 22 (27%) proliferating/ metaplastic WTs revealed oncogenic KRAS mutations clustering at codon 12 (exon 2), while all conventional tumors lacked these mutations. Our findings are in line with a neoplastic nature of the epidermoid/ mucoepidermoid proliferations in non-injured “metaplastic” Warthin tumors. We propose the descriptive term “de novo proliferating Warthin tumor” for this variant to distinguish it from infarcted/inflamed genuine metaplastic Warthin tumor.

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Section: Discussionmentioning

confidence: 99%

KRAS codon 12 mutations characterize a subset of de novo proliferating “metaplastic” Warthin tumors

et al. 2023

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“…Furthermore, because smoking is an identical risk factor for lung cancer ( 2 ) and Warthin’s tumor ( 37 ), lung cancer coexisting with Wartin’s tumor is not puzzling ( 38 – 41 ). It is reported that there is a significant correlation between the occurrence of parotid gland warthin’s tumor and lung cancer ( 38 , 42 ). About 19% of patients with warthin’s tumor in parotid gland also have lung cancer ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Parotid metastases from primary lung cancer: Case series and systematic review of the features

Wang

Zhou

2022

Front. Oncol.

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Most parotid metastases have been reported to come from the head and neck; however, cases metastasized from the lung are extremely rare. Missed diagnoses and misdiagnoses occurred quite a few times. Thus, accurately identifying the clinical features of parotid metastasis of lung cancer is important. However, current studies about this issue are mostly case reports, and little is known about the detailed and systematic aspects. We reported three cases of parotid metastases from lung cancer and then systematically searched similar cases through “Pub-Med” and “Web of Science”. Finally, twenty-three patients were included in the study. Eighty-three percent of which were males, and 19 patients were over 50 years old. In all cases with smoking history mentioned, 93% were smokers. The predominant pathological type was small cell lung cancer (SCLC, 13 patients, 56%). Seventeen combined with other site metastasis, while more than half of which were brain metastases. The survival time ranged from 3months-17years, and as for SCLCs, it was only 3months-40months. It can be concluded that clinical features, such as sex, age, smoking history, pathological types, and metastasis patterns, could provide valuable evidence for diagnosis. The lung seems to be the most common primary site of parotid metastases except for head and neck tumors. The two circumstances, SCLC coexisting with Warthin’s tumor and parotid small cell carcinoma with lung metastasis, should be differentiated from parotid metastasis of lung cancer with caution For cases presented as SCLC, more aggressive strategies, such as chemotherapy with immunotherapy and maintenance therapy, may be more suitable. Due to the greater tendency of brain metastasis in such diseases, whole-brain radiation therapy, stereotactic radiosurgery or prophylactic cranial irradiation should be applied to corresponding patients in time. Additionally, lung cancer parotid metastases may be a marker of poor prognosis.

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“…Pain can be present in some WT patients, especially when the tumor is compressed. However, with regard to pain, one should keep in mind that the tumor may represent another type of salivary gland tumor or could be malignant, which is more likely to cause this symptom [4]. Finally, some patients clearly prefer to have their WT removed because of persistent fear of an underlying malignancy.…”

Section: Primary Surgical Excisionmentioning

confidence: 99%

“…Around 15% of WTs are multifocal in the same gland and in approximately 10% of cases are present bilaterally [1,3]. WTs have been reported in association with other salivary gland neoplasms (benign and malignant) [4]. It has also been reported that WTs arise in intra-and periparotid lymph nodes and may account for the diagnosis of the WT-isolated extraparotid gland in the neck [1,5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Incidence of Non-Salivary Gland Neoplasms in Patients with Warthin Tumor: A Study of 73 Cases

Cited by 7 publications

References 59 publications

KRAS codon 12 mutations characterize a subset of de novo proliferating “metaplastic” Warthin tumors

KRAS codon 12 mutations characterize a subset of de novo proliferating “metaplastic” Warthin tumors

Parotid metastases from primary lung cancer: Case series and systematic review of the features

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

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