Warthin tumor within the superficial lobe of the parotid gland: a suggested criterion for diagnosis

Abstract

The location of Warthin tumor (WT) in the parotid gland impacts the surgical approach and may be indicative of the elusive origin of this intriguing entity. Location in the deep versus superficial lobe of the gland is not directly addressed when defining WT characteristics. Our observation, of rare occurrence of deep lobe WT, if at all, led to the current investigation. The study design is cohort study. This is a retrospective chart review of all patients undergoing parotidectomy for WT in two tertiary academic referral centers: the Sheba Medical Center (SMC), Israel, and the Christiana Care (CC), Newark, Delaware, USA. 122 consecutive adult patients underwent parotidectomy for WT (72 from SMC and 50 from CC). Seventy percent were males, with a mean age of 60.6 years. Bilateral WT or multi-centric WT were found in 9.8 and 17.2% of the cases, respectively. In one case, the tumor was described as originating in the deep lobe. In all other cases, the tumor originated and was limited to the superficial lobe. 99.2% of WT originated in the superficial lobe, corresponding with the few reports directly addressing its location in the gland. The reason for the tumor to be limited almost uniformly to the superficial lobe is unknown, and could be related to the etiopathogenesis of this elusive entity. We suggest adding tumor location within the superficial lobe to the common characteristics of WT (male, smoking, and lower pole) that serve as "common criterion" while evaluating a parotid lesion.

Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

“…Warthin tumor (also known as papillary cystadenoma lymphomatosum) almost always occurs within the parotid gland, with exceptional single cases reported in minor salivary glands [45]. Around 10-15% are bilateral, with up to 30% being multifocal [46,47]. They typically occur in adults, males, and especially smokers.…”

Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin’s tumor of the parotid gland

“…9 In addition, as shown in our study, MWT is characterized as a lesion located in the parotid tail and the superficial lobe, which is similar to those of WT in previous studies. 21,[23][24][25] The fact that the the parotid gland's lower pole contains the majority of intra-parotid lymph nodes may be consistent with the lymphoid component within WT. 24,26 Consequently, our results support this hypothesis.…”

Can the height of the parotid tumor be a predictor of malignancy?

“…Likewise, various studies have attempted to point out the characteristic features of parotid tumors to improve the accuracy of diagnosis, but most of the reports mainly focused on diagnosis using imaging tools, determining the involvement of adjacent structures (e.g., facial nerve, etc.) and verifying the tumor location by superficial or deep lobe in which it is contained (10)(11)(12).…”