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. 2013 Dec;33(6):393-7.

Warthin's tumour of the parotid gland: our experience

T C Chulam  1 , A L Noronha Francisco  2 , J Goncalves Filho  1 , C A Pinto Alves  3 , L P Kowalski  1
Affiliations

Warthin's tumour of the parotid gland: our experience

T C Chulam et al. Acta Otorhinolaryngol Ital. 2013 Dec.

Abstract
in English, Italian

Benign tumours account for approximately 60-80% of parotid neoplasms and among these, Warthin's tumour is the second most common benign neoplasm accounting for approximately 15% of all parotid epithelial tumours. The medical records of 100 consecutive patients with Warthin's tumour of the parotid gland admitted for treatment at the Department of Head and Neck Surgery and Otorhinolaryngology, Hospital A.C. Camargo, São Paulo, Brazil, between 1983 and 2011 were retrospectively analyzed. The surgical procedures included 104 (96%) subtotal parotidectomies and 4 (3.7%) total parotidectomies. One hundred and eight parotidectomies were performed in 100 patients with Warthin's tumour. Postoperative complications occurred in 67 (62.3%) of surgical procedures, and facial nerve dysfunction was the most frequent complication, occurring in 51 of 108 surgeries (47.2%). The marginal mandibular branch of the facial nerve was affected in 46 of the 48 cases (95.8%) of facial nerve dysfunction. Frey's syndrome was diagnosed in the late postoperative period in 19 patients (17.6%). We conclude that either superficial or total parotidectomy with preservation of facial nerve are the treatment of choice for Warthin's tumour with no case of recurrence seen after long-term follow-up. Facial nerve dysfunction and Frey's syndrome were the main complications associated with this surgery. Thus, if on one hand total parotidectomy is an appropriate radical resection of parotid parenchyma reducing, in theory, the risk of recurrence, on the other hand superficial parotidectomy is also a radical and efficient method with lower morbidity in terms of facial nerve dysfunction and Frey's syndrome.

Le neoplasie benigne rappresentano circa il 60-80% dei tumori della ghiandola parotide e fra questi, il tumore di Warthin è il secondo istotipo più frequente con una prevalenza del15% circa dei tumori epiteliali della parotide. Abbiamo analizzato retrospettivamente le cartelle cliniche di 100 pazienti affetti da tumore di Warthin trattati fra il 1983 e il 2011 presso il dipartimento di chirurgia della testa e del collo dell'ospedale di San Paolo "A.C. Camargo" (Brasile). Nei 100 pazienti analizzati furono effettuate 108 parotidectomie di cui 104 parotidectomia subtotale (96%), e 4 parotidectomia totali (3,7%). Complicanze post operatorie si sono verificate nel 62,3% delle procedure chirurgiche e in particolare la disfunzione del nervo facciale fu la più frequentemente osservata (51/108 procedure effettuate – 47,2%). Una disfunzione del ramo marginalis mandibulae del nervo facciale eè stata riscontrata in 46 dei 48 casi (95,8%) con disfunzione del facciale. La sindrome di Frey's fu riscontrata invece tardivamente in 19 pazienti (17,6% dei casi). Nella nostra casistica anche ad un follow-up a lungo termine non sono state apprezzate recidive di tumori di Warthin dopo parotidectomia esofacciale o totale con preservazione del nervo facciale. La disfunzione del nervo facciale e la sindrome di Frey erano le principali complicanze osservate dopo la chirurgia. Benché la parotidectomia totale rappresenti l'approccio chirurgico più radicale i nostri dati dimostrano che la parotidectomia superficiale non solo consente di ottenere una buona radicalità chirurgica ma allo stesso tempo si associa ad una bassa moribidità in termini di disfunzione del nervo facciale e sindorme di Frey.

Keywords: Complications; Parotid; Parotid tumours; Recurrence; Treatment; Warthin's tumour.

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Figures

Fig. 1.
Fig. 1.
Histological section stained with HE with 40x magnification, showing the interface between the salivary gland and the tumor.
Fig. 2.
Fig. 2.
Histological section stained with HE with 40x magnification, demonstrating the neoplasm characterized by cystic and solid areas, cells with abundant granular and eosinophilic cytoplasm with central nuclei. The stroma is rich in lymphocytes.
See this image and copyright information in PMC

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