Warthin’s tumor is a benign tumor of the salivary gland. The neoplasia primarily affects older men.
What is Warthin’s tumor
The Warthin tumor was first mentioned in 1895 by the German surgeon Otto Hildebrand. At that time the tumor was still called adenolymphoma. In 1910, the tumor was described in more detail by Heinrich Albrecht and Leopold Arzt and then made known by Warthin in 1929 as papillary cystadenoma lymphomatosum. For chronic intestinal pseudo-obstruction overview, please visit homethodology.com.
Warthin’s tumor is also known as adenolymphoma or cystadenolymphoma papilliferum. The median age at diagnosis is 62 years. The tumor is found primarily in men between the ages of 60 and 70. A manifestation in childhood is certainly possible, but the tumor rarely develops before the age of 40.
Although more and more men are being affected by the tumor, the incidence rate has shifted in recent years. While ten times more men than women were affected in the 1950s, today more and more women are affected due to changed lifestyles. It is expected that in the future a balanced gender ratio in disease incidence will be achieved.
The cause of the tumor development is not yet known. Although the disease is usually assigned to true neoplasms, the tumors could also be acquired multicystic reactive diseases. It turned out that the tumors are of polyclonal origin. However, other studies have shown that some Warthin tumors have fusion genes between chromosome 11 and chromosome 19.
Exactly the same changes were also found in the so-called mucoepidermoid carcinoma, a malignant neoplasm. Researchers suspect that the tumor originates from heterotropic salivary ducts in lymph nodes. Heterotrophic tissue is outside of its proper anatomical location. The fact that Warthin’s tumors are often located at the lower pole of the parotid gland supports this theory.
This is also where most of the lymph nodes are found. Still other hypotheses see the tumor as an adenomatous proliferation of tissue. This proliferation is said to cause lymphocytic infiltration. Smoking is a major risk factor. Smoking probably increases the incidence of the disease by a factor of eight to ten. The risk increases the longer the affected person smokes. In contrast, the intensity of tobacco consumption seems to play only a minor role.
Studies show that more than 90 percent of patients with Warthin’s tumor are smokers. In addition, the risk of bilateral tumors is increased in smokers. The mitochondrial DNA is probably damaged by smoking. In the histological examination, the cells of the Warthin tumor often show a missing mitochondrial DNA and pathologically altered mitochondria.
An increased incidence of disease was also observed after contact with ionizing radiation. For example, Warthin’s tumors were more common in survivors of atomic bomb blasts. The involvement of viruses in the development of tumors is also under discussion. The human herpes virus type 8 is often found in the cells of the tumor. In addition, the tumor occurs more frequently in HIV -infected patients. Various [[autoimmune diseases] also appear to be associated with parotid gland tumors.
Symptoms, Ailments & Signs
A characteristic symptom of Warthin’s tumor is a painless swelling in the area of the parotid gland. At the time of diagnosis, the tumor is usually between two and four centimeters in size. In extreme cases, however, it can also be twelve or thirteen centimeters tall.
Only a tenth of patients complain of pain. However, if the tumor tissue becomes inflamed, severe pain can occur. Compression of the facial nerve is also associated with pain. Facial paralysis (facial paralysis), on the other hand, is only observed in rare cases.
Diagnosis & course of disease
Swelling in the parotid glands suggests a Warthins tumor. If there is any suspicion, imaging methods are used to confirm the diagnosis. Ultrasound, computed tomography or magnetic resonance imaging are suitable for diagnosis. Scintigraphy is only rarely used for diagnosis. In most cases, a definitive diagnosis can only be made with a preoperative biopsy.
The histological examination reveals a tumor that is delimited by a thin connective tissue capsule. The tumor consists of epithelial areas and cysts embedded in lymphoid connective tissue. Cells and cell nuclei are usually formed normally. With the help of fine-needle biopsy, correct diagnoses can be made in more than 95 percent of cases.
At the latest with the help of the removed tumor, the diagnosis can be secured thanks to histological examination. Since the histological structure of the Warthin tumor is very characteristic, the diagnosis is usually unproblematic. Nevertheless, a differential diagnosis must be made between lymphoepithelioma-like carcinoma and mucoepidermoid carcinoma.
In most cases, Warthin’s tumor does not lead to any particular complications and does not lead to a serious course. Since the tumor itself is benign, no direct treatment is usually necessary if the disease does not lead to severe restrictions in the patient’s everyday life. Those affected suffer from swelling in the area of the ear.
The size of this swelling depends very much on the severity of the tumor, so that it can also have a negative effect on everyday life. In some cases, Warthin’s tumor can cause severe pain, requiring patients to seek treatment. Should the tumor damage and compress the nerve, it can cause facial paralysis. If the nerve is completely damaged, this paralysis can often no longer be repaired.
Warthin’s tumor is treated with the help of a surgical procedure. There are no complications and the tumor can usually be completely removed, resulting in a positive course of the disease. With the early diagnosis and treatment of this tumor, the patient’s life advice is not negatively influenced.
When should you go to the doctor?
Since Warthin’s tumor usually cannot heal itself, the affected person is dependent on a visit to a doctor. This is the only way to prevent further complications and complaints, so that a doctor should be contacted as soon as the first symptoms and signs of the disease appear. Men in particular should consult a doctor if the symptoms of Warthin’s tumor occur. In most cases, this tumor makes itself felt by a strong swelling that occurs in the area of the ear.
This can usually be felt with the fingers. Severe pain in the ears also often indicates a Warthin tumor if it occurs for no particular reason and does not go away on its own. This tumor can also lead to swelling or paralysis of the entire face. You should also consult a doctor if you have these symptoms.
The disease can be diagnosed by a general practitioner or by an ENT doctor. Further treatment usually takes place in a hospital. Whether the disease will lead to a reduced life expectancy of those affected cannot be universally predicted.
Treatment & Therapy
As a rule, the Warthin tumor is surgically completely removed. The operation usually takes the form of a superficial parotidectomy. In this case, the outer lobe of the parotid gland is completely removed or peeled out. Enucleation is preferable because the operation time is significantly shorter. In addition, the complication rate is lower and the cosmetic result is better.
Surgery is usually avoided in patients with a high anesthetic risk. Warthin’s tumor does not grow aggressively and does not metastasize, so removal is not mandatory. However, it should be noted that a diagnosis based solely on fine-needle biopsy can easily miss malignancy.
Smoking seems to be the main risk factor for Warthin’s tumor. Cigarettes and other tobacco products should therefore be avoided as a preventative measure.
If the Warthin tumor was completely surgically removed as part of a parotidectomy, follow-up treatment follows. In contrast to malignant tumours, which require regular follow-up care, in the case of benign Warthin’s tumour, the period immediately after the operation is sufficient.
The focus of follow-up care for Warthin’s tumor is the control of wound healing. If the facial nerve has not been affected and there are no complications, no further follow-up measures are required. It usually takes around four weeks for the pain that occurs following the parotidectomy to subside.
After the operation, the patient is allowed to move. For about three days he wears a wound drain to drain the wound fluid. It takes about six weeks to three months for the facial nerve to recover from the procedure. The surgical scar will gradually heal. Sometimes a prolonged numbness in the earlobe can occur, which is usually unavoidable. The scar often reddens six months after the surgical procedure.
In certain cases, the patient receives antibiotic medication for a few days after the operation. In addition, an injection is given daily into the abdomen, which serves to prevent blood clots (thrombosis). If there is damage to the facial nerve, physiotherapy exercises are recommended to train facial expressions.
You can do that yourself
A Warthin tumor usually has to be surgically removed. A superficial parotidectomy is usually necessary, in which the tumor is completely removed. The self-help of the patients is limited to the typical general measures such as rest and rest.
It is important to prepare adequately for the hospital stay. After the tumor is removed, it is necessary to consult the doctor regularly. If you have any unusual symptoms, it is advisable to see a doctor. The doctor will make precise specifications regarding physical protection and other measures. Natural remedies can help with the pain. The use of homeopathic preparations must first be discussed with the doctor.
A tumor disease always represents a psychological burden. The patient should contact a self-help group or a therapist at an early stage in order to work through the disease and exchange experiences. The Internet is a good way to gather information. The German Cancer Society offers patients and their relatives important contact points and information. The responsible ENT doctor can also support the treatment and aftercare and help the patient to quickly return to normal everyday life after the illness.