Oral cavity normally has a moist environment and it is because of the continuous secretion of the saliva in the mouth by the salivary glands Salivary glands comprise of three paired major glands, namely the parotids, the submandibular and the sublingual glands. Besides these major glands, there are numerous minor salivary glands present in almost every part of oral cavity. The secretion of saliva is essential for the normal health and function of the mouth. Disorders of salivary gland function which affects the composition and secretion of the saliva predisposes to many oral diseases.
Tumor is the abnormal growth of the body tissue.
Warthin’s Tumor is the second most common tumor of the salivary glands. The most commonly affected gland is the parotid gland. However, other glands may also be affected by this condition.
Alternative Name: Adenolymphoma, Papillary Cystadenoma Lymphomatosum
Etio-patho-genesis (Causes and Mechanisms)
The exact cause for Warthin’s Tumor is unknown; however it is believed that Warthin’s Tumor starts forming at the time of development of the salivary glands, even before the child is born. The tumor is formed due to the salivary gland tissue entrapped within the lymph nodes.
Some studies also suggest that this tumor is formed as a result of some exaggerated immune response.
A number of studies have demonstrated a strong association between the development of Warthin’s Tumor and smoking. Smokers have eight fold greater risk of Warthin’s Tumor than non smokers.
Epstein-Barr virus has also been associated with Warthin’s Tumor.
Presentation (Signs & Symptoms)
The clinical features of Warthin’s Tumor are:
- The tumor usually occurs in the parotid gland. It always forms in the lower portion of the parotid gland. The tumor is generally superficial.
- It is more common in men than women. It is common in 6th decade.
- The usual complaint is painless slow growing tumor over the mandible (the lower jaw).
- Tumor clinically presents a slow enlarging, well circumscribed, soft, painless swelling in the parotid gland.
- It is usually well encapsulated, movable and consistently found over the angle of mandible (the lower jaw).
- The maximum size of the tumor can be up to 2 to 4 cm in diameter.
- In some cases, Warthin’s Tumor may develop in association with Pleomorphic Adenoma in the parotid gland, which is the other tumor of the parotid gland
- It may be seen on one or both sides of the jaw
- In rare instances, the Warthin’s Tumor has also been reported within the submandibular gland or minor salivary glands.
The diagnosis of Warthin’s Tumor is based on the following:
- Clinical features of the tumor: If the patient presents with the earlier mentioned symptoms, then it is diagnosed as Warthin’s Tumor.
- Sialography: Sialography is the X-ray of the salivary glands. In this procedure, a special dye is injected into the salivary gland duct and then the X-rays are taken.
- Scintigram: A scintigram may also be done. In this procedure, a medicine which is a radiotracer is injected and the radiations emitted are captured by the camera. This may also be advised by the doctor.
Surgery is the only option for the treatment of Warthin’s Tumor.
- Surgical removal is the treatment of choice for patients with Warthin’s tumor. The procedure is easily accomplished because of the superficial location of the tumor.
- Some surgeons prefer local resection with minimal surrounding tissue.
- Superficial parotidectomy (removal of the part of parotid gland) can also be done depending on the extent of the tumor.
Prognosis is good in case of Warthin’s Tumor. 6% to 12% recurrence rate is reported; however due to multicentric nature of the tumor, it is difficult to determine whether they are true recurrences or secondary tumor sites.
Warthin’s Tumor usually has no complications. Although rare, but chances of the tumor becoming cancerous are present.