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Abstract
Neoplasms of the salivary glands are not uncommon. The dentist is in the unique position to make an early diagnosis and refer the patient for definitive treatment. This article will review the clinical appearance, pathology, treatment and potential complications of Warthin's tumor, a benign salivary gland tumor. It describes a case presented at the Salivary Gland Center, Columbia University School of Dental and Oral Surgery, New York Presbyterian Hospital-Columbia Campus.
THE HUMAN SALIVARY GLANDS, as with other tissues of the head and neck, are subject to a variety of neoplastic disorders. The majority of the neoplasms are epithelial in nature, originating from salivary secretory or salivary duct cells. Only a small number of these tumors are derived from connective tissue.
Approximately 63 percent of salivary gland tumors are benign, while 37 percent are malignant. In addition, it has been shown that 60 percent of all salivary gland tumors occur in the parotid gland.' Warthin's tumor, a benign neoplasm also known as papillary cystadenoma lymphomatosum, represents between five and 10 percent of all parotid gland tumors. After the pleomorphic adenoma (mixed tumor), it is the second most common parotid gland tumor. The majority occur within the substance of the parotid, but a few are situated in the upper part of the neck close to the parotid gland but not in continuity with the gland.'
Warthin's tumor is composed of glandular and often cystic structures, sometimes with a papillary cystic arrangement, lined by characteristic eosinophilic columnar epithelium. The stroma contains a variable amount of lymphoid tissue with follicles! The pathogenesis of Warthin's tumor is uncertain. The most accepted hypothesis suggests that the tumor arises from salivary gland tissue found within intraparotid lymph nodes? Recent studies have shown a strong association between development of the tumor and smoking. Indeed, the relative incidence of Warthin's tumor among smokers compared with nonsmokers was 7.6:1 for males and 17.4:1 for females.'
Clinical Features
Warthin's tumor is similar clinically to other benign parotid salivary gland tumors in that it usually presents as a solitary, nodular, slowly...