Warthin tümörü: Tükürük bezi ve tükürük bezi dışı malign tümörler ile ilişkisinin klinikopatolojik ve radyolojik veriler ile değerlendirilmesi

Öz

Bu çalışmanın amacı, Warthin tümörü (WT) olan hastalarda tükürük bezi veya diğer organlardan kaynaklanan malign tümörlerin görülme sıklığını bulmayı ve malign tümörü olan ve olmayan WT hastalarının klinikopatolojik, radyolojik ve demografik verilerini karşılaştırmayı amaçlamaktadır. Çalışma popülasyonunu 2010-2021 yılları arasında hastanemizde sitoloji, cerrahi ve konsültasyon materyallerinden WT tanısı alan 170 hasta oluşturmuştur. Hasta dosyaları demografik veriler, sigara içme durumu, malign tümör varlığı, radyolojik bulgular, semptom süresi ve operasyon şekli açısından incelendi. WT'li 170 hastanın 36'sında (%21.2) toplam 40 malign tümör tespit edildi. Malign tümörlerin en sık lokalizasyonları akciğer (%35.0), baş-boyun (%35.0) ve genitoüriner (%12.5) bölge idi. Malign tümör tanısı olan hastaların ortalama yaşı (62.1±9.2), olmayan hastalara göre (56.5±9.8) daha yüksekti (p=0.002). Malign tümörü olan ve olmayan olgular arasında cinsiyet, multifokalite, bilateralite, sigara içme miktarı ve ağrı şikayeti açısından anlamlı fark yoktu (p>0.05). WT'lerin SUVmaks'ı 3 ila 17.7 (medyan: 6.8, IQR: 5.5-11.0) arasında, malign tümörlerin SUVmaks'ı ise 2.7 ila 16.2 (medyan: 8, IQR: 5.1-10.3) arasında değişmekte idi (p=0.756). Bu çalışma, WT'nin malign tümörlerle eş zamanlı olarak görülebildiği gibi, malign tümör tanısı öncesinde ve sonrasında da karşılaşılabileceğini göstermektedir. Özellikle baş-boyun bölgesinde, malign tümör tanısı olan ya da araştırılan hastalarda bu olasılık göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Warthin tümörü
• Malign tümör
• İnsidans
• PET-CT

Warthin tumor: Assessment of association with salivary gland and non-salivary gland malignant tumors via clinicopathological and radiological data

Öz

This study aims to find out the incidence of malignant tumors originating from the salivary gland or other organs in patients with Warthin tumor (WT) and compare the clinicopathological, radiological, and demographic data of WT patients with or without malignant tumors. The study population consisted of 170 patients diagnosed with WT from cytology, surgery, and consultation materials between 2010 and 2021 in our hospital. Patient files were reviewed in terms of demographic data, smoking status, presence of malignant tumor, radiological findings, symptom duration, and operation procedure. A total of 40 malignant tumors were detected in 36 (21.2%) of 170 patients with WT. The most common localizations of malignant tumors were lung (35.0%), head and neck (35.0%), and genitourinary (12.5%) regions. The mean age of the patients with malignant tumor diagnosis (62.1±9.2) was higher than the patients without (56.5±9.8) (p=0.002). There was no significant difference between cases with and without malignant tumors in terms of gender, multifocality, bilaterality, amount of smoking, and pain complaints (p>0.05). The SUVmax of WTs ranged from 3 to 17.7 (median: 6.8, IQR: 5.5-11.0), and that of malignant tumors ranged from 2.7 to 16.2 (median: 8, IQR: 5.1-10.3) (p=0.756). This study demonstrates that WT can be seen with malignant tumors synchronously but also encountered before and after the malignant tumor diagnosis. This possibility should be considered, especially in the head and neck region, in patients diagnosed with malignant tumors or being investigated.

Anahtar Kelimeler

• Warthin tumor
• Malignant tumor
• Incidence
• PET-CT

Kaynakça

1. 1. El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ. WHO 1. El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ. WHO Classification of Head and Neck Tumours: International Agency for Research on Cancer; 2017.
2. 2. Sentani K, Ogawa I, Ozasa K, Sadakane A, Utada M, Tsuya T, et al. Characteristics of 5015 Salivary Gland Neoplasms Registered in the Hiroshima Tumor Tissue Registry over a Period of 39 Years. Journal of clinical medicine. 2019;8(5).
3. 3. Gontarz M, Bargiel J, Gąsiorowski K, Marecik T, Szczurowski P, Zapała J, et al. Epidemiology of Primary Epithelial Salivary Gland Tumors in Southern Poland-A 26-Year, Clinicopathologic, Retrospective Analysis. Journal of clinical medicine. 2021;10(8).
4. 4. Kotwall CA. Smoking as an etiologic factor in the development of Warthin's tumor of the parotid gland. Am J Surg. 1992;164(6):646-7.
5. 5. Peter Klussmann J, Wittekindt C, Florian Preuss S, Al Attab A, Schroeder U, Guntinas-Lichius O. High risk for bilateral Warthin tumor in heavy smokers – review of 185 cases. Acta Oto-Laryngologica. 2006;126(11):1213-7.
6. 6. Zaccarini DJ, Khurana KK. Incidence of Non-Salivary Gland Neoplasms in Patients with Warthin Tumor: A Study of 73 Cases. Head and Neck Pathology. 2020;14(2):412-8.
7. 7. Bhatlawande H, Desai KM, Kale AD, Angadi P, Hallikerimath S, Chibborah R. Co-occurrence of Warthin's tumor with oral squamous cell carcinoma - Overlapping risk factors and implications. Oral Oncol. 2020;100:104449.
8. 8. White CK, Williams KA, Rodriguez-Figueroa J, Langer CJ. Warthin's tumors and their relationship to lung cancer. Cancer Invest. 2015;33(1):1-5.

9. 9. Cardoso SV, do Nascimento Souza KC, de Faria PR, Lima RA, Nascimento MF, Eisenberg AL, et al. Warthin's tumor at the Brazilian National Cancer Institute: additional evidence of homogeneous sex prevalence and association with other neoplasms. ORL J Otorhinolaryngol Relat Spec. 2008;70(6):339-43.
10. 10. Maiorano E, Lo Muzio L, Favia G, Piattelli A. Warthin's tumour: a study of 78 cases with emphasis on bilaterality, multifocality and association with other malignancies. Oral Oncol. 2002;38(1):35-40.
11. 11. Shikhani AH, Shikhani LT, Kuhajda FP, Allam CK. Warthin's tumor-associated neoplasms: report of two cases and review of the literature. Ear Nose Throat J. 1993;72(4):264-9, 72-3.
12. 12. Lee SK, Rho BH, Won KS. Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at grayscale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core-needle biopsy. European Radiology. 2009;19(9):2268-74.
13. 13. Klijanienko J, Petras S, De Bosschere L, Paulmier B, Le Tourneau C, Rodriguez J. False-positive FDG PET/CT uptake in Warthin tumor in head and neck oncological patients confirmed by a fine needle aspiration. Diagn Cytopathol. 2012;40(3):282-4.
14. 14. Seifert G, Bull HG, Donath K. Histologic subclassification of the cystadenolymphoma of the parotid gland. Virchows Archiv A. 1980;388(1):13-38.
15. 15. Ichihara T, Kawata R, Higashino M, Terada T, Haginomori S-I. A more appropriate clinical classification of benign parotid tumors: investigation of 425 cases. Acta Oto-Laryngologica. 2014;134(11):1185-91.
16. 16. Franzen AM, Kaup Franzen C, Guenzel T, Lieder A. Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2018;275(10):2593-8.
17. 17. Tunç O, Gönüldaş B, Arslanhan Y, Kanlıkama M. Change in Warthin's tumor incidence: a 20-year joinpoint trend analysis. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2020;277(12):3431-4.
18. 18. Kadletz L, Grasl S, Perisanidis C, Grasl MC, Erovic BM. Rising incidences of Warthin's tumors may be linked to obesity: a single-institutional experience. European Archives of Oto-Rhino-Laryngology. 2019;276(4):1191-6. 19. Al-Balas H, Metwalli ZA, Eberson S, Sada DM. Clinicopathological features of incidental parotid lesions. Head & Face Medicine. 2021;17(1):10.
19. 20. Patel DK, Morton RP. Demographics of benign parotid tumours: Warthin's tumour versus other benign salivary tumours. Acta Otolaryngol. 2016;136(1):83-6.
20. 21. Psychogios G, Vlastos I, Thölken R, Zenk J. Warthin's tumour seems to be the most common benign neoplasm of the parotid gland in Germany. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2020;277(7):2081-4.
21. 22. Luers JC, Guntinas-Lichius O, Klussmann JP, Küsgen C, Beutner D, Grosheva M. The incidence of Warthin tumours and pleomorphic adenomas in the parotid gland over a 25-year period. 2016;41(6):793-7.
22. 23. Uchida Y, Minoshima S, Kawata T, Motoori K, Nakano K, Kazama T, et al. Diagnostic Value of FDG PET and Salivary Gland Scintigraphy for Parotid Tumors. Clinical Nuclear Medicine. 2005;30(3):170-6.
23. 24. Alipour R, Smith S, Gupta SK. Utility of metabolic heterogeneity factor in differentiating malignant versus benign parotid uptake on (18)F FDG PET-CT. Am J Nucl Med Mol Imaging. 2018;8(6):415-20.
24. 25. Makis W, Ciarallo A, Gotra A. Clinical significance of parotid gland incidentalomas on 18F-FDG PET/CT. Clinical Imaging. 2015;39(4):667-71.
25. 26. Xu W, Lu H, Zhu Y, Ruan M, Zhang C, Yang W, et al. Warthin's tumour in oral and maxillofacial regions: an 18-year retrospective study of 1084 cases in an eastern-Chinese population. Int J Oral Maxillofac Surg. 2018;47(7):913-7.
26. 27. Health Risks of Smoking Tobacco: American Cancer Society, Inc. https://www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/health-risks-of-smoking-tobacco.html#. Updated 28.10.2020.
27. 28. National Center for Chronic Disease P, Health Promotion Office on S, Health. Reports of the Surgeon General. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.
28. 29. Lin C-C, Tsai M-H, Huang C-C, Hua C-H, Tseng H-C, Huang S-T. Parotid tumors: a 10-year experience. American Journal of Otolaryngology. 2008;29(2):94-100.
29. 30. Alnoor FNU, Gandhi JS, Stein MK, Solares J, Gradowski JF. Prevalence of Lymphoid Neoplasia in a Retrospective Analysis of Warthin Tumor: A Single Institution Experience. Head and Neck Pathology. 2020.