Incidence of Warthin Tumor in a Veteran Population: A Shifting Paradigm

Presentation: D190
Topic: Salivary
Type: Poster
Date: Wednesday, May 1, 2019 (1:00 PM - 7:00 PM) | Thursday, May 2, 2019 (9:00 AM - 7:00 PM)
Session: Wednesday, May 1, 2019 (1:00 PM - 7:00 PM) | Thursday, May 2, 2019 (9:00 AM - 7:00 PM)
Authors: Adnan S Hussaini1, Edina Paal, MD2, Sonya Malekzadeh, MD3, Jessica H Maxwell3
Institution(s): 1Medstar Georgetown University Hospital - Department of Otolaryngology - Head & Neck Surgery, 2The George Washington University, Department of Pathology, 3Washington DC Veterans Affairs Medical Center, Department of Otolaryngology - Head & Neck Surgery

Background: Salivary gland tumors account for 2-4% of head and neck neoplasms with the parotid gland as the most common primary site. Studies have shown that pleomorphic adenomas (PA) are the most common benign parotid gland tumors, followed by Warthin tumors (WT). While smoking is a known risk factor for WT, the rates of smoking have declined over the last few decades. The aim of this study was to investigate the distribution of parotid gland neoplasms among a veteran population. 

Methods: Patients who underwent fine needle aspiration (FNA) for a parotid gland mass at the Washington DC Veterans Affairs Medical Center (VAMC) from 2004 to 2018 were included. Of those patients who underwent parotid gland FNA, medical records were reviewed for gender, age, tobacco use, date of FNA, histology, surgery type and date, margin status, and recurrence. FNA histology results were correlated with gender and tobacco use. 

Results: One hundred and thirty-one patients who underwent parotid gland FNA were  included in the analysis. Thirty-ninefour (29.826%; 39/131) were excluded due to benign cysts (n=22), non-diagnostic/normal parotid tissue (n=12), or sialadenitis (n=5). Of the remaining 927 patients, 79 (88.91.4%; 79/927) were benign on FNA histology, whereas 138 (14.118.6%; 138/927) were malignant. Of the benign neoplasms, WT accounted for the majority at 58.2% (46/79), followed by PA at 36.711.4% (29/79), oncocytic neoplasm (3.8%; 3/79), and lipoma (1.3%; 1/79).  Of patients with WT, 82.6% were former or current smokers, compared to 62% among patients with PA. Patients with a smoking history were more likely to have a WT compared to a PA (OR: 3.49 [95% confidence interval 1.45-8.37] p=0.046). Male gender was also significantly associated with a diagnosis of WT compared to PA (p=0.028). Among patients with WT, 47.8% (22/46) underwent parotidectomy, slightly less than 58.6% (17/46) of patients with PA who underwent surgery.

Conclusion: In our veteran cohort who underwent FNA for parotid gland masses, Warthin tumor was the most common benign neoplasm encountered, surpassing pleomorphic adenomas in incidence. It remains unclear whether this is due to a higher prevalence of tobacco use or male gender among the veteran population. However, a thorough understanding of the distribution of parotid gland neoplasms in this specific population is critical to patient counseling and surgical planning.