24af2039f5e9376f52338aed5c4dac20 269661.pdf 7d9cee5fd0d1fbdda6862eb7fcfdc7831cf8e638 269661.pdf f19f16f660d14d537f385ad88953a7c0e66eef97a58c8246913bc3b7ca8e812f 269661.pdf Title: Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland "2279 Subject: Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies. Keywords: Warthin tumor; papillary cystadenoma lymphomatosum; cystadenolymphoma; adenolymphoma; lymphomatous adenoma; parotid tumor Author: Miquel Quer, Juan C. Hernandez-Prera, Carl E. Silver, Maria Casasayas, Ricard Simo, Vincent Vander Poorten, Orlando Guntinas-Lichius, Patrick J. Bradley, Wai Tong-Ng, Juan P. Rodrigo, Antti A. Mäkitie, Alessandra Rinaldo, Luiz P. Kowalski, Alvaro Sanabria, Remco de Bree, Robert P. Takes, Fernando López, Kerry D. Olsen, Ashok R. Shaha and Alfio Ferlito Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Aug 16 09:07:43 2021 CEST ModDate: Mon Aug 16 09:16:57 2021 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2282231 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SOZKOC+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 QZNTXY+VnURWPalladioL Type 1 Custom yes yes no 15 0 JFCVKZ+URWPalladioL-Ital Type 1 Custom yes yes no 19 0 JFAKAA+URWPalladioL-Bold Type 1 Custom yes yes no 24 0 KLRTQO+URWPalladioL-Roma Type 1 Custom yes yes no 28 0 BXZUUH+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 58 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 62 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 66 0 BDKHDP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 88 0 BDKHFB+PalatinoLinotype TrueType WinAnsi yes yes no 91 0 BDKHFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 94 0 BDKHNC+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 97 0 AULFWG+CMSY10 Type 1 Builtin yes yes no 105 0 BDKHDP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 115 0 BDKHFB+PalatinoLinotype TrueType WinAnsi yes yes no 118 0 BDKHFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 121 0 BDKJJJ+Calibri CID TrueType Identity-H yes yes yes 137 0 BDKHDP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 143 0 BDKHFB+PalatinoLinotype TrueType WinAnsi yes yes no 146 0 BDKHFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 149 0 BDKHDP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 159 0 BDKHFB+PalatinoLinotype TrueType WinAnsi yes yes no 162 0 BDKHFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 165 0 BDKHDP+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 172 0 BDKHEA+PalatinoLinotype CID TrueType Identity-H yes yes yes 175 0 BDKHFB+PalatinoLinotype TrueType WinAnsi yes yes no 181 0 BDKHFD+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 184 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-05-27 03:16:18 CEST RepresentationInformation: 269661.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-31 12:04:40 CEST Size: 2282231 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 785 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Epidemiology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Diagnosis of Warthin Tumors (WT) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Diagnostic Pathology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Primary Surgical Excision Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Extent of Surgery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Parotidectomy I IV (Total Parotidectomy) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Parotidectomy I II (Lateral Parotidectomy) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Parotidectomy II (Partial Lateral Parotidectomy) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Extracapsular Dissection (ECD) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Capsular Dissection (CD) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Active Surveillance (AS) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Alternatives to Surgery and AS Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Children: Item: Title: Microwave Ablation (MWA) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Radiofrequency Ablation (RFA) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Ultrasound-Guided Ethanol Sclerotherapy (UGES) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Info: Title: Current Trends and Controversies in the Management of Warthin Tumor of the Parotid Gland "2279 Author: Miquel Quer, Juan C. Hernandez-Prera, Carl E. Silver, Maria Casasayas, Ricard Simo, Vincent Vander Poorten, Orlando Guntinas-Lichius, Patrick J. Bradley, Wai Tong-Ng, Juan P. Rodrigo, Antti A. Mäkitie, Alessandra Rinaldo, Luiz P. Kowalski, Alvaro Sanabria, Remco de Bree, Robert P. Takes, Fernando López, Kerry D. Olsen, Ashok R. Shaha and Alfio Ferlito Subject: Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies. 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