Warthin's Tumor Research Articles

TRPS1 immunohistochemical expression in salivary gland tumors: A pilot study.

TRPS1 is a new, sensitive marker for breast carcinoma (BC). Salivary glands and breasts are both exocrine glands; thus, their tumors may share similar morphology and immunophenotype. Among salivary gland-type BC, TRPS1 is reported to be positive in secretory carcinomas (SCs) but negative in acinic cell carcinomas (AciCCs) and most adenoid cystic carcinomas (AdCCs). A subset of salivary duct carcinomas (SDCs) is positive for TRPS1. Herein, we investigate TRPS1 immunohistochemical expression in salivary gland tumors (SGTs). A retrospective search yielded 110 SGTs (97 primary and 13 metastatic). TRPS1 immunohistochemistry was scored as negative, low positive, intermediate positive, or strongly positive. TRPS1 was expressed in 78% (14/18) of pleomorphic adenoma (PA) cases but negative/low positive in all Warthin tumors (6/6 [100%]). In basal cell adenoma (BCA), TRPS1 expression was intermediate to strong (13/14 [92%]) in the stromal cells, whereas ductal or basal cells showed low expression. TRPS1 expression varied in malignant SGTs, with intermediate to strong staining in 100% (15/15) of AdCCs, 100% (5/5) of basal cell adenocarcinoma, 100% (3/3) of intraductal carcinoma, 89% (8/9) of polymorphous adenocarcinoma, and 89% (7/8) of SDCs; negative/low positive expression was observed in 100% (3/3) of SCs, 89% (8/9) of AciCCs, and 50% (3/3) of mucoepidermoid carcinomas. In addition, strong and intermediate TRPS1 expression was observed in metastatic SGT to the lungs, lymph nodes, and soft tissue. Overall, TRPS1 is strongly expressed in PA as well as malignant and metastatic SGT. In addition, TRPS1 is positive in stromal cells of BCA but negative or low positive in ductal and basal cells.

Novel Discovery of the Somatostatin Receptor (SSTR2) in Pleomorphic Adenomas via Immunohistochemical Analysis of Tumors of the Salivary Glands.

Reliable preoperative diagnosis between salivary gland tumor entities is difficult. In this monocentric retrospective study, we examined the somatostatin receptor 2 (SSTR2) status of salivary gland tumors after salivary gland tumor resection via immunohistochemistry (IHC), and stains were compared in analogy to the HER2 mamma scale. A total of 42.3% of all pleomorphic adenoma (PA) tumors (42 of 99, 95% confidence interval 32.5-52.8%) demonstrated ≥20% of cells displaying the SSTR2 as compared to just 1% of all other tumors (1/160, 95% CI 0.02-3.4%). The other tumor was a neuroendocrine carcinoma. PA had a higher intensity of SSTR2 staining, with 90.9% staining ≥ an intensity of 2 (moderate). Tumors with an intensity of SSTR2 expression equal to or greater than 2 had an 89.9% likelihood of being a PA (95% CI: 82.2-95.0%, AUC: 0.928). Only one Warthin tumor demonstrated a 'strong' SSTR2 staining intensity. No Warthin tumor showed a percentage of cells staining for SSTR2 above ≥20%. This result demonstrates consistent and strong expression of SSTR2 in PAs as compared to Warthin tumors, which may allow physicians to utilize radioligand-somatostatin analog PET CT/MR imaging to diagnose the PA. SSTR2 positivity, if shown to be clinically relevant, may allow peptide receptor radionuclide therapy in the future.

Adding automated decision-tree models to multiparametric MRI for parotid tumours improves clinical performance

PurposeTherapeutic management of parotid gland tumours depends on their histological type. To aid its characterisation, we sought to develop automated decision-tree models based on multiparametric magnetic resonance imaging (MRI) parameters and to evaluate their added diagnostic value compared with morphological sequences. Methods206 MRIs from 206 patients with histologically proven parotid gland tumours were included from January 2009 to January 2018. Multiparametric MRI findings (including parameters derived from diffusion-weighted imaging [DWI] and dynamic contrast-enhanced [DCE]) were used to build predictive classification and regression tree (CART) models for each histological type. All MRIs were read twice: first, based on morphological sequence findings only, and second, with the addition of multiparametric sequences and CART findings. The diagnostic performance between these two readings was compared using ROC curves. ResultsCompared to morphological sequences alone, the addition of multiparametric analysis significantly increased the diagnostic performance for all histological types (p < 0.001 to p = 0.011), except for lymphomas, where the increase was not significant (AUC 1.00 vs. 0.99, p = 0.066). ADCmean was the best parameter to identify pleomorphic adenomas, carcinomas and lymphomas with respective cut-offs of 1.292 × 10–3 mm2/s, 1.181 × 10–3 mm2/s and 0.611 × 10–3 mm2/s, respectively. × 10–3 mm2/s. The mean extracellular-extravascular space coefficient was the best parameter to Warthin tumours from the others, with a cut-off of 0.07. ConclusionsThe addition of decision tree prediction models based on multiparametric sequences improves the non-invasive diagnostic performance of parotid gland tumours. ADC and extracellular-extravascular space coefficient are the two best parameters for decision making.

Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations.

(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.

A Safety and Feasibility Trial of Ultrasound-Guided Radiofrequency Ablation of Parotid Warthin's Tumor.

To determine if ultrasound-guided (USG) radiofrequency ablation (RFA) of Parotid Warthin's tumor under local anesthesia is a safe and effective procedure. Safety and feasibility study. Tertiary academic medical center. This is an IDEAL phase 2a trial in a tertiary referral center. Twenty patients with Parotid Warthin's tumor were recruited. RFA was done between September and December 2021 for all 20 patients using a CoATherm AK-F200 machine with a disposable, 18G × 7 mm radiofrequency electrode. Results and follow-up statistics were compared with a historic sample of patients with parotid Warthin's tumor who underwent parotidectomy between 2019 and 2021 in the same center. Nineteen patients were included in the analysis as 1 patient dropped out after 4 weeks of follow-up. The mean age for the RFA group was 67 years old with most of them being male smokers. At a median of 45 weeks (44-47 weeks) postprocedure there was a 7.48 mL (68.4%) volume reduction compared to baseline. Three patients had transient facial nerve (FN) paresis, 1 recovered within hours, and the other 2 by 12 weeks follow-up. Three patients had great auricular nerve numbness; 1 patient had infected hematoma treated in an out-patient manner. Compared to a historic cohort of parotidectomy patients for Warthin's tumor, there was no significant difference in FN paresis and other minor complications between the 2 treatment modalities. The current analysis suggests that USG RFAof Warthin's Tumor is a safe alternative to parotidectomy with shorter operative time and length of stay.

Warthin tumor complicated with small lymphocytic lymphoma:report of a case

Warthin tumor complicated with small lymphocytic lymphoma:report of a case

Warthin cyst of lacrimal sac: A rare presentation of a common tumor!

Warthin tumor is a common and benign salivary gland tumor comprising of 2-15% of all epithelial tumors of the parotid gland. The extra-parotid presentation is seen to be rare at sites like the eyelid, caruncle, and the lacrimal gland. In this study, we have reported an extremely rare case of Warthin cyst of the lacrimal sac in an 82-year-old male patient with swelling over the medial canthal region since the past 2 years.

Preoperative Diagnosis of Warthin Tumors Combining Cytological, Clinical and Ultrasonographic Information within a Multidisciplinary Approach in a Lump Clinic.

(1) Background: Warthin tumors account for about 20% of all benign salivary tumors, approaching 50% if we consider only the parotid gland. Wait and see is considered a reasonable option, but the diagnosis should be certain. Diagnosis can be based on morphological and cytological data, but the sensitivity of the fine needle aspiration cytology (FNAC) is not absolute, with a high rate of non-diagnostic findings in the event of a Warthin tumor, hindering the counseling and therapeutic decisions. The aim of the study is to evaluate the reliability of FNAC and its combination with anamnestic, clinical, and ultrasonographic data in diagnosing Warthin tumors. (2) Methods: A total of 413 patients affected by masses within the major salivary gland and managed between 2017 and 2022 at our institution have been included in the present retrospective study. Each patient underwent fine needle aspiration biopsy (FNAB) with a subsequent cytological diagnosis; successively, for each patient, the clinician (otolaryngologist) and the histopathologist discussed the combination of cytological (even non-diagnostic), clinical, and ultrasonographic data in order to make a "multiparametric" diagnosis. A total of 214 cases were subsequently submitted to surgical resection and had a final histopathology report, to which the cytological and the multiparametric diagnoses can be compared. We extracted all the patients with a cytological, multiparametric, and/or histological diagnosis of Warthin tumors in order to assess the sensitivity and specificity of FNAC and of multiparametric analysis in diagnosing Warthin tumors in case of a major salivary gland mass. (3) Results: One hundred thirty-two cases had a cytological, multiparametric, and/or histological diagnosis of Warthin tumors. FNAC displays a sensitivity of 68.4% and a specificity of 98.7% in diagnosing Warthin tumors. The multiparametric evaluation allowed a considerable improvement in sensitivity (92.9% vs. 68.4%), minimizing the number of non-diagnostic results and preserving at the same time a similar value of specificity (95.5% vs. 98.7%). Notably, none of the patients with a cytological or multiparametric diagnosis of Warthin were affected by a malignant lesion in the final histopathological report. (4) Conclusions: In the case of Warthin tumors, a multiparametric evaluation encompassing anamnestic, clinical, and cytological data is effective in reducing the number of non-diagnostic reports and can safely guide the management of a tumor (e.g., antibiotic treatment of infectious complications, assign a low priority to surgery, even consider observation avoiding surgery) which is absolutely benign and can be associated with no clinically relevant issues.

A nomogram incorporating clinical, conventional ultrasound and shear wave elastography findings for distinguishing pleomorphic adenoma from Warthin's tumor of the major salivary glands.

Pre-operative differentiation between pleomorphic adenoma (PA) and Warthin's tumor (WT) of the major salivary glands is crucial for treatment decisions. The purpose of this study was to develop and validate a nomogram incorporating clinical, conventional ultrasound (CUS) and shear wave elastography (SWE) features to differentiate PA from WT. A total of 113 patients with histological diagnosis of PA or WT of the major salivary glands treated at Fujian Medical University Union Hospital were enrolled in training cohort (n = 75; PA = 41, WT = 34) and validation cohort (n = 38; PA = 22, WT = 16). The least absolute shrinkage and selection operator (LASSO) regression algorithm was used for screening the most optimal clinical, CUS, and SWE features. Different models, including the nomogram model, clinic-CUS (Clin+CUS) and SWE model, were built using logistic regression. The performance levels of the models were evaluated and validated on the training and validation cohorts, and then compared among the three models. The nomogram incorporating the clinical, CUS and SWE features showed favorable predictive value for differentiating PA from WT, with the area under the curves (AUCs) of 0.947 and 0.903 for the training cohort and validation cohort, respectively. Decision curve analysis showed that the nomogram model outperformed the Clin+CUS model and SWE model in terms of clinical usefulness. The nomogram had good performance in distinguishing major salivary PA from WT and held potential for optimizing the clinical decision-making process.

Cytodiagnosis of Primary Hodgkin’s Lypmhoma arising in Warthin’s Tumour

Warthins tumour is a benign neoplasm with a proliferative epithelial component of salivary gland epithelium and lymphoid stroma [1]. It is commonly found in the lower pole of the parotid gland,

Warthin Tumor of the Parotid Gland: The History of an Eponym.

The eponymous history of Warthin tumor (WT) is a fascinating issue in the field of salivary gland pathology. The late decades of the nineteenth century and the turn of the century saw notable German and French contributions on WT. Especially, the seminal 1910 paper of Albrecht and Arzt of Vienna is the foundation for the current knowledge of WT. It is generally believed that prior to this pioneering study, Hildebrand of Göttingen accurately described the lesion of WT in 1895. However, the historical origins of WT appear to be unsettled, and only a few German pathologists and surgeons are aware that dating back to 1885, the first recognizable reference to WT was that by the renowned German-Swiss pathologist Zahn, whose name is eponymously associated with "Zahn infarct" and "lines of Zahn". Two noted French surgeons with a major interest in pathology, Albarrán in 1885 and Lecéne in 1908, did not contribute to the topic. Since the 1950s, a mostly American group of pathologists and surgeons gradually adopted the term WT to replace the very accurate histologic descriptor "papillary cystadenoma lymphomatosum" coined by Warthin himself in 1929. It is our opinion that from a historical viewpoint, there is no particular reason why this tumor should have been named WT.

Surgical management of Warthin tumor: long-term follow-up of 224 patients from 2002 to 2018

PurposeWarthin tumors (WT) are the second most common benign parotid gland neoplasms. They can occur as synchronous or metachronous lesions in 6–10% of cases. This study aims to compare the complication rate in 224 patients who underwent extracapsular dissection (ECD) or superficial parotidectomy (SP) for the treatment of a WT.MethodsThis retrospective study was conducted at the Department of Maxillo-Facial Surgery at the University of Naples “Federico II” from February 2002 to December 2018 on a group of patients who underwent surgical treatment for WT. The type of surgical technique was chosen based on Quer’s classification. The complications evaluated were facial nerve palsy, hematoma, Frey’s syndrome, and bleeding.ResultsA total of 224 patients treated from 2002 to 2018 for Warthin tumor were included in the study. Two hundred elven had solitary tumors (94.1%) and 13 had multicentric lesions (5.8%), of which 9 cases presented synchronous lesions and 4 cases presented metachronous lesions. Extracapsular dissection (ECD) was performed in 130 patients (58.3% of cases) and superficial parotidectomy (SP) in the other 94 (41.7% of cases).ConclusionsWe consider both surgical techniques as valid. In our opinion, it is essential to study each case based on Quer’s Classification to obtain the best surgical outcome. Based on a lower observed rate of complications such as facial nerve palsy, Frey’s syndrome, and bleeding, ECD seems to be the best option for the surgical treatment of Quer Class I lesions.

A Case of Warthin Tumor Highlighting the Diagnostic Dilemmas Encountered

Introduction: Warthin’s tumour (WT) previously known as papillary cystadeno-lymphomatosum is the most frequent ‘monomorphic’ adenoma of the major salivary glands, representing about 2–15% of all parotid tumours. It is a benign epithelial salivary gland neoplasm affecting elderly individuals and commonly involves the inferior pole of parotid glands. Fine needle aspiration cytology is considered the first diagnostic approach for salivary gland lesions; however, the cytological findings in Warthin tumor can be dubious many a times.&#x0D; Case Presentation: We present a case of a female in sixth decade of life with left neck swelling which mimicked a necrotic lymph node on imaging and turned out to be Warthin tumor.&#x0D; Conclusion: In the present paper, we discuss the diagnostic dilemmas faced in a case of warthin tumor.

Epidemiological distribution of primary salivary gland tumors. Retrospective analysis in Baghdad Medical City

Background: Studies on the incidence of salivary tumors around the world showed variations, including in Iraq. This study was intended to evaluate the relative incidence of these tumors among the Iraqi population. Materials and methods: The current retrospective study encompassed 109 cases retrieved from the file records of the pathology laboratory of Baghdad Medical City over a five-year period from January 2017 to December 2021. Information regarding age, gender, site, and tumor type was assembled and analyzed using a statistical package for social sciences (SPSS version 20). Results: The present study documented that salivary gland tumors represent 1.35% of the total sample studied. Approximately 56% were benign and 44% were malignant, with a ratio of benign to malignant was 1.27/1. The male-to-female ratio was 1/1. The prevalent benign tumor was pleomorphic adenoma, followed by Warthin's tumor. Warthin's tumor showed a predilection for male patients. The most common sites were the parotid gland (50%), palate (29%), and submandibular gland (10%), respectively. Regarding malignant tumors, adenoid cystic carcinoma ranked first followed by mucoepidermoid carcinoma. Conclusions: Salivary gland tumors chiefly arise in major salivary glands without sex predilection, with pleomorphic adenoma and adenoid cystic carcinoma being the most common salivary tumors.

A CLINICOPATHOLOGICAL STUDY OF 100 CASES OF SALIVARY GLAND LESIONS AT A TERTIARY CARE CENTRE.

Background: Salivary gland shows varied types of pathological lesions ranging from inammatory lesions to neoplasms. We have studied the salivary gland lesions with correlation to clinical and histopathologic features. Objective: Aim of this study was – 1. To study the epidemiology of salivary gland lesions in a tertiary care centre with respect to the age, sex and site distribution. 2. To study the histomorphological aspect of these lesions. 3. To correlate between ne needle aspiration cytology and histopathology of these lesions. Materials and Methods: The present observational study was conducted in the department of pathology in Dr. VPMCH&amp;RC, Nashik. Total 100 cases were studied over a period of two years with particular reference to age, sex, site, cytological details &amp; histological types as per WHO classication. Detailed FNAC &amp; histopathological examination was done in all the cases. Correlation between the cytological &amp; histopathological diagnoses was assessed. A total of 100 cases were studied, comprising of 62 Results: male &amp; 38 female and 16 cases were malignant. The parotid gland was the most commonly involved site (70% of cases). Of the 46 non-neoplastic cases, 38 were of chronic sialadenitis and 8 cases of mucous retention cyst. Among the 38 benign neoplastic lesions, 32 were Pleomorphic adenoma and 6 were Warthin's tumour. Mucoepidermoid carcinoma (8 cases) was the most common malignant neoplastic lesions. Correlated in 95% of instances. Salivary gland lesions, are most Conclusion: nd th commonly seen in 2 to 6 decade of life with more male predominance. Parotid gland is the most common site. Lesions have more frequent occurrences compared to neoplastic lesions, with chronic sialadenitis having highest incidence. Histopathologic examination is fairly accurate in making a diagnosis especially in non-neoplastic &amp; benign neoplasms.

Warthin-like mucoepidermoid carcinoma of the parotid gland: Clinicopathological observation and literature review.

Warthin tumor (WT)-like mucoepidermoid carcinoma resembles the histologic pattern of WT and pathologists unaware of this possibility may misdiagnose it as WT with squamous and mucous epithelium metaplasia or WT malignant transfer into mucoepidermoid carcinoma. The present study reported a case of a 41-year-old Chinese female with a solitary mass in the left parotid gland. In this case, microscopic observation revealed prominent lymph node stroma and multiple cystic structures similar to those seen in WT. However, it lacked the two layers of oncocytic epithelial tissue characteristic of WT. Furthermore, fluorescence in situ hybridization detected MAML2 rearrangement in the case. Considering the histological findings, this case was diagnosed as WT-like mucoepidermoid carcinoma. The present case report provides pathological and clinical features to differentiate it from WT malignant transition into mucoepidermoid carcinoma, WT with squamous and mucous epithelium metaplasia and non-sebaceous lymphadenoma-like mucoepidermoid carcinoma. In conclusion, WT-like mucoepidermoid carcinoma as a special subtype of mucoepidermoid carcinoma has special histological characteristics, which required further observations and more case reports to clearly define this variant.

Differential diagnosis of parotid gland tumors using apparent diffusion coefficient, texture features, and their combination.

Warthin's tumors (WT) and pleomorphic adenomas (PA) are the commonest parotid gland tumors; however, their differentiation remains difficult. This study aimed to investigate the utility of the apparent diffusion coefficient (ADC) value, texture features, and their combination for the differential diagnosis of parotid gland tumors. Patients who underwent magnetic resonance imaging (MRI) between April 2008 and March 2021 for parotid gland tumors were included and divided into two groups according to the tumor type: WT and PA. The tumor types were used as predictor variables, while the ADC value, texture features, and their combination were the outcome variables. Texture features were measured on short tau inversion recovery (STIR) images and selected using the Fisher's coefficient method and probability of error, and average correlation coefficients. The Mann-Whitney U-test was used to analyze bivariate statistics. Receiver operating characteristic curve analysis was used to assess the ability of the ADC value, texture features, and their combination to distinguishing between the two tumor types. A total of 22 patients were included, 11 in each group. The ADC value, 10 texture features, and their combination were significantly different between the two groups (p < .001). Moreover, all three variables had high area under the curve values of 0.93-0.96. The ADC value, texture features, and their combination demonstrated good diagnostic ability to distinguish between WTs and PAs. This method may be used to aid the differential diagnosis of parotid gland tumors, thereby promoting timely and adequate treatment.

Evaluation of Mucinous Metaplasia (MUM) in Warthin Tumor

Amaç: Warthin tümörü (WT) ikinci en sık benign tükürük bezi tümörüdür ve en sık parotiste yerleşir. Literatürde WT’ünde müsinöz metaplazi (MüM) ile ilgili sınırlı sayıda çalışma bulunmaktadır. Ayrıca yakın zamanda tanımlanan “WT benzeri mukoepidermoid karsinom (MEK)” ile WT’de MüM ayrımı da özel bir önem arz etmektedir. Burada 50 vakalık WT serimizde MüM değerlendirilmiş, kantitatif olarak skorlanmış ve MüM’nin klinik parametrelerle ilişkisi araştırılmıştır. Gereç ve Yöntem: Hastanemizde WT tanısı alan 50 olgu çalışmaya alındı. Olgulara ait hemotoksilen eozin (H&amp;amp;E) kesitler tekrar değerlendirildi. MüM izlenen olgulara müsikarmen histokimyasal boyası uygulanarak metaplazi derecelendirildi. Derecelendirme; mukus hücrelerin dağılımı (&amp;lt;10,≥10 hücre grubu), kolumnar hücrelere göre yüzdesi (&amp;lt;%1,≥%1-5,≥%5) ve x100 büyütmedeki mukus hücre sayısına (&amp;lt;50,≥50) göre yapıldı ve puanlamaya göre hafif, orta, şiddetli şeklinde gruplandırıldı. Bulgular: Toplam 50 olgunun 14’ü (%28) kadın, 36’sı (%72) erkekti. Olguların yaş ortalaması 61.3 idi. Olguların 18’inde (%36) MüM mevcuttu. Metaplazi tümörlerin 13’ünde (%72) hafif, 4’ünde (%23) orta, birinde (%5) şiddetli olarak derecelendirildi. Bu olguların 14’ü (%78) erkek, 4’ü (%22) kadındı. Cinsiyet ile MüM varlığı arasında istatistiksel olarak anlamlı ilişki görülmedi. MüM derecesi ile cinsiyet arasındaki ilişki tekrar değerlendirildi. Buna göre erkeklerin 12’si hafif, 1’i orta, 1’i şiddetli, kadınların 1’i hafif, 3’ü orta şiddetli olarak derecelendirildi. İstatistiksel olarak MüM derecesi ile cinsiyet arasında anlamlı bir ilişki görüldü (p=0.040). Yaş ve tümör boyutu ile MüM varlığı arasında anlamlı bir ilişki izlenmedi. Olgulara operasyon öncesi ince iğne aspirasyon yapılması ve tümör odak sayısı ile MüM varlığı arasında da anlamlı istatistiksel ilişki görülmedi. Sonuç: WT de MüM varlığı değişken oranlarda izlenmekte olup rutin incelemeler sırasında rahatlıkla gözden kaçabilmektedir. Özellikle yoğun MüM izlenen tümörlerde, WT ile örtüşen morfolojik özelliklere sahip “Warthin benzeri mukoepidermoid karsinom” ayırıcı tanıya alınmalı ve gerekirse moleküler incelemeler ile desteklenmelidir.

Support Tools in the Differential Diagnosis of Salivary Gland Tumors through Inflammatory Biomarkers and Radiomics Metrics: A Preliminary Study

The purpose of this study was to investigate how the systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), and radiomic metrics (quantitative descriptors of image content) extracted from MRI sequences by machine learning increase the efficacy of proper presurgical differentiation between benign and malignant salivary gland tumors. A retrospective study of 117 patients with salivary gland tumors was conducted between January 2015 and November 2022. Univariate analyses with nonparametric tests and multivariate analyses with machine learning approaches were used. Inflammatory biomarkers showed statistically significant differences (p < 0.05) in the Kruskal-Wallis test based on median values in discriminating Warthin tumors from pleomorphic adenoma and malignancies. The accuracy of NLR, PLR, SII, and SIRI was 0.88, 0.74, 0.76, and 0.83, respectively. Analysis of radiomic metrics to discriminate Warthin tumors from pleomorphic adenoma and malignancies showed statistically significant differences (p < 0.05) in nine radiomic features. The best multivariate analysis result was obtained from an SVM model with 86% accuracy, 68% sensitivity, and 91% specificity for six features. Inflammatory biomarkers and radiomic features can comparably support a pre-surgical differential diagnosis.

Top Ten Oncocytic Head and Neck Lesions to Contemplate.

Oncocytes are a component of many metaplastic and neoplastic lesions throughout the head and neck area, primarily originating in salivary/seromucinous glands and the thyroid gland. In addition, other lesions can contain cells that mimic oncocytes (pseudo-oncocytes); these can be of epithelial or non-epithelial origin. Review article. Oncocytic metaplasia is common in seromucinous glands throughout the upper aerodigestive tract, most notable in the oral cavity, nasopharynx and larynx. The main oncocytic salivary gland neoplasms are Warthin tumor and oncocytoma. Infarction of Warthin tumor may lead to recognition difficulties. Oncocytic subtypes of mucoepidermoid carcinoma and intraductal carcinoma have morphologic and immunohistochemical features that allow distinction from major oncocytic entities. Oncocytic thyroid tumors include adenoma, carcinoma (follicular, papillary and medullary), along with poorly differentiated tumors. Oncocytic papillary sinonasal and middle ear tumors must be distinguished from low grade adenocarcinomas. Pseudo-oncocytic entities include paraganglioma, Langerhans cell histiocytosis, giant cell tumor, rhabdomyoma, and metastatic tumors. Correct diagnosis of oncocytic head and neck lesions requires a knowledge of the spectrum of possible entities, their characteristic sites of occurrence, architecture, histomorphology, and immunohistochemistry. Oncocytic subtypes of several newly described entities are now recognized. Both epithelial and non-epithelial mimics of oncocytes exist. The molecular features of oncocytic tumors can be helpful in their diagnosis and understanding their pathogenesis.