Parotis bezi Warthin tümörü: Cerrahi sonrası takip ve tedavi değerlendirilmesi

Amaç: Bu çalışmanın amacı, parotis bezi Warthin tümörü olan hastaları retrospektif olarak inceleyerek, hastaların demografik ve klinik özelliklerini, uygulanan cerrahi tedavi sonuçlarını ve nüks durumlarını tanımlamaktır.Yöntemler: Temmuz 2008 ile Ağustos 2014 tarihleri arasında parotis bezi Warthin tümörü nedeniyle opere edilen kırk bir hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, operasyon şekli, takip süresi, çift taraflılık ve cerrahi tedavi sonrası nüks durumu kaydedildi. Takipte bütün hastalara kontrastlı manyetik rözenans görüntüleme uygulandı. Bulgular: Çalışmaya dahil edilen hastalar 40 ile 81 yaş arasındaydı (ortalama yaş 57,9). Erkek kadın oranı 4,8:1 idi. Kırk bir hastanın yedisinde çift taraflı Warthin tümörü saptandı. Kırk üç yüzeyel parsiyel parotidektomi ve üç total parotidektomi uygulandı. Çift taraflı tümörü olan hastalardan ikisi tedaviyi reddetmesi üzerine diğer taraftan cerrahi yapılmadı. Cerrahi sonrası hastalar ortalama 21,7 ay takip edildi, iki hastada nüks saptandı. Sonuç: Uzun dönem nüks riski göz önüne alındığında yüzeyel parsiyel parotidektominin yüzeyel lob yerleşimli Warthin tümörlerinde uygun tedavi yöntemi olduğu görüldü.

Warthin's tumour of the parotid gland: Post-surgical evaluation of follow-up and treatment

Objective: The aim of this study is to describe patients' demographic and clinical features, results of applied surgical treatment and recurrence status by retrospectively investigating the patients with Whartin`s tumor of parotis gland. Methods: Forty-one patients who were operated between July 2008 and August 2014 because of Warthin's tumour of parotid gland were included in the study. Patients' demographic features, operation type, follow-up time, bilaterality and recurrence status after surgical treatment were noted. Magnetic resonance imaging with contrast was implemented to all patients during follow-up. Results: The patients aged between 40 and 81 years (median age, 57.9) were included in the study. Male/female ratio was 4,8:1. Bilateral Warthin's tumours were detected in seven of the forty-one patients. Forty-three superficial partial parotidectomies and three total parotidectomies were performed. Contralateral surgeries were not performed in 2 patients with bilateral tumors who refused surgical treatment. The patients were followed up for a median of 21.7 months after surgery. The disease recurred in two patients. Conclusion: Superficial partial parotidectomy was established as a suitable treatment modality with Warthin's tumours localized in superficial lobe when the long-term risk of recurrence was taken into consideration.

Kaynakça

1. McHugh JB, Visscher DW, Barnes EL. Update on selected salivary gland neoplasms. Arc Pathol Lab Med 2009;133:1763- 74.

2. Bussu F, Parrilla C, Rizzo D, et al. Clinical approach and treatment of benign and malignant parotid masses, personal experience. Acta Otorhinolaryngol Ital 2011;31:135-43.

3. Barnes L, Eveson JW, Reichart P, et al. Pathology and genetics, head and neck tumours. In: World Health Organization classification of tumors. Lyon: IARC Press; 2005, p.209-81.

4. Neville BW, Damm DD, Allen CM, et al. Salivary Gland Pathology. In: Oral and Maxillofacial. Pathology 2009;11:461-2.

5. Yoo GH, Eisele DW, Askin FB, et al. Warthin's tumor: a 40-year experience at The Johns Hopkins Hospital. Laryngoscope 1994;104:799-803.

6. Thangarajah T, Reddy VM, Castellanos-Arango F, et al. Current controversies in the management of Warthin tumour. Postgrad Med J 2009;85:3-8. http://dx.doi.org/10.1136/pgmj.2008.071282

7. Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP. Warthin's tumour of the parotid gland: our experience. ACTA Otorhinolaryngologica Italica 2013;33:393-97.

8. Faur A, Lazfér E, Cornianu M, et al. Warthin tumor: a curious entity - case reports and review of literature. Rom J Morphol Embryol 2009;50:269-73.

9. Orabona GDA, et al. Warthin's tumour: Aetiopathogenesis dilemma, ten years of our experience, Journal of CranioMaxillo-Facial Surgery. 2014. http://dx.doi.org/10.1016/j.jcms.2014.11.019

10. Chapnik JS. The controversy of Warthin's tumor. Laryngoscope 1983;93:695-716. http://dx.doi.org/10.1288/00005537-198306000-00002

11. Teymoortash A, Krasnewicz Y, Werner JA. Clinical features of cystadenolymphoma (Warthin's tumor) of the parotid gland: A retrospective comparative study of 96 cases. Oral Oncology 2006;42:569-73. http://dx.doi.org/10.1016/j.oraloncology.2005.10.017

12. 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;38:35-40. http://dx.doi.org/10.1016/S1368-8375(01)00019-7

13. Seifert G, Bull HG, Donath K. Histologic subclassification of the Virchows. Arch A Pathol Anat 1980;388:13-38.

14. Tatlıpınar AU, Gökçeer T, Gerçeker M, Ertugay ÖÇ, Tuncel A, Güneş P. Majör Tükürük Bezi Kitlelerinde İnce İğne Aspirasyon Biyopsisinin Tanısal Değeri. Gazi Tıp Dergisi 2010;21:103-6.

15. Bektaş S, Barut F, Bahadır B ve ark. Tükrük bezi kitlelerinde ince iğne aspirasyon sitolojisi. Türk Patoloji Dergisi 2008;24:153-8.

16. Demir D, Akçam MT, Karakoç Ö ve ark. Baş boyun kitlelerine ince iğne aspirasyon biopsisinin tanısal değeri. KBB Forum 2006;5:5-9.

17. Upton DC, McNamar JP, Connor NP, et al. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol Head Neck Surg 2007;136:788-92. http://dx.doi.org/10.1016/j.otohns.2006.11.037

18. Bron LP, O'Brien CJ. Facial nerve function after parotidectomy. Arch Otolaryngol Head Neck Surg 1997;123:1091-6. http://dx.doi.org/10.1001/archotol.1997.01900100065009

19. Gaillard C, Peries S, Susini B, et al. Facial nerve dysfunction after parotidectomy: the role of local factors. Laryngoscope 2005;115:287-91. http://dx.doi.org/10.1097/01.mlg.0000154735.61775.cd

20. Guntinas-Lichius O, Gabriel B, Klussmann JP. Risk of facial palsy and severe Frey's syndrome after conservative parotidectomy for benign disease: analysis of 610 operations. Acta Otolaryngol 2006;126:1104-9. http://dx.doi.org/10.1080/00016480600672618

21. de Bree R, van der Waal I, Leemans CR. Management of Frey syndrome. Review. Head Neck 2007;29:773-8. http://dx.doi.org/10.1002/hed.20568

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