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Warthin's tumor - Wikipedia

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Warthin's tumor
Other names	Warthin tumour, monomorphic adenoma, adenolymphoma

Cytopathology of Warthin's tumor, with typical cellular features (and a relatively uncommon binucleated cell).^[1] Pap stain.
Specialty	Oncology

Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers (lymph node-like stroma). It is named for pathologist Aldred Scott Warthin, who described two cases in 1929.^[2]

Signs and symptoms

Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight male predilection according to recent studies. The tumor is slow growing, painless, and usually appears in the tail of the parotid gland near the angle of the mandible. In 5–14% of cases, Warthin's tumor is bilateral, but the two masses usually are at different times. Warthin's tumor is highly unlikely to become malignant.^[3]

Locations

The gland most likely affected is the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Warthin's tumor is the second most common benign parotid tumor after pleomorphic adenoma, but its prevalence is steadily increasing.^[5]

Cause

Its cause is unknown, but there is a strong association with cigarette smoking. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population.^[6]

Diagnosis

The appearance of this tumor under the microscope is unique. There are cystic spaces surrounded by two uniform rows of oncocytes, which are epithelial cells with abundant, granular, eosinophilic cytoplasm.^[7] The cystic spaces have epithelium referred to as papillary infoldings that protrude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.^{[citation needed]}

The differential diagnosis includes sebaceous lymphadenoma and oncocytoma.

This Warthin's tumor presented as a parotid mass in a middle-aged male, who underwent superficial parotidectomy. The tumor, at the right of the image, is well-demarcated from the adjacent parotid tissue and tends to shell out from it.
Low magnification micrograph of a Warthin tumor arising from the parotid gland.
Histopathology of Warthin tumor in the parotid gland. H&E stain.
Histopathology of Warthin tumor in the parotid gland. Another view of a file "Warthin tumor (1).jpg". H&E stain.
Histopathology of Warthin tumor in the parotid gland. Higher magnification of a file "Warthin tumor (1).jpg". H&E stain.
Intermediate magnification micrograph of a Warthin tumor.
High magnification micrograph of a Warthin tumor showing the characteristic bilayered epithelium.

Treatment

Most of these tumors are treated with surgical removal called parotidectomy. Contrary to pleomorphic adenoma, it is non recurrent.

References

^ Image by Mikael Häggström, MD. References for entries:
- Köybaşioğlu FF, Önal B, Han Ü, Adabağ A, Şahpaz A (2020). "Cytomorphological findings in diagnosis of Warthin tumor". Turk J Med Sci. 50 (1): 148–154. doi:10.3906/sag-1901-215. PMC 7080357. PMID 31769640.{{cite journal}}: CS1 maint: multiple names: authors list (link)
Binucleation:
- Dr.S. Malliga (2006-10-18). "A correlative cytological and histopathological study on lesions of salivary gland" (PDF).
- Chan MKM, McGuire LJ: Cytodiagnosis of Lesions Presenting as Salivary Gland Swellings: A Report of Seven Cases. Diagn Cytopathol 8: 439-443, 1992b.
^ Witt RL, ed. (2005). "Chapter 9 "Benign tumors, cysts, and tumor-like conditions of the salivary glands". Salivary Gland Diseases: Surgical and Medical Management. New York: Thieme Medical Publishers. p. 123. ISBN 1-58890-414-8.
^ Limaiem, Faten; Jain, Prachi (2023), "Warthin Tumor", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32491572, retrieved 2023-11-03
^ Steve C Lee (22 December 2022). "Salivary Gland Neoplasms". Medscape. Updated: Jan 13, 2021
Diagrams by Mikael Häggström
^ Psychogios G, Vlastos I, Thölken R, Zenk J (July 2020). "Warthin's tumour seems to be the most common benign neoplasm of the parotid gland in Germany". European Archives of Oto-Rhino-Laryngology. 277 (7): 2081–2084. doi:10.1007/s00405-020-05894-z. PMID 32189070. S2CID 212940703.
^ Kumar V, Abbas AK, Fausto N (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, MO: Elsevier Saunders. ISBN 0-7216-0187-1.
^ Chakrabarti I, Basu A, Ghosh N (2012). "Oncocytic lesion of parotid gland: A dilemma for cytopathologists". J Cytol. 29 (1): 80–2. doi:10.4103/0970-9371.93236. PMC 3307464. PMID 22438628.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Additional sources

Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.

External links

Wikimedia Commons has media related to Warthin's tumor.

Glandular and epithelial cancer

Epithelium

Papilloma/carcinoma	Small-cell carcinoma Combined small-cell lung carcinoma Verrucous carcinoma Squamous-cell carcinoma Basal-cell carcinoma Transitional cell carcinoma Inverted papilloma
Complex epithelial	Warthin's tumor Thymoma Bartholin gland carcinoma

Glands

Adenomas/
adenocarcinomas

Gastrointestinal	tract: Linitis plastica Familial adenomatous polyposis pancreas Insulinoma Glucagonoma Gastrinoma VIPoma Somatostatinoma Cholangiocarcinoma Klatskin tumor Hepatocellular adenoma/Hepatocellular carcinoma
Urogenital	Renal cell carcinoma Endometrioid tumor Renal oncocytoma
Endocrine	Prolactinoma Multiple endocrine neoplasia Adrenocortical adenoma/Adrenocortical carcinoma Hürthle cell
Other/multiple	Neuroendocrine tumor Carcinoid Adenoid cystic carcinoma Oncocytoma Clear-cell adenocarcinoma Apudoma Cylindroma Papillary hidradenoma

Adnexal and
skin appendage

sweat gland
- Hidrocystoma
- Syringoma
Syringocystadenoma papilliferum

Cystic,
mucinous,
and serous

Cystic general	Cystadenoma/Cystadenocarcinoma
Mucinous	Signet ring cell carcinoma Krukenberg tumor Mucinous cystadenoma / Mucinous cystadenocarcinoma Pseudomyxoma peritonei Mucoepidermoid carcinoma
Serous	Ovarian serous cystadenoma / Pancreatic serous cystadenoma / Serous cystadenocarcinoma / Papillary serous cystadenocarcinoma

Ductal,
lobular,
and medullary

Ductal carcinoma	Mammary ductal carcinoma Pancreatic ductal carcinoma Comedocarcinoma Paget's disease of the breast / Extramammary Paget's disease
Lobular carcinoma	Lobular carcinoma in situ Invasive lobular carcinoma
Medullary carcinoma	Medullary breast carcinoma Medullary thyroid cancer

Acinar cell

Acinic cell carcinoma

Tumors of lip, oral cavity and pharynx / head and neck cancer

Oral cancer

Salivary gland

malignant epithelial tumors	Acinic cell carcinoma Mucoepidermoid carcinoma Adenoid cystic carcinoma Salivary duct carcinoma Epithelial-myoepithelial carcinoma Polymorphous low-grade adenocarcinoma Hyalinizing clear cell carcinoma
benign epithelial tumors	Pleomorphic adenoma Warthin's tumor
ungrouped	Oncocytoma

Tongue

Oropharynx

Categories:

Hidden categories:

Classification	D ICD-10: D11 ICD-9-CM: 210.2 ICD-O: 8561/0 MeSH: D000235 DiseasesDB: 31941 SNOMED CT: 422470007
External resources	eMedicine: plastic/371