Warthin's tumor is a benign neoplasm of the salivary glands. An older name is papillary cystadenoma lymphomatosum. It accounts for 4-15% of salivary gland neoplasms and is more common in men during their 6-7th decades. It almost exclusively occurs in the parotid gland and bilateral or multifocal tumors. The tumors present as a painless swelling, usually within the lower portion of the salivary gland.
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EPIDEMIOLOGY CHARACTERIZATION SYNONYMS Papillary cystadenoma lymphomatosum INCIDENCE 4-11.2% of all salivary gland tumors
Second most common benign salivary gland tumor
AGE RANGE-MEDIAN Average age 62 years
60% occur between 50-79 years
SEX (M:F) Slight male predominance but there has been an increased incidence in women GEOGRAPHY Low incidence in African Americans EPIDEMIOLOGIC ASSOCIATIONS Tobacco smoking Smokers have 8x increased risk
DISEASE ASSOCIATIONS CHARACTERIZATION Malignancy Rarely lymphoma or carcinoma may arise
PATHOGENESIS CHARACTERIZATION Clonal analysis of the epithelial component Hum Pathol 2000;31:1377-1380
Analysis of 7 cases showed a polyclonal pattern using a PCR method based on the trinucleotide repeat polymorphism of the X-chromosome linked human androgen receptor gene (HUMARA) and on random gene inactivation of the gene by methylation
Reactive condition? Some have suggested this is a reactive condition with extensive metaplasia and a secondary lymphoid response
Mod Pathol. 2005 Jul;18(7):964-8 Abstract quote.
Warthin's tumors are benign lesions of the head and neck that have a characteristic morphologic appearance. The etiology of Warthin's tumors is controversial and whether they are true neoplasms or developmental malformations continues to be debated.
In this study, we examined 12 Warthin tumors with a molecular and immunohistochemical approach. Immunostains for p53 and p16ink were performed. The epithelial and lymphoid components of each lesion were microdissected and PCR was performed for 13 microsatellite markers at or near common tumor suppressor genes. The results were analyzed semiquantitatively using capillary electrophoresis. Frequency of allelic loss was calculated. The epithelial component of all tumors was negative for p53 and p16ink. By molecular genotyping there was only one case that had one locus with allelic imbalance, while the remainder had no evidence of clonal allelic loss.
The immunohistochemical and molecular results in this study lend support to the hypothesis that Warthin tumors are non-neoplastic, as there was no evidence of aberrant staining for tumor suppressor gene protein products and no evidence of consistent clonal allelic losses.
CHARACTERIZATION Radiographs Can concentrate 99mTc so scintigraphic examination can be performed
Can also concentrate radioactive iodine
Well circumscribed averaging about 2-4 cm
Usually cystic with brown fluid and papillary excrescences
10% occur in the deep lobe
8% occur in the periparotid lymph nodes, often found incidentally
VARIANTS Bilateral or multifocal tumors 10-12% of cases Papillary cystadenoma lymphomatosum syndrome Acute onset of pain with sudden increase in size of the tumor
May be secondary to leakage of fluid into surrounding tissues and retrograde infection from the oral cavity through Stenson's duct
Extraparotid Warthin's tumor
Synderman C, Johnson JT, Barnes EL.
Otolaryngol Head Neck Surg 1986;94:169-175
Review of 176 Warthin's tumors accessioned over a 22 year period at U. of Pittsburgh
14 (8%) were extraparotid and occurred in high cervical lymph nodes adjacent to the parotid gland
Occurred in 13 patients between 41-77 years (average 63 years)
7 M:6 F
Extraglandular Warthin's tumours: clinical evaluation and long-term follow-up.
Ellies M, Laskawi R, Arglebe C.
Department of Otorhinolaryngology, University of Gottingen, Germany.
Br J Oral Maxillofac Surg 1998 Feb;36(1):52-3 Abstract quote
Nine patients with extraglandular cystadenolymphoma (Warthin's tumour) were treated between 1965 and 1995 at the Department of Otorhinolaryngology, University of Gottingen.
This number corresponds to 2.7% of all Warthin's tumours treated at our clinic so far. Although this rare tumour is well documented by case reports, a controlled follow-up study has not yet been published to the best of our knowledge. The retrospective investigation presented here gives the patients' clinical data and documents therapeutic success.
Our results show the complete absence of recurrences after surgical excision of extraglandular cystadenolymphomas.
HISTOLOGICAL TYPES CHARACTERIZATION General
Hum Pathol 1984;15:361-367
Characteristic appearance and is usually cystic. The cysts are lined by epithelial cells with oncocytic features extending as papillary structures, surrounding an abundant lymphoid stroma with germinal centers.
Ratio of B-T cells is 0.8:1
50% of the B lymphocytes contain IgG and 33% contain IgA
77% of tumors are typical subtype
Typical Epithelial component 50% Stroma poor Epithelial component of 70-80% Stroma rich Epithelial component of 20-30% Metaplastic forms VARIANTS Metastases Rarely the lymphoid stroma acts as a lymph node receiving metastases from various carcinomas
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES Metastatic carcinoma Extraparotid Warthin's tumor may occur in high cervical lymph nodes
This does not represent a metastasis
Sebaceous lymphadenoma Lymphoepithelial lesions
PROGNOSIS AND TREATMENT CHARACTERIZATION Prognostic Factors Benign Survival Benign Recurrence Range from 2-12%
Some recurrences may represent multifocal occurrence
Metastasis J Surg Oncol 1980;15:7-10
Hum Pathol 1980;11:80-83
Lymphomas and carcinomatous transformation have been to known to arise
Treatment Simple excision
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Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.
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Last Updated July 15, 2005
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