Warthin's tumor overview: Difference between revisions
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{{Warthin's tumor}} | {{Warthin's tumor}} | ||
==Overview== | ==Overview== | ||
Warthin's tumor is a type of [[benign]] [[tumor]] of the [[salivary glands]]. It is also known as benign [[papillary]] [[cystadenoma]] lymphomatosum. Its [[etiology]] is unknown, but there is a strong association with the cigarette [[Tobacco smoking|smoking]]. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population. The most common symptoms of | Warthin's tumor is a type of [[benign]] [[tumor]] of the [[salivary glands]]. It is also known as [[benign]] [[papillary]] [[cystadenoma]] lymphomatosum. Its [[etiology]] is unknown, but there is a strong association with the cigarette [[Tobacco smoking|smoking]]. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population. Warthin's tumor arises from [[salivary gland]] [[Epithelium|epithelium,]] which are secretory cells of the [[salivary gland]]. On [[gross pathology]], [[cystic]] and multicentric appearance are characteristic findings of Warthin's tumor. On [[microscopic]] [[Histopathological|histopathologica]]<nowiki/>l analysis, [[papillae]], [[Fibrous capsule|fibrous capsule,]] and [[cystic]] spaces are characteristic findings of Warthin's tumor. Warthin's tumor must be differentiated from [[salivary gland]] cysts, salivary gland lymphoma, and [[Salivary gland cancer|salivary gland cance]]<nowiki/>r. The [[prevalence]] of Warthin's tumor is [[Estimate|estimated]] to be 2000 to 2500 cases annually. Warthin's tumor commonly affects [[elderly]] patients greater than 60 years old. Males are more commonly affected with Warthin's tumor than females. The male to female ratio ranges from 2.6:1 to 10:1. The most potent [[risk factor]] in the [[development]] of Warthin's tumor is [[smoking]]. Other [[risk factors]] include [[irradiation]], [[Epstein-Barr virus]], and [[alcohol]]. If left untreated, few patients with Warthin's tumor may progress to develop [[facial paralysis]]. Common [[complications]] of Warthin's tumor include [[squamous cell carcinoma]] and [[facial paralysis]]. [[Prognosis]] is generally good. The most common symptoms of Warthin's tumor include [[Swelling|swollen]] [[salivary gland]], [[lump]] near the back of the lower [[jaw]], [[Jaw pain/swelling|jaw]] [[pain]], the [[sensation]] of [[pressure]], [[facial nerve paralysis]], [[tinnitus]], impaired hearing, [[earache]], etc. [[X-ray|X-ray,]] [[Computed tomography|computed tomography (CT) scan]] and [[Magnetic resonance imaging|magnetic resonance imaging (MRI)]] may help [[diagnosis]]. [[Surgery]] is the mainstay of treatment for Warthin's tumor. As a [[benign tumor]], the [[prognosis]] of Warthin's tumor is good. | ||
==Historical Perspective== | ==Historical Perspective== | ||
Warthin's tumor was first discovered by Hildebrand, a German surgeon, in 1895. | Warthin's tumor was first discovered by Hildebrand, a German surgeon, in 1895. | ||
==Pathophysiology== | ==Pathophysiology== | ||
Warthin's tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. On gross pathology, cystic and multicentric appearance are characteristic findings of Warthin's tumor. On microscopic histopathological analysis, papillae, fibrous capsule, and cystic spaces are characteristic findings of Warthin's tumor. | Warthin's tumor arises from [[salivary gland]] [[epithelium]], which are secretory cells of the [[salivary gland]]. On gross pathology, [[cystic]] and multicentric appearance are characteristic findings of Warthin's tumor. On [[microscopic]] [[histopathological]] [[analysis]], [[papillae]], [[fibrous capsule]], and [[Cystic|cystic spaces]] are characteristic findings of Warthin's tumor. | ||
==Causes== | ==Causes== | ||
There are no known direct causes for Warthin's tumor. | There are no known direct causes for Warthin's tumor. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Warthin's tumor must be differentiated from salivary gland cysts, salivary gland lymphoma, and salivary gland cancer. | Warthin's tumor must be [[Differentiating (disease name) from other diseases page|differentiated]] from [[salivary gland]] [[Cyst|cysts]], [[salivary gland]] [[Lymphomas|lymphoma]], and [[salivary gland cancer]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The prevalence of Warthin's tumor is estimated to be 2000 to 2500 cases annually. Warthin's tumor commonly affects elderly patients greater than 60 years old. The male is more commonly affected with Warthin's tumor than female. The male to female ratio ranges from 2.6:1 to 10:1. | The [[prevalence]] of Warthin's tumor is estimated to be 2000 to 2500 cases annually. Warthin's tumor commonly affects elderly patients greater than 60 years old. The male is more commonly affected with Warthin's tumor than female. The male to female ratio ranges from 2.6:1 to 10:1. | ||
==Risk Factors== | ==Risk Factors== | ||
The most potent risk factor in the development of Warthin's tumor is smoking. Other risk factors include irradiation, Epstein-Barr virus, and alcohol. | The most potent [[risk factor]] in the development of Warthin's tumor is [[smoking]]. Other risk factors include [[irradiation]], [[Epstein-Barr virus]], and [[alcohol]]. | ||
==Natural history, Complications and Prognosis== | ==Natural history, Complications and Prognosis== | ||
If left untreated, few patients with Warthin's tumor may progress to develop facial paralysis. Common complications of Warthin's tumor include squamous cell carcinoma and facial paralysis. Prognosis is generally good. | If left untreated, few patients with Warthin's tumor may progress to develop [[Facial nerve paralysis|facial paralysis]]. Common [[complications]] of Warthin's tumor include [[squamous cell carcinoma]] and [[Facial nerve paralysis|facial paralysis]]. [[Prognosis]] is generally good. | ||
==History and Symptoms== | ==History and Symptoms== | ||
The hallmark of Warthin's tumor is swelling of jaw, cheek, mouth, or neck. A positive history of swollen salivary gland and jaw [[pain]] is suggestive of Warthin's tumor. The most common | The hallmark of Warthin's tumor is [[swelling]] of [[jaw]], [[cheek]], [[mouth]], or [[neck]]. A positive history of [[Swelling|swollen]] [[salivary gland]] and jaw [[pain]] is suggestive of Warthin's tumor. The most common | ||
symptoms of Warthin's tumor include [[tinnitus]], [[an earache]], and blood in saliva. | [[symptoms]] of Warthin's tumor include [[tinnitus]], [[Earache|an earache]], and blood in [[saliva]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Patients with Warthin's tumor usually appear well. Physical examination of patients with Warthin's tumor is usually remarkable for mobile nontender mass which is firm | Patients with Warthin's tumor usually appear well. Physical examination of patients with Warthin's tumor is usually remarkable for mobile nontender mass which is firm, [[solitary]], and normal in color and [[appearance]]. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
There are no diagnostic lab findings associated with Warthin's tumor. | There are no [[diagnostic]] [[Lab finding|lab findings]] associated with Warthin's tumor. | ||
==CT== | ==CT== | ||
Neck CT scan may be helpful in the diagnosis of Warthin's tumor. Findings on CT scan suggestive of Warthin's tumor include cystic lesion posteriorly within the parotid with a focal tumor nodule and absence of calcifications. | Neck CT scan may be helpful in the diagnosis of Warthin's tumor. Findings on CT scan suggestive of Warthin's tumor include [[cystic]] lesion posteriorly within the [[parotid]] with a focal tumor nodule and absence of [[Calcification|calcifications]]. | ||
==MRI== | ==MRI== | ||
On MRI, Warthin's tumor is characterized by well-defined bilateral lesions which are heterogeneous and variable in signal intensity. | On MRI, Warthin's tumor is characterized by well-defined [[bilateral]] [[lesions]] which are [[heterogeneous]] and [[variable]] in signal intensity. | ||
==Echocardiography or Ultrasound== | ==Echocardiography or Ultrasound== | ||
Neck ultrasound may be helpful in the diagnosis of Warthin's tumor. Findings on neck ultrasound suggestive of Warthin's tumor include well defined, ovoid, hyperechoic mass | Neck [[ultrasound]] may be helpful in the [[diagnosis]] of Warthin's tumor. Findings on neck ultrasound suggestive of Warthin's tumor include well defined, [[ovoid]], hyperechoic mass with internal [[cystic]] areas and hypervascularity. | ||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
Other diagnostic studies for Warthin's tumor include scintigraphy, which demonstrates uptake of with Tc99-pertechnetate, thallium, and FDG-PET. | Other diagnostic studies for Warthin's tumor include [[scintigraphy]], which demonstrates uptake of with Tc99-pertechnetate, [[thallium]], and [[FDG-PET]]. | ||
==Biopsy== | ==Biopsy== | ||
On biopsy, Warthin's tumor is characterized by cystic spaces surrounded by two uniform rows of [[cell (biology)|cells]] with centrally placed pyknotic [[cell nucleus|nuclei]], papillae with a two rows of pink epithelial cells, and lymphoid stroma. | On [[biopsy]], Warthin's tumor is characterized by cystic spaces surrounded by two uniform rows of [[cell (biology)|cells]] with centrally placed pyknotic [[cell nucleus|nuclei]], [[papillae]] with a two rows of pink [[epithelial cells]], and [[Lymphoid|lymphoid stroma]]. | ||
==Surgery== | ==Surgery== | ||
Surgery is the mainstay of treatment for Warthin's tumor. | Surgery is the mainstay of treatment for Warthin's tumor. | ||
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[[Category:Oral pathology]] | [[Category:Oral pathology]] | ||
[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Hereditary cancers]] | [[Category:Hereditary cancers]] | ||
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[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Gastroenterology]] | |||
Latest revision as of 19:43, 29 November 2018
| https://https://www.youtube.com/watch?v=IKG8McDLoB8 |350}} |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nazia Fuad M.D.
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Risk calculators and risk factors for Warthin's tumor overview |
Overview
Warthin's tumor is a type of benign tumor of the salivary glands. It is also known as benign papillary cystadenoma lymphomatosum. Its etiology is unknown, but there is a strong association with the cigarette smoking. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population. Warthin's tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. On gross pathology, cystic and multicentric appearance are characteristic findings of Warthin's tumor. On microscopic histopathological analysis, papillae, fibrous capsule, and cystic spaces are characteristic findings of Warthin's tumor. Warthin's tumor must be differentiated from salivary gland cysts, salivary gland lymphoma, and salivary gland cancer. The prevalence of Warthin's tumor is estimated to be 2000 to 2500 cases annually. Warthin's tumor commonly affects elderly patients greater than 60 years old. Males are more commonly affected with Warthin's tumor than females. The male to female ratio ranges from 2.6:1 to 10:1. The most potent risk factor in the development of Warthin's tumor is smoking. Other risk factors include irradiation, Epstein-Barr virus, and alcohol. If left untreated, few patients with Warthin's tumor may progress to develop facial paralysis. Common complications of Warthin's tumor include squamous cell carcinoma and facial paralysis. Prognosis is generally good. The most common symptoms of Warthin's tumor include swollen salivary gland, lump near the back of the lower jaw, jaw pain, the sensation of pressure, facial nerve paralysis, tinnitus, impaired hearing, earache, etc. X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) may help diagnosis. Surgery is the mainstay of treatment for Warthin's tumor. As a benign tumor, the prognosis of Warthin's tumor is good.
Historical Perspective
Warthin's tumor was first discovered by Hildebrand, a German surgeon, in 1895.
Pathophysiology
Warthin's tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. On gross pathology, cystic and multicentric appearance are characteristic findings of Warthin's tumor. On microscopic histopathological analysis, papillae, fibrous capsule, and cystic spaces are characteristic findings of Warthin's tumor.
Causes
There are no known direct causes for Warthin's tumor.
Differential Diagnosis
Warthin's tumor must be differentiated from salivary gland cysts, salivary gland lymphoma, and salivary gland cancer.
Epidemiology and Demographics
The prevalence of Warthin's tumor is estimated to be 2000 to 2500 cases annually. Warthin's tumor commonly affects elderly patients greater than 60 years old. The male is more commonly affected with Warthin's tumor than female. The male to female ratio ranges from 2.6:1 to 10:1.
Risk Factors
The most potent risk factor in the development of Warthin's tumor is smoking. Other risk factors include irradiation, Epstein-Barr virus, and alcohol.
Natural history, Complications and Prognosis
If left untreated, few patients with Warthin's tumor may progress to develop facial paralysis. Common complications of Warthin's tumor include squamous cell carcinoma and facial paralysis. Prognosis is generally good.
History and Symptoms
The hallmark of Warthin's tumor is swelling of jaw, cheek, mouth, or neck. A positive history of swollen salivary gland and jaw pain is suggestive of Warthin's tumor. The most common symptoms of Warthin's tumor include tinnitus, an earache, and blood in saliva.
Physical Examination
Patients with Warthin's tumor usually appear well. Physical examination of patients with Warthin's tumor is usually remarkable for mobile nontender mass which is firm, solitary, and normal in color and appearance.
Laboratory Findings
There are no diagnostic lab findings associated with Warthin's tumor.
CT
Neck CT scan may be helpful in the diagnosis of Warthin's tumor. Findings on CT scan suggestive of Warthin's tumor include cystic lesion posteriorly within the parotid with a focal tumor nodule and absence of calcifications.
MRI
On MRI, Warthin's tumor is characterized by well-defined bilateral lesions which are heterogeneous and variable in signal intensity.
Echocardiography or Ultrasound
Neck ultrasound may be helpful in the diagnosis of Warthin's tumor. Findings on neck ultrasound suggestive of Warthin's tumor include well defined, ovoid, hyperechoic mass with internal cystic areas and hypervascularity.
Other Imaging Findings
Other diagnostic studies for Warthin's tumor include scintigraphy, which demonstrates uptake of with Tc99-pertechnetate, thallium, and FDG-PET.
Biopsy
On biopsy, Warthin's tumor is characterized by cystic spaces surrounded by two uniform rows of cells with centrally placed pyknotic nuclei, papillae with a two rows of pink epithelial cells, and lymphoid stroma.
Surgery
Surgery is the mainstay of treatment for Warthin's tumor.