Warthin's tumor pathophysiology: Difference between revisions

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== Pathophysiology ==
== Pathophysiology ==
 
===Pathogenesis===
=== Physiology ===
The exact pathogenesis of warthins tumor is not completely understood. Acording to a study in 2016,<ref name="KuzenkoRomanuk20162">{{cite journal|last1=Kuzenko|first1=Yevhen V.|last2=Romanuk|first2=Anatoly M.|last3=Dyachenko|first3=Olena Olegivna|last4=Hudymenko|first4=Olena|title=Pathogenesis of Warthin’s tumors|journal=Interventional Medicine and Applied Science|volume=8|issue=2|year=2016|pages=41–48|issn=2061-1617|doi=10.1556/1646.8.2016.2.2}}</ref> :
The normal physiology of [name of process] can be understood as follows:
*[[Stroma]] and [[parenchyma]] of the [[tumor]] was histopathologically analyzed.
 
*The [[epithelial]] and [[stromal]] component was equally distributed in [[tumor]] mass.
=== Pathogenesis ===
*This study showed that the Warthin's tumor occurs as a result of of [[inflammatory]] process.
The exact pathogenesis of warthins tumor is not completely understood. A study in 2016 revealed that<ref name="KuzenkoRomanuk2016">{{cite journal|last1=Kuzenko|first1=Yevhen V.|last2=Romanuk|first2=Anatoly M.|last3=Dyachenko|first3=Olena Olegivna|last4=Hudymenko|first4=Olena|title=Pathogenesis of Warthin’s tumors|journal=Interventional Medicine and Applied Science|volume=8|issue=2|year=2016|pages=41–48|issn=2061-1617|doi=10.1556/1646.8.2016.2.2}}</ref> :
*[[Epithelial]] part of the Warthin's tumor is the main trigger for the [[tumor]] process.
* Stroma and parenchyma of the tumor was histopathologically analyzed.
* The epithelial and stromal component was equally distributed in tumor mass.
* This study showed that the Warthin tumor is a the result of of inflammatory process.
* Epithelial part of the Warthin's tumor is the main trigger for the tumor process.
 
==Genetics==
==Genetics==
* Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.
*Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.
==Gross Pathology==
==Gross Pathology==
Warthin's tumor is often multicentric (20%) and is usually small (1-4 cm). It has typically heterogeneous appearance on all modalities, often with cystic components (30%). Other features include:<ref>{{cite book | last = Blake | first = Michael | title = Adrenal imaging | publisher = Humana Press | location = Totowa, NJ | year = 2009 | isbn = 193411586X }}</ref><ref name="Radiopaedia">{{cite web | title = Radiopedia 2015 Warthin tumor [Dr Henry Knipe and A.Prof Frank Gaillard]| url = http://radiopaedia.org/articles/warthin-tumour }}</ref>
Characteristic findings of warthin's tumor on gross pathology are;
* Encapsulated
* Size of the [[tumor]] varies between 2-5 cm.
* Lobulated with inter spread heamorrhagic and pale gray surface areas
* The [[tumor]] is well demarcated, grey yellow in color.
* It is encapsulated, [[Lobular|lobulated]] and multicentric.
* Warthin;s tumor can be fixed to overlying skin.
* 10-15% are multifocal/bilateral.
* Tumor can have serous/mucinous secretion.


==Microscopic Pathology==
==Microscopic Pathology==
The appearance of this [[tumor]] under the [[microscope]] is unique. Following features can be observed on microscopic picture
On microscopic histopathological analysis the characteristic findings of warthin;s tumor are;
* There are cystic spaces surrounded by two uniform rows of [[cell (biology)|cells]] with centrally placed pyknotic [[cell nucleus|nuclei]].<ref name="EllisAuclair2009">{{cite journal|last1=Ellis|first1=Gary L.|last2=Auclair|first2=Paul L.|title=Salivary Glands|year=2009|pages=246–294|doi=10.1016/B978-1-4160-3966-2.00011-4}}</ref>
* Dense lymphoid stroma with double layer of epithelial cells resting on the stroma.
 
* The cystic spaces are present which are narrowed by polypoid projections.
* The cystic spaces have epithelium referred to as papillary infoldings that protude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.
* Basal cell layer is not continuous and is interrupted in places .
* Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) - key feature
* The oncocytic columnar cells palisade on the surface.
* Fibrous capsule - pink & homogenous on H&E stain
* There is no myoepithelial component present in tumor.
* Cystic space filled with debris in situ (not necrosis)
* Occasional features include [[Cilia|cilia,]] [[squamous metaplasia]] with [[Necrosis|necrosis,]] [[Mast cell|mast cells]], [[dendritic cells]] and [[Sebaceous|sebaceous cells]].  
* Lymphoid stroma
* Additionally, the [[epithelium]] has [[lymphoid stroma]] with [[germinal center]] formation.


[[image:Warthin tumor (1).jpg|center|400px|thumb| CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507400]]
[[image:Warthin tumor (1).jpg|center|400px|thumb| CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507400]]

Latest revision as of 00:53, 21 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

Overview

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.

Pathophysiology

Pathogenesis

The exact pathogenesis of warthins tumor is not completely understood. Acording to a study in 2016,[1] :

Genetics

  • Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.

Gross Pathology

Characteristic findings of warthin's tumor on gross pathology are;

  • Size of the tumor varies between 2-5 cm.
  • The tumor is well demarcated, grey yellow in color.
  • It is encapsulated, lobulated and multicentric.
  • Warthin;s tumor can be fixed to overlying skin.
  • 10-15% are multifocal/bilateral.
  • Tumor can have serous/mucinous secretion.

Microscopic Pathology

On microscopic histopathological analysis the characteristic findings of warthin;s tumor are;

  • Dense lymphoid stroma with double layer of epithelial cells resting on the stroma.
  • The cystic spaces are present which are narrowed by polypoid projections.
  • Basal cell layer is not continuous and is interrupted in places .
  • The oncocytic columnar cells palisade on the surface.
  • There is no myoepithelial component present in tumor.
  • Occasional features include cilia, squamous metaplasia with necrosis, mast cells, dendritic cells and sebaceous cells.
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507400
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507402

References

  1. Kuzenko, Yevhen V.; Romanuk, Anatoly M.; Dyachenko, Olena Olegivna; Hudymenko, Olena (2016). "Pathogenesis of Warthin's tumors". Interventional Medicine and Applied Science. 8 (2): 41–48. doi:10.1556/1646.8.2016.2.2. ISSN 2061-1617.


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