Warthin's tumor pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Pathogenesis

• Warthin tumor is a benign tumor of the salivary gland. The first symptom is usually a painless, slow-growing bump in front of the ear, on the bottom of the mouth, or under the chin. Warthin tumors may increase in size over time, but few become cancerous.
• The gland most likely affected is the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Though much less likely to occur thanpleomorphic adenoma, Warthin's tumor is the second most common benign parotid tumor.
• The appearance of this tumor under the microscope is unique. There are cystic spaces surrounded by two uniform rows of cells with centrally placed pyknotic nuclei.
• The cystic spaces have epithelium referred to as papillary infoldings that protude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.
• Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight female predilection according to recent studies, but historically it has been associated with a strong male predilection. This change is possibly due to the tumor's association with cigarette smoking and the growing use of cigarettes by women. 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.

Microscopic Pathology

The appearance of this tumor under the microscope is unique. There are cystic spaces surrounded by two uniform rows of cells with centrally placed pyknotic nuclei. The cystic spaces have epithelium referred to as papillary infoldings that protrude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.

The differential diagnosis includes sebaceous lymphadenoma and oncocytoma.

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  Histopathology of Warthin tumor in the parotid gland. H&E stain

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  Histopathology of Warthin tumor in the parotid gland. Another view of a file "Warthin tumor (1).jpg". H&E stain..

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  Histopathology of Warthin tumor in the parotid gland. Higher magnification of a file "Warthin tumor (1).jpg". H&E stain.

References

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