Warthin's tumor biopsy

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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]

Overview

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.

Biopsy

Salivary gland biopsy is the most important test for diagnosis of Warthin's tumor.

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 protude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.
• Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) - key feature.
• Fibrous capsule - pink & homogenous on H&E stain.
• Cystic space filled with debris in situ (not necrosis).
• Lymphoid stroma
• Additionally, the epithelium has lymphoid stroma with germinal center formation.

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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.
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  Histopathology of Warthin tumor in the parotid gland. Image courtesy of Nephron librepathology (original file ‘’here’’). Creative Commons BY­SA­NC
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  Histopathology of Warthin tumor in the parotid gland. Image courtesy of Nephron librepathology (original file ‘’here’’). Creative Commons BY­SA­NC
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  Histopathology of Warthin tumor in the parotid gland. Image courtesy of Nephron librepathology (original file ‘’here’’). Creative Commons BY­SA­NC
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  Histopathology of Warthin tumor in the parotid gland. Image courtesy of Nephron librepathology (original file ‘’here’’). Creative Commons BY­SA­NC