Warthin's tumor pathophysiology
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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
Physiology
The normal physiology of [name of process] can be understood as follows:
Pathogenesis
The exact pathogenesis of warthins tumor is not completely understood. A study in 2016 revealed that[1] :
- 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
- Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.
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:[2][3]
- Encapsulated
- Lobulated with inter spread heamorrhagic and pale gray surface areas
Microscopic Pathology
The appearance of this tumor under the microscope is unique. Following features can be observed on microscopic picture
- There are cystic spaces surrounded by two uniform rows of cells with centrally placed pyknotic nuclei.[4]
- 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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References
- ↑ 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.
- ↑ Blake, Michael (2009). Adrenal imaging. Totowa, NJ: Humana Press. ISBN 193411586X.
- ↑ "Radiopedia 2015 Warthin tumor [Dr Henry Knipe and A.Prof Frank Gaillard]".
- ↑ Ellis, Gary L.; Auclair, Paul L. (2009). "Salivary Glands": 246–294. doi:10.1016/B978-1-4160-3966-2.00011-4.