Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a

benign Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malign ...

cystic

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

of the

salivary glands The salivary glands in mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands (parotid, submandibular, and sublingual), as well as hundreds of minor salivary glands. Salivary gla ...

containing abundant

lymphocytes A lymphocyte is a type of white blood cell (leukocyte) in the immune system of most vertebrates. Lymphocytes include natural killer cells (which function in cell-mediated, cytotoxic innate immunity), T cells (for cell-mediated, cytotoxic adap ...

and

germinal centers Germinal centers or germinal centres (GCs) are transiently formed structures within B cell zone (follicles) in secondary lymphoid organs – lymph nodes, ileal Peyer's patches, and the spleen – where mature B cells are activated, prolifer ...

(lymph node-like stroma). It is named for pathologist

Aldred Scott Warthin Aldred Scott Warthin (October 21, 1866 − May 23, 1931) was an American pathologist whose research laid the foundation for understanding the heritability of certain cancers. He has been described as "the father of cancer genetics." Early life an ...

, who described two cases in 1929.

Signs and symptoms

Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight male predilection according to recent studies. The tumor is slow growing, painless, and usually appears in the tail of the parotid gland near the angle of the

mandible In anatomy, the mandible, lower jaw or jawbone is the largest, strongest and lowest bone in the human facial skeleton. It forms the lower jaw and holds the lower tooth, teeth in place. The mandible sits beneath the maxilla. It is the only movabl ...

. 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 Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...

Locations

The gland most likely affected is the

parotid gland The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the man ...

. In fact, it is the only tumor virtually restricted to the parotid gland. Warthin's tumor is the second most common benign parotid tumor after

pleomorphic adenoma Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of epithelial (ductal) cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gla ...

, but its prevalence is steadily increasing.

Cause

Its cause is unknown, but there is a strong association with cigarette

smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have bee ...

. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population.

Diagnosis

The appearance of this tumor under the

microscope A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisibl ...

is unique. There are cystic spaces surrounded by two uniform rows of

oncocyte An oncocyte is an epithelial cell characterized by an excessive number of mitochondria, resulting in an abundant acidophilic, granular cytoplasm. Oncocytes can be benign or malignant. Other names Also known as: *'' Hürthle cell'' ( thyroid gla ...

s, which are

epithelial Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...

cells with abundant, granular, eosinophilic cytoplasm. The cystic spaces have epithelium referred to as papillary infoldings that protrude into them. Additionally, the epithelium has lymphoid stroma with

germinal center Germinal centers or germinal centres (GCs) are transiently formed structures within B cell zone (follicles) in secondary lymphoid organs – lymph nodes, ileal Peyer's patches, and the spleen – where mature B cells are activated, prolifera ...

formation. The

differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

includes

sebaceous lymphadenoma Sebaceous lymphadenoma is a benign tumour of the salivary gland. Diagnosis Sebaceous lymphadenoma is a tissue diagnosis, e.g. salivary gland biopsy. It may be confused with a number of benign and malignant neoplasms, including Warthin tumour, muc ...

and

oncocytoma An oncocytoma is a tumor made up of oncocytes, epithelial cells characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm. The cells and the tumor that they compose are often benign but sometim ...

. Image:Warthin's tumor.jpg, This Warthin's tumor presented as a parotid mass in a middle-aged male, who underwent superficial parotidectomy. The tumor, at the right of the image, is well-demarcated from the adjacent parotid tissue and tends to shell out from it. Image:Papillary cystadenoma lymphomatosum1.jpg, Low magnification

micrograph A micrograph or photomicrograph is a photograph or digital image taken through a microscope or similar device to show a magnified image of an object. This is opposed to a macrograph or photomacrograph, an image which is also taken on a mic ...

of a Warthin tumor arising from the parotid gland. Image:Warthin tumor (1).jpg, Histopathology of Warthin tumor in the parotid gland. H&E stain. Image:Warthin tumor (2).jpg, Histopathology of Warthin tumor in the parotid gland. Another view of a file "Warthin tumor (1).jpg". H&E stain. Image:Warthin tumor (3).jpg, Histopathology of Warthin tumor in the parotid gland. Higher magnification of a file "Warthin tumor (1).jpg". H&E stain. Image:Papillary cystadenoma lymphomatosum2.jpg, Intermediate magnification

of a Warthin tumor. Image:Papillary cystadenoma lymphomatosum3.jpg, High magnification

of a Warthin tumor showing the characteristic bilayered epithelium.

Treatment

Most of these tumors are treated with surgical removal called

parotidectomy A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells ...

. Contrary to

, it is non recurrent.

References

Additional sources

*Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.

External links

{{DEFAULTSORT:Warthin's Tumor Salivary gland neoplasia Benign neoplasms