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

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

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 many vertebrates including mammals are exocrine glands that produce saliva through a system of Duct (anatomy), ducts. Humans have three paired major salivary glands (Parotid gland, parotid, Submandibular gland, submandibula ...

containing abundant

lymphocytes A lymphocyte is a type of white blood cell (leukocyte) in the immune system of most vertebrates. Lymphocytes include T cells (for cell-mediated and cytotoxic adaptive immunity), B cells (for humoral, antibody-driven adaptive immunity), and ...

and germinal centers (lymph node-like stroma). It is named for pathologist Aldred Scott Warthin, 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 jawed vertebrates, the mandible (from the Latin ''mandibula'', 'for chewing'), lower jaw, or jawbone is a bone that makes up the lowerand typically more mobilecomponent of the mouth (the upper jaw being known as the maxilla). The jawbone i ...

. 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; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...

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 m ...

. 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, 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 combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

. 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 equipment, 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 ...

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 gl ...

s, which are

epithelial Epithelium or epithelial tissue is a thin, continuous, protective layer of cells with little extracellular matrix. An example is the epidermis, the outermost layer of the skin. Epithelial ( mesothelial) tissues line the outer surfaces of man ...

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 formation. The

differential diagnosis In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...

includes sebaceous lymphadenoma and

oncocytoma An oncocytoma is a tumor made up of oncocytes, epithelial cell (biology), 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 be ...

. 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 is an image, captured photographically or digitally, taken through a microscope or similar device to show a magnify, magnified image of an object. This is opposed to a macrograph or photomacrograph, an image which is also taken ...

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. Contrary to pleomorphic adenoma, it is non recurrent.

Signs and symptoms

Locations

Cause

Diagnosis

Treatment

See also

References

Additional sources

External links