Warthin's tumor

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Warthin's tumor
Other namesWarthin tumour, monomorphic adenoma, adenolymphoma
Cytopathology of Warthin's tumor.jpg
Cytopathology of Warthin's tumor, with typical cellular features (and a relatively uncommon binucleated cell). [1] Pap stain.
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Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers (lymph node-like stroma). It is named for pathologist Aldred Scott Warthin, who described two cases in 1929. [2]

Contents

Signs and symptoms

Warthin's tumor primarily affects older individuals (age 6070 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 514% 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. [3]

Locations

Relative incidence of parotid tumors, with Warthin's tumor near top right. Relative incidence of parotid tumors.png
Relative incidence of parotid tumors, with Warthin's tumor near top right.

The gland most likely affected is the parotid gland. 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. [5]

Cause

Its cause is unknown, but there is a strong association with cigarette smoking. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population. [6]

Diagnosis

The appearance of this tumor under the microscope is unique. There are cystic spaces surrounded by two uniform rows of oncocytes, which are epithelial cells with abundant, granular, eosinophilic cytoplasm. [7] The cystic spaces have epithelium referred to as papillary infoldings that protrude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.[ citation needed ]

The differential diagnosis includes sebaceous lymphadenoma and oncocytoma.

Treatment

Most of these tumors are treated with surgical removal called parotidectomy. Contrary to pleomorphic adenoma, it is non recurrent.

See also

Related Research Articles

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<span class="mw-page-title-main">Pleomorphic adenoma</span> Medical condition

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 gland tumor and the most common tumor of the parotid gland. It derives its name from the architectural Pleomorphism seen by light microscopy. It is also known as "Mixed tumor, salivary gland type", which refers to its dual origin from epithelial and myoepithelial elements as opposed to its pleomorphic appearance.

<span class="mw-page-title-main">Canalicular adenoma</span> Benign salivary gland tumor

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<span class="mw-page-title-main">Acinic cell carcinoma</span> Medical condition

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<span class="mw-page-title-main">Papillary hidradenoma</span> Medical condition

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<span class="mw-page-title-main">Oncocyte</span> Epithelial cell

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<span class="mw-page-title-main">Metanephric adenoma</span> Medical condition

Metanephric adenoma (MA) is a rare, benign tumour of the kidney, that can have a microscopic appearance similar to a nephroblastoma, or a papillary renal cell carcinoma.

<span class="mw-page-title-main">Solid pseudopapillary tumour</span> Medical condition

A solid pseudopapillary tumour is a low-grade malignant neoplasm of the pancreas of papillary architecture that typically afflicts young women.

<span class="mw-page-title-main">Myoepithelioma of the head and neck</span> Medical condition

Myoepithelioma of the head and neck, also myoepithelioma, is a salivary gland tumour of the head and neck that is usually benign. When malignant, which is exceedingly rare, they are known as malignant myoepithelioma or Myoepithelial carcinoma, and they account for 1% of the salivary tumors with poor prognosis.

<span class="mw-page-title-main">Epithelial-myoepithelial carcinoma</span> Medical condition

Epithelial-myoepithelial carcinoma (EMCa) is a rare malignant tumour that typically arises in a salivary gland and consists of both an epithelial and myoepithelial component. They are predominantly found in the parotid gland and represent approximately 1% of salivary gland tumours.

A sialoblastoma is a low-grade salivary gland neoplasm that recapitulates primitive salivary gland anlage. It has previously been referred to as congenital basal cell adenoma, embryoma, or basaloid adenocarcinoma. It is an extremely rare tumor, with less than 100 cases reported worldwide.

<span class="mw-page-title-main">Ceruminous adenocarcinoma</span> Medical condition

Ceruminous adenocarcinoma is a malignant neoplasm derived from ceruminous glands of the external auditory canal. This tumor is rare, with several names used in the past. Synonyms have included cylindroma, ceruminoma, ceruminous adenocarcinoma, not otherwise specified (NOS), ceruminous adenoid cystic carcinoma (ACC), and ceruminous mucoepidermoid carcinoma.

<span class="mw-page-title-main">Carcinoma ex pleomorphic adenoma</span> Medical condition

Carcinoma ex pleomorphic adenoma is a type of cancer typically found in the parotid gland. It arises from the benign tumour pleomorphic adenoma.

<span class="mw-page-title-main">Parotidectomy</span> Surgical removal of the parotid gland

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. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The majority of parotid gland tumors are benign, however 20% of parotid tumors are found to be malignant. Parotidectomy is performed mostly by oral and maxillofacial surgeon and ENT surgeon.

Pancreatic mucinous cystic neoplasm (MCN) is a type of cystic lesion that occurs in the pancreas. Amongst individuals undergoing surgical resection of a pancreatic cyst, about 23 percent were mucinous cystic neoplasms. These lesions are benign, though there is a high rate of progression to cancer. As such, surgery should be pursued when feasible. The rate of malignancy present in MCN is about 10 percent. If resection is performed before invasive malignancy develops, prognosis is excellent. The extent of invasion is the single most important prognostic factor in predicting survival.

References

  1. Image by Mikael Häggström, MD. References for entries:
    - Köybaşioğlu FF, Önal B, Han Ü, Adabağ A, Şahpaz A (2020). "Cytomorphological findings in diagnosis of Warthin tumor". Turk J Med Sci. 50 (1): 148–154. doi:10.3906/sag-1901-215. PMC   7080357 . PMID   31769640.{{cite journal}}: CS1 maint: multiple names: authors list (link)
    Binucleation:
    - Dr.S. Malliga (2006-10-18). "A correlative cytological and histopathological study on lesions of salivary gland" (PDF).
    - Chan MKM, McGuire LJ: Cytodiagnosis of Lesions Presenting as Salivary Gland Swellings: A Report of Seven Cases. Diagn Cytopathol 8: 439-443, 1992b.
  2. Witt RL, ed. (2005). "Chapter 9 "Benign tumors, cysts, and tumor-like conditions of the salivary glands". Salivary Gland Diseases: Surgical and Medical Management. New York: Thieme Medical Publishers. p. 123. ISBN   1-58890-414-8.
  3. Limaiem, Faten; Jain, Prachi (2023), "Warthin Tumor", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32491572 , retrieved 2023-11-03
  4. Steve C Lee (22 December 2022). "Salivary Gland Neoplasms". Medscape. Updated: Jan 13, 2021
    Diagrams by Mikael Häggström
  5. Psychogios G, Vlastos I, Thölken R, Zenk J (July 2020). "Warthin's tumour seems to be the most common benign neoplasm of the parotid gland in Germany". European Archives of Oto-Rhino-Laryngology. 277 (7): 2081–2084. doi:10.1007/s00405-020-05894-z. PMID   32189070. S2CID   212940703.
  6. Kumar V, Abbas AK, Fausto N (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, MO: Elsevier Saunders. ISBN   0-7216-0187-1.
  7. Chakrabarti I, Basu A, Ghosh N (2012). "Oncocytic lesion of parotid gland: A dilemma for cytopathologists". J Cytol. 29 (1): 80–2. doi: 10.4103/0970-9371.93236 . PMC   3307464 . PMID   22438628.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Additional sources