Pathophysiology of brain tumors oncogenes and cns oncogenes tumor supressor genes pathology of brain tumorsd r amit thapa growth factors sis, fgfs, csfs, egf, tgf. Warthin s tumor is an adenoma composed of bilayered columnar and basaloid oncocytic epithelium that forms multiple cysts with numerous papillae, accompanied by a proliferation of folliclecontaining lymphoid tissue. The characteristic findings are cohesive flat sheets of oncocytes and lymphocites pap100x pap200x. The tumor type and microscopic grade have been shown to be independent predictors of behavior. Malignant transformation of the epithelial component in warthins.
Discussion warthins tumor is a benign neoplasm of sali vary glands, first described by aldred warthin in. Moreover, the most effective treatment and longterm prognosis of this tumor are not yet clear. The aspirated material is usually brown, dirty and thick. Warthin tumor of the parotid gland american journal of. Occasional features are cilia, squamous metaplasia associated with infarctlike necrosis, mast cells, dendritic cells, mucin secreting cells, sebaceous cells. Etiology several studies showed that a significant number of patients suffering from warthin s tumor are smokers, in contrast to patients with other salivary gland tumors. It is the second most common benign parotid gland tumor and accounts for 4% to 25% of all salivary gland tumors. The background of the smear is composed by this cystic dirty fluid, which contains oncocytic cells, lymphocytes and histiocytes. A sudden increase in a tumour s size is usually due to a malignant transformation of the tumour. Is warthins tumour of the parotid gland a lymph node. Case report open access warthins tumor of the larynx. Histologically, the tumor was characterized by oncocytic follicular cells showing nuclear features reminiscent of papillary carcinoma and lymphoid rich stroma. Warthins tumour shows multiple cysts that have numerous papillations covered by bilayered columnar and basaloid oncocytic epithelium. Warthin s tumour is the second most common benign neoplasm to affect the salivary glands.
With a slight white male predominance, presentation normally occurs in the 6th to 7th decades as an asymptomatic, slowgrowing 1. Here we present a case of a neck swelling which created a diagnostic dilemma to be a branchial cyst clinically but later came out to be warthins tumor. The transformation of the lymphoid stroma into malignant lymphoma is relatively common, while an epithelial malignancy is extremely rare. The whartin tumor cystadenoma papillare lymphomatosum frequently undergoes necrotic changes. Squamous cell carcinoma arising from warthins tumor in.
Warthins tumor is the second most common benign neoplasm of the salivary gland and accounts for 510% of all parotid tumors. We evaluated ct images of 30 warthins tumors in 22 patients and mr images of seven warthins. The oncocytes are in papillary or pseudopapillary structures. Warthin tumors are the 2 nd most common benign parotid tumor after pleomorphic adenoma and represent up to 10% of all parotid tumors. The historical significant male predominance of warthins tumor was. Media in category histopathology of warthins tumor the following 2 files are in this category, out of 2 total. Warthins tumor or cystadenolymphoma cal is a benign salivary gland tumor occurring almost.
On biopsy, warthins 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. Warthins tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. Warthin tumor benign tumor composed of doublelayered epithelium with oncocytic lumin cells and basal cell lining papillary and cystic structures and lymphoid stroma slides for the practical. All structured data from the file and property namespaces is available under the creative commons cc0 license. Warthins tumour is more common in men, with a peak incidence in the seventh decade and it is associated with cigarette smoking. Most cases of reported malignancy can be attributed to a second tumor in association with warthins tumor. Warthins tumor adenolymphoma was first described by.
Differentiation of pleomorphic adenoma and warthins tumor. A diagnostic dilemma jiaomr as branchial cleft cyst, lymphoid hyperplasia, head and neck. Only a few studies describing the sonographic features of pleomorphic adenomas and warthins tumors have been published, and most of. Most cases of reported malignancy can be attributed to a second tumor in association with warthin s tumor. Warthin tumour is a relative common benign tumour of the parotid gland. Warthins tumor is usually cited as the second most common neoplasm and comprises 4%14% of all salivary gland neoplasm pap40x. Nov 19, 2018 while the transthoracic biopsy performed for the mass indicated nonsmall cell lung carcinoma, histopathologic diagnosis established for the lymph node reported warthin tumor.
Warthins tumor is the second most frequent benign neoplasm of salivary glands after pleomorphic salivary adenoma 8,9, with a higher incidence at elderly men 10, although the recent study. Squamous cell carcinoma arising in warthins tumour. We evaluate the histopathological aspect of warthin tumors using hematoxylin eosin stain, and immunohistochemical and histological techniques. Malignant transformation of a benign warthins tumour adenolymphoma is extremely rare. Meanwhile, the conversion of warthins tumor into malignant carcinoma is extremely uncommon 0. Studies have shown that there is a close association between warthins tumor and cigarette smoking. With a slight white male predominance, presentation normally occurs in the 6th to 7th decades as an asymptomatic, slowgrowing 1 to 4cm mass. Malignant transformation of a benign warthin s tumour adenolymphoma is extremely rare. Differentiation of pleomorphic adenoma and warthins tumor of the parotid gland. They are the commonest bilateral or multifocal benign parotid tumor. Sep 20, 2014 warthins tumour papillary cystadenoma lymphomatosum pcl constitutes a minority of salivary gland neoplasms and it is a monomorphic adenoma which primarily involves the parotid gland. Home education eatlas histopathology salivary glands warthin tumor.
It is also known as papillary cystadenoma lymphomatosum. In fact, it is the only tumor virtually restricted to the parotid gland. Synchronous extraparotid warthins tumour the journal. Pdf warthins tumor is a relatively rare and generally benign neoformation whose incidence is second. Sep 08, 2015 warthin tumor is a benign tumor of the salivary gland. Mar 29, 2011 bilateral warthins tumours of parotid constitute a small proportion of all salivary gland tumours. Histopathological analysis of the stroma and parenchyma revealed.
Squamous carcinoma arising in a parotid warthins tumour. Bilateral warthins tumours of parotid constitute a small proportion of all salivary gland tumours. The gland most likely affected is the parotid gland. Warthins tumor, also known as papillary cystadenoma lymphomatosum. We report a case of malignant transformation of a warthins tumor of the right parotid gland. The histopathology of warthins tumour is highly distinctive and fnac fails to detect the lesion in up to 20% of cases. It has a cystic, oncocytic lymphoepithelial appearance. Warthins tumor is more common in men with the average age range from 60 to 70 years. It arises exclusively in lower part of the parotid gland and affects mainly male in sixth or seventh decades of life. Warthin tumor, aka papillary cystadenoma lymphomatosum, is a type of benign tumor of the parotid gland.
Warthins tumor also known as papillary cystadenoma lympho. Warthins tumor is the second most common benign lesion of the parotid gland. Warthins tumor is an adenoma composed of bilayered columnar and basaloid oncocytic epithelium that forms multiple cysts with numerous papillae, accompanied by a proliferation of folliclecontaining lymphoid tissue. Warthin tumor genetic and rare diseases information center. Materials and methods in this study, ct and mr images of surgically proven 37 warthins tumors in 26 patients were included. Warthin tumor gross cystic lesion fluid resembles motor oil histology 7 oncocytic epithelium papillary growth lymphoid stroma germinal centers 8 warthin tumor 9 warthin tumor. Histopathological study of salivary gland lesions international. We use cookies to distinguish you from other users and to provide you with a better experience on our websites.
Warthins tumor, also known as papillary cystadenoma lymphomatosum, is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers lymph nodelike stroma. Sometimes it has an extraparotid origin like neck, palate, etc. Warthin tumor is the second most common benign salivary gland tumor and characteristically presents in the lower portion of the lateral lobe of the parotid gland. The patient had a right parotid tumor and underwent tumor excision. Histologically, warthins tumor is composed of epithelial and lymphoid elements. Light microscopy demonstrated a transition zone from the benign to the malignant component, and the malignant cells revealed oncocytic features by both light. Presentation of chronic lymphocytic leukemiasmall lymphocytic lymphoma in a warthin tumor. Etiology several studies showed that a significant number of patients suffering from warthins tumor are smokers, in contrast to patients with other salivary gland tumors. It occurs mainly in males, it is frequently bilateral.
Pdf histopathological study of salivary gland tumors. Warthinlike tumor variant of papillary thyroid carcinoma. Warthins tumour is the second most common benign neoplasm of the salivary glands and it accounts for 5% 10% of all the parotid tumours. Warthins tumor, also known as papillary cystadenoma lymphomatosum or adenolymphoma, is the second most common benign tumor of the salivary glands. It is most commonly encountered in male smokers in the fifth to seventh decades of life. Differentiation of pleomorphic adenoma and warthins tumor of. Acinic cell carcinoma, basal cell adenocarcinoma, clear cell adenocarcinoma, and epithelialmyoepithelial carcinoma are all lowgrade neoplasms whereas salivary duct carcinoma, oncocytic carcinoma, primitive epidermoid carcinoma, and undifferentiated. The tumor consists of papillary formations lined by tall columnar cells arrowhead enclosing a dense lymphoid population with or without lymphoid follicles arrow. Case report an unusual warthins tumor arising from minor. On gross pathology, cystic and multicentric appearance are characteristic findings of warthins tumor. Warthins tumour papillary cystadenoma lymphomatosum pcl constitutes a minority of salivary gland neoplasms and it is a monomorphic adenoma which primarily involves the parotid gland. Mucoepidermoid carcinoma arising in warthins tumor of the. Warthins tumor, extraparotid location, parotid neoplasm, surgery.
The salivary glands are the site of origin of a wide variety of neoplasms and are also relatively uncommon. Pdf fine needle aspiration cytology of warthins tumor. We report a rare case of a warthinlike tumor variant of papillary thyroid carcinoma in a 41yearoldwoman. Though the cause is currently unknown, smoking is believed to increase the chance of. Files are available under licenses specified on their description page. Though much less likely to occur than pleomorphic adenoma, warthin s tumor is the second most common benign parotid tumor. Warthins tumor of the parotid gland with the use of ct and mr imaging. The purpose of our study was to describe the mr imaging appearance of warthin tumors multiple mr imaging techniques and to interpret the difference in appearance from that of malignant parotid tumors. We present a case report of surgical management of a prototype case. Uniquely, among benign lesions of the parotid gland, it can be seen bilaterally in 710% of cases.
Malignant transformation in a parotid warthins tumor. Papillary cystadenoma lymphomatosum warthin tumor, adenolymphoma is a benign salivary gland tumor that. Histopathology after surgery showed malignant transformation of warthins tumor. It is named for pathologist aldred scott warthin, who described two cases in 1929. T1weighted, t2weighted, short inversion time inversion recovery, diffusionweighted, and contrastenhanced dynamic mr images of 19 warthin. Warthin tumor causes, symptoms, diagnosis, treatment. Poorly differentiated carcinoma arising in a warthins tumor of the parotid gland. The majority of warthins tumors are benign and malignant. Only a few studies describing the sonographic features of pleomorphic adenomas and warthins tumors have been published, and most of those reports a. Warthins tumor is second only to the pleo morfic adenoma and it. The light microscopic and ultrastructural features of an adenocarcinoma arising in a warthins tumour in the parotid gland are described. Synchronous extraparotid warthins tumour volume 103 issue 8 h. The patient was followed up for six months without any signs of recurrence of the lesion.
Warthin tumor causes, symptoms, diagnosis, treatment, pathology. A vasoconstrictor was injected, with skin incision and platysma incision done followed by tissue dissection to expose the. The light microscopic and ultrastructural features of an adenocarcinoma arising in a warthin s tumour in the parotid gland are described. They typically occur in the elderly 6 th decade, and twice as common in men 2. 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 nodelike stroma. Warthin tumors may increase in size over time, but few become cancerous. Warthin described warthins tumour adenolymphoma in 1929. Department of pathology university of medicine and pharmacy v.
Metastatic lung cancer associated with warthins tumour. In one series, essentially all were located in the parotid. The first symptom is usually a painless, slowgrowing bump in front of the ear, on the bottom of the mouth, or under the chin. Mr studies of seven patients with warthin tumors in the parotid gland were. Department of otolaryngology, head and neck surgery. Warthin s tumor is the second most frequent benign neoplasm of salivary glands after pleomorphic salivary adenoma 8,9, with a higher incidence at elderly men 10, although the recent study. Squamous cell carcinoma arising from warthins tumor in the. T1weighted, t2weighted, short inversion time inversion recovery, diffusionweighted, and contrastenhanced dynamic mr images of 19 warthin tumors and 17. Warthins tumor accounts for about 510% of all parotid tumors and it is the second most common benign tumor of the salivary glands.
Is warthins tumour of the parotid gland a lymph node disease. Variants such as solid variant, clear cell and oxyphilic variant, papillary carcinoma with lipomatous stroma, warthins like tumor or with nodular fasciitislike stroma and cribriform papillary carcinoma have been reported, but they are too few in number for an adequate assessment. Early detection of warthin tumor may result in earlier diagnosis of lung cancer since patients with warthin tumor have a higher risk of lung malignancy. The background of the smear is composed by this cystic dirty fluid, which contains oncocytic cells, lymphocytes and. All images and textual data are property of pathpedia llc. Warthin s tumor is highly unlikely to become malignant. Warthins tumor in this case differ from the typical findings of other malignant carcinomas and benign warthins tumor.
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