With a slight white male predominance, presentation normally occurs in the 6th to 7th decades as an asymptomatic, slowgrowing 1. Warthins tumour is the second most common benign neoplasm of the salivary glands and it accounts for 5% 10% of all the parotid tumours. It is the second most common benign parotid gland tumor and accounts for 4% to 25% of all salivary gland tumors. Is warthins tumour of the parotid gland a lymph node. Salivary gland biopsy is the most important test for diagnosis of warthins tumor. 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 is second only to the pleo morfic adenoma and it. While the transthoracic biopsy performed for the mass indicated nonsmall cell lung carcinoma, histopathologic diagnosis established for the lymph node reported warthin tumor. Warthin tumor causes, symptoms, diagnosis, treatment. Pdf warthins tumor is a relatively rare and generally benign neoformation whose incidence is second. Differentiation of pleomorphic adenoma and warthins tumor of. Malignant transformation of the epithelial component in warthins.
A vasoconstrictor was injected, with skin incision and platysma incision done followed by tissue dissection to expose the. Very rarely, warthins tumor can also mimic malignant or metastatic disease by presenting within cervical lymph nodes. 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. The background of the smear is composed by this cystic dirty fluid, which contains oncocytic cells, lymphocytes and histiocytes. Squamous cell carcinoma arising from warthins tumor in the. Differentiation of pleomorphic adenoma and warthins tumor. Uniquely, among benign lesions of the parotid gland, it can be seen bilaterally in 710% of cases. T1weighted, t2weighted, short inversion time inversion recovery, diffusionweighted, and contrastenhanced dynamic mr images of 19 warthin tumors and 17. Warthins tumor is usually cited as the second most common neoplasm and comprises 4%14% of all salivary gland neoplasm pap40x. Sep 08, 2015 warthin tumor is a benign tumor of the salivary gland. Light microscopy demonstrated a transition zone from the benign to the malignant component, and the malignant cells revealed oncocytic features by both light. Occasional features are cilia, squamous metaplasia associated with infarctlike necrosis, mast cells, dendritic cells, mucin secreting cells, sebaceous cells. 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.
Warthins tumor is the second most common benign neoplasm of the salivary gland and accounts for 510% of all parotid tumors. Synchronous extraparotid warthins tumour the journal. Histopathological study of salivary gland lesions international. The majority of warthins tumors are benign and malignant. The light microscopic and ultrastructural features of an adenocarcinoma arising in a warthins tumour in the parotid gland are described. In one series, essentially all were located in the parotid. It is most commonly encountered in male smokers in the fifth to seventh decades of life. Department of pathology university of medicine and pharmacy v. Most cases of reported malignancy can be attributed to a second tumor in association with warthins tumor. Warthins tumor, also known as papillary cystadenoma lymphomatosum. Department of otolaryngology, head and neck surgery. The tumor type and microscopic grade have been shown to be independent predictors of behavior.
Mucoepidermoid carcinoma arising in warthins tumor of the. The gland most likely affected is the parotid gland. Histopathological analysis of the stroma and parenchyma revealed. 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. Warthins tumor in this case differ from the typical findings of other malignant carcinomas and benign warthins tumor. It is also known as papillary cystadenoma lymphomatosum. 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. On gross pathology, cystic and multicentric appearance are characteristic findings of warthins tumor. Sometimes it has an extraparotid origin like neck, palate, etc. Histologically, the tumor was characterized by oncocytic follicular cells showing nuclear features reminiscent of papillary carcinoma and lymphoid rich stroma. The histopathology of warthins tumour is highly distinctive and fnac fails to detect the lesion in up to 20% of cases. Warthins tumour is more common in men, with a peak incidence in the seventh decade and it is associated with cigarette smoking. 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.
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. Only a few studies describing the sonographic features of pleomorphic adenomas and warthins tumors have been published, and most of. Presentation of chronic lymphocytic leukemiasmall lymphocytic lymphoma in a warthin tumor. Is warthins tumour of the parotid gland a lymph node disease. We present a case report of surgical management of a prototype case. Squamous carcinoma arising in a parotid warthins tumour. Discussion warthins tumor is a benign neoplasm of sali vary glands, first described by aldred warthin in. The tumor consists of papillary formations lined by tall columnar cells arrowhead enclosing a dense lymphoid population with or without lymphoid follicles arrow. Squamous cell carcinoma arising in warthins tumour. Warthin s tumour is the second most common benign neoplasm to affect the salivary glands.
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. The oncocytes are in papillary or pseudopapillary structures. 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. Warthin tumor causes, symptoms, diagnosis, treatment, pathology. Warthins tumor of the parotid gland with the use of ct and mr imaging. 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. Warthins tumor, also known as papillary cystadenoma lymphomatosum or adenolymphoma, is the second most common benign tumor of the salivary glands. Warthin tumor, aka papillary cystadenoma lymphomatosum, is a type of benign tumor of the parotid gland. A diagnostic dilemma jiaomr as branchial cleft cyst, lymphoid hyperplasia, head and neck. Malignant transformation of a benign warthins tumour adenolymphoma is extremely rare. 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.
Scott warthin, a professor of pathology, university. 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. 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. Only a few studies describing the sonographic features of pleomorphic adenomas and warthins tumors have been published, and most of those reports a.
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. The transformation of the lymphoid stroma into malignant lymphoma is relatively common, while an epithelial malignancy is extremely rare. Warthins tumor or cystadenolymphoma cal is a benign salivary gland tumor occurring almost. The salivary glands are the site of origin of a wide variety of neoplasms and are also relatively uncommon. Case report an unusual warthins tumor arising from minor. Warthins tumour shows multiple cysts that have numerous papillations covered by bilayered columnar and basaloid oncocytic epithelium. Home education eatlas histopathology salivary glands warthin tumor. We evaluated ct images of 30 warthins tumors in 22 patients and mr images of seven warthins tumors in four patients. Warthins tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. 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. We report a case of malignant transformation of a warthins tumor of the right parotid gland.
Warthins tumor also known as papillary cystadenoma lympho. Warthin tumor genetic and rare diseases information. Warthins tumor adenolymphoma was first described by. Malignant transformation in a parotid warthins tumor. We report a rare case of a warthinlike tumor variant of papillary thyroid carcinoma in a 41yearoldwoman. Pdf histopathological study of salivary gland tumors. Case report open access warthins tumor of the larynx. 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. We evaluated ct images of 30 warthins tumors in 22 patients and mr images of seven warthins.
The patient had a right parotid tumor and underwent tumor excision. We evaluate the histopathological aspect of warthin tumors using hematoxylin eosin stain, and immunohistochemical and histological techniques. It is named for pathologist aldred scott warthin, who described two cases in 1929. Files are available under licenses specified on their description page. It occurs mainly in males, it is frequently bilateral. On microscopic histopathological analysis, papillae, fibrous capsule, and cystic spaces are characteristic findings of warthins tumor. Histologically, warthins tumor is composed of epithelial and lymphoid elements. They are the commonest bilateral or multifocal benign parotid tumor. In fact, it is the only tumor virtually restricted to the parotid gland. Warthin tumour is a relative common benign tumour of the parotid gland. Media in category histopathology of warthins tumor the following 2 files are in this category, out of 2 total. Papillary cystadenoma lymphomatosum warthin tumor, adenolymphoma is a benign salivary gland tumor that.
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. The aspirated material is usually brown, dirty and thick. Synchronous extraparotid warthins tumour volume 103 issue 8 h. T1weighted, t2weighted, short inversion time inversion recovery, diffusionweighted, and contrastenhanced dynamic mr images of 19 warthin. It arises exclusively in lower part of the parotid gland and affects mainly male in sixth or seventh decades of life. May 14, 2018 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. Warthin tumor genetic and rare diseases information center. Malignant transformation of a benign warthin s tumour adenolymphoma is extremely rare. Warthins tumor is the second most common benign lesion of the parotid gland. Warthin tumors are the 2 nd most common benign parotid tumor after pleomorphic adenoma and represent up to 10% of all parotid tumors. 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. Squamous cell carcinoma arising from warthins tumor in. 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.
A sudden increase in a tumour s size is usually due to a malignant transformation of the tumour. The characteristic findings are cohesive flat sheets of oncocytes and lymphocites pap100x pap200x. Warthin s tumor is highly unlikely to become malignant. Metastatic lung cancer associated with warthins tumour.
Warthin tumor is a benign tumor of the salivary 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. With a slight white male predominance, presentation normally occurs in the 6th to 7th decades as an asymptomatic, slowgrowing 1 to 4cm mass. Though much less likely to occur than pleomorphic adenoma, warthin s tumor is the second most common benign parotid tumor. Differentiation of pleomorphic adenoma and warthins tumor of the parotid gland. 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. Materials and methods in this study, ct and mr images of surgically proven 37 warthins tumors in 26 patients were included. Warthins tumor is more common in men with the average age range from 60 to 70 years. Warthin tumors may increase in size over time, but few become cancerous. The historical significant male predominance of warthins tumor was. Moreover, the most effective treatment and longterm prognosis of this tumor are not yet clear. Pdf fine needle aspiration cytology of warthins tumor. Though the cause is currently unknown, smoking is believed to increase the chance of.
Warthins tumor accounts for about 510% of all parotid tumors and it is the second most common benign tumor of the salivary glands. 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 background of the smear is composed by this cystic dirty fluid, which contains oncocytic cells, lymphocytes and. Mar 29, 2011 bilateral warthins tumours of parotid constitute a small proportion of all salivary gland tumours. Warthins tumor, extraparotid location, parotid neoplasm, surgery. Most cases of reported malignancy can be attributed to a second tumor in association with warthin s tumor.
Warthinlike tumor variant of papillary thyroid carcinoma. All images and textual data are property of pathpedia llc. The light microscopic and ultrastructural features of an adenocarcinoma arising in a warthin s tumour in the parotid gland are described. Poorly differentiated carcinoma arising in a warthins tumor of the parotid gland. All structured data from the file and property namespaces is available under the creative commons cc0 license. The patient was followed up for six months without any signs of recurrence of the lesion. Warthin tumor of the parotid gland american journal of. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. It has a cystic, oncocytic lymphoepithelial appearance. The first symptom is usually a painless, slowgrowing bump in front of the ear, on the bottom of the mouth, or under the chin. The whartin tumor cystadenoma papillare lymphomatosum frequently undergoes necrotic changes. Mr studies of seven patients with warthin tumors in the parotid gland were.
743 676 1459 960 1216 1473 921 1250 413 1252 148 520 417 383 831 44 1023 197 1177 1522 193 920 308 607 667 200 698 1159 1124