Warthin tumor

/WP/AGCOH/

Digital cases

 JRC:10325 : Warthin tumor of the salivary gland.
 JRC:10326 : Warthin tumor of the salivary gland.
 JRC:10329 : Warthin tumor of the salivary gland.
 JRC:14750 : Warthin tumor of the salivary gland.
 JRC:18973 : Oncocytic nodular hyperplasia in Warthin tumor with a discussion of oncocytoma and diffuse oncocytosis ( M / Age: 79.00 / Organ: Left parotid gland).
 JRC:18961 : Warthin tumor of the salivary gland.
 FNA of Warthin Tumor of Parotid Salivary Gland by Ed Eutman

Definition: Warthin tumor is a type of benign tumor of the salivary glands. Warthin’s tumor is the second most common benign salivary gland tumor, which is located almost exclusively in the parotid gland. Warthin’s tumor accounts for about 15% of all epithelial tumors of the parotid gland.

History and nosology

The initial description of the tumor goes back to Hildebrand in 1895, who considered this disease a variant of congenital epithelial cyst of the neck. In 1910, Albrecht and Arzt reported two tumors of the upper neck region which they interpreted as "confused tissue" in the entodermal pharyngeal anlage, particularly that of salivary glands, in the lymph nodes. They called them papillary cystadenomas in lymph nodes.

In the WHO classification, the disease was named "Warthin’s tumor" after the pathologist who published the first two case reports in the American literature in 1929.

He gave the tumor the name "papillary cystadenoma lymphomatosum" and regarded it as heterotopia of the mucous membrane of the accessory eustachian tube anlage.

The term Warthin’s tumor was chosen later, in order to avoid confusion with malignant lymphomas.

Clinical synopsis

Warthin’s tumors most commonly present as an asymptomatic, slowly growing round or oval mass usually affecting men in the 5th and 6th decade. The male to female ratio ranges from 2.6:1 to 10:1. They occur extremely rarely in patients of Black African origin.

The average size of Warthin’s tumor at diagnosis is about 2.5 centimeter. The great majority of these tumors are located in the lower pole of the parotid gland.

In about 12% of cases, there is bilateral tumor development, which is commonly synchronous. In about 6% of cases, multiple Warthin’s tumors may be observed in one parotid gland. They may occur simultaneously with pleomorphic adenomas, various types of carcinoma and malignant lymphomas.

In large registries, Warthin’s tumors located outside of the parotid gland account for about 8% of the cases. Case reports concern particularly cervical lymph nodes, the submandibular gland, and the larynx.

Microscopy

These tumors are well encapsulated lesions with cystic and solid areas. These tumors consist of an oncocytic epithelial cell component arranged in double layers, which develops cysts and papillary projections, and a variable amount of lymphoid tissue often with germinal centers. The immunoprofile of the lymphocyte subsets is similar to that in normal or reactive lymph nodes. A few Warthin’s tumors (about 8%) show areas of squamous cell metaplasia and regressive changes.

 cystic spaces surrounded by two uniform rows of cells with centrally placed pyknotic nuclei.

• The cystic spaces have epithelium referred to as papillary infoldings that protrude into them.

 The epithelium has lymphoid stroma with germinal center formation.

Differential diagnosis

 sebaceous lymphadenoma
 oncocytoma.

Molecular biology

 TORC1-MAML2 fusion gene by t(11;19)(q21;p13)

• fusion of the N-terminal CREB-binding domain of the cAMP coactivator TORC1 (a.k.a. MECT1 and WAMTP1) to the Notch coactivator MAML2.

Treatment and management

On the basis of the clinical characteristics, a limited partial parotidectomy is recommended as an effective treatment of Warthin’s tumor of the parotid gland.

See also

 Warthin-like papillary carcinoma (JRC:14938)

References

Cytogentic characterisation of Warthin’s tumour.
Martins C, Fonseca I, Roque L, Soares J.
Oral Oncol. 1997; 33: 344-347.
PMID 9415334

Clonal analysis of the epithelial component of Warthin’s tumor.
Honda K, Kashima K, Daa T, Yokoyama S, Nakayama I.
Hum Pathol. 2000; 31: 1377-1380.
PMID 11112212

Detection of damage to the mitochondrial genome in the oncocytic cells of Warthin’s tumour.
Lewis PD, Baxter P, Paul Griffiths A, Parry JM, Skibinski DO.
J Pathol. 2000; 191: 274-281.
PMID 10878549

Steroid hormone receptors in parotid gland cystadenolymphoma (Warthin’s tumour).
Teymoortash A, Lippert BM, Werner JA.
Clin Otolaryngol Allied Sci. 2001; 26: 411-6.
PMID 11678950

Tissue that has lost its track: Warthin’s tumour.
Teymoortash A, Werner JA.
Virchows Arch. 2005; 446: 585-8.
PMID 15912361

Clinical features of cystadenolymphoma (Warthin’s tumor) of the parotid gland: a retrospective comparative study of 96 cases.
Teymoortash A, Krasnewicz Y, Werner JA.
Oral Oncol. 2006; 42: 569-73.
PMID 16469528

Evidence of lymphangiogenesis in Warthin’s tumor of the parotid gland.
Teymoortash A, Schrader C, Shimoda H, Kato S, Werner JA.
Oral Oncol. 2007; 43: 614-8.
PMID 16996778

A closer look at Warthin tumors and the t(11;19).
Fehr A, Roser K, Belge G, Loning T, Bullerdiek J.
Cancer Genet Cytogenet. 2008; 180: 135-9.
PMID 18206539