Warthin tumour

Warthin tumour
Diagnosis in short
Warthin tumour. H&E stain.
LM	papillae with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells), fibrous capsule, cystic space filled with debris, lymphoid stroma
LM DDx	lymphoepithelial cyst, oncocytoma of the salivary gland, lymphoma associated with Warthin tumour
Gross	classically cystic, motor oil-like fluid
Site	salivary gland - parotid gland only
Clinical history	strong association with smoking
Signs	mass lesion
Prevalence	common benign salivary gland lesion
Prognosis	good, benign
Clin. DDx	other salivary gland tumours

Warthin tumour is a relative common benign tumour of the parotid gland. It is also known as papillary cystadenoma lymphomatosum.

General

• Benign.

Epidemiology:

• May be multicentric ~ 15% of the time.
• Bilateral ~6% of the time.
• Classically: male > female - changing with more women smokers.
• Smokers - almost 80% of patients is a series of 70 cases.
• Old - usually 60s, very rarely < 40 years old.

Notes:

• No malignant transformation.
• Not in submandibular gland.
• Not in sublingual gland.
• Not in children.

Gross

Features:

• Motor oil-like fluid.
• Cystic component larger in larger lesions.
  • Small lesions may be solid.

Image:

• Warthin tumour (flickr.com).

Microscopic

Features:

• Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) - key feature.
• Fibrous capsule - pink & homogenous on H&E stain.
• Cystic space filled with debris in situ (not necrosis).
• Lymphoid stroma.

Notes:

• +/-Squamous differentiation.
• +/-Goblet cell differentiation.

DDx:

• Lymphoepithelial cyst.
  • Cyst within a lymph node.
• Lymphoma associated with Warthin tumour - case reports.
• Oncocytoma of the salivary gland.

Images

Case 1

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  Warthin tumour - low mag. (WC/Nephron)

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  Warthin tumour - intermed. mag. (WC/Nephron)

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  Warthin tumour - high mag. (WC/Nephron)

Case 2

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  Warthin tumour. (WC/KGH)

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  Warthin tumour. (WC/KGH)

Sign out

Parotid Gland, Left, Excision:
- Warthin's tumour (papillary cystadenoma lymphomatosum).
- NEGATIVE for malignancy.

Block letters

PAROTID GLAND, RIGHT, EXCISION:
- WARTHIN TUMOUR.

Micro

The sections show a cystic tumour with lymphoid tissue associated with benign salivary gland tissue. The lymphoid tissue is composed of small cells and forms morphologically unremarkable follicles. The cyst-lining epithelium has a bilayered appearance and is composed of cells with abundant eosinophilic cytoplasm and nucleoli. The tumour focally extends to the edge of the tissue (ink present on tumour).

See also

• Salivary glands.
• Head and neck pathology.
• Papillary thyroid carcinoma Warthin-like variant.