Warthin tumour

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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.


  • Benign.


  • May be multicentric ~ 15% of the time.
  • Bilateral ~6% of the time.[1]
  • Classically: male > female - changing with more women smokers.
  • Smokers - almost 80% of patients is a series of 70 cases.[1]
  • Old - usually 60s,[2] very rarely < 40 years old.


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



  • Motor oil-like fluid.[3]
  • Cystic component larger in larger lesions.
    • Small lesions may be solid.




  • 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.


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



Case 1

Case 2

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

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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


  1. 1.0 1.1 Chedid, HM.; Rapoport, A.; Aikawa, KF.; Menezes, Ados S.; Curioni, OA.. "Warthin's tumor of the parotid gland: study of 70 cases.". Rev Col Bras Cir 38 (2): 90-4. PMID 21710045.
  2. Dăguci, L.; Simionescu, C.; Stepan, A.; Munteanu, C.; Dăguci, C.; Bătăiosu, M. (2011). "Warthin tumor--morphological study of the stromal compartment.". Rom J Morphol Embryol 52 (4): 1319-23. PMID 22203940.
  3. Hunt, JL. (Jan 2006). "Warthin tumors do not have microsatellite instability and express normal DNA mismatch repair proteins.". Arch Pathol Lab Med 130 (1): 52-6. doi:10.1043/1543-2165(2006)130[52:WTDNHM]2.0.CO;2. PMID 16390238.
  4. Alnoor, F.; Gandhi, JS.; Stein, MK.; Gradowski, JF. (Jun 2019). "Follicular Lymphoma Diagnosed in Warthin Tumor: A Case Report and Review of the Literature.". Head Neck Pathol. doi:10.1007/s12105-019-01045-x. PMID 31183747.
  5. Jawad, H.; McCarthy, P.; O'Leary, G.; Heffron, CC. (May 2018). "Presentation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma in a Warthin Tumor: Case Report and Literature Review.". Int J Surg Pathol 26 (3): 256-260. doi:10.1177/1066896917734371. PMID 28978260.