Salivary Gland Neoplasms: Warthin’s Tumor

on 29.12.07 with 0 comments

The second most common benign parotid neoplasm is Warthin’s tumor, also known as papillary cystadenoma lymphomatosum. It makes up 6-10% of cases of parotid tumors and has only rarely been described as occurring outside the parotid gland. It is primarily a disease of older white males, often being diagnosed in the 4th to 7th decades of life and occurring with a male-to-female ratio of approximately 5:1. Bilateral or multicentric Warthin’s tumors are seen in 10% of cases. Three percent are associated with other benign or malignant tumors.

Like the pleomorphic adenoma, Warthin’s tumors typically present as a slowly enlarging, painless mass. They tend to be firm or rubbery in texture and may be nodular. A minority of patients may report rapid enlargement of the tumor with associated pain or pressure.

Grossly, a Warthin’s tumor possesses a smooth lobulated surface and a thin but tough capsule. The diagnosis is often obvious just by the appearance of the cut surface of the tumor. Multiple cysts of varying diameter and containing variably viscous fluid are seen. The lining of the cysts appears shaggy and irregular. The lymphoid component makes up the solid areas of the tumor and lymphoid follicles can occasionally be seen. The pathognomonic microscopic features are epithelial cells forming papillary projections into cystic spaces in a background of a lymphoid stroma. The epithelium is a double cell layer with tall columnar cells lining the cystic spaces and cuboidal cells along the basement membrane. The nuclei of the columnar cells is oriented toward the cystic space while the cuboidal cell nuclei is oriented toward the basement membrane.

Treatment of Warthin’s tumors is surgical resection. Enucleation of the tumor may be adequate therapy but superficial parotidectomy with facial nerve preservation is the standard management.

Category: Pathology Notes



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