Salivary glands - Warthin’s tumor

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Salivary glands

Epithelial / myoepithelial tumors

Warthin’s tumor

Reviewer: Adriana Handra-Luca, M.D. (see Reviewers page)
Revised: 1 February 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Common tumor of parotid gland with double layer of epithelial cells resting on dense lymphoid stroma
● Also called papillary cystadenoma lymphomatosum papilliferum, adenolymphoma
● #2 most common benign salivary gland tumor (after pleomorphic adenoma)

Clinical features
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● Almost always in parotid gland; 10% of parotid gland tumors
● 70% of bilateral salivary gland tumors are Warthin’s tumors
● Occasionally in oral cavity, larynx, cervical lymph nodes (Auris Nasus Larynx 2004;31:293)
● Usually male smokers age 40+ years
● Arises from incorporation of lymphoid tissue in parotid gland or induction of cystic and oncocytic changes by inflammatory infiltrate
● Associated with tuberculosis, Brucella mellitensi
● May occur synchronous with pleomorphic adenoma and salivary duct carcinoma
● Malignant change (1%) to lymphoma, Merkel cell carcinoma, adenocarcinoma NOS, basal cell carcinoma, mucoepidermoid carcinoma, oncocytic carcinoma, salivary duct carcinoma, squamous cell carcinoma, Warthin adenocarcinoma

Case reports
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● 76 year old man with tumor of nasopharynx (Case of the Week #112)

Treatment
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● Surgical excision
● 2% recur after resection

Gross description
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● Encapsulated, lobulated, pale gray surface, multicystic with mucinous/serous secretion, 10-15% multifocal/bilateral
● 2-5 cm
● May be fixed to overlying skin
● May undergo hemorrhagic infarction, particularly after fine needle aspiration

Gross images
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Well-demarcated gray-yellow tumor

Micro description
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● Double layer of epithelial cells resting on dense lymphoid stroma with variable germinal centers
● Cystic spaces narrowed by polypoid projections of lymphoepithelial elements
● Surface palisading of oncocytic columnar cells with underlying discontinuous basal cells
● Occasional features are cilia, squamous metaplasia associated with infarct-like necrosis, mast cells, dendritic cells, mucin secreting cells, sebaceous cells
● Very rarely signet ring cells
● No myoepithelial component

Micro images
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Nasopharyngeal tumor

Various images

Cytology description
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● Squamous appearance of degenerated oncocytes

Cytology images
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Various images

Positive stains
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● Keratin (CK7, CK 8/18, CK19), mitochondrial markers
● Focal CEA, CK5/6, CK10, CK14, p63, 34betaE12

Negative stains
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● Amylase, vimentin, desmin, smooth muscle actin, EBV, HHV8

Electron microscopy description
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● Oncocytes are stuffed with mitochondria with cup shapes or concentric-ring forms but no partitions

Molecular / cytogenetics description
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● Not clonal (Hum Pathol 2000;31:1377, Mod Pathol 2005;18:964), although cases with coexisting mucoepidermoid carcinoma are associated with t(11;19) and the CRTC1/MAML2 fusion transcript (Genes Chromosomes Cancer 2008;47:309)
● Diploid, t(11,19), HHV8 DNA may be positive

Differential diagnosis
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● Acinic cell carcinoma
● Squamous cell carcinoma: may resemble at fine needle aspiration

End of Salivary glands > Epithelial / myoepithelial tumors > Warthin’s tumor

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