Salivary glands

Primary salivary gland neoplasms

Benign

Warthin tumor


Editorial Board Member: Lisa Rooper, M.D.
Deputy Editor-in-Chief: Kelly Magliocca, D.D.S., M.P.H.
Sapna Balgobind, M.B.B.Ch.
Ruta Gupta, M.D.

Last author update: 13 February 2023
Last staff update: 27 March 2024

Copyright: 2003-2024, PathologyOutlines.com, Inc.

PubMed Search: Warthin tumor

Sapna Balgobind, M.B.B.Ch.
Ruta Gupta, M.D.
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Cite this page: Balgobind S, Gupta R. Warthin tumor. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/salivaryglandswarthin.html. Accessed July 13th, 2024.
Definition / general
  • Benign salivary gland tumor that is composed of oncocytic epithelial cells lining papillary and cystic structures in a lymphoid stroma
  • Second most frequent benign tumor of the parotid gland (after pleomorphic adenoma) (Head Neck Pathol 2020;14:412)
  • Infarcted / metaplastic subtype may occur following FNA biopsy (Clin Otolaryngol Allied Sci 1989;14:205)
Essential features
  • Benign salivary gland tumor
  • Bilayered papillae and cysts lined by oncocytic cells and flattened basal cells
  • Lymphoid stroma
Terminology
  • Papillary cystadenoma lymphomatosum, adenolymphoma, cystadenolymphoma
ICD coding
  • ICD-10: D11.9 - benign neoplasm of major salivary gland, unspecified
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
Radiology description
Prognostic factors
Case reports
Treatment
Gross description
Gross images

Contributed by Sapna Balgobind, M.B.B.Ch.
Cut surface

Cut surface

Microscopic (histologic) description
  • Varying proportions of papillary cystic structures lined by bilayered oncocytic epithelial cells and surrounded by a lymphoid stroma including germinal centers
  • Epithelial component is comprised of inner columnar and outer cuboidal cells
  • Limited foci of squamous, mucous, ciliated and sebaceous cells can be present
  • Infarcted / metaplastic subtype (Am J Surg Pathol 2013;37:1743, Histopathology 1999;35:432):
    • Bilayered epithelium is replaced by squamous metaplastic epithelium with no atypia
    • Mucinous metaplasia may also be present
    • Biopsy site reaction may be present with necrosis, squamous metaplasia and a stromal reaction (including granuloma formation)
  • Stroma poor tumors have bilayered oncocytic lining but minimal lymphoid stroma (Oral Oncol 2002;38:163)
Microscopic (histologic) images

Contributed by Sapna Balgobind, M.B.B.Ch. and @AnaPath10 on Twitter
Parotid gland with circumscribed tumor

Parotid gland with
circumscribed
tumor

Bilayered oncocytic epithelium with lymphoid background Bilayered oncocytic epithelium with lymphoid background

Bilayered oncocytic epithelium with lymphoid background

Mucinous metaplasia

Mucinous metaplasia


Squamous metaplasia

Squamous metaplasia

Warthin tumor

Warthin tumor

p40 staining

p40 staining

p63 staining

p63 staining

Cytology description
Cytology images

Contributed by Sapna Balgobind, M.B.B.Ch.
Oncocytic cells in groups

Oncocytic cells in groups

Oncocytic cells

Oncocytic cells

Proteinaceous debris

Proteinaceous debris

Oncocytic cells with dense cytoplasm

Oncocytic cells with dense cytoplasm

Positive stains
Negative stains
Electron microscopy description
Molecular / cytogenetics description
  • Absent MAML2 fusion (positive in mucoepidermoid carcinoma)
Sample pathology report
  • Salivary gland, parotidectomy:
    • Warthin tumor (see comment)
    • Comment: Sections show a well circumscribed tumor with a papillary architecture. The papillae are lined by bilayered oncocytic epithelial cells with a surrounding lymphoid stroma, containing germinal centers.
Differential diagnosis
Board review style question #1

A 49 year old man presents with bilateral, slow growing parotid masses. An H&E section of the tumor is pictured above. What is the most likely diagnosis?

  1. Classic Warthin tumor
  2. Lymphoepithelial cyst
  3. Oncocytoma
  4. Warthin-like variant of mucoepidermoid carcinoma
Board review style answer #1
A. Classic Warthin tumor. The photograph shows features of a classic Warthin tumor with papillary structures lined by bilayered oncocytic epithelium. The other entities on the list do not match the entity shown on the H&E photograph provided.

Comment Here

Reference: Warthin tumor
Board review style question #2
Which of the following is a risk factor for developing a Warthin tumor?

  1. Alcohol abuse
  2. Cigarette smoking
  3. Intravenous drug use
  4. MAML2 translocation
Board review style answer #2
B. Cigarette smoking. The other risk factors listed have not been proven to be associated with Warthin tumor.

Comment Here

Reference: Warthin tumor
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