Salivary glands

Primary salivary gland neoplasms

Benign

Warthin tumor



Topic Completed: 1 September 2012

Minor changes: 11 June 2021

Copyright: 2003-2021, PathologyOutlines.com, Inc.

PubMed Search: Warthin tumor[TIAB] salivary

Adriana Handra-Luca, M.D., Ph.D.
Jen-Fan Hang, M.D.
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Cite this page: Handra-Luca A, Hang JF. Warthin tumor. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/salivaryglandswarthin.html. Accessed September 19th, 2021.
Definition / general
  • 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
  • Almost always in parotid gland; 10% of parotid gland tumors
  • 70% of bilateral salivary gland tumors are Warthin 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
Treatment
  • Surgical excision
  • 2% recur after resection
Gross description
  • 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
Microscopic (histologic) description
  • 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
Microscopic (histologic) images

Case #112

Nasopharyngeal tumor

Cytology description
  • Squamous appearance of degenerated oncocytes
  • Sheets of oncocytes and mixed population of lymphocytes in a characteristic dirty proteinaceous background
  • Oncocytic sheets show an organized honeycombing or papillary arrangement and are typically cyanophilic at the periphery and bright orange at the center on Papanicolaou stain
  • Oncocytes show densely granular cytoplasm, centrally located nuclei and small nucleoli
  • Lymphocytes are mostly small mature cells
Cytology images

Contributed by Robin Pike, M.D. and Jen-Fan Hang, M.D.
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Oncocytic cells in lymphoid background

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Finely granular cytoplasm of oncocytic cells

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"Junky" cystic background

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Oncocytic and lymphoid cells

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Oncocytic and lymphoid cells, cyst contents


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Oncocytic cells with squamous features

Dirty background

Fragment of oncocytes

Dense cytoplasm

Bilayered epithelium

Positive stains
Negative stains
Electron microscopy description
  • Oncocytes are stuffed with mitochondria with cup shapes or concentric ring forms but no partitions
Molecular / cytogenetics description
Differential diagnosis
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