Warthin's tumor

{{distinguish|Submandibular duct{{!}}Wharton's duct}} {{More citations needed|date=January 2022}} {{Infobox medical condition | name = Warthin's tumor | synonyms = Warthin tumour, monomorphic adenoma, adenolymphoma | image = Cytopathology of Warthin's tumor.jpg | caption = Cytopathology of Warthin's tumor, with typical cellular features (and a relatively uncommon binucleated cell).<ref>Image by Mikael Häggström, MD. References for entries: - {{cite journal |vauthors=Köybaşioğlu FF, Önal B, Han Ü, Adabağ A, Şahpaz A| title=Cytomorphological findings in diagnosis of Warthin tumor | journal=Turk J Med Sci | year= 2020 | volume= 50 | issue= 1 | pages= 148–154 | pmid=31769640 | doi=10.3906/sag-1901-215 | doi-access=free| pmc=7080357 }} Binucleation: - {{cite thesis |type=PhD |url=http://repository-tnmgrmu.ac.in/464/1/200300307malliga.pdf|title=A correlative cytological and histopathological study on lesions of salivary gland|date=2006-10-18|first=S. |last=Malliga |publisher=Madurai Medical College}} - {{cite journal |vauthors=Chan MK, McGuire LJ |title=Cytodiagnosis of lesions presenting as salivary gland swellings: a report of seven cases |journal=Diagn Cytopathol |volume=8 |issue=5 |pages=439–443 |date=1992 |doi=10.1002/dc.2840080503 |pmid=1396021}}</ref> Pap stain. | pronounce = | field = | medlineplus = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Warthin's tumor''', also known as '''papillary cystadenoma lymphomatosum''', is a benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers (lymph node-like stroma). It is named for pathologist Aldred Scott Warthin, who described two cases in 1929.<ref>{{cite book| veditors = Witt RL |title=Salivary Gland Diseases: Surgical and Medical Management|chapter-url={{GBurl|DzeFVDYopvIC|p=123}} |year=2005|publisher=Thieme Medical |isbn=1-58890-414-8|page=123|chapter=9. "Benign tumors, cysts, and tumor-like conditions of the salivary glands }}</ref>

==Signs and symptoms== Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight male predilection according to recent studies. The tumor is slow growing, painless, and usually appears in the tail of the parotid gland near the angle of the mandible. In 5–14% of cases, Warthin's tumor is bilateral, but the two masses usually are at different times. Warthin's tumor is highly unlikely to become malignant.<ref>{{Citation |last1=Limaiem |first1=Faten |title=Warthin Tumor |date=2023 |url=https://www.ncbi.nlm.nih.gov/books/NBK557640/ |id=NBK557640 |work=StatPearls |access-date=2023-11-03 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491572 |last2=Jain |first2=Prachi}}</ref>

===Locations=== thumb|320px|Relative incidence of parotid tumors, with Warthin's tumor near top right.<ref name=Medscape>{{cite journal|url=https://emedicine.medscape.com/article/852373-overview|title=Salivary Gland Neoplasms|author=Steve C Lee |website=Medscape|date=22 December 2022 }} Updated: Jan 13, 2021 Diagrams by Mikael Häggström</ref> The gland most likely affected is the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Warthin's tumor is the second most common benign parotid tumor after pleomorphic adenoma, but its prevalence is steadily increasing.<ref>{{cite journal | vauthors = Psychogios G, Vlastos I, Thölken R, Zenk J | title = Warthin's tumour seems to be the most common benign neoplasm of the parotid gland in Germany | journal = European Archives of Oto-Rhino-Laryngology | volume = 277 | issue = 7 | pages = 2081–4 | date = July 2020 | pmid = 32189070 | doi = 10.1007/s00405-020-05894-z | s2cid = 212940703 | url = https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/77340 }}</ref>

==Cause== Its cause is unknown, but there is a strong association with cigarette smoking. Smokers are at 8 times greater risk of developing Warthin's tumor than the general population.<ref name=robbins>{{cite book |vauthors=Kumar V, Abbas AK, Fausto N |title=Robbins and Cotran pathologic basis of disease |edition=7th |publisher=Elsevier Saunders |year=2005 |isbn=0-7216-0187-1 }}</ref>

==Diagnosis== The appearance of this tumor under the microscope is unique. There are cystic spaces surrounded by two uniform rows of oncocytes, which are epithelial cells with abundant, granular, eosinophilic cytoplasm.<ref name="pmid22438628">{{cite journal |vauthors=Chakrabarti I, Basu A, Ghosh N| title=Oncocytic lesion of parotid gland: A dilemma for cytopathologists. | journal=J Cytol | year= 2012 | volume= 29 | issue= 1 | pages= 80–2 | pmid=22438628 | doi=10.4103/0970-9371.93236 | pmc=3307464 | doi-access=free }}</ref> The cystic spaces have epithelium referred to as papillary infoldings that protrude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.{{Citation needed|date=January 2022}}

The differential diagnosis includes sebaceous lymphadenoma and oncocytoma.

<gallery> Image:Warthin's tumor.jpg|This Warthin's tumor presented as a parotid mass in a middle-aged male, who underwent superficial parotidectomy. The tumor, at the right of the image, is well-demarcated from the adjacent parotid tissue and tends to shell out from it. Image:Papillary cystadenoma lymphomatosum1.jpg|Low magnification micrograph of a Warthin tumor arising from the parotid gland. Image:Warthin tumor (1).jpg|Histopathology of Warthin tumor in the parotid gland. H&E stain. Image:Warthin tumor (2).jpg|Histopathology of Warthin tumor in the parotid gland. Another view of a file "Warthin tumor (1).jpg". H&E stain. Image:Warthin tumor (3).jpg|Histopathology of Warthin tumor in the parotid gland. Higher magnification of a file "Warthin tumor (1).jpg". H&E stain. Image:Papillary cystadenoma lymphomatosum2.jpg|Intermediate magnification micrograph of a Warthin tumor. Image:Papillary cystadenoma lymphomatosum3.jpg|High magnification micrograph of a Warthin tumor showing the characteristic bilayered epithelium. </gallery>

==Treatment== Most of these tumors are treated with surgical removal called parotidectomy. Contrary to pleomorphic adenoma, it is non recurrent.

== See also == * Pleomorphic adenoma

== References == {{reflist}}

==Additional sources== *Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.

== External links == {{Medical resources | ICD10 = {{ICD10|D|11||d|10}} | ICD9 = {{ICD9|210.2}} | ICDO = 8561/0 | OMIM = | eMedicineSubj = plastic | eMedicineTopic = 371 | DiseasesDB = 31941 | MeshID = D000235 | SNOMED CT = 422470007 }} {{Commons category|Warthin's tumor}}

{{DEFAULTSORT:Warthin's Tumor}} Category:Salivary gland neoplasia Category:Benign neoplasms