Warthin's tumor

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

Warthin’s tumor was first discovered by Hildebrand, a German surgeon, in 1895. Warthin’s tumor is named after the pathologist Aldred Scott Warthin, who described two cases in 1929 and named them as papillary cystadenoma lymphomatosum.

• Warthin’s tumor was first discovered by Hildebrand, in 1895 who consider it as a variant of epithelial cyst of the neck.^[1]
• In 1910, Albrecht and Artz reported two cases of tumors of salivary gland,and reported this tumor as papillary cystadenoma.
• Warthin’s tumor is named after the pathologist Aldred Scott Warthin, who described two cases in 1929 and named them as papillary cystadenoma lymphomatosum.
• The term Warthin’s tumor was given to it by Martin and Ehrlich in 1944.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

Warthin’s tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. On gross pathology, cystic and multicentric appearance are characteristic findings of Warthin’s tumor. On microscopic histopathological analysis, papillae, fibrous capsule, and cystic spaces are characteristic findings of Warthin’s tumor.

The exact pathogenesis of warthins tumor is not completely understood. Acording to a study in 2016,^[1] :

• Stroma and parenchyma of the tumor was histopathologically analyzed.
• The epithelial and stromal component was equally distributed in tumor mass.
• This study showed that the Warthin’s tumor occurs as a result of of inflammatory process.
• Epithelial part of the Warthin’s tumor is the main trigger for the tumor process.

• Expression of CRTC1 – MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin’s tumor.

Characteristic findings of warthin’s tumor on gross pathology are;

• Size of the tumor varies between 2-5 cm.
• The tumor is well demarcated, grey yellow in color.
• It is encapsulated, lobulated and multicentric.
• Warthin;s tumor can be fixed to overlying skin.
• 10-15% are multifocal/bilateral.
• Tumor can have serous/mucinous secretion.

On microscopic histopathological analysis the characteristic findings of warthin;s tumor are;

• Dense lymphoid stroma with double layer of epithelial cells resting on the stroma.
• The cystic spaces are present which are narrowed by polypoid projections.
• Basal cell layer is not continuous and is interrupted in places .
• The oncocytic columnar cells palisade on the surface.
• There is no myoepithelial component present in tumor.
• Occasional features include cilia, squamous metaplasia with necrosis, mast cells, dendritic cells and sebaceous cells.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

There are no known direct causes for Warthin’s tumor.

• The exact underlying cause of Warthin’s tumor is currently unknown. ^[1]
• Some studies suggest that smoking may be a causative factor in the development of this tumor.
• Radiation exposure and autoimmune disorders are considered to be associated with Warthin’s tumor.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

Warthin’s tumor must be differentiated from, salivary gland lymphoma, and salivary gland cancer.

• Congenital
  • 1st brancheal cleft cyst
  • Infantile hemangioma
  • lymphangioma
• Inflammatory
  • Reactive adenopathy
  • Kimura disease
  • Sarcoidosis
  • BLL-HIV
  • Sjogren syndrome
  • Parotiditis
• Benign tumor
  • Benign mixed tumor
  • Oncocytoma
  • Lipoma
  • Facial nerve schwannoma
• Malignant tumor, primary
  • Adenoid cystic carcinoma
  • Actininic cell carcinoma
  • squamous cell carcinoma
• Metastatic tumor
  • Systemic metastasis
  • Non-hodgkin lymphoma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

The prevalence of Warthin’s tumor is estimated to be 2000 to 2500 cases annually. Warthin’s tumor commonly affects elderly patients greater than 60 years old. The males are more commonly affected with Warthin’s tumor than females. The male to female ratio ranges from 2.6:1 to 10:1.

• The prevalence of Warthin’s tumor is estimated to be 2000 to 2500 cases annually.

• The prevalence of Warthin’s tumor increases with age.
• Warthin’s tumor commonly affects elderly patients greater than 60 years old.
• Warthin’s tumor rarely affects individuals < 40 years old.^[1]

• Male are more commonly affected with Warthin’s tumor than female.
• The male to female ratio ranges from 2.6:1 to 10:1.

• Warthin’s tumor most commonly affects Asians and Caucasians.
• Warthin’s tumor are extremely rare in African-Americans.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

The most potent risk factor in the development of Warthin’s tumor is smoking. Other risk factors include irradiation, Epstein-Barr virus, and alcohol.

• The most potent risk factor in the development of Warthin’s tumor is smoking.^[1]

• Other risk factors are:

• Irradiation
• Epstein-Barr virus (EBV)
• Alcohol
• Occupational exposures
• Cell phones
• Family history of salivary gland cancer
• Diet

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

If left untreated, few patients with Warthin’s tumor may progress to develop facial paralysis. Common complications of Warthin’s tumor include squamous cell carcinoma and facial paralysis. Prognosis is generally good.

• If left untreated, few patients with Warthin’s tumor may progress to develop facial paralysis.

• Squamous cell carcinoma
• Facial paralysis

• The long-term outlook for people with Warthin tumor is generally good.
• The tumor is almost always benign and is generally cured with surgery.
• The risk of recurrence is thought to be 2% or less.^[1]

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