Warthin tumor

Definitions & Key takeaways

Warthin tumor, also known as papillary cystadenoma lymphomatosum, is a benign tumor that most commonly occurs in the parotid gland, a salivary gland located in the cheek. It is characterized by a cystic structure lined by tall columnar epithelium with lymphoid stroma, and typically presents as a slow-growing, painless mass. Treatment is generally surgical removal of the tumor, and the prognosis is excellent as the tumor is typically benign and does not tend to recur after removal.

Chapters:

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Introduction0:00–0:15

Warthin’s tumor, or Warthin tumor, is a benign slow-growing tumor of the parotid gland named for Dr. Aldred Scott Warthin, who was the first pathologist to describe it.

Pathophysiology0:15–1:55

Normally, the parotid gland has glandular cells that make enzymes that help to break down food, as well as tiny ducts lined by epithelial cells that carry those enzymes towards the mouth.
Warthin tumor’s other name, papillary cystadenoma lymphomatosum, is long and technical but describes the disease pretty well.
Cystadenoma refers to the fact that the ducts grow in size and fill up with serous fluid and cellular debris which forms a large cyst.
Papillary refers to the fact that the layer of epithelial cells start to fold into the duct which forms a finger-like projection, called a papilla.
Finally, lymphomatosum refers to the fact that the epithelium layer gets infiltrated by lymphocytes which organize themselves into what look like germinal centers, which is something you’d expect to find if you looked at the cross section of a lymph node.
Looking at histology, we can see the papilla, the lymphocytes, and the cystic space where the serous fluid and cellular debris are.
Now, Warthin’s tumor isn’t malignant, meaning that it doesn’t break through the basement membrane layer of the tissue, although there is a connective tissue capsule usually forms around the growing tumor, which clearly demarcates it from the rest of the parotid gland.
Also, the parotid gland start to not function normally, since the ducts turn into cysts and normal epithelial cells stop functioning.
Now, because a Warthin tumor is typically slow-growing, it can take a bit of time before the symptoms are detected—most of which are related to the physical mass pushing up against other anatomic structures.

Symptoms1:55–2:31

The most common symptom is a bump or swelling in front of or below the ear, which is typically painless. There are also nerves, though, that pass through the parotid gland which, when they’re pushed on, can cause problems like impaired hearing, earaches, tinnitus, which is ringing in the ears, and facial paralysis.
The cause of Warthin tumor is unknown, but there are a few risk factors have been associated with it - the strongest link being smoking, but there are also non-modifiable risk factors like being elderly, being Caucasian, and being m ale.

Diagnosis2:31–2:47

Diagnosis of a Warthins tumor begins with feeling a mass around the parotid gland, followed by diagnostic imaging with an X-ray, ultrasound, CT scan, or MRI.
Finally, a tissue biopsy is often done to confirm the diagnosis. The treatment of choice for Warthin tumors is surgical removal, specifically removing as much of the tumor as possible while avoiding damage to the nerves passing through the parotid gland.

Treatment2:47–2:57

Review2:57–3:26

Alright, as a quick recap, Warthin tumor, also called a papillary cystadenoma lymphomatosum, is a benign parotid tumor with papillae that push into cystic areas, as well as lymphocytic infiltration and germinal center formation in the epithelial layer.