Warthin Tumor

Papillary Cystadenoma Lymphomatosum

Warthin Tumor
• Second most common salivary gland neoplasm
• Arises almost exclusively in the parotid gland
• Only tumor virtually restricted in the parotid
• Occurs more commonly in males than in females
• Usually in the 5th to 7th decades of life
• 10% are multifocal
• 10% are bilateral
• Smokers have 8 times the risk of nonsmokers for developing these
tumors
• 65-80% arise in the parotid
• 10% in the submandibular gland
• remainder in the minor salivary gland including the sublingual gland

• BUT the likelihood of a salivary gland tumor being malignant is more

or less INVERSELY PROPORTIONAL to the size of the gland
Warthin Tumor Gross Morphology
• Most are round to oval encapsulated masses
• 2 to 5 cm in diameter
• Usually arising in the superficial parotid gland, where they are readily
palpable
• Transection reveals a pale gray surface punctuated by narrow cystic or
cleftlike spaces filled with mucinous or serous secretions
Microscopic Morphology
• These spaces are lined by a double layer of neoplastic epithelial cell resting
on a dense lymphoid stroma sometimes bearing a germinal center
• The spaces are frequently narrowed by polypoid projections of the
lymphoepithelial elements
• The double layer of lining cells is distinctive
• The upper layer consists of palisading columnar cells with abundant, finely
granular, eosinophilic cytoplasm
• Granular appearance of the cytoplasm of the upper layer of these cells is due to the
presence of numerous mitochondria, a feature referred to as “oncocytic”
• Secretory cells are dispersed in the columnar cell layer accounting for the secretions
within the dilated lumens
• The lower layer is comprised of cuboidal to polygonal cells
• On occasion, there is a foci of squamous metaplasia
Warthin Tumor
• The histiogenesis of these tumors has long been debated
• The epithelial component of the tumor appears to be neoplastic and
presumably these cells make factors that serve as attractants for the
lymphoid cells, which are believed to be reactive
• Rarely, Warthin tumors have arisen within cervical lymph nodes, a
finding that should not be mistaken for metastases
• These neoplasms are benign, with recurrence rates of only 2% after
resection
• Cystic or cleft-like spaces lined by a double layer of neoplastic
epithelial cells resting on a lymphoid stroma
• Double layer lining consists of a surface palisade of columnar cells
with abundant, finely granular, eosinophilic cytoplasm giving a
“oncocytic” appearance which rests on a layer of cuboidal to
polygonal cells
• Lymphoid stroma may exhibit prominent germinal centers
• Occasionally foci of squamous metaplasia may be seen
• Warthin tumor, microscopic
• Papillary fronds project into cystic to cleftlike spaces filled with pale pink
mucinous to serous secretions. The papillary fronds are covered by
• a double layer of pink (oncocytic) cuboidal to columnar epithelial cells.

• Beneath the epithelium are lymphocytes, sometimes with germinal

• centers. The oncocytic cells on electron microscopy are filled with mitochondria.

• This neoplasm, also known as papillary cystadenoma lymphomatosum, is the

second most common salivary gland tumor. It is almost always found in
• the parotid gland and is much more common in men and in smokers. About 10%
of cases are multifocal, and 10% are bilateral.