Warthin tumor – causes, symptoms, diagnosis, treatment, pathology

Warthin tumor – causes, symptoms, diagnosis, treatment, pathology


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. 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. 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. 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. 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.

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