Warthins tumor

WARTHINS TUMOR

• Synonym – papillary cystadenoma lymphomatosum, adenolymphoma, cystadenolymphoma
• It is a benign tumor which contains multiple cysts lined by bilayered epithelium i,e columnar and basaloid oncocytic epithelium
• Numerous papillae will be projecting into cysts which are accompanied by proliferation of lymphoid follicles.
• This tumor exclusively occurs in parotid
• Occurs more commonly in males and in the 5th and 6th decade.
• It is associated smoking
• Warthins tumor present as painless, sometimes fluctuant swellings in the lower portion of the parotid gland

Gross

• Cut section shows variable number of cysts that excude  clear, mucoid or brown fluid or caseous semisolid debris
• Lining of cysts have small knob-like excrescence that represent papillary epithelial proliferation supported by lymphoid tissue

Microscopy

• Warthins tumor  have thin capsule and are usually sharply demarcated from the surrounding parenchyma
• Cystic spaces are lined by the papillary proliferation of bilayered oncocytic epithelium whose supporting stroma is composed largely of lymphoid tissue
• The two types of epithelium are  (a) the luminal epithelium composed of tall columnar cells that have granular eosinophilic cytoplas and palisading of their own nuclei, which are in the centre or apical ends of the cells (b) Beneath and between the columnar cells are less obvious, smaller basaloid cells which are triangular having fusiform nuclei and are arranged perpendicular to the long axis of tall columnar cells.