Warthins

Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is a benign neoplasm of the salivary glands, most commonly arising in the parotid gland. It is one of the more frequent benign parotid tumors, after pleomorphic adenoma. Warthin's tumors account for a significant minority of salivary gland neoplasms, with a higher incidence in older adults and a strong association with smoking. The condition can occur bilaterally or multifocally in a minority of cases, and bilateral tumors are more common among smokers.

Pathology and histology: Warthin's tumor typically presents as a cystic, sometimes multilocular lesion. Microscopically it shows a double-layered oncocytic epithelium that forms papillary projections into cystic spaces, set in a prominent dense lymphoid stroma with germinal centers. This characteristic combination of epithelial and lymphoid components is the hallmark of the tumor. The epithelium is usually benign, and mitotic activity is rare.

Clinical features and diagnosis: Patients often present with a slow-growing, painless mass in the parotid region. Facial nerve involvement is uncommon. Imaging (ultrasound, CT, or MRI) usually reveals a well-defined cystic lesion with a solid component or papillary nodules. Fine-needle aspiration (FNA) can aid diagnosis and typically shows oncocytic cells within a lymphoid background; however, FNA can yield false negatives in some cases.

Management and prognosis: The standard treatment is surgical excision with preservation of the facial nerve, typically via superficial parotidectomy or targeted lesion removal. Recurrence is rare after adequate resection. Malignant transformation is uncommon but has been reported. Overall prognosis is excellent with appropriate treatment.

History: The tumor is named after Aldred Warthin, who described it in the early 20th century.