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RESIDENT
CASE
STUDIES
Week 6 May 26 - May 30, 2003: Case
1
Table
of Contents | List of Diagnoses | Case 1 | Case 2
| Case
3 | Case 4
61 year old male with left
parotid mass
Discussion:
Warthin's tumor (also known as Papillary cystadenoma lymphomatosum, or
adenolymphoma) usually is a benign, slow growing and painless salivary
gland neoplasm, which usually arises in men in the sixth or seventh
decades of life.1 The incidence in women is rising and now approaches a
1:1 male/female ratio.2 The occurrence of Warthin's tumor is strongly
associated with cigarette smoking, with data to indicate that smokers have
eight times the risk of developing Warthin's tumor over nonsmokers.3
Bilateral or multifocal tumor involvement is observed in less than 10% of
patients.4 The tumor occurs almost exclusively in the vicinity of the
parotid, accounting for 2-10% of all parotid tumors.5 Among benign
tumors of the parotid, it is exceeded only by pleomorphic adenoma.5
Grossly,
sectioning classically reveals papillary cystic spaces containing serous
or mucoid, clear or brown fluid. The tumor however, may appear as a solid
mass. Histologically, there are papillary projections that are lined by a
double layer of granular eosinophilic cells (oncocytes). In addition,
there is a prominent lymphoid component which usually contains germinal
centers. The epithelial component may undergo squamous metaplasia (which
on occasion may be predominant, simulating mucoepidermoid tumor). In some
instances, this epithelium may also give rise to sebaceous glands. The
cystic spaces may contain lamellated concentric eosinophilic bodies,
similar to corpora amylacea.
References:
1Rodriguez Bigas MA, Sako K,
Razack MS, Castillo NB. Extraparotid Warthin's tumor: an unexpected
finding in three female patients. N Y State J Med 1990;90:465-6.
2Batsakis
JG, El-Naggar AK. Pathology
consultation: Warthin's tumor. Ann Otol Rhinol Laryngol 1990;99:588-915.
3Kotwall CA. Smoking as an
etiologic factor in the development of Warthin's tumor of the parotid
gland. Am J Surg 1992;164:646-7.
4Eveson JW, Cawson RA.
Warthin’s tumor (cystadenolymphoma) of salivary glands: a
clinicopathologic investigation of 278 cases. Oral Surg Oral Med Oral
Pathol 1986;61:256-262.
5Leegard J, Lindman H.
Salivary gland tumors: clinical picture and treatment. Acta
Otolaryngol 1970;263:155-159.
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