Warthin Tumour
(Papillary Cystadenoma Lymphomatosum)
Common sites:
- Virtually exclusive to parotid
Gross features:
- round/oval
- encapsulated
- 2-5cm
- superficial parotid
- cut surface is pale gray punctuated by narrow
cystic or cleftlike spaces filled with mucinous
or serous secretion
- 10% multifocal
- 10% bilateral
Histologic features:
- cystic spaces lined by a double layer of
epithelial cells
- surface palisade of columnar cells with
abundant, finely granular, eosinophilic cytoplasm (oncocytic
appearance)
- resting on a layer of cuboidal to polygonal
cells
- dense lymphoid stroma
- sometimes germinal centres
- sometimes foci of squamous metaplasia
Cytopathologic features:
- oncocytic
epithelium (similar to oncocytic cells in
chronic lymphocytic thyroiditis)
- flat cohesive sheets
- relatively large, variable nuclei
- nucleoli sometimes prominent
- abundant cytoplasm, finely granular (dense on
air-dried smears)
- cyanophilic on Pap (eosinophilia may not be seen in Pap stained samples)
- maybe sebaceous, squamous, mucinous, or
pleomorphic adenoma-like
- lymphocytes (need this component to be
diagnostic)
- mostly single small cells with densely
hyperchromatic nuclei and thin rim of basophilic to cyanophilic
cytoplasm
- crushed cell aggregates (‘lymphoid tangles’)
maybe
- detached cytoplasmic droploets
(‘lymphoglandular bodies’) maybe
- cyst fluid background (usually most prominent
feature)
- histiocytes
- few inflammatory cells
- DDx:
- Oncocytic
neoplasm (prominent oncocytes)
- acinic
cell carcinoma (closely resembles oncocytes)
Immunophenotype:
Marker:
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Sensitivity:
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Specificity:
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Molecular features:
Other features:
References:
- (?Robbins)
- Silverberg (ed.)
Silverberg’s Principles and Practice of Surgical Pathology and
Cytopathology, 4th ed. (2006)