Warthins Tumor Papillary Cystadenoma Lymphomatosum

Introduction

• Pathophysiology: entrapped lymphoid tissue (parotid is the last gland embryologically to be encapsulated), ectopic ductal epithelium that develops within intraparotid lymph nodes, or hypersensitivity disease resulting in metaplasia of the duct

• second most common salivary gland tumor

• almost exclusively found in middle-aged to elderly men

• almost always involves the parotid

• 10% bilateral (synchronous or metachronous); 10% multicentric

• rare malignant transformation

• SSx: slow growing, painless, cystic, compressible mass

• Dx: surgical biopsy (parotidectomy), FNA (thick, turbid fluid), radiosialography (concentrates technetium-99m due to the presence of high mitochondrial content of oncocytes)

• Rx: superficial or deep parotidectomy (see below)

Histopathology

• Biphasic Layers

1. epithelial component: lines papillary projections; double lining of oncocytes; inner or luminal cells, nonciliated, tall columnar nuclei at luminal aspect; outer or basal cells are round, cuboidal with vesicular nuclei

2. lymphoid component: mature lymphocytes with germinal centers

3. mucous secreting cells

• Oncocytic Cell: metaplasia (cytoplasmic alteration) of myo- or epithelial cells

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