Warthin's tumor pathophysiology: Difference between revisions

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{{CMG}}
{{Warthin's tumor}}
{{Warthin's tumor}}
{{CMG}}; {{AE}} {{Ammu}}  {{N.F}}
==Overview==
==Overview==
Warthin's tumor arises from [[salivary gland]] epithelium, which are secretory cells of the [[salivary gland]]. On gross pathology, cystic and multicentric appearance are characteristic findings of Warthin's tumor. On microscopic histopathological analysis, papillae, fibrous [[capsule]], and cystic spaces are characteristic findings of Warthin's tumor.


==Pathogenesis==
== Pathophysiology ==
* Warthin tumor is a benign tumor of the salivary gland. The first symptom is usually a painless, slow-growing bump in front of the ear, on the bottom of the mouth, or under the chin. Warthin tumors may increase in size over time, but few become cancerous.
===Pathogenesis===
* The gland most likely affected is the parotid gland. In fact, it is the only tumor virtually restricted to the parotid gland. Though much less likely to occur thanpleomorphic adenoma, Warthin's tumor is the second most common benign parotid tumor.
The exact pathogenesis of warthins tumor is not completely understood. Acording to a study in 2016,<ref name="KuzenkoRomanuk20162">{{cite journal|last1=Kuzenko|first1=Yevhen V.|last2=Romanuk|first2=Anatoly M.|last3=Dyachenko|first3=Olena Olegivna|last4=Hudymenko|first4=Olena|title=Pathogenesis of Warthin’s tumors|journal=Interventional Medicine and Applied Science|volume=8|issue=2|year=2016|pages=41–48|issn=2061-1617|doi=10.1556/1646.8.2016.2.2}}</ref> :
* The appearance of this tumor under the microscope is unique.  There are cystic spaces surrounded by two uniform rows of [[cell (biology)|cells]] with centrally placed pyknotic [[cell nucleus|nuclei]].  
*[[Stroma]] and [[parenchyma]] of the [[tumor]] was histopathologically analyzed.
* The cystic spaces have epithelium referred to as papillary infoldings that protude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.
*The [[epithelial]] and [[stromal]] component was equally distributed in [[tumor]] mass.
* Warthin's tumor primarily affects older individuals (age 60–70 years). There is a slight female predilection according to recent studies, but historically it has been associated with a strong male predilection. This change is possibly due to the tumor's association with cigarette smoking and the growing use of cigarettes by women. The tumor is slow growing, painless, and usually appears in the tail of the parotid gland near the angle of the mandible. In 5–14% of cases, Warthin's tumor is bilateral, but the two masses usually are at different times. Warthin's tumor is highly unlikely to become malignant.<ref name=NIH Warthin tumor>{{cite web | title = Rarediseases Warthin tumor| url = https://rarediseases.info.nih.gov/gard/8569/warthin-tumor/resources/1 }}</ref><ref> NIH Warthin tumor. Rarediseases (2015). https://rarediseases.info.nih.gov/gard/8569/warthin-tumor/resources/1 Accessed on December 02, 2015</ref>
*This study showed that the Warthin's tumor occurs as a result of of [[inflammatory]] process.
*[[Epithelial]] part of the Warthin's tumor is the main trigger for the [[tumor]] process.
==Genetics==
==Genetics==
*Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.
==Gross Pathology==
Characteristic findings of warthin's tumor on gross pathology are;
* Size of the [[tumor]] varies between 2-5 cm.
* The [[tumor]] is well demarcated, grey yellow in color.
* It is encapsulated, [[Lobular|lobulated]] and multicentric.
* Warthin;s tumor can be fixed to overlying skin.
* 10-15% are multifocal/bilateral.
* Tumor can have serous/mucinous secretion.


==Associated Conditions==
==Microscopic Pathology==
On microscopic histopathological analysis the characteristic findings of warthin;s tumor are;
* Dense lymphoid stroma with double layer of epithelial cells resting on the stroma.
* The cystic spaces are present which are narrowed by polypoid projections.
* Basal cell layer is not continuous and is interrupted in places .
* The oncocytic columnar cells palisade on the surface.
* There is no myoepithelial component present in tumor.
* Occasional features include [[Cilia|cilia,]] [[squamous metaplasia]] with [[Necrosis|necrosis,]] [[Mast cell|mast cells]], [[dendritic cells]] and [[Sebaceous|sebaceous cells]].


==Gross Pathology==
[[image:Warthin tumor (1).jpg|center|400px|thumb| CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507400]]


==Microscopic Pathology==
[[image:Warthin tumor (2).jpg|center|400px|thumb| CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507402]]
* The appearance of this tumor under the [[microscope]] is unique.
* Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) - key feature.
* Fibrous capsule - pink & homogenous on H&E stain.
* Cystic space filled with debris in situ (not necrosis).
* Lymphoid stroma
* Additionally, the epithelium has lymphoid stroma with [[germinal center]] formation.
<gallery>
Image:Warthin tumor (1).jpg|Histopathology of Warthin tumor in the parotid gland. H&E stain<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
Image:Warthin tumor (2).jpg|Histopathology of Warthin tumor in the parotid gland. Another view of a file "Warthin tumor (1).jpg". H&E stain..<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
Image:Warthin tumor (3).jpg|Histopathology of Warthin tumor in the parotid gland. Higher magnification of a file "Warthin tumor (1).jpg". H&E stain.<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
</gallery>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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==References==
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Latest revision as of 00:53, 21 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Nazia Fuad M.D.

Overview

Warthin's tumor arises from salivary gland epithelium, which are secretory cells of the salivary gland. On gross pathology, cystic and multicentric appearance are characteristic findings of Warthin's tumor. On microscopic histopathological analysis, papillae, fibrous capsule, and cystic spaces are characteristic findings of Warthin's tumor.

Pathophysiology

Pathogenesis

The exact pathogenesis of warthins tumor is not completely understood. Acording to a study in 2016,[1] :

Genetics

  • Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.

Gross Pathology

Characteristic findings of warthin's tumor on gross pathology are;

  • Size of the tumor varies between 2-5 cm.
  • The tumor is well demarcated, grey yellow in color.
  • It is encapsulated, lobulated and multicentric.
  • Warthin;s tumor can be fixed to overlying skin.
  • 10-15% are multifocal/bilateral.
  • Tumor can have serous/mucinous secretion.

Microscopic Pathology

On microscopic histopathological analysis the characteristic findings of warthin;s tumor are;

  • Dense lymphoid stroma with double layer of epithelial cells resting on the stroma.
  • The cystic spaces are present which are narrowed by polypoid projections.
  • Basal cell layer is not continuous and is interrupted in places .
  • The oncocytic columnar cells palisade on the surface.
  • There is no myoepithelial component present in tumor.
  • Occasional features include cilia, squamous metaplasia with necrosis, mast cells, dendritic cells and sebaceous cells.
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507400
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507402

References

  1. ↑ Kuzenko, Yevhen V.; Romanuk, Anatoly M.; Dyachenko, Olena Olegivna; Hudymenko, Olena (2016). "Pathogenesis of Warthin's tumors". Interventional Medicine and Applied Science. 8 (2): 41–48. doi:10.1556/1646.8.2016.2.2. ISSN 2061-1617.


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