Warthin's tumor pathophysiology: Difference between revisions

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{{Warthin's tumor}}
{{Warthin's tumor}}
{{CMG}}; {{AE}} {{Ammu}}
{{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.
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==
 
* Warthin tumor (or papillary cystadenoma lymphomatous) is a benign, sharply demarcated tumor of the [[salivary gland]]. It is bilateral in 10-15% of cases.
== Pathophysiology ==
* 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 than pleomorphic adenoma, Warthin's tumor is the second most common benign parotid tumor.
===Pathogenesis===
* 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.
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 [[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 = Rare diseases 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>
*[[Stroma]] and [[parenchyma]] of the [[tumor]] was histopathologically analyzed.
*The [[epithelial]] and [[stromal]] component was equally distributed in [[tumor]] mass.
*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.
*Expression of CRTC1 - MAML2 chimeric genes through t(11;19)(q21;p13) translocation is involved in the pathogenesis of Warthin's tumor.
==Gross Pathology==
==Gross Pathology==
* Warthin's tumor is often multicentric (20%) and is usually small (1-4 cm). It has typically heterogeneous appearance on all modalities, often with cystic components (30%).<ref>{{cite book | last = Blake | first = Michael | title = Adrenal imaging | publisher = Humana Press | location = Totowa, NJ | year = 2009 | isbn = 193411586X }}</ref><ref name=Radiopaedia 2015 Warthin tumor>{{cite web | title = Radiopedia 2015 Warthin tumor  [Dr Henry Knipe and A.Prof Frank Gaillard]| url = http://radiopaedia.org/articles/warthin-tumour }}</ref>
Characteristic findings of warthin's tumor on gross pathology are;
* The size of Warthin's tumor is usually 2.5 centimeter.
* Size of the [[tumor]] varies between 2-5 cm.
* Warthin's tumor tend to favor the [[parotid]] tail region.
* 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.


==Microscopic Pathology==
==Microscopic Pathology==
* 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]].  
On microscopic histopathological analysis the characteristic findings of warthin;s tumor are;
* The cystic spaces have epithelium referred to as papillary infoldings that protude into them. Additionally, the epithelium has lymphoid stroma with germinal center formation.
* Dense lymphoid stroma with double layer of epithelial cells resting on the stroma.
* Papillae (nipple-shaped structures) with a two rows of pink (eosinophilic) epithelial cells (with cuboidal basal cells and columnar luminal cells) - key feature
* The cystic spaces are present which are narrowed by polypoid projections.
* Fibrous capsule - pink & homogenous on H&E stain
* Basal cell layer is not continuous and is interrupted in places .
* Cystic space filled with debris in situ (not necrosis)
* The oncocytic columnar cells palisade on the surface.
* Lymphoid stroma
* There is no myoepithelial component present in tumor.
* Additionally, the [[epithelium]] has [[lymphoid stroma]] with [[germinal center]] formation.<ref> Warthin's tumor librepathology (2015) http://librepathology.org/wiki/index.php/Warthin_tumour Accessed on December 14, 2015</ref>
* Occasional features include [[Cilia|cilia,]] [[squamous metaplasia]] with [[Necrosis|necrosis,]] [[Mast cell|mast cells]], [[dendritic cells]] and [[Sebaceous|sebaceous cells]].  
<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 (1).jpg|center|400px|thumb| CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507400]]
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>
Image:Papillary cystadenoma lymphomato 01.jpg|Histopathology of Warthin tumor in the parotid gland.  Image courtesy of Nephron [http://www.librepathology.org librepathology] (original file [http://librepathology.org/wiki/index.php/File:Papillary_cystadenoma_lymphomatosum1.jpg ‘’here’’]).  [http://librepathology.org/licence Creative Commons BY­SA­NC]
Image:Papillary cystadenoma lymphomato 02.jpg|Histopathology of Warthin tumor in the parotid gland.  Image courtesy of Nephron [http://www.librepathology.org librepathology] (original file [http://librepathology.org/wiki/index.php/File:Papillary_cystadenoma_lymphomatosum2.jpg ‘’here’’]).  [http://librepathology.org/licence Creative Commons BY­SA­NC]
Image:Papillary cystadenoma lymphomato 02.jpg|Histopathology of Warthin tumor in the parotid gland.  Image courtesy of Nephron [http://www.librepathology.org librepathology] (original file [http://librepathology.org/wiki/index.php/File:Papillary_cystadenoma_lymphomatosum2.jpg ‘’here’’]).  [http://librepathology.org/licence Creative Commons BY­SA­NC]
Image:777px-Papillary cystadenoma lymphomato 03.jpg|Histopathology of Warthin tumor in the parotid gland.  Image courtesy of Nephron [http://www.librepathology.org librepathology] (original file [http://librepathology.org/wiki/index.php/File:Papillary_cystadenoma_lymphomatosum2.jpg ‘’here’’]).  [http://librepathology.org/licence Creative Commons BY­SA­NC]


</gallery>
[[image:Warthin tumor (2).jpg|center|400px|thumb| CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=507402]]


==References==
==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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