Warthin’s tumor, or adenolymphoma, is a benign neoplasm of the salivary glands, although in most cases, the parotid gland is affected.
It is named after the scientists Heinrich Albrecht, Leopold Arzt, and Aldred Scott Warthin, who first described it.
EPIDEMIOLOGY
It is a rather rare neoplasm, but it is estimated to represent 5-15% of all parotid tumors, the second most frequent after Pleomorphic adenoma.
In a percentage ranging from 10% to 20% of cases, adenolymphoma is bilateral, and more rarely, it can be multifocal.
It is more common in smokers and in men (in some statistics, over 80% of cases); the most frequent age of onset is between the sixth and seventh decades of life.
PATHOLOGICAL ANATOMY
Macroscopic appearance of Warthin’s tumor.
It most frequently arises in the lower portion of the parotid gland, near the mandibular angle.
Macroscopically, it appears as a solid, spheroidal mass, covered by a capsule and with a lobulated appearance. Upon cutting, cystic spaces filled with a serous or mucous secretion are evident, internally lined with a cylindrical epithelium, arranged in two layers; the innermost layer, on the side of the cystic space, is lined with rather tall cylindrical cells, with abundant acidophilic cytoplasm and a rather small nucleus; the outer layer is composed of smaller cells, tendentially cubic or polygonal in shape, with a vesicular nucleus. The whole is embedded in a stroma rich in lymphoid tissue with voluminous germinal centers. Warthin-like tumors of the thyroid have been described in the literature as a variant of papillary thyroid carcinoma.
SYMPTOMATOLOGY AND CLINICAL PICTURE
Adenolymphoma presents as a painless swelling of the parotid gland; it is a benign neoplasm and does not tend to malignant transformation, but locally it is capable of creating compression symptoms that can also be of significant severity; here is an article on PubMed (in English) about a case of carotid sinus syndrome in a subject with Warthin’s tumor.
THERAPY
Treatment is exclusively surgical and is necessary for local compressive problems; given the benign nature of the neoplasm (it has no infiltrating ability and does not metastasize), no further therapy is foreseen.
Warthin’s tumor on PubMed (the search returns numerous results; then the filter must be refined)
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Dr. Salvatore Nicolosi
General Practitioner with National Health Service