Warthin tumor
Updates to Article Attributes
Warthin tumours (or papillary cystadenoma lymphomatosum) are a benign, sharply demarcated tumour of the salivary- lymphoid origin most commonly arising from parotid gland tail. They are bilateral or multifocal in up to 20% of cases, and are the most common neoplastic cause of multiple solid parotid masses.
Epidemiology
They are the 2nd most common (up to 10% of all parotid tumours) benign parotid tumour (after pleomorphic adenoma) and are the commonest bilateral or multifocal benign parotid tumour. It typically occurs in the elderly (6th decade). There is a recognised male predilection. Patients typically present with painless parotid swelling.
Morphology
They are often multicentric (20%) and are usually small (1-4 cm). They have a typically heterogeneous appearance on all modalities, often with cystic components (30%).
Location
Tends to favour the parotid tail region at the level of mandibular angle.
Associations
- smoking
- irradiation
Radiographic features
Has a greater tendency to undergo cystic change (~30%) than any other salivary gland tumour 4,5.
Ultrasound
Most tumours tend to be ovoid, had well-defined margins, contain multiple irregular, small, sponge-like anechoic areas 10. Tumours that are large (e.g. >5 cm) tend to have a higher proportion of cystic content than smaller lesions had and in some cases can be composed almost entirely of cystic material. They are often hypervascular.
CT
- classic appearance is a well defined heterogeneous solid cystic lesion within the superficial lobe of parotid/parotid tail
- well defined
- no calcification
- cystic changes appear as intra lesional lower attenuation
- moderate enhancement
- presence of mural nodule is strongly suggestive of Warthin tumour
- can be often seen bilaterally
MRI
Well defined and can be bilateral.
- T1: low to intermediate signal with cyst containing cholesterol components containing focal high signal 2
- T2: heterogenous and variable signal intensity
- T1 C+ (Gd): usually no contrast enhancement 3
Nuclear medicine
Often shows uptake with Tc99-pertechnetate, thallium and FDG-PET 7.
Treatment and prognosis
They are benign with extremely low incidence of malignant transformation. Some advocate surgical excision while others favour conservative management with follow up imaging.
Differential diagnosis
Possible imaging differential considerations include:
- pleomorphic adenoma
- other salivary gland tumours
- mucoepidermoid carcinoma
- adenoid cystic carcinoma (ACC)
- acinic cell carcinoma(of salivary gland)
- parotid nodal metastasis
- parotid non-Hodgkin lymphoma
- Sjogren syndrome
- benign lymphoepithelial lesions (BLEL) in HIV
- infiltrative lesion, e.g. sarcoidosis
-<a href="/articles/acinic-cell-carcinoma-of-salivary-glands">acinic cell carcinoma</a><a href="/articles/acinic-cell-carcinoma"> </a>(of salivary gland)</li>- +<a href="/articles/acinic-cell-carcinoma-salivary-glands">acinic cell carcinoma</a><a href="/articles/acinic-cell-carcinoma"> </a>(of salivary gland)</li>
Image 7 CT (With-contrast) ( create )
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