A Warthin tumour (or papillary cystadenoma lymphomatosum) is a benign sharply demarcated tumour of the parotid gland. It is bilateral in 10-15% of cases.
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.
They are often multi-centric (20%) and are usually small (1-4 cm). They have a typically heterogenous appearance on all modalities, often with cystic components (30%).
Tends to favour the parotid tail region.
Has a greater tendency to under go cystic change than any other salivary gland tumour 4.
Usually seen as a relatively well defined, ovoid, hyperechoic mass. In some cases anechoic internal cystic areas may be present. They are often hypervascular.
- can be often seen bilaterally
- classic appearance is a cystic lesion posteriorly within the parotid with a focal tumour nodule
- relatively well defined
- cystic changes appear as intra lesional lower attenuation
- no calcification
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
- C+ (Gd) : usually no contrast enhancement 3
Often shows uptake with Tc99-pertechnetate, thallium and FDG-PET.
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.
The differential for parotid lesions includes
- 1. Ikeda M, Motoori K, Hanazawa T et-al. Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation. AJNR Am J Neuroradiol. 2004;25 (7): 1256-62. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 2. Minami M, Tanioka H, Oyama K et-al. Warthin tumor of the parotid gland: MR-pathologic correlation. AJNR Am J Neuroradiol. 14 (1): 209-14. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 3. Joe VQ, Westesson PL. Tumors of the parotid gland: MR imaging characteristics of various histologic types. AJR Am J Roentgenol. 1994;163 (2): 433-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Choi DS, Na DG, Byun HS et-al. Salivary gland tumors: evaluation with two-phase helical CT. Radiology. 2000;214 (1): 231-6. Radiology (full text) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Papillary cystadenoma lymphomatosum||✓|