Warthin tumour

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. 

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

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.

They are benign with extremely low incidence of malignant transformation. Some advocate surgical excision while others favour conservative management with follow up imaging.

Possible imaging differential considerations include:

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Article Information

rID: 2280
System: Head & Neck
Section: Pathology
Tag: parotid
Synonyms or Alternate Spellings:
  • Papillary cystadenoma lymphomatosum
  • Warthin's tumour
  • Warthin tumor
  • Warthin's tumor
  • Warthin tumours
  • Warthin tumors
  • Warthin's tumors
  • Warthin's tumours

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Cases and Figures

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    Fig 1: relative frequency of salivary gland tumours
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  • Drag
    Case 1: left parotid gland lesion
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    Case 2: on right
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    Case 3: on left
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    Case 4: with atypical calcification
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