Warthins Tumour

Definition

• Benign salivary gland tumour

Epidemiology

• Rare <1%
• 2nd most common benign parotid gland tumour
• M>F

Risk Factor

• SMOKING (only salivary gland tumour associated to smoking)
• Others
  • Radiation
  • EBV

Location

• Parotid (almost exclusively)

Features

• Commonly cystic and bilateral

Pathology

• Macro
  • Well circumscribed mass
  • Solid and cystic components
• Micro
  • Bilayered oncocytic epithelium
  • Cyst formation
  • Lymphoid stroma

Clinical

• Painless lump near angle of mandible

Investigations

• Assess both sides - bilaterality and multiple
• USS - well defined mass, anechoic areas, post acoustic shadowin
• CT - bony involvement
• MRI - soft tissue involvement, encapsulated, hypo T1
• Biopsy - FNA or core

Management

• Usually superficial parotidectomy
• Surveillance if biopsy proven and not changing, asymptomatic
  • Low recurrence rate and minimal malignant potential

Spiel on Warthin’s tumour

• 2nd most common benign salivary tumour
• Affects almost exclusively the parotid gland
• Typified by bilayered oncocytic epithelium, cyst formation and lymphoid stroma
• RF - SMOKING, prior RTX, viral (EBV/HPV/HIV) and exposures - nickel, rubber, hairdresser
• Minimal risk of malignant transformation
• Can avoid surgery and monitor if no sx
• Presents with painless lump
• Work up with USS/CT/MRI and FNA/core
• Mx is superficial parotidectomy and facial nerve preservation
• Minimal benefit for doing total even if deep component is involved