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Fine-needle sampling of salivary gland lesions. II. Cytology and histology correlation of 71 cases of Warthin's tumor (adenolymphoma).

Fine-needle sampling (FNS) of 71 Warthin's tumors was performed preoperatively in 70 patients. Cytologic diagnoses were concordant with histology in 50 (70.4%) tumors, whereas 14 (19.7%) cases were cytologically misclassified as benign lesions. Material for cytologic evaluation was unsatisfactory in seven (9.9%) cases, and no suspicious or false-positive diagnoses were observed. FNS is therefore a reliable preoperative technique for assessment of Warthin's tumor with a concordant/benign diagnostic rate of 90.1%.

Adenolymphoma↗

Immunohistochemical detection of cytokeratin 18 and its neo-epitope in Warthin's tumor (adenolymphoma) of the parotid glands.

An immunohistochemical method using a monoclonal antibody M30 (MAb M30), which reacts with the product released by cleavage of cytokeratin 18 (CK18) by activated caspase, was used to investigate the presence and extent of apoptosis in 36 cases of Warthin's tumor (WT) of the parotid glands. The distribution of CK18 in WT was also determined and compared with that of the product detected by MAb M30. In WT, CK18 was observed mainly in the tumor cells of duct-like structures, but not in the cells of lymphatic tissues. Positive MAb M30 reaction products were found in luminal contents, duct-like structures and the cytoplasm of some macrophages in lymphatic areas near the duct-like structures in WT. These findings indicated that apoptotic cells are phagocytosed and eliminated as waste by macrophages. It is suggested that a mechanism which regulates the balance of proliferative activity and apoptosis may be closely linked to the growth of WT.

Adenolymphoma↗

[Adenolymphoma (Warthin's tumor) located bilaterally].

Adenolymphoma (Warthin's tumor) is the second in occurrence of the parotid gland's benign neoplasms. In most cases (80%) it is observed as an unilateral tumor, smoking males aged from 50 to 60 are mainly affected. The authors present an interesting case of simultaneously occurring bilateral Warthin's tumor growing in parotid gland. A 59-year-old male patient, smoker was admitted to E.N.T. Dept. with a bilateral tumor. He underwent surgical treatment: superficial parotidectomy on the left side and right side tumor exterpation at the same time. After the operation we got the confirmation of the preoperation diagnosis. The patient was discharged home and stayed on the follow-up. Smoking patients with diagnosed unilateral adenolymphoma should be followed up because of the possibility of the neoplasmatic recurrence.

Adenolymphoma↗

Radiological findings of adenolymphoma (Warthin's tumor).

The radiological findings of adenolymphomas (Warthin's tumor) treated in six hospitals between 1985 and 1994 were compared with the operative and histological findings and the usefulness of the radiological examinations was evaluated. The total number of patients was 72. The mean age was 61.8 years; 61 were males and 11 were females. All tumors developed in the parotid gland. Tc-99m-pertechnetate salivary gland scanning was performed in 13 patients and an increased uptake of the isotope was observed in only six patients. Even if Tc-99m-pertechnetate salivary gland scanning does not reveal intense accumulation, this tumor should not be ruled out. By computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI), the margin of all tumors was evident; however, the contents of the tumor varied. The contents and multiplicity of the tumors were well demonstrated by MRI, which was found to be the most accurate imaging modality.

Adenolymphoma↗

Squamous cell carcinoma arising in benign adenolymphoma (Warthin's tumor) of the parotid gland.

Adenolymphoma of the parotid gland is a benign tumor occurring primarily in middle-aged males. Major texts of surgery and pathology state that this tumor is not malignant nor does it undergo malignant degeneration. This report demonstrates squamous cell carcinoma arising in a parotid adenolymphoma in a patient with no other malignancy or previous irradiation to the head and neck.

Adenolymphoma↗

Pigmented cells in adenolymphoma (Warthin's tumor).

A study of a series of adenolymphomas showed the presence of pigmented cells in the lymphoid stroma in 85% of the cases. The pigmented cells contained light brown cytoplasmic pigment and manifested sudanophila, acid-fastness, silver reduction capacity, PAS positivity and yellow autofluorescence in ultraviolet light. The morphology, histochemical reactions and autofluorescence suggest that the pigmented cells are macrophages containing ceroid derived from breakdown of damaged organelles of the epithelial tumor cells. It is possible that these cells play a role in the elimination of undigestable pigment material present in the cystic spaces of the tumor.

Adenolymphoma↗

Adenolymphoma (Warthin's tumor) with multiple sarcoid-like granulomas.

Five cases of adenolymphoma (Warthin's tumor) (AL) with numerous sarcoid-like granulomas within the lymphoid stroma are described. All patients were males, aged from 44 to 71 years (mean 57.3 years); all tumors were localized in the parotid gland. Fine needle aspiration cytology was performed in two cases 7.5 and 2 weeks before operation, respectively. Microscopic examination demonstrated the typical structure of AL. In addition, dispersed throughout the lymphoid stroma there were numerous granulomas formed by both epithelioid and multinucleated giant cells of Langhans type, strongly resembling sarcoidosis. The pathogenesis of the granulomatous change remains speculative. It could be caused by a toxic effect of the cysts' contents but probably not by its direct action; the spread of the fluid via sinuses into the lymphatic tissue seems to be more probable. We presume that the previous FNA may have some triggering effect. Granulomatous transformation of the lymphoid stroma resembling sarcoidosis is rare, but should be included in the spectrum of secondary changes in AL. It is not limited to metaplastic AL; it can be seen in an otherwise typical AL without any additional histologic changes. Knowledge of a previous FNA and awareness of the possibility of this peculiar histologic change are necessary to avoid incorrect diagnosis.

Adenolymphoma↗

Heterogeneity of keratin expression in epithelial tumor cells of adenolymphoma in paraffin sections.

Immunohistochemical expressions of keratin polypeptides detected by monoclonal antibodies were described in tumor cells of adenolymphoma, and the possibility of intercalated duct and ductal basal cells in the salivary glands being the progenitors was discussed. Basal cells in the tumor showed positive staining for keratin nos. 8, 13, 16, 18 and 19 detecting for monoclonal keratin antibodies (PKK 1, K 4.62, K 8.12, K 8.13), columnar tumor cells displayed strongly positive reactions with RPN 1164 and K4.62 suggesting keratin nos. 8 and 19. Great heterogeneity of distribution for keratin polypeptides was displayed by epithelial cells of adenolymphoma. Intercalated duct cells of normal salivary glands reacted with RPN 1164, RPN 1165, K 4.62 and K 8.13 monoclonal antibodies, which indicates the presence of keratins 8 and 19; and ductal basal cells reacted with PKK 1, K 4.62 and K 8.12, suggesting nos. 8, 13, 16, 18 and 19 keratins. Distribution of involucrin was variable in tumor epithelium of adenolymphoma, and was negative in the normal gland. The immunohistochemical distribution of keratin types between basal tumor cells of adenolymphoma and ductal basal cells of the normal salivary gland was compared.

Adenolymphoma↗

[Bilateral Warthin's tumor of the parotid gland].

Three cases of bilateral Warthin's tumor (adenolymphoma) of the parotid gland in patients treated in the ENT Department, Medical University of Gdańsk were presented. They were stated 3.3% of all Whartin's tumors in our institution. In two cases the contralateral tumor developed after 2.5 and 15 years and in one case arised synchronically. Our three patients were males, 50-65 years old, cigarette smokers more than 25 years. All of the patients were treated surgically--conservative parotidectomy was performed. We did not observe the complications and reccurence of the disease. Opinions on the diagnostic and therapeutic methods in that disease reported in Polish and foreign references are discussed.

Adenolymphoma↗

Oncocytic adenocarcinoma arising in Warthin's tumor.

Warthin's tumor (adenolymphoma) is a monomorphous adenoma of the salivary glands well characterized histologically. Its clinical evolution is almost invariably benign, the malignant change being extremely unusual. We present the case of a 67 year-old man with a right retromandibular tumor which has evolved over a two year period, with peripheral involvement of V, VI and VII cranial nerves on the same side, and direct invasion of intracranial structures. The biopsy revealed a classic adenolymphoma which shows foci of well differentiated adenocarcinoma. Transitional areas between benign and malignant epithelium were evident. In addition, histological findings support the hypothesis of the origin of adenolymphoma from epithelial ducts trapped in the regional lymphatic tissue.

Adenocarcinoma↗

Morphometrical analysis of cystadenolymphoma (Warthin's tumor). Subclassification and characterization of the lymphoid stroma in comparison with gastric lymphoid follicles.

Morphometrical analysis was applied to cystadenolymphoma (Warthin's tumor, adenolymphoma: CAL). By quantitative analysis of tissue sections, the examined cases were divided into three subtypes according to the ratio of the lymphoid stroma (LS) to the whole tissue: type I "stroma-rich type", the LS of this type was more than 57% of the whole tissue; type II "typical type", the LS of this type was 37% to 56% of the whole tissue; and type III "stroma-poor type", the LS of this type was less than 36% of the whole tissue. The average age of the patients in subtypes I, II and III was 57.7, 68.0, and 62.4 years, respectively. The age of the patients with type I CAL was significantly lower than that of those with type II CAL. In many type II cases, a reticular distribution of IgE in the germinal centers was frequently observed. From an analysis of the sections immunohistochemically stained with monoclonal antibodies to B and T cells, there appeared to be a trend that the greater the percentage of the LS to the whole tissue, the lower the ratio of B cell region to the LS. In contrast to CAL, an analysis of the change of the ratio of B cell region to the lymphoid follicles (LF) seen in the gastric mucosa of patients with chronic gastritis showed that the larger the volume of LF, the higher the ratio of the B cell region to the entire LF.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenolymphoma↗

Corpora amylacea in adenolymphoma (Warthin's tumor).

Round or polyhedral, acellular, lamellated or amorphous eosinophilic structures were observed in the cystic spaces of adenolymphomas. These eosinophilic bodies ahd several of the histochemical characteristics of amyloid, viz., pink color with green specific birefringence and bright red fluorescence with alkaline Congo red; positive DMAB-nitrite and DC reactions, and spontaneous autofluorescence. It is suggested that these bodies are derived from spontaneous assembly or polymerization of microfibrils of desquamated epithelial cells lining the cystic spaces of the tumor, as has been described to occur in prostatic corpora amylacea.

Adenolymphoma↗

[Adenolymphoma (Warthin's tumor) of the larynx: coexistence with the bilateral laryngocele. Contribution to differential diagnosis with oncocytic papillary cystadenoma].

Adenolymphoma is a benign monomorphic lesion composed of epithelial tissue. Usually it is found in parotid gland; however, its laryngeal occurrence was rarely described. Extraparotid Warthin's tumour as scanty lymphatic tissue. In cases when there is no lymphatic tissue in subepithelial layer it is called oncocytic cystadenoma. The authors describe the case of bifocal adenolymphoma in bilateral laryngocoele and indicate classification difficulties of oncocytic lesions in the larynx.

Adenolymphoma↗

[Bilateral adenolymphoma (Warthin's tumor) of the parotid. The anatomicoclinical, diagnostic and therapeutic aspects of 2 cases].

Cystadenoma lymphomatosum or Warthin's tumor of the parotid glands appears bilateral in 8-10% of cases, synchronous (rarely), metachronous (frequently) and sometimes with multicentric aspects. After the review of the epidemiological, pathogenetic, clinical, radiographic and histologic data, the authors present two cases of bilateral Warthin's tumor, metachronous (7 years), nodular-isolated in the first one and metachronous (5 years), nodular-multicentric in the second one. The patients after CAT scan and NMR examinations, and a fine needle aspiration biopsy were treated with superficial parotidectomy with preservation of the facial nerve. In our experience the management of patients affected by Warthin's tumors, needs the following steps: CAT scan and NMR examinations to outline multiple and bilateral lesions, fine needle aspiration biopsy, superficial parotidectomy with preservation of the facial nerve, an extended follow-up (10 years after the last surgery).

Adenolymphoma↗

Unilateral multiple adenolymphomas originating in the parotid gland: a clinicopathological study.

The validity of Seifert's hypothesis about growth pattern of adenolymphomas has been evaluated in three of five patients with adenolymphomas of the parotid gland, who at the time of a parotidectomy, were found to have multiple unilateral adenolymphomas in the intraglandular lymph nodes. This evaluation, which was based on assessing the epithelial: lymphoid tissue ratio in excised adenolymphomas and the growth in tumor size, showed that there was no association between the histological changes in the epithelial:lymphoid tissue and the tumor size. Adenolymphomas seem to have no consistent growth pattern and develop independently. However, as multiple tumors were detected histopathologically in lymph nodes as small as 5 mm in diameter the importance of a detailed examination of patients with adenolymphomas is stressed, so that other tumours are not overlooked.

Adenolymphoma↗