Elsevier

Human Pathology

Volume 2, Issue 3, September 1971, Pages 403-420
Human Pathology

Warthin's tumor: A hypersensitivity disease?: Ultrastructural, light, and immunofluorescent study

https://doi.org/10.1016/S0046-8177(71)80007-2Get rights and content

Abstract

Five cases of papillary cystadenoma lymphomatosum (Warthin's tumor) studied by light, fluorescent, and electron microscopy revealed remarkable cytoarchitectural similarities between the lymphoid stroma of this condition and that of a group of immune diseases of the delayed hypersensitivity type best exemplified in Hashimoto's disease of the thyroid. Four cases were typical localized tumors, while one case was a diffuse process extending throughout the parotid gland. All cases were cytologically identical at the light and ultrastructural levels. The following steps in the development of the disease are postulated:o

  1. 1.

    In the early stages of the disease the epithelial cells of the striated ducts undergo oxyphilic metaplasia. An apocrine type of secretory activity ensues.

  2. 2.

    The metaplastic process triggers the proliferation of the ductal epithelium with resulting papillary formations. The secretion accumulates in the ducts, producing the cysts.

  3. 3.

    This process is followed by an intense cellular infiltration of the basement membrane of the epithelim by basophils, histiocytes, and macrophages.

  4. 4.

    At some point in the course of the disease an immune reaction of the delayed hypersensitivity type follows. Stem cells, immunoblasts, and immunocytes with polyribosomal aggregations of the cytoplasmic ribosomes, small lymphocytes, plasmoblasts, and plasma cells as well as histiocytes and macrophages proliferate beneath the basement membrane, and thus the lymphoid component of Warthin's tumor is generated and sustained.

On the basis of experimental work by other investigators it may be postulated that at least in some cases nutritional or metabolic deficiencies may be the source of the epithelial metaplasia of the salivary ducts.

References (42)

  • FlaxM.H.

    Experimental allergic thyroiditis

  • FlaxM.H.

    Experimental allergic thyroiditis in the guinea pig. II. Morphological studies of the development of thyroiditis

    Lab. Invest.

    (1963)
  • FlaxM.H. et al.

    Experimental allergic thyroiditis in the guinea pig. III. Correlation of morphological and functional changes in early lesions

    Ann. N.Y. Acad. Sci.

    (1965)
  • FlaxM.H. et al.

    Cellular and vascular components of allergic contact dermatitis

    Amer. J. Path.

    (1963)
  • FlaxM.H. et al.

    Experimental allergic thyroiditis in the guinea pig. I. Relationship of delayed hypersensitivity and circulating antibody to the development of thyroiditis

    Lab. Invest.

    (1963)
  • FooteF.W. et al.

    Tumors of the major salivary glands

  • FrazellE.L.

    Clinical aspects of tumors of the major salivary glands

    Cancer

    (1954)
  • HarrisM.

    The cellular infiltrate in Hashimoto's disease and focal lymphocytic thyroiditis

    J. Clin. Path.

    (1969)
  • HayesK.C. et al.

    The fine structure of vitamin A deficiency. I. Parotid duct metaplasia

    Lab. Invest.

    (1970)
  • HübnerG.

    Onkocytase adenomartige Hyperplasien, Adenolymphoma and Oncocyteme der Speicheldrüsen

    Arch. Klin. Exp. Ohr. Nas. Kehlkopfheilk.

    (1966)
  • HübnerG. et al.

    Zur Feinstruktur und Genese der Onkocyten

    Virchows Arch. Path. Anat.

    (1967)
  • Cited by (0)

    *

    Associate Professor of Pathology. Tufts University School of Medicine, Boston, Massachusetts. Pathologist-in-Chief, St. Joseph's Hospital, Providence, Rhode Island.

    View full text