Summary
Cystadenolymphomas (CAL) of the parotid gland are variable in their epithelial differentiation and the ratio of the epithelial tumor component to lymphoid stroma. Two hundred and seventy five cases of CAL from the files of the Salivary Glands Register of the Institute of Pathology, University of Hamburg (1965–1979) were analysed. Their pathogenesis from parenchyma included in regional lymph nodes is discussed. The following Subclassification was established.
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1.
Depending on to the ratio of epithelial tumor component to lymphoid stroma, three subtypes were distinguished. Subtype 1, “typical CAL” with an epithelial tumor component of 50%, amounted to 77% of all cases of CAL studied. Oncocytic differentiation and focal metaplasia to goblet cells or squamous epithelium was also found. 13.5% of CAL were classified as subtype 2, “stroma-poor CAL” with an epithelial tumor component of 70 to 80%). The tumor structure was similar to that of an oncocytoma in places. Two per cent of the CAL were in subtype 3, “stroma-rich CAL” with an epithelial tumor component of only 20 to 30%. Subtype 3 was found solely in men. The average age at presentation (61 years) was slightly lower than that of all the cases studied (65 years).
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2.
In 7.5% of the cases large areas of squamous cell metaplasia and regressive changes was found within a CAL. These cases were classified as subtype 4 (“metaplastic CAL”). The average age was 67 years. The case histories showed that 20% of these metaplastic CAL had previously been irradiated.
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3.
Bilateral CAL was found in 7.5% of the cases. In 4% multifocal CAL occurred in the parotid gland unilaterally. Recurrences were observed in 2% of all CAL.
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4.
Carcinoma in CAL is rare (we found two cases in our own material). In 50% of all cases reported radiotherapy was mentioned in the case histories.
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Malignant tumors coincident with CAL were recorded in 3% of the cases.
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The lymphoid stroma showed reaction patterns similar to those of the regional lymph nodes. These included granulomatous changes (foreign body granuloma with cholesterol deposits, tuberculosis) and tumor metastases. In the neighborhood of oncocytic tumor epithelium focal accumulations of plasma cells forming IgA and IgG were found.
Metaplasia to squamous epithelium is believed to be caused by circulatory disturbances, irradiation, and other noxae. In the differential diagnosis of the stroma-poor subtype 2, oncocytoma and cystic sialadenoma must be excluded, and in the differential diagnosis of subtype 4 (the metaplastic CAL), sebaceous adenoma, mucepidermoid tumor, squamous cell carcinoma, lymphoepithelioma, and other non-tumorous lesions of the parotid gland (lymphoepithelial cysts, myoepithelial parotitis) must be ruled out. Our findings suggest that CAL develops from parenchyma included in parotid lymph nodes with the oncocytic ductal epithelium representing the neoplastic component.
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References
Albertini A von (1974) Histologische Geschwulstdiagnostik, 2nd ed. Stuttgart: Thieme
Allegra SR (1971) Warthin's tumor: a hypersensitivity disease? Ultrastructural, light, and immunofluorescent study. Hum Pathol 2:403–420
Assor D (1974) Bilateral carcinoma of the parotid, one cancer arising in a Warthin's tumor. Am J Clin Pathol 61:270–274
Astacio JN (1974) Papillary cystadenoma lymphomatosum associated with pleomorphic adenoma of the parotid gland. Oral Surg 38:91–95
Bernier JL, Bhaskar SN (1958) Lymphoepithelial lesions in salivary glands; classification and histogenesis. Cancer 11:1156–1179
Bucciarelli E (1969) Adenolinfoma e tubercolosi clicicamente primitiva della parotide. Lav Anat Pat Perugia 29:139–146
Buchner A, David R (1977) Pigmented cells in adenolymphoma (Warthin's tumor). J Oral Pathol 6:106–112
Bull H-G (1979) Pathomorphologische Subklassifikation der papillären Cystadenolymphome der Parotis. Analyse von 204 Fällen. Diss Hamburg
Cossman J, Deegan MJ, Batsakis JG (1977) Warthin's tumor. B-lymphocytes within the lymphoid infiltrate. Arch Pathol Lab Med 101:354–356
Cruickshank AH (1965) Benign lymphoepithelial lesion to be distinguished from adenolymphoma. J Clin Pathol 18:391–400
Doebroessy L, Ronay P, Molnar L (1972) Malignant papillary cystadenoma lymphomatosurn. Oncology 26:457–465
Doerr W (1956) Über die lymphoepithelialen Geschwülste Schmincke-Regaud. Ärztl Wochenschr 11:169–182
Donath K (1979) Pathohistologie des Parotisinfarktes. — Necrotizing sialometaplasia. Laryngol Rhinol 58:70–76
Donath K, Dietrich H, Seifert G (1979) Entwicklung und ultrastrukturelle Cytodifferenzierung der Parotis des Menschen. Virchows Arch A Path Anat and Histol 378:297–314
Eneroth C-M (1964) Histological and clinical aspects of parotid tumours. Acta Oto-Laryngol Suppl 191
Evans RW, Cruickshank AH (1970) Epithelial tumours of the salivary glands. Philadelphia-London-Toronto: Saunders
Fahmy S (1973) Adenolymphoma of the tonsillar fossa. J Laryngol 87:675–679
Fleischer I, Caselitz J, Löning Th, Seifert G (1980) Histological and immunocytochemical examinations of the stromal reaction in carcinomas of the parotid gland. — Analysis of 52 cases. Cancer Res Clin Oncol 96:193–209
Gadient StE, Kalfayan B (1975) Mucoepidermoid carcinoma arising within a Warthin's tumor. Oral Surg 40:391–398
Gumberz Ch v (1980) Über das Vorkommen Immunglobulin-produzierender Plasmazellen bei chronischer Parotitis, malignen Lymphomen und Cystadenolymphomen der Parotis. Diss Hamburg
Hurlimann J (1971) Immunoglobulin synthesis and transport by human salivary glands. Curr Top Pathol 55:69–108
Iannaccone Ph (1975) Multiple primary tumors. Four distinct head and neck tumors. Arch Pathol (Chicago) 99:270–272
Jensen PSt, Husted E (1970) Cystadenolymphoma (Warthin's Tumor) of the parotid gland. Scand J Plast Reconstr Surg 4:114–121
Kavka SJ (1970) Bilateral simultaneous Warthin's tumors. Arch Otolaryngol 91:302–303
Kessler E, Koznizky IL, Schindel J (1977) Malignant Warthin's tumor. Oral Surg 43:111–115
Kleinsasser O (1964) Über das Sebaceolymphom der Parotis. Monatsschr Ohrenheilk 98:318–325
Kleinsasser O, Klein HJ, Steinbach E, Hübner G (1966) Onkozytäre adenomartige Hyperplasien, Adenolymphome und Onkozytome der Speicheldrüsen. Arch klin exp Ohr-, Nas-Kehlk-Heilk 186:317–336
Korsrud FR, Brandtzaeg P (1979) Immunohistochemical studies on the epithelial and lymphoid components of Warthin's tumour. Acta Otolaryngol Suppl 360:221–224
Kurreja HK, Jain HK (1971) Adenolymphoma of submandibular salivary gland. J Laryng 85:1201–1203
Lederman M (1943) Adenolymphoma of the parotid salivary gland. Br J Radiol 16:383–385
Lindberg LG, Akerman M (1976) Aspiration cytology of salivary gland tumors: Diagnostic experience from six years of routine laboratory work. Laryngoscope 86:584–594
Little JW, Rickles NH (1965) Malignant papillary cystadenoma lymphomatosum. Report of a case, with a review of the literature. Cancer (Philad) 18:851–856
Lumerman H, Freedman P, Caracciolo P, Remigio PS (1975) Synchronous malignant mucoepidermoid tumor of the parotid gland and Warthin's tumor in adjacent lymph node. Oral Surg 39:953–958
Matteson StR, Cutler LS, Herman PA (1976) Warthin's tumor. Report of a case and survey of 205 salivary neoplasms. Oral Surg 41:129–134
Pape H-D (1963) Das papilläre Zystenadenolymphom. Ein Bericht über 20 Fälle. Stoma (Heidelberg) 15:189–207
Patey DH, Thackray AC (1970) Infected adenolymphoma: a new parotid syndrome. Br J Surg 57:569–572
Pava S de la, Knutson GH, Mukhtar F, Pickren JW (1965) Squamous cell carcinoma arising in Warthin's tumor of the parotid gland. First case report. Cancer (Philad) 18:790–794
Richardson GS, Clairmont AA, Erickson ER (1978) Cystic lesions of the parotid gland. Plast Reconstr Surg 61:364–370
Ruebner B, Bramhall JL (1960) Malignant papillary cystadenoma lymphomatosum. Arch Path (Chicago) 69:110–117
Schmid KO, Albrich W (1973) Die Bedeutung von Talgzellen und Talgdrüsen für Parotisgeschwülste. Virchows Arch Arch Abt A Path Anat 359:239–253
Schmincke A (1921) Über lymphoepitheliale Geschwülste. Beitr path Anat 68:161–170
Seifert G (1964) Die Sekretionsstörungen (Dyschylien) der Speicheldrüsen. Ergeb Pathol 44:103–188
Seifert G (1966) Mundhöhle, Mundspeicheldrüsen, Tonsillen und Rachen. In Doerr W. Uehlinger E (eds) Spezielle pathologische Anatomie, vol 1. Berlin-Heidelberg-New York: Springer
Seifert G (1979) Wangenschwellungen bei Speicheldrüsenentzündungen. Pathologisch-anatomische Differentialdiagnose der Sialadenitis. HNO (Berlin) 27:119–128
Seifert G (1980) Lymphoid lesions of the oral cavity. Path Res Pract 167:179–203
Seifert G, Donath K (1976a) Die Morphologie der Speicheldrüsenerkrankungen. Arch Oto-Rhino-Laryngol 213:111–208
Seifert G, Donath K (1976b) Classification of the pathohistology of diseases of the salivary glands. Review of 2,600 cases in the salivary glands register. Beitr Pathol 159:1–32
Seifert G, Geier W (1971) Zur Pathologie der Strahlen-Sialadenitis. Z Laryngol Rhinol 50:376–388
Seifert G, Heckmayr M, Donath K (1977) Carcinome in papillären Cystadenolymphomen der Parotis. Definition und Differentialdiagnose. Z Krebsforsch 90:25–36
Seifert G, Schulz C-P (1979) Das monomorphe Speichelgangadenom. Klassifikation und Analyse von 79 Fällen. Virchows Arch A Path Anat and Histol 383:77–99
Skorpil F (1939) Über die Lymphoepitheliome (Schmincke) der Speicheldrüsen. Frankf Z Pathol 53:450–466
Smith JF, Fesmire FM (1969) The benign papillary cystadenoma lymphomatosum. Oral Surg 27:95–102
Taylor CR, Burns J (1974) The demonstration of plasma cells and other immunoglobulin-containing cells in formalin-fixed, paraffin-embedded tissues using peroxidase-labelled antibody. J Clin Pathol 27:14–20
Thackray AC, Lucas RB (1974) Tumors of the major salivary glands. Atlas of tumor pathology, second series, fasc 10. Washington: Armed Forces Institute of Pathology
Thackray AC, Sobin LH (1972) Histological typing of salivary gland tumors. Geneva: World Health Organization
Tschen JA, McGavran MH (1979) Sebaceous lymphadenoma. — Ultrastructural observations and lipid analysis. Cancer 44:1388–1392
Zajicek J, Eneroth CM, Jakobsson P (1976) Aspiration biopsy of salivary gland tumors. VI. Morphologic studies on smears and histologic sections from mucoepidermoid carcinoma. Acta Cytologica 20:35–41
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Dedicated to Prof. Dr. W. Sandritter, Freiburg/Br., on the occasion of his 60th birthday
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Seifert, G., Bull, H.G. & Donath, K. Histologic subclassification of the cystadenolymphoma of the parotid gland. Virchows Arch. A Path. Anat. and Histol. 388, 13–38 (1980). https://doi.org/10.1007/BF00430674
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DOI: https://doi.org/10.1007/BF00430674