New insights into the nature of Warthin’s tumour

Abstract

Warthin's tumour is considered heterogeneous as to its pathogenesis with some data supporting a polyclonal origin for the epithelium, implying a non-neoplastic nature. After inconsistent reports, current information from molecular studies suggests that a recurrent t(11;19) and associated CRTC1-MAML2 fusion oncogene characterizes a subset of Warthin's tumours and supports a clonal origin in such cases. CRTC1-MAML2 is also a frequent feature of mucoepidermoid carcinoma. These findings, and the recent reports of Warthin's tumour and co-existent mucoepidermoid carcinoma with common CRTC1-MAML2 expression, provide a morphological and molecular framework for future studies as a basis for a fresh appraisal of the pathogenesis of Warthin's tumour. The underlying molecular basis and the pivotal studies defining such events are discussed.

Birt-Hogg-Dube syndrome presenting as multiple oncocytic parotid tumors

“…Molecular studies of Warthin tumors of the salivary glands indicate a recurrent t(11;19) translocation with associated CRTC1-MAML2 fusion oncogene in a subset of Warthin tumors [10]. We were not able to study this biopsy for this finding.…”

Increased phosphatidylcholine (16:0/16:0) in the folliculus lymphaticus of Warthin tumor

“…The tumor characteristics of War-T have been investigated in many studies. Although it has a polyclone origin, War-T is considered a neoplasm [7]. …”

Warthin's tumor of the larynx: A very rare case and systematic review of the literature

“…While some authors have classically considered CAL to be more similar to a reactive process than to a true neoplasia, the views on pathogenesis have evolved over the last decades. Current techniques show that the epithelial portion of a substantial subset of CALs is monoclonal and frequently harbors a translocation between chromosomes 11 and 19 t (11;19), which in turn results in the fusion oncogene CRTC1-MAML2 [CREB(cAMP response element-binding protein)-regulated transcription co-activator 1–mastermind-like protein 2], which is a master key involved in several signaling pathways that contribute to cell survival and proliferation, primarily the Notch pathway [15]. Van der Wal et al underlined the fact that laryngeal CALs are indeed rare tumors and pathologic diagnosis can be challenging, especially when it comes to distinguishing CAL from oncocytic hyperplasia or metaplasia, pointing out that the only basic difference between these entities is the lack of lymphoid stroma in oncocytic lesions [11].…”