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The second most common tumor of the parotid

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gland is the Warthin's Tumor.

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This is a tumor that also has the

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name cystadenoma lymphomatosum.

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And it should bear in mind that there are portions of the

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tumor which may be cystic as in the cystadenoma portion.

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And then the Lymphomatosum is the Lymphoid tissue.

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That can be apparent in Warthin's Tumor as one would

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expect with that kind of wide variety of cystic portion,

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adenomatous portion and lymphomatosum portion.

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The T2 signal intensity is typically quite variable

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while Peter Sam says that most of these are bright in

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signal intensity and Thomas Vogel says that they're

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predominantly low in signal intensity.

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My experience has been that these are usually mixed tumors.

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You see areas that are bright,

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areas that are dark within the same tumor.

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Remember that Warthin's tumor is the tumor that

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is the most common multiple tumor primary.

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Tumor in the parotid gland and 30% may be bilateral.

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For whatever reason,

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this tumor tends to favor the tail of the parotid

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gland down by the angle of the mandible.

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This tumor also, as opposed to the pleomorphic adenoma,

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which we say occurs in young women 30 to 50 years of age,

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the Warthin's tumor tends to occur

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in men over 60 years of age.

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So here are patients with

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Warthin's tumors, so-called cystadenoma lymphomatosum.

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And what you see is a patient who has bilateral

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lesions in the parotid gland.

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So here is tumor number one here.

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It looks like tumor number two.

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Maybe tumor number three here.

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So multiple lesions bilaterally in the parotid gland.

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This one's very bright on T2-weighted scan.

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This one is dark but also.

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So has cystic areas and therefore is sort of a mixed

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signal intensity on T2-weighted imaging.

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This appearance on the T2-weighted scan

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to me, is very characteristic of a Warthin's tumor.

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On the T1-weighted scan, again,

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you notice that there's some areas that

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are a little bit brighter than others.

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That is pretty typical of a Warthin's tumor.

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Here on the image to the right,

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you see a different patient who has, again,

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bilateral parotid masses. Well,

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once you have bilateral parotid masses,

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usually you're thinking about either Warthin's tumor or

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you're thinking about a patient who has lymph nodes,

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multiple lymph nodes in the parotid

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gland that may be enlarged.

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You note that this is down by the angle of the mandible.

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This is a little bit higher,

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but bilateral lesions in the parotid gland.

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We're going with Warthin's tumor.

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As I mentioned previously, the ADC values.

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Of Warthin's tumor tend to overlap the ADC values of

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malignancies and therefore we are not as reliant

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on DWI for the diagnosis of Warthin's tumor.

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A few other examples of patients with Warthin's tumor to me,

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the characteristic feature is the heterogeneity of the

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signal intensity on T2-weighted image and often

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T1-weighted imaging in these lesions.

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Now I showed you several pleomorphic adenomas

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that had some heterogeneity to it,

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but not this darker area admixed with brighter area the

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way you have on the parotid Warthin's

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tumors here's another one

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in the inferior aspect and it too has some

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the to it even on the T1-weighted scan.

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You see a somewhat bright area here,

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darker area here and brighter area or intermediate

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signal intensity there. We also note that this.

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Way far down in the parotid gland,

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down by the submandibular gland.

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So, angle of the mandible,

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tail of the parotid gland, multiple lesions,

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heterogeneous mixed signal intensity.

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And the differential diagnosis, as I mentioned,

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is in this example.

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Here we have a patient who has multiple lesions.

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They are relatively homogeneous.

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These are lymph nodes within the parotid gland.