Warthin's tumor with multiple granulomas: a clinicopathologic study of six cases

Granulomatous inflammation occurring in Warthin's tumor is a rare phenomenon. It has been suggested that prior fine-needle aspiration (FNA) might be a triggering factor. We studied cases of Warthin's tumor with granulomatous inflammation to analyze the possible relationship with prior FNA. Granulomatous inflammation was noted in 6 cases (1.6%) of 382 cases of Warthin's tumor in a medical center. Clinical history, histology, and cytology slides were reviewed. Special stains for detection of infective agents were performed. All 6 cases showed typical features of Warthin's tumor accompanied by multiple granulomas. No specific microbiologic infective agents were revealed in these cases. There were 2 cases with history of preoperative FNA; both already had granulomas in Warthin's tumor in cytologic specimens taken by aspiration. The pathogenesis of granulomatous inflammation in Warthin's tumor remains speculative. Our observation of granulomas in the cytology specimens did not support the hypothesis of prior FNA being the cause.