# Corpora Amylacea in Warthin's Tumor: A Rare Histopathological Finding

Ajay Kumar Verma, Anjali Narwal, Mala Kamboj, Anju Devi, Gopikrishnan

Vijayakumar

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Ajay Kumar Verma, Anjali Narwal, Mala Kamboj, Anju Devi, Gopikrishnan Vijayakumar. Corpora Amylacea in Warthin's Tumor: A Rare Histopathological Finding. Asian journal of case reports in surgery, 2025, 8 (1), pp.142-146. 10.9734/ajcrs/2025/v8i1613. hal-05003779

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# Corpora Amylacea in Warthin's Tumor: A Rare Histopathological Finding

Ajay Kumar Verma a++*, Anjali Narwal a#, Mala Kamboj a†, Anju Devi a# and Gopikrishnan Vijayakumar a‡

## Authors' contributions

This work was carried out in collaboration among all authors. All authors read and approved the final manuscript.

## Article Information

DOI: https://doi.org/10.9734/ajcrs/2025/v8i1613

### Open Peer Review History:

This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers, peer review comments, different versions of the manuscript, comments of the editors, etc are available here: https://pr.sdiarticle5.com/review-history/132824

Received: 18/01/2025

Accepted: 21/03/2025

Published: 24/03/2025

## Case Report

### ABSTRACT

This case report presents a rare instance of Warthin's tumor with presence of corpora amylacea. While Warthin's tumor is a common benign neoplasm of the parotid gland, the occurrence of corpora amylacea is exceedingly rare. Histopathologically it is characterized by presence of double layered oncocytic epithelium within a papillary and cystic pattern, surrounded by lymphocytic germinal centres. This report aims to shed light on the histopathological characteristics, potential etiologies, and clinical significance of corpora amylacea in Warthin's tumor.

<footnote>a Department of Oral Pathology, Pt. B. D Sharma University of Health Sciences, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India.</footnote>

<footnote>++ PG Student;</footnote>

<footnote># Professor MDS;</footnote>

<footnote>† Senior Professor & Head MDS;</footnote>

<footnote>‡ Senior Resident;</footnote>

<footnote>*Corresponding author: E-mail: Ajaykumarajju4@gmail.com;</footnote>
Keywords: Warthin's tumor; Papillary cystadenoma lymphomatosum; Corpora amylacea.

**1. INTRODUCTION**

Warthin's tumor was first reported by Hildebrand
in 1895 as a variant of lateral cervical cyst.
Albrechet and Artz, in 1910, termed this tumor as
papillary cystadenoma. In 1929, Aldred Scott
Warthin published two additional cases and
called it Papillary cystadenoma lymphomatosum
(PCL). The term 'Warthin's tumor' was first used
in 1944 by Martin and Ehrlich, and since then it
has been extensively used. However, its
alternative name, "Adenolymphoma" should not
be used as it's a misnomer because it
overemphasizes the lymphoid component and
could mistakenly suggest that lesion is a kind of
lymphoma (Ellis and Auclair, 1991, Neville et al.,
2002).

It presents usually as a slow growing, painless,
superficial firm mass, lying just beneath the
parotid capsule. Macroscopically, it is large,
encapsulated and well demarcated from the
surrounding tissue (Kobayashi et al., 2001).
Histopathologically, it is characterized by
presence of double layered oncocytic epithelium
with a papillary and cystic pattern (Limaiem et al.,
2023) The presence of round, acellular,
lamellated eosinophilic structures within cystic
spaces, called "Corpora Amylacea", is an
exceptionally rare finding (David and Buchner,
1978). These eosinophilic bodies
have several amyloid-like characteristics
histochemically and have been reported only in a
handful of cases in literature (David and
Buchner, 1978).

Allegra suggested that oxyphilic metaplasia of striated ducts followed by papillary projections with secretions leads to delayed hypersensitivity reaction & infiltration of lymphocytic stroma (Raghu et al., 2014). Another reason for delayed hypersensitivity reaction could be Epstein Barr Virus (EBV), which may infect ductal epithelium cells and release of EBV gene products may cause polyclonal B cell response (Raghu et al., 2014).

There has been an increased incidence of
Warthin's tumor by four to eight times in smokers
as compared to non-smokers. The
pathophysiology could be related to the fact that
a variety of chemical irritants of tobacco, like
benzopyrene, arsenic, N-nitrosoguanidine, etc.,
impact the aberrant salivary gland tissue of a
lymph node (Raghu et al., 2014).

**2. CASE PRESENTATION**

A 52-year-old male patient reported to OPD with the chief complaint of swelling over the right parotid region for the past 7 months (Chart 1). The swelling was insidious in onset and progressively increased in size. There was no history of pain, pus discharge, paraesthesia or halitosis during enlargement. The patient had been a chronic smoker for 32 years with a frequency of 6-8 bidis per day.

On extraoral examination, a single swelling of dimension 4.9×3.3 cm was palpated in the right preauricular area involving the submandibular lymph nodes. The swelling was painless, non-pulsatile and non-reducible. The right ear lobe was raised, lymph nodes were palpable and facial asymmetry was evident. Intraoral examination revealed no abnormalities, and mouth opening was adequate.

Hematological and biochemical findings were within normal limits. MRI of the neck revealed a large lobulated cystic lesion appearing hypotense on T1 and hypertense on T2 in the superficial lobe of the right parotid gland. Ultrasound of the neck revealed a mass of size 4×3×5.3 cm over the right parotid region.

**3. MACROSCOPIC FINDINGS**

The gross examination of the excised mass
revealed a creamish, brown colored, ovoid
shaped lesion measuring about 7×4×3.5 cm. The
cut section showed a large circumscribed,
encapsulated colloid mass, yellowish tan in color
with a soft consistency measuring about 4×3.5×3
cm (Fig. 2A). Another small encapsulated lesion
was present 3 cm away from the first lesion,
measuring about 2×1.5×1.5 cm.

<figure><img src="image_3.png" /><figcaption>**Fig. 1.** Clinical image demonstrating swelling of right parotid region</figcaption></figure>
Multiple sections from the specimen showed a well encapsulated tumor with varying proportion of papillary cystic architecture lined by bilayer oncocytic epithelium (Fig. 2C). The epithelial cells comprised of inner columnar and outer cuboidal cells with granular eosinophilic cytoplasm and round to oval nucleus (Fig. 3D). The intervening stroma within the papillary

structures showed dense lymphocytic infiltrate with germinal centre formation (Fig. 3E). The cystic spaces contained homogeneous eosinophilic material with few concentric lamellar condensed deposits resembling corpora amylacea (Fig. 3F). The surrounding glandular tissue appeared normal in morphology.

<figure><img src="image_4.png" /><figcaption>Fig. 2. A) Inked cut section of the gross specimen shows a large circumscribed encapsulated colloid mass, yellowish tan in colour and glistening with soft consistency measuring approximately 4×3.5×3 cm, B) Hand draw illustration of Warthin's tumor, C) Photo micrograph a panoramic view showing well encapsulated tumor with papillary architecture of tumor lined by bilayered oncocytic epithelial cells. The cystic spaces contain homogeneous eosinophilic material with stroma showing lymphocytic infiltrate. (H&E 40X)</figcaption></figure>

<figure><img src="image_5.png" /><figcaption>Fig. 3. D) Photo micrograph showing bilayered oncocytic epithelial cells lining the papillary structures. Stroma show lymphocytic infiltrates. (H&E 200X), E) Photo micrograph showing well encapsulated tumor with papillary architecture of tumor lined by bilayered oncocytic epithelial cells. The cystic spaces contain homogeneous eosinophilic material with stroma showing lymphocytic infiltrate. (H&E 40X), F) Photo micrograph showing homogeneous eosinophilic material with presence of concentric lamellar structures suggestive of corpora amylacea. (H&E 400X), G) Photo micrograph showing bilayered oncocytic epithelial cells lining the papillary structures. (PTAH 200X)</figcaption></figure>
## 4. DISCUSSION

Warthin's tumor accounts for approximately 5-10% of all salivary gland neoplasm and typically presents as a painless swelling (Salaria et al., 2019). Histopathologically, it consists of papillary cystic structures lined by inner columnar and outer cuboidal cells, with occasional foci of mucus-secreting, ciliated, and epithelial cells (Limaiem et al., 2023). Corpora amylacea are round, eosinophilic, laminated structures typically composed of glycoproteins and polysaccharides. They are commonly observed in aging tissues or degenerative diseases but are rare in Warthin's tumor (David and Buchner, 1978). Theories regarding their formation include degenerative processes, ductal obstruction, and secretory stasis (Kolary-Siekierska et al., 2024). Their presence in Warthin's tumor could be attributed to the cystic and oncocytic nature of the lesion, promoting secretory stasis. The clinical significance of corpora amylacea remains uncertain, but their identification is crucial to avoid misdiagnosis with amyloid or other calcified bodies.

Several studies have discussed corpora amylacea in various organs, but its occurrence in salivary gland neoplasms, particularly Warthin's tumor, remains rare (David and Buchner, 1978, Singh et al., 2013, Eveson and Cawson, 1986). This rarity contributes to diagnostic challenges. Additionally, its histochemical similarity to amyloid poses potential diagnostic pitfalls, necessitating awareness among pathologists. The review of literature also suggests a possible link between chronic inflammation and corpora amylacea formation, which could be relevant given the patient's history of chronic smoking (Kolary-Siekierska et al., 2024).

## 5. CONCLUSION

In summary, previous studies have reported the presence of round, laminated eosinophilic structures, known as corpora amylacea, in the cytology and biopsy specimens of Warthin's tumor—structures more commonly associated with the prostate (Fležar and Pogačnik, 2002). In the present case, these eosinophilic structures appear as concentric lamellar deposits, further emphasizing the tumor's diagnostic specificity.

## DISCLAIMER (ARTIFICIAL INTELLIGENCE)

Author(s) hereby declare that NO generative AI technologies such as Large Language Models

(ChatGPT, COPILOT, etc) and text-to-image generators have been used during writing or editing of this manuscript.

## CONSENT

As per international standards or university standards, patient(s) written consent has been collected and preserved by the author(s).

## ETHICAL APPROVAL

As per international standards or university standards written ethical approval has been collected and preserved by the author(s).

## COMPETING INTERESTS

Authors have declared that no competing interests exist.

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