Vascular morphogenesis in Warthin’s tumor and insights into its origin

Abstract

Although the morphological aspect of Warthin's tumor (WT) is known since 1895, its pathogenesis is still unclear. Because neovascularization in a tumor is considered the main mechanism for its development, in this study we analyzed the immunoexpression of CD31, D2-40 and vascular endothelial growth factor (VEGF) antibodies in 10 cases of WT. We found a significantly elevated vascular density (p=0.000) in all the 10 WT as compared to the surrounding normal parotid gland and VEGF expression in the oncocytic epithelial component of WTs (9/10 cases). Our results highlight the importance of studying the vascularization in WTs, the role of the epithelial component in the tumorigenesis of WTs and support the hypothesis that these tumors develop in lymph nodes, on heterotopic salivary gland tissue. To the best of our knowledge, our study is the first study to analyze and correlate the immunoexpression of the three specific vascular and angiogenic markers on a series of WT cases and with results that underline the similar morphological aspects between the histopathological characteristics of WTs and the changes that appear in the context of a neoplastic process in lymph nodes.