Which imaging features help distinguish Warthin tumor from pleomorphic adenoma of the parotid?

Which imaging features help distinguish Warthin tumor from pleomorphic adenoma of the parotid?
OpenRadiology

Question mentions: Warthin tumor, pleomorphic adenoma.

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Pleomorphic adenoma (PA) more often has a T2-dominantly hyperintense pattern with internal signal hypointensity, whereas Warthin tumor (WT) more often has the reverse pattern—T2-dominantly hypointense with hyperintense components; these patterns are suggestive, not definitive, as 28% of WTs in one 60-tumor study were misdiagnosed as PA.1

Diffusion may help: that study reported mean ADC values of 1.9 ± 0.3 × 10⁻³ mm²/s for PA and a median of 1 (range 0.9–1.8) × 10⁻³ mm²/s for WT. PA ADC varies with cellularity and stromal composition; cellular PA can have intermediate values, while typical myxochondroid-rich PA has higher ADC.1 2

Cystic change is more commonly seen in WT but is not specific, as it can also occur in PA. WT is described as having cystic and lymphoid structures, often with relatively uniform high T2 signal; PA more often has heterogeneous internal architecture. WT is also associated with older male patients, smoking, and multifocality or bilaterality.2 3

Parotid Pleomorphic AdenomaPublished cases by modality

Warthin TumorPublished cases by modality

References

  1. 1.

    Paz-Expósito J, Monsalve-Guil L, Egido-Moreno S, Jiménez-Guerra Á, López-López J, Velasco-Ortega E, Ortiz-Garcia I.. Importance of magnetic resonance in the diagnosis of pleomorphic parotid adenoma. Clinical case series. Medicina oral, patologia oral y cirugia bucal. 2026. doi:10.4317/medoral.27991 PMC13312327 · CC BY 2.5 · License

  2. 2.

    Wong AS, Phal PM, Thong M, McKenzie DP, Dixon BJ.. Parotid pleomorphic adenoma: can a biopsy be omitted in the setting of a characteristic MRI?. Oral radiology. 2026. doi:10.1007/s11282-026-00942-6 PMC13619716 · CC BY 4.0 · License

  3. 3.

    Suzuki K, Kikuta S, Yabe K, Nomura Y, Oshima T.. Synchronous Pleomorphic Adenoma and Warthin Tumor in the Parotid Gland: MRI Findings of Structural Compartmentalization and Quantitative T2 Signal Differences. Cureus. 2026. doi:10.7759/cureus.106632 PMC13153998 · CC BY 4.0 · License

  4. 4.

    Johnson JM, Mohamed ASR, Ding Y, et al. Ultra‐small superparamagnetic iron oxide (USPIO) magnetic resonance imaging in benign mixed tumor of the parotid gland. Clin Case Rep. 2020;9(1):123–7. doi:10.1002/ccr3.3477 PMC7813040 · CC BY 4.0 · Image source

  5. 5.

    Kikuchi M, Koyasu S, Shinohara S, Imai Y, Hino M, Naito Y. Preoperative Diagnostic Strategy for Parotid Gland Tumors Using Diffusion-Weighted MRI and Technetium-99m Pertechnetate Scintigraphy: A Prospective Study. PLoS One. 2016;11(2):e0148973. doi:10.1371/journal.pone.0148973 PMC4744013 · CC BY 4.0 · Image source

  6. 6.

    Kato H, Seko T, Shibata H, et al. MRI and CT features of head and neck myoepithelioma: comparison with parotid pleomorphic adenoma. Jpn J Radiol. 2025;44(1):55–65. doi:10.1007/s11604-025-01867-6 PMC12769523 · CC BY 4.0 · Image source

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