Oncocytic papillary carcinoma with lymphoid stroma (Warthin-like tumour) of the thyroid: a distinct entity with favourable prognosis
Aims: We report the clinicopathological and immunohistochemical characteristics of 12 cases of a recently recognized entity, oncocytic papillary thyroid carcinoma (PC) with lymphoid stroma (Warthin-like tumour).
Methods and results: The cases were retrieved from the surgical pathology files of our departments. There were 11 female patients and one male patient; they ranged in age from 45 to 85 years (mean 64.2 years). The immunohistochemical profile demonstrated positivity of tumour cells for cytokeratins, thyroglobulin, Leu-M1 and anti-mitochondrial antigen. S100 protein-positive stromal dendritic/Langerhans cells were uniformly present. Polymerase chain reaction, in situ hybridization, and immunohistochemistry for Epstein–Barr virus (EBV) detection revealed no significant positive signal. MIB-1 labelling index was low, compatible with that of ‘classical’ PC.
Conclusions: Warthin-like tumour is a rare variant of PC, occurring predominantly in elderly women. Its histological features are distinct and well recognizable, differentiating this tumour from a more aggressive tall-cell variant of PC. The apparent indolent behaviour seems to be consistent with the presence of dendritic/Langerhans cells and with low proliferative activity. A possible role of EBV in pathogenesis of this lesion was not proven. Further studies are necessary to determine the prognosis and metastatic potential of this neoplasm.
"Oncocytic variant accounted for 2% of PTC and most of them were diagnosed as having Warthin-like tumor showing abundant chronic inflammatory cells that are associated with chronic thyroiditis. Previous studies showed that this variant generally had a mild character [74–76], which was identical to our findings, because none of the patients with this oncocytic variant died of carcinoma in our study . "
[Show abstract][Hide abstract] ABSTRACT: There are some important prognostic factors for papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). In this paper, clinicopathological features significantly affecting patient prognosis are described based on our data as well as others. Distant metastasis at diagnosis is the most important prognostic factor for both PTC and FTC. Other than that, preoperative and intraoperative findings are important to evaluate the biological behavior of PTC. Extrathyroid extension, large lymph-node metastasis, and extranodal tumor extension that can be evaluated preoperatively or intraoperatively are significant prognostic factors for PTC patients. In contrast, pathological findings are important not only for diagnosis of FTC, but also for the evaluation of its biological character. Grade of invasiveness (minimally or widely invasive) and degree of differentiation (well differentiated or including a poorly differentiated component) greatly affect the prognosis of FTC patients.
Journal of Thyroid Research 01/2012; 2012(5):973497. DOI:10.1155/2012/973497
"Molecular biology studies have shown that Warthin tumor-like PTC and conventional PTC share the same BRAF and RET mutations, supporting that the former is a morphological variant of the latter . However, whether Warthin tumor-like PTC should be considered a distinct clinico-pathologic entity with a favourable prognosis is still matter of debate     , because some authors have reported that about 30% of cases exhibit a tendency to lymph nodal metastases and extrathyroidal extension   . The possibility of PTC to undergo dedifferentiation is a rare but well-known event which has "
[Show abstract][Hide abstract] ABSTRACT: Warthin tumor-like papillary thyroid carcinoma is an uncommon variant of papillary thyroid carcinoma. We report a rare case of Warthin tumor-like variant of papillary thyroid carcinoma with a dedifferentiated component consisting of a solid tumor area composed of neoplastic cells with a spindle to tall cell morphology associated with marked nuclear pleomorphism, atypical mitoses, and foci of necrosis. Although our patient presented with a locally aggressive disease (T3 N1b Mo), she is disease-free without radioiodine therapy after a 23-month follow-up period. We emphasize that Warthin tumor-like papillary thyroid carcinoma, like other morphological variants of papillary carcinoma, may occasionally undergo dedifferentiation. As this component may be only focally detectable, we suggest an extensive sampling of all large-sized (>3 cm) papillary thyroid carcinoma. Recognition of any dedifferentiated component in a Warthin tumor-like papillary thyroid carcinoma should be reported, including its percentage, because it may reflect a more aggressive clinical course.
Case Reports in Medicine 06/2010; 2010(7):495281. DOI:10.1155/2010/495281
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