Warthin-like papillary carcinoma of the thyroid.
ABSTRACT Warthin-like papillary carcinoma of thyroid is characterized by distinct papillary formations lined by tumor cells with oncocytic cytoplasm, nuclear features of papillary carcinoma, and brisk lymphoplasmacytic infiltrates in the papillary stalks. This tumor derives its name from its close resemblance to Warthin tumor of major salivary glands.
The clinicopathologic features of 17 patients with Warthin-like papillary carcinoma were studied.
Fifteen tumors occurred in women and 2 arose in men (age range, 23-63 years). The lesions ranged in size from 3 mm to 2.5 cm. Fine-needle aspiration biopsies were performed in 7 cases; 4 were diagnosed as papillary carcinoma, 2 as consistent with lymphocytic thyroiditis, and 1 as atypical cells. All 17 tumors were confined to the thyroid; 6 showed prominent cyst formation and the remaining tumors were solid. In each case, the tumor arose in a background of lymphocytic thyroiditis. Nodal metastases were identified in 3 cases; however, none showed distant metastases. In 7 cases, foci of papillary microcarcinoma and follicular variant of papillary carcinoma were found in other areas of the thyroid.
Warthin-like tumors can be mistaken for benign lymphoepithelial lesions of the thyroid, Hürthle cell carcinoma, and tall cell variant of papillary carcinoma in both fine-needle aspiration and histology specimens. Follow-up information on the previously reported cases has suggested that these tumors behave similarly to usual papillary carcinoma. The extensive lymphocytic infiltration in these tumors and their association with chronic lymphocytic thyroiditis may suggest a role for immunological mechanisms in the pathogenesis of thyroid tumors.
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ABSTRACT: Aim-Background With less than 100 cases reported in the English literature to date, Warthin-like tumour papillary thyroid carcinoma is a relatively uncommon variant of papillary thyroid carcinoma (PTC). This term was first coined on the basis of its close morphological resemblance to the Warthin tumour that characteristically occurs in the salivary glands.We present a case of this uncommon variety of PTC, and through a brief literature review we describe the diagnostic challenges presented in distinguishing between several varieties of PTC and benign lesions to provide optimal treatment. Case Report A 48-year-old woman was referred to our department for surgical treatment of an enlarged goitre that had presented over the last year. Dominant nodule FNA revealed suspicion of a follicular neoplasm, and she was submitted to total thyroidectomy. Results Histopathology showed multifocal PTC on chronic lymphocytic thyroiditis ground. Left lobe foci of 0.3 cm follicular variant of PTC, 0.6 cm isthmus foci of Warthin-like tumour PTC and 1.5 cm of conventional PTC with extrathyroidal extension were reported. Conclusion/Discussion Previous studies showed prognosis to be similar to that for conventional PTC. Distinction between Hurthle cell tumours, tall cell and oncocytic variants of PTC or medullary carcinoma, or even lymphocytic thyroiditis and this entity, is intriguing and poses diagnostic difficulties. Data from new studies will reveal more on this uncommon tumour.Hellēnikē cheirourgikē. Acta chirurgica Hellenica 05/2013; Volume 85(Issue 3):pp 197-201. DOI:10.1007/s13126-013-0037-1
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ABSTRACT: Correct diagnosis of the variants of papillary thyroid carcinoma (PTC) is important because these variants differ in clinical course. The Warthin-like variant (WLV) is relatively uncommon and is recognized as not different from conventional PTC. We therefore assessed the clinicopathological features of patients with WLV of PTC who were diagnosed and treated at our institution.ANZ Journal of Surgery 07/2014; DOI:10.1111/ans.12725 · 1.50 Impact Factor
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ABSTRACT: Hashimoto's thyroiditis (HT), part of the spectrum of autoimmune thyroid diseases is a major cause of thyroid hypofunction worldwide. Papillary thyroid carcinoma (PTC), the most prevalent of all thyroid carcinomas has been associated with HT. Literature on this association are based on preoperative FNA or post thyroidectomy histopathology reports, which are subject to potential biases. Molecular, hormonal and histopathalogical basis of this association has been hypothesized, however a definite causal association has not been proved till date. This review aims to study the basis of this association and clinical features and management of HT concurrent with PTC. There are no distinctive clinical or radiological features that categorically differentiates HT concurrent with PTC from PTC or which can pick up a nodule harboring PTC in setting of HT. Smaller nodule size and radiological features like hypoechogenecity; hyper vascularity and calcification in a clinical setting of hypothyroidism have a higher odds ratio for malignancy and merit further investigations. PTC associated with HT has been seen to be less aggressive with earlier presentation with lesser chances of extra thyroidal extension and lymph nodal metastasis. The management and follow up of PTC in HT is no different from that of PTC alone. The prognosis of PTC concurrent with HT is better compared to age and stage matched PTC in terms of lower recurrence and disease free and overall survival.09/2014; 5(3):199-204. DOI:10.1007/s13193-014-0325-4