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JPTM > Ahead-of Print

doi: https://doi.org/10.4132/jptm.2017.12.26    [Epub ahead of print]
Preoperative Cytologic Diagnosis of Warthin-like Tumor Variant of Papillary Thyroid Carcinoma
Jisup Kim, Beom Jin Lim, Soon Won Hong, Ju Yeon Pyo
Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Corresponding Author: Ju Yeon Pyo ,Tel: +82-2-2019-3540, Fax: +82-2-3463-2103, Email: jypyo@yuhs.ac
Received: October 26, 2017;  Revised: December 15, 2017  Accepted: December 26, 2017.  Published online: February 12, 2018.

Warthin-like variant of papillary thyroid carcinoma (WLV-PTC) is a relatively rare variant of papillary thyroid carcinoma with favorable prognosis. However, preoperative diagnosis using fine-needle aspiration (FNA) specimens is challenging especially with lymphocytic thyroiditis characterized by Hürthle cells and lymphocytic background. To determine a helpful cytological differential point, we compared WLV-PTC FNA findings with conventional papillary thyroid carcinoma with lymphocytic thyroiditis (PTC-LT) and conventional papillary thyroid carcinoma without lymphocytic thyroiditis (PTC) regarding infiltrating inflammatory cells and their distribution. Preoperative diagnosis or potential for WLV-PTC will be helpful for surgeons to decide the scope of operation.
Of the 8,179 patients treated for papillary thyroid carcinoma between January 2007 and December 2012, 16 patients (0.2%) were pathologically confirmed as WLV-PTC and four cases were available for cytologic review. For comparison, we randomly selected six PTC-LT cases and five PTC cases during the same period. The number of intratumoral and background lymphocytes, histiocytes, neutrophils, and the presence of giant cells were evaluated and compared using conventional smear and Thin-prep preparations.
WLV-PTC showed extensive lymphocytic smear with incorporation of thyroid follicular tumor cell clusters and frequent histiocytes. WLV-PTC was associated with higher intratumoral and background lymphocytes and histiocytes compared with PTC-LT or PTC. The difference was more distinct in liquid-based cytology.
The lymphocytic smear pattern and the number of inflammatory cells of WLV-PTC are different from those of PTC-LT or PTC and will be helpful for the differential diagnosis of WLV-PTC in preoperative FNA.
Key Words: Warthin-like variant; Thyroid cancer, papillary; Hashimoto disease; Biopsy, fine-needle