Journal of Pathology and Translational Medicine

Original Articles

Preoperative Cytologic Diagnosis of Warthin-like Variant of Papillary Thyroid Carcinoma: Jisup Kim, Beom Jin Lim, Soon Won Hong, Ju Yeon Pyo; J Pathol Transl Med. 2018;52(2):105-109. Published online February 12, 2018; DOI: https://doi.org/10.4132/jptm.2017.12.26

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Background
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.
Methods
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 ThinPrep preparations.
Results
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.
Conclusions
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.

Citations

Citations to this article as recorded by

An Algorithmic Approach to Defining Variants of Papillary Thyroid Carcinoma: Accuracy of Fine Needle Aspiration Cytology
Neha Nigam, Neha Kumari, Rishabh Sahai, Nandita Chaudhary, Sabaretnam Mayilvaganan, Pallavi Prasad, Prabhakar Mishra
Journal of Cytology.2025; 42(1): 27. CrossRef
Warthin-like variant of papillary thyroid carcinoma with lymph node metastases: a case report and review of the literature
Andrii Hryshchyshyn, Andrii Bahrii, Pavlina Botsun, Volodymyr Chuba
Journal of Medical Case Reports.2024;[Epub] CrossRef
Cytologic hallmarks and differential diagnosis of papillary thyroid carcinoma subtypes
Agnes Stephanie Harahap, Chan Kwon Jung
Journal of Pathology and Translational Medicine.2024; 58(6): 265. CrossRef
Warthin-like papillary thyroid carcinoma: a case report and comprehensive review of the literature
Abdel Mouhaymen Missaoui, Fatma Hamza, Wafa Belabed, Manel Mellouli, Mohamed Maaloul, Slim Charfi, Issam Jardak, Tahya Sellami-Boudawara, Nabila Rekik, Mohamed Abid
Frontiers in Endocrinology.2023;[Epub] CrossRef
The Warthin-like variant of papillary thyroid carcinomas: a clinicopathologic analysis report of two cases
Xing Zhao, Yijia Zhang, Pengyu Hao, Mingzhen Zhao, Xingbin Shen
Oncologie.2023; 25(5): 581. CrossRef
Challenges in Cytology Specimens With Hürthle Cells
Eleni Thodou, Sule Canberk, Fernando Schmitt
Frontiers in Endocrinology.2021;[Epub] CrossRef
Warthin-like variant of Papillary thyroid carcinoma—Case report of an uncommon tumour with review of literature
Pradyumna Kumar Sahoo, Rashmi Patnayak, Perwez Alam Khan, Amitabh Jena
International Journal of Surgery Case Reports.2020; 77: 9. CrossRef

Lymphocyte Rich Papillary Oxyphilic Carcinoma of Thyroid.: Soon Ran Kim, Jin Hee Sohn; Korean J Cytopathol. 1997;8(2):150-154.

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Abstract PDF: Lymphoid infiltration can be seen in some lesions such as Hashimoto's thyroiditis, subacute thyroiditis and several neoplasm of the thyroid. In case of malignancy, there are a few reports of lymphoid infiltration in the diffuse sclerosing variant of papillary carcinoma. But heavy lymphoid infiltraton without evidence of sclerosis is uncommon. We experienced a case of papillary oxyphilic carcinoma with massive lymphoid infiltration, which looks like Warthin tumor of salivary gland. However cytological feature of epithelial cells exhibit that of papillary carcinoma.

Case Reports

Fine Needle Aspiration Cytology of the Warthin's Tumor Misinterpretated as Squamous Cell Carcinoma: A Case Report.: Kyungji Lee, Chan Kwon Jung, Ahwon Lee, Kyo Young Lee, Chang Suk Kang; Korean J Cytopathol. 2005;16(2):106-109.

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Abstract PDF: We report a case of Warthin's tumor of the parotid gland in a 53?year?old man, which is incorrectly diagnosed as squamous cell carcinoma. Fine needle aspiration cytology(FNAC) smear obtained from the right parotid gland revealed scattered epithelial cell clusters or nests in a diffuse inflammatory and necrotic background. Some epithelial cells had squamoid appearance showing variable sized bizarre shaped nuclei. They had abundant of dense eosinophilic keratinized cytoplasm. Occasionally, parakeratotic cells were also present. These cytologic findings with significant atypia and necrotic background made diagnosis as squamous cell carcinoma. But, the resection specimen from this patient showed classic Warthin's tumor in addition to abundant areas of inflammation and squamous metaplasia. Metaplastic or infarcted Warthin's tumor in the salivary gland may be confused with false positive diagnosis of malignancy on FNAC. Therefore, cytopathologist should have adequate awareness of potential of erroneous diagnosis in FNAC of Warthin's tumor.

Warthin-like Tumor Variant of Papillary Thyroid Carcinoma: A Case Report.: Sun Hee Chang, Chang Sig Choi, Yoon Suk Kim; Korean J Pathol. 2004;38(3):200-203.

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Abstract PDF: An unusual oncocytic papillary thyroid carcinoma with abundant lymphoid stroma bearing a resemblance to Warthin? tumor of salivary gland is described. We report a rare case of a Warthin-like tumor variant of papillary thyroid carcinoma in a 41-year-old-woman. Histologically, the tumor was characterized by oncocytic follicular cells showing nuclear features reminiscent of papillary carcinoma and lymphoid rich stroma. The surrounding non-neoplastic thyroid parenchyma showed focal peritumoral lymphocytic thyroiditis.

Scleroma of the Larynx: A Case Report.: Hun Soo Kim, Seok Won Park, Jin Man Kim; Korean J Pathol. 2003;37(4):287-290.

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Abstract PDF: Scleroma of the larynx is a rare specific granulomatous disease and is usually presented as alaryngeal extension of a primary rhinoscleroma. We report an unusual case of laryngeal scleromain a 64-year-old female patient whose presented with progressive upper respiratory obstructivesymptoms lasted for 2 years. Symptoms were acutely exaggerated during the course of one month.On physical examination, the nasal mucosa was atrophic and crusted, and septal perforationwas noted. The fiberoptic laryngoscopy revealed a yellowish granulated epiglottic mass with adirty surface mimicking laryngeal cancer. Histological sectioning showed the characteristic featuresof scleroma including Mikulicz cells with scattered plasma cells and some neutrophils.Warthin-starry stains and electron microscopy examination showed numerous short rods insidethe cytoplasm of the Mikulicz cells. After the diagnosis, the patient underwent an emergency tracheostomyfollowed by long-term antibiotic treatment, and her symptoms have slowly improved.

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