Fine‑needle aspiration cytology of Warthin‑like mucoepidermoid carcinoma: A case report with cytological review

Noda, Yuri; Ishida, Mitsuaki; Okano, Kimiaki; Sandoh, Kaori; Ebisu, Yusuke; Miyasaka, Chika; Fujisawa, Takuo; Yagi, Minoru; Iwai, Hiroshi; Tsuta, Koji

doi:10.3892/mco.2021.2438

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…Nuclear atypia in MEC that resembles Warthin is modest. In the Warthin‐like MEC cases reported in the literature, no oncocytic cells are found 13 . Several cytologic features of our case report that can be helpful in the differential diagnosis are summarized in Table 1 which is adapted from the study of Klijanienko and Vielh 12 …”

Section: Discussionmentioning

confidence: 99%

“…In the Warthin-like MEC cases reported in the literature, no oncocytic cells are found. 13 Several cytologic features of our case report that can be helpful in the differential diagnosis are summarized in Table 1 which is adapted from the study of Klijanienko and Vielh. 12 Since the cytology of mammary analogue secretory carcinoma (MASC) shares many characteristics with ACC, it is particularly challenging to distinguish between zymogen granule-poor ACC and MASC without molecular analysis or immunohistochemical analysis.…”

Section: Although Serous Acinar Cell Differentiation Is What Defines ...mentioning

confidence: 99%

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Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine‐needle cytology

Yaprak Bayrak,

Ozturk

2023

Diagnostic Cytopathology

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The cytologic diagnosis of acinic cell carcinoma (ACC) can be challenging due to its polymorphous appearance and sharing cytomorphologic characteristics with other benign and malignant neoplasms as well as non‐neoplastic diseases, even though various histomorphological aspects of ACC have been documented. We presented a 39‐year‐old female patient applied with right pre‐auricular parotid swelling spreading infra‐auricular region which was gradually increased in size for 3 months. Ultrasonographic examination revealed hypoechoic well‐circumscribed mass with 17 × 22 × 29 mm size. Magnetic resonance imaging revealed intra‐parotid solid lesion with cystic areas, slightly hypointense on T1 and hyperintense on T2 weighted images. The mass was pushing the retromandibular vein medially, still lateral to it in the caudal images, but in dumbbell‐shape spreading through parapharyngeal space in superiorly cranial images. Fine‐needle aspiration cytology was also performed with guidance of ultrasonography. The cytological examination of the lesion was characterized by the predominance of heterogeneous lymphoid cells, clusters of epithelial cells with a variety of cytologic appearances, including granular, transparent, vacuolated, and oncocytic, and the presence of numerous naked nuclei with a protein‐like foamy background. Due to intense lymphocytic inflammation, it was considered as benign primary parotid tumor such as Warthin's tumor. The excision material was examined histopathologically. Immunohistochemical analysis showed that this carcinoma was positive for DOG1, SOX10, cytokeratin 7 and negative for mammaglobin. This salivary gland tumor was reported as a rare variant of ACC with lymphoid‐rich stroma. To improve the diagnostic accuracy, various morphological aspects of ACC should be considered in the pathological practice.

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Section: Discussionmentioning

confidence: 99%

Section: Although Serous Acinar Cell Differentiation Is What Defines ...mentioning

confidence: 99%

Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine‐needle cytology

Yaprak Bayrak,

Ozturk

2023

Diagnostic Cytopathology

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“…The most important finding is that WT-like MECs lack the well-arranged, bilayered oncocytic epithelial tissue characteristic of WTs. 11 In rare cases, perineural invasion and necrosis are also observed. 12 In the study of McLean-Holden et al, 13 extrafollicular reticulum cells were identified via low molecular weight keratin CAM 5.2 immunohistochemistry in all of the WTs and most of the controlled lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Warthin-like mucoepidermoid carcinoma of the parotid gland: Clinicopathological observation and literature review

Yan

Xu²,

Liu

et al. 2023

Science Progress

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Warthin tumor (WT)-like mucoepidermoid carcinoma resembles the histologic pattern of WT and pathologists unaware of this possibility may misdiagnose it as WT with squamous and mucous epithelium metaplasia or WT malignant transfer into mucoepidermoid carcinoma. The present study reported a case of a 41-year-old Chinese female with a solitary mass in the left parotid gland. In this case, microscopic observation revealed prominent lymph node stroma and multiple cystic structures similar to those seen in WT. However, it lacked the two layers of oncocytic epithelial tissue characteristic of WT. Furthermore, fluorescence in situ hybridization detected MAML2 rearrangement in the case. Considering the histological findings, this case was diagnosed as WT-like mucoepidermoid carcinoma. The present case report provides pathological and clinical features to differentiate it from WT malignant transition into mucoepidermoid carcinoma, WT with squamous and mucous epithelium metaplasia and non-sebaceous lymphadenoma-like mucoepidermoid carcinoma. In conclusion, WT-like mucoepidermoid carcinoma as a special subtype of mucoepidermoid carcinoma has special histological characteristics, which required further observations and more case reports to clearly define this variant.

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“…Because WT is typically cystic and may undergo both squamous and mucinous metaplasia, it is among the most commonly confused SG neoplasms with MEC 7,23,35–46 . Klijanienko et al however profess to never having encountered an example in their large series of MEC, or an example of MEC in their large series of WT 11,47 .…”

Section: Discussionmentioning

confidence: 99%

“…Because WT is typically cystic and may undergo both squamous and mucinous metaplasia, it is among the most commonly confused SG neoplasms with MEC. 7,23,[35][36][37][38][39][40][41][42][43][44][45][46] never having encountered an example in their large series of MEC, or an example of MEC in their large series of WT. 11,47 Mucinous WT is not uncommon, however, Zhang et al 48 encountered mucinous metaplasia in 24 WTs (83%), with 14% having an abundant amount.…”

Section: Discussionmentioning

confidence: 99%

Mucoepidermoid carcinoma: Analysis of 76 cytologic cases and correlation with histologic grade

Wakely

2022

Cancer Cytopathology

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BACKGROUND: Mucoepidermoid carcinoma (MEC) is the most common salivary gland (SG) malignancy. In this study, the author undertook analysis of a large collection of MEC cytologic cases. MATERIALS AND METHODS: Cytopathology files were searched for MEC cases with histopathologic confirmation. Fine-needle aspiration (FNA) smears used standard technique. RESULTS: Seventy-six cases (63 patients [M:F = 1:1; age range, 23-87 years; mean age, 58 years]) met inclusion criteria. Aspirates were primary (54 [71%]), metastatic (18 [24%]), and locally recurrent (4 [5%]). FNA sites included parotid gland (49 [64%]), regional lymph nodes (11 [14%]), submandibular gland (5 [7%]), inner canthus of eye (2 [3%]), and lung (2 [3%]); and single specimens from palate, jaw, shoulder, paranasal sinus, floor of mouth, ear canal, and effusion. Cytologic diagnoses included MEC (30 cases [39%]), suspicious for MEC (16 [21%]), non-MEC carcinoma (9 [12%]), suspicious for malignancy (SM) (2 [3%], malignant (M) (1 [1%]), SG and/or suspicious SG neoplasm (7 [8%]), atypical (3 [5%]), nonneoplastic (5 [6%]), nondiagnostic (2 [3%]), and benign SG neoplasm (1 [1%]). A total of 26% of low-grade (LG) cases were diagnosed as malignant in contrast to 87% malignant in high-grade (HG) cases. Cytomorphology depended on tumor grade.LG MEC contained intra-and/or extra-cellular mucin and more uniform cell and/or nuclear morphology, whereas cytologic atypia, anisonucleosis, and keratotic cells were more typical of HG tumors. CONCLUSION: A malignant (M) or suspicious for malignancy (SM) cytologic interpretation was made in 76% of mucoepidermoid carcinoma (MEC) cases. In contrast to high-grade MEC (97% identified as M/SM), only 59% of low-grade (LG) MEC cases were interpreted as such, illustrating the continued diagnostic challenge posed by LG MEC using fine-needle aspiration biopsy. Cancer Cytopathol 2022;.

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Fine‑needle aspiration cytology of Warthin‑like mucoepidermoid carcinoma: A case report with cytological review

Cited by 5 publications

References 20 publications

Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine‐needle cytology

Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine‐needle cytology

Warthin-like mucoepidermoid carcinoma of the parotid gland: Clinicopathological observation and literature review

Mucoepidermoid carcinoma: Analysis of 76 cytologic cases and correlation with histologic grade

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