Letter to the Editor Mucoepidermoid carcinoma in Warthin tumor of the parotid gland

Smółka, Wojciech; Markowski, Jarosław; Piotrowska-Seweryn, Agnieszka; Paleń, Piotr; Dobrosz, Zuzanna; Dziubdziela, Włodzimierz

doi:10.5114/aoms.2015.52379

Cited by 13 publications

(8 citation statements)

References 31 publications

(34 reference statements)

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“…In addition, the metaplasia of WT may show a precursor or early phase of MEC. In 27 previously reported cases of MEC in or coexisting with WT [7–21],14 cases were accompanied by squamous or mucinous metaplasia, [8, 11–14, 16, 19], and six of the 14 cases were confirmed or suspected to have MECs that had transformed from the metaplastic portions of WT [11, 16, 19]. Rotellini et al reported that two of eight cases of metaplastic WT showed a MAML2 gene rearrangement in the squamous cells, but not in the mucinous cells and oncocytic cells [28].…”

Section: Discussionmentioning

confidence: 99%

“…Metaplastic WTs may develop mucinous epithelial metaplasia [5, 6], which can pathologically mimic a low-grade mucoepidermoid carcinoma (MEC). WTs rarely coexist with malignant epithelial neoplasms, such as the squamous cell carcinoma (the most common [7]) and MEC; 27 cases of MEC in or coexisting with WT have been described [7–21]. Pathological differentiation of a metaplastic WT from a MEC can be difficult because some metaplastic WTs have been reclassified as MECs based on clinicopathological and genetic studies [17, 22].…”

Section: Introductionmentioning

confidence: 99%

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Infarcted Warthin tumor with mucoepidermoid carcinoma-like metaplasia: a case report and review of the literature

et al. 2019

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BackgroundWarthin tumor is a common, benign, painless salivary gland neoplasm. Rarely, Warthin tumors show large areas of squamous metaplasia; such Warthin tumors are called metaplastic or infarcted Warthin tumors because they are occasionally accompanied with tumor necrosis. The histological distinction between mucoepidermoid carcinomas and the metaplastic portions of Warthin tumors can be challenging; without a genetic study, mucoepidermoid carcinomas can be misdiagnosed as metaplastic Warthin tumors. We report a case of infarcted Warthin tumor partly showing mucoepidermoid carcinoma-like epithelial metaplasia. Only two cases of infarcted Warthin tumor similar to our case have been reported.Case presentationA 69-year-old Japanese man presented with a right parotid tumor. He had noticed the swelling on his right buccal region 1 year previously; the lesion had rapidly enlarged, with associated pain, 1 month previously. A radiological examination revealed a mass in the tail of the right parotid gland. Superficial parotidectomy was performed. On histological examination, the mass showed typical focal features of Warthin tumor; other areas showed coagulation necrosis of the tumor. These areas were surrounded by non-oncocytic epithelium comprising squamous and mucinous epithelial cells. Although cellular atypia of the non-oncocytic epithelium was not observed, a mixture of squamous and mucinous cells and lack of abundant lymphoid tissue mimicked low-grade mucoepidermoid carcinoma. Based on the results of fluorescence in situ hybridization, MAML2 gene rearrangement was not present in the typical portions of Warthin tumor and the mucoepidermoid carcinoma-like lesion. Therefore, a metaplastic or infarcted Warthin tumor was diagnosed. Our patient was disease-free 8 months after surgery.ConclusionsClinicians need to know that pain is a clinical symptom of infarcted/metaplastic Warthin tumor. Pathologists should be aware that a metaplastic Warthin tumor can mimic a low-grade mucoepidermoid carcinoma. Our case showed a mucoepidermoid carcinoma-like lesion that was confined near the area of tumor necrosis, and neither cytological atypia nor apparent invasive growth was present. These findings appeared to be histological clues of a metaplastic Warthin tumor rather than a mucoepidermoid carcinoma. Careful clinicopathological evaluation as well as genetic studies are needed to clarify the distinction between mucoepidermoid carcinoma and metaplastic portions of Warthin tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Infarcted Warthin tumor with mucoepidermoid carcinoma-like metaplasia: a case report and review of the literature

et al. 2019

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“…The main differential of such types of lesions is the malignant transformation of WT, metaplastic changes in WT and the Warthin-like variant of MEC. The coexistence of WT and MEC is rare, with only 29 cases reported worldwide 4 - 6. Malignant transformation of the epithelial component of WT, such as squamous cell carcinoma, MEC, adenocarcinoma, and undifferentiated, poorly differentiated, and anaplastic carcinoma is extremely rare and only seen in 0.3% of cases 4.…”

Section: Discussionmentioning

confidence: 99%

Warthin-like mucoepidermoid carcinoma of the parotid gland: a diagnostic and therapeutic dilemma

Balasubiramaniyan¹,

Sultania²,

Sable³

et al. 2019

Autops. Case Rep.

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Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor. Although the parotid gland is the most common site of involvement, other major salivary glands and the minor salivary glands—most commonly of the palate—also can be involved. The management of mucoepidermoid carcinoma depends on the grade of the tumor and the adequacy of resection. We present the case of a 56-year-old female presenting a painless progressive cheek mass over 2 months. Imaging and fine-needle aspiration cytology provided the diagnosis of Mucoepidermoid carcinoma. A superficial parotidectomy was done, and the histopathology revealed a predominantly cystic tumor with a bilayered epithelium of oncocytic and basal cells. Moderate nuclear pleomorphism with infiltration of atypical squamous cells in few glandular cysts was seen. Special staining revealed the presence of intracellular mucin. A diagnosis of Warthin-like variant of MEC was made, based on these findings. After the surgical procedures, the patient is disease-free at 8 months of follow-up. The Warthin-like variant is a rare variant of MEC with fewer than 10 cases described in the English literature. Various differential diagnoses include the malignant transformation of Wartin tumor (WT), squamous metaplasia of WT, and metastasis from a distant primary. We emphasize the role of routine microscopy in identifying rare variants of common malignancies. Even though translocation studies are helpful in diagnosis, the typical histopathological findings should confirm it.

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“…It was proposed that limited excisions including enucleation and removal of the inferior half of the superficial lobe are sufficient 5 6 . Other investigators argued that superficial parotidectomy is standard 7 . Manifestation of a tumor in the inner lobe requires total parotidectomy.…”

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confidence: 99%

“…Only 19 cases of WT co-existing with MEC have been reported worldwide 7 . Here we reported 5 new cases of MECs arising in Warthin’s tumor of the parotid gland.…”

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confidence: 99%

Mucoepidermoid carcinoma arising in Warthin’s tumor of the parotid gland: Clinicopathological characteristics and immunophenotypes

Song

Xiao

et al. 2016

Sci Rep

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Mucoepidermoid carcinoma (MEC), an extremely rare tumor, arises from the epithelial component of preexisting parotid Warthin tumors (WT). Among the 309 cases of surgically resected WTs in Chinese PLA General Hospital and Beijing Shijitan Hospital of Capital Medical University, 5 cases (1.6%) fulfilled the criteria for MECs transformed from WTs. Clinicopathological characteristics of MECs was demonstrated in order to avoid misdiagnosis of this rare type of tumor. All the 5 patients, 3 males and 2 females, presented painless masses in the parotid gland. MECs were located inside or at the edge of WTs, with an obvious transitional zone between WT and MEC. Basal cells of WTs and epidermoid cells of MECs were strongly positive for cytokeratin CK5/6, CK34βE12, and P63; whereas negative for CK7, CK20, and CEA. Mucous cells of MECs were positive for CK7, CEA, as well as periodic acid-Schiff (PAS), whereas negative for CK5/6, CK34βE12, CK20, and P63. MECs patients were followed up for 25–69 months after surgery, presenting no evidence of recurrence or metastasis. Collectively, MECs arising from WT is very rare. The pathological diagnosis was based on histological morphology, especially the transitional zone between WT and MEC.

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Letter to the Editor Mucoepidermoid carcinoma in Warthin tumor of the parotid gland

Cited by 13 publications

References 31 publications

Infarcted Warthin tumor with mucoepidermoid carcinoma-like metaplasia: a case report and review of the literature

Infarcted Warthin tumor with mucoepidermoid carcinoma-like metaplasia: a case report and review of the literature

Warthin-like mucoepidermoid carcinoma of the parotid gland: a diagnostic and therapeutic dilemma

Mucoepidermoid carcinoma arising in Warthin’s tumor of the parotid gland: Clinicopathological characteristics and immunophenotypes

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