Oncocytic variant of papillary thyroid carcinoma with lymphocytic stroma (Warthin‐like variant): report of a case with fine needle aspiration cytology and review of the literature

Abstract

A 47-year-old woman presented with swelling on the front of her neck. Ultrasound of the thyroid revealed a 3.0 cm partially cystic, hyperechogenic nodule in the left lobe. The residual thyroid parenchyma was hypoechoic and heterogenous. Fine needle aspiration (FNA) cytology of the nodule was consistent with a papillary thyroid carcinoma, oncocytic variant. This tumour is not well recognized and we discuss how it may be distinguished from other oncocytic thyroid lesions. Materials and methodsUltrasound-guided FNA was carried out using a 27-G needle attached to a 10-ml syringe. The smears were air-dried and stained with May-Grü nwald-Giemsa (MGG) or fixed in 95% alcohol and stained by Haematoxylin and Eosin (H&E). The patient underwent total thyroidectomy and lymph node dissection. The surgical specimen was fixed in 10% formalin and embedded in paraffin. Histological sections were stained with H&E.

Ultrasonographic features and clinical characteristics of Warthin-like variant of papillary thyroid carcinoma

“…needle aspiration (FNA) may be difficult even though histological characters of WVPTC are so particular [2,3,9]. Meanwhile, preoperative ultrasonographic (US) features of PTC would allow clinicians to predict the biologic behavior of PTC, and some US features would help to suggest certain PTC variants [1,10].…”

Warthin-like Tumor of the Thyroid - A Rare Variant of Papillary Thyroid Cancer: Report of Two Cases

“…Although WALTT has a similar prognosis compared to conventional PC, two cases in the literature had a dedifferentiated component and showed poor prognosis (4,10 (11,12). In case one, FNAB slides show high cellularity with papillary structure which contains tumor cells with large nucleus, eosinophilic cytoplasm, nuclear grooves, and intranuclear pseudo inclusions.…”

“…On the FNAB slides, observation of lymphocytes and Hurthle cells can be considered as Hashimoto thyroiditis, but for the differential diagnosis of these lesions evaluation of the nucleus is very important. The main cytologic criteria on the diagnosis of WALTT are the presence of lymphocytes and oncocytic cells with nuclear features reminiscent of papillary carcinoma (12).…”

Warthin-Like Papillary Thyroid Carcino Ma: Report of a New Case

“…However, HCC usually lacks lymphocytic infiltrates and is rarely associated with lymphocytic thyroiditis (11,13). Also, unlike WLPTC, TCC is characterized by a papillary structure with elongated oncocytes, with a height that is more than twice their width, and by tumoral agressiveness with more frequent vascular, capsular and nodal invasion (10,13,28). Moreover, the tumor cells do not show the cytoplasmic granularity of Hürthle cells (29).…”

“…Warthin-like papillary thyroid carcinoma (WLPTC) is an uncommon variant of thyroid PTC (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). This morphologic variant is characterized by a prominent lymphocytic infiltration in the stalks of the papillae and in the surrounding stroma with extensive oxyphilic change of epithelium, resembling Warthin tumor of the salivary gland (6,7).…”