Primary Warthin’s-like adenocarcinoma of the lung: A clinicopathological, immunohistochemical, and molecular analysis of three cases

Alqaidy, Doaa; Moran, César A.

doi:10.1016/j.prp.2021.153648

Cited by 1 publication

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“…KRAS mutations are ubiquitous in benign and malignant tumors across several histological types at different anatomic sites. They represent frequent primary drivers of several common aggressive cancers including the majority of pancreatobiliary carcinomas, colorectal carcinomas, and subsets of non-small cell lung cancer including rare Warthin-like pulmonary adenocarcinoma [ 26 , 27 ] and subsets of indolent papillary renal cell carcinoma [ 28 ]. Moreover, KRAS mutations are emerging as major players in a variety of non-neoplastic malformative vascular lesions and benign tumors including subsets of capillary hemangioma [ 29 ], non-ossifying fibroma of bone [ 30 ], brown tumor of hyperparathyroidism [ 31 ] and others.…”

Section: Discussionmentioning

confidence: 99%

KRAS codon 12 mutations characterize a subset of de novo proliferating “metaplastic” Warthin tumors

et al. 2023

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Warthin tumor (WT; synonym: cystadenolymphoma) represents one of the most frequent salivary gland tumors with a frequency equaling or even outnumbering that of pleomorphic adenomas in some series. Histologically, the tumor displays tall columnar oncocytic cells, arranged into two cell-thick layers lining variably cystic glands within an organoid lymphoid stroma. Tumors with exuberant squamous metaplasia in response to FNA-induced or other types of tissue injury/infarction have been referred to as “metaplastic WTs.” However, the same terminology was used for tumors with variable mucinous cell and solid or stratified epidermoid proliferations (occasionally mimicking mucoepidermoid carcinoma), although the “metaplasia concept” has never been proven for the latter. We herein investigated 22 WTs showing prominent mucoepidermoid-like or solid oncocytoma-like proliferations without prior FNA or histological evidence of infarction/ trauma using the TruSight Tumor 15 gene panel and KRAS pyrosequencing. As a control, we tested 11 conventional WTs. No statistically significant differences were observed between the two subcohorts regarding patient’s age and tumor size. Six of 22 (27%) proliferating/ metaplastic WTs revealed oncogenic KRAS mutations clustering at codon 12 (exon 2), while all conventional tumors lacked these mutations. Our findings are in line with a neoplastic nature of the epidermoid/ mucoepidermoid proliferations in non-injured “metaplastic” Warthin tumors. We propose the descriptive term “de novo proliferating Warthin tumor” for this variant to distinguish it from infarcted/inflamed genuine metaplastic Warthin tumor.

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