The significance of mucinous metaplasia in Warthin tumor: a frequent occurrence and potential pitfall

Zhang, Xiaoming; Baloch, Zubair W.; Cooper, Kumarasen; Zhang, Paul J.; Puthiyaveettil, Raghunath; LiVolsi, Virginia A.

doi:10.1016/j.humpath.2020.03.008

Cited by 13 publications

(20 citation statements)

References 48 publications

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“…However, more data are required from specific investigations into morphological features that may be associated with an increased ROM. These features may include the presence of clear cells, which can be seen in a minority of myoepithelial lesions, including epithelial myoepithelial carcinomas 29,30 ; the presence of oncocytic epithelium and mucin, which can be seen in some WTs and mucoepidermoid carcinomas 31 ; or squamous epithelium, which can be seen occasionally in WTs and PAs as well as mucoepidermoid carcinomas or squamous cell carcinomas 32 …”

Section: Discussionmentioning

confidence: 99%

Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

Allison

Smith

et al. 2020

Cancer Cytopathology

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Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has established distinct diagnostic categories for reporting cytopathological findings, and each is associated with a defined risk of malignancy (ROM). However, the ROM is applied at the overall category level and is not specific for particular morphological entities within a category. Here, the diagnostic performance of the MSRSGC for pleomorphic adenoma (PA) and Warthin tumor (WT) is reported. Methods The pathology archives of 11 institutions from 4 countries were retrospectively searched to identify all salivary gland fine‐needle aspiration (FNA) biopsies with a differential or definitive diagnosis of PA or WT and all resection specimens with a diagnosis of PA or WT; only paired cases were included. All FNA diagnoses were retrospectively classified according to the MSRSGC. Results A total of 1250 cases met the inclusion criteria, and they included 898 PA cases and 352 WT cases. The ROM in the benign neoplasm category was 3.0% and 1.3% for cases with a differential or definitive diagnosis of PA and WT, respectively. The ROM in the salivary gland neoplasm with uncertain malignant potential (SUMP) category was 2.7% and 18.8% for PA and WT, respectively (P = .0277). The diagnostic accuracy for PA and WT was 95.1% and 96.1%, respectively. Conclusions The diagnostic accuracy for PA and WT on FNA is high. Furthermore, these findings highlight the difference in the ROMs associated with 2 specific differential diagnoses in the SUMP category: basaloid neoplasms and oncocytoid neoplasms.

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Section: Discussionmentioning

confidence: 99%

Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

Allison

Smith

et al. 2020

Cancer Cytopathology

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“…At the other end of the spectrum, there are cases similar to our first case which present with an epithelial component consisting almost entirely of oncocytoid columnar cells in addition to prominent cystic growth and a lymphoid stroma [10]. These cases are not many in number but could easily be misdiagnosed as WT due to the presence of oncocyte-like columnar cells lining the cystic and papillary structures [5, 6, 9, 15, 16]. Indeed, it is stated that the two-row epithelium typical for WT is not found in WL-MEC cases, and it is the only differential histological feature of MAML2 rearranged tumors that makes it the most critical finding in the differential diagnosis [7, 9].…”

Section: Discussionmentioning

confidence: 92%

“…The absence of a typical two-row columnar oncocytic epithelium for WT is crucial [4, 15]. The disorganized arrangement of the columnar epithelium with or without oncocytic appearance, diffuse squamous-cell proliferation within the epithelium (lining the cystic spaces and papillary structures, either in full thickness or basally as a subcolumnar proliferation) [4-6, 9, 15, 19], and the presence of variable amounts of mucinous cells [16, 20] are the main histological changes defined for WL-MEC [4, 5, 7, 15, 20].…”

Section: Discussionmentioning

confidence: 99%

“…The first cases diagnosed as WL-MEC were showing at least 1 classical MEC focus in addition to features resembling WT, and tumors highly similar to WT without any usual MEC focus were being misdiagnosed as WT [5][6][7][8][9][10]. After the identification of t (11;19) translocation and CRTC1-MAML2 gene fusion in MECs [11][12][13], some WTs with different histological features even though subtle were reclassified as WL-MEC by the detection of this mutation, and MAML2 rearrangement became necessary to differentiate these cases [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Warthin-Like Mucoepidermoid Carcinoma: A Morphological Spectrum – A Report of 3 Cases with Histological and Cytological Findings and Review of the Literature

2022

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Background: Mucoepidermoid carcinoma (MEC) showing Warthin’s tumor (WT)-like features is a low-grade malignancy which should be differentiated from WT. Morphological features may be distinctly different in each case, causing diagnostic difficulties. Case Presentation: Three cases were presented and discussed with their morphologies. All cases that presented with a mass in the parotid gland went to parotidectomy, and all had preoperative fine-needle aspirations (FNAs). Case 1 was a 16-year-old female; FNA was suggestive of WT and initially interpreted as WT histologically. Case 2 was a 27-year-old male; FNA was interpreted as noninformative due to the presence of cyst fluid only. Case 3 was a 53-year-old male and cytologically was found to be suspicious for MEC which contained squamous and goblet cells on a mucoid background. On histopathological examination, case 2 and case 3 were morphologically consistent with low-grade MEC with WT-like features. Prominent lymphoid stroma and the cystic pattern were the characters of these tumors. Case 1 had the classical WT appearance with some mucinous and squamous metaplasia which could only be interpreted as MEC after the detection of MAML2 rearrangement by FISH. The other 2 showed either focal or relatively diffuse usual low-grade MEC findings, and case 3 was also confirmed by MAML2 rearrangement. Conclusion: Cytological and histopathological features revealed a spectrum. Differentiating WT-like MECs from ordinary WTs may be challenging. On the one end of the spectrum, they may look very much like WT, and on the other end, even though usual MEC features are present, still, WT-like appearance may pose diagnostic difficulty. Showing MAML2 rearrangement in these cases is very helpful. The presence of mucinous and squamous cells in an otherwise WT-like looking tumor should be alarming for MEC, and if possible, each case should be analyzed for MAML2 rearrangement.

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“…This rare variant is characterized histopathologically by the presence of prominent lymphocytic infiltration and cystic changes that resemble Warthin's tumour (3). The neoplastic cells comprising Warthin-like MEC are intermediate cells and a variable number of mucinous cells may be present, similar to that in conventional MEC; however, the bi-layered tall oncocytic cells, which are characteristic of Warthin's tumour, are not observed in Warthin-like MEC (3,4). Mastermind-like transcriptional coactivator 2 (MAML2) encodes a transcription coactivator of NOTCH proteins.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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The significance of mucinous metaplasia in Warthin tumor: a frequent occurrence and potential pitfall

Cited by 13 publications

References 48 publications

Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi‐institutional study

Warthin-Like Mucoepidermoid Carcinoma: A Morphological Spectrum – A Report of 3 Cases with Histological and Cytological Findings and Review of the Literature

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

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