Warthin-like papillary carcinoma of the thyroid: a case series and review of the literature

Abstract

Warthin-like tumor of the thyroid is a recently described rare variant of thyroid papillary carcinoma. The distinguishing histological feature of this variant is papillary foldings lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. Its prognosis has been reported to be almost similar to conventional papillary carcinoma. In this case series, we report four cases with Warthin-like papillary carcinoma of the thyroid, diagnosed at Dokuz Eylul University Faculty of Medicine Department of Pathology in 2008 and 2009. Three patients were female. The mean patient age was 39 years (range, 20-56) and the mean tumor size was 1.7 cm (range, 0.9-2.0 cm). All of the cases had lymphocytic thyroiditis in the background. None of the tumors showed lymphovascular invasion. The patients are free of any recurrence and/or distant metastasis with a mean follow-up of 25 months. This rare variant of thyroid papillary carcinoma with distinct histopathological features should be indicated in pathology reports. Further studies and long-term follow-up of patients are needed to highlight the biological behavior of this variant.

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

“…Six out of nine patients had no regional nodal metastasis in our study and this result is consistent with previous trend with a lower incidence of nodal metastasis of WVPTC than conventional PTC [7,8]. Coexistences of WVPTC and other variants of PTC might cause worse prognosis because of the unfavorable side among the variants [5,19]; in our study, all two patients who had additional conventional PTCs showed nodal metastases. Curiously enough, the other patient with nodal metastases demonstrated irregular nodules with mutliple microcalcifications, which had the closest US features to conventional PTC among our cases (case 6).…”

“…Our patients were somewhat older than those reported in previous studies, but showed similar wide range of age distribution [5,6,8,11]. The mean nodule size was smaller than previous studies [5,6], but similar to the recent studies [8,11].…”

“…Our patients were somewhat older than those reported in previous studies, but showed similar wide range of age distribution [5,6,8,11]. The mean nodule size was smaller than previous studies [5,6], but similar to the recent studies [8,11]. No BRAF V600E mutation was detected in patients with WVPTCs although three of nine had undergone BRAF V600E mutation analysis in this study: this trend is comparable to the findings of a previous study in which WVPTCs showed fewer mutations than conventional PTCs [11].…”

“…Therefore, the seemingly anechoic or marked hypoechoic part itself in the nodule may be correlated with lymphocytic stroma of WVPTC, which is a distinct histological feature distinguishing WVPTC from other types or subtypes of thyroid cancer or cysts which were observed accompanied with lymphocystic stroma in the papillary stalks [5][6][7]. Generally, WVPTC is said to behave like conventional PTC showing good long-term overall survival and rare extrathyroidal extension, nodal metastasis, recurrence or distant metastasis [2,5,6,8,11]; our findings were similar to previous reports showing favorable prognosis. All WVPTCs in our study were assigned as T1 stage except the last case (case 9) in which conventional PTC larger than 1 cm were accompanied in the ipsilateral lobe with extrathyroidal extension and nodal metastases.…”

Warthin-like papillary thyroid carcinoma with immunoglobulin G4-positive plasma cells possibly related to Hashimoto’s thyroiditis

“…Meanwhile, the heavy lymphoplasmacytic infiltrate is among the defining characteristics of Warthin-like papillary thyroid carcinoma (WL-PTC) in microscopic analysis, and this variant is frequently accompanied by Hashimoto's thyroiditis [12,13]. Given that Hashimoto's thyroiditis with the heavy lymphoplasmacytic infiltration is a common comorbidity of IgG4-RT and WL-PTC, we hypothesize that WL-PTC may have a strong correlation with IgG4-RT.…”