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

Abstract

Abstract. Hashimoto's thyroiditis with heavy lymphoplasmacytic infiltration is a common comorbidity of immunoglobulin G4 (IgG4)-related thyroiditis and Warthin-like papillary thyroid carcinoma (WL-PTC). We hypothesized that WL-PTC may have a strong association with IgG4-related thyroiditis. To validate this hypothesis, we clinically and immunohistochemically studied 17 WL-PTC cases. Fourteen patients (82.4%) had anti-thyroglobulin antibody and were confirmed to have Hashimoto's thyroiditis through microscopic analysis. Among them, five (29.4%) had disease consistent with IgG4-related thyroiditis but did not exhibit a "storiform" pattern or obliterative phlebitis. IgG4-related diseases were not found in other organs. No cases with serum IgG4 level of >135 mg/dL were noted. A total of 94.1% of WL-PTC cases had IgG4-positive plasma cells ( + PCs) in the stroma, and cases with rich IgG4 + PCs were more frequently associated with Hashimoto's thyroiditis than those with poor IgG4 + PCs. In this study, all three cases without Hashimoto's thyroiditis had poor IgG4 + PCs, and one of them did not exhibit IgG4 + PCs in the stroma of WL-PTC and Hashimoto's thyroiditis. Nodal metastatic lesions were seen in eight cases, all of which were not WL-PTC. As such, we should consider that the Hashimoto's disease with rich IgG4 + PCs seen in our cases is representative of non-IgG4-related disease and not IgG4-related disease involving multiple organs. This study is the first to demonstrate the presence of IgG4 + PCs in the stroma of WL-PTC. We concluded that the appearance of IgG4 + PCs in the stroma of WL-PTC may be related to Hashimoto's thyroiditis with rich IgG4 + PC.

Clinical and sonographic characteristics of Warthin-like variant papillary thyroid carcinomas

“…WVPTC is a rare subgroup of oncocytic variant [1] PTC, with about 162 cases reported in the English literature up to now [4,5,7,8]. Similar to previous reports, we found that WVPTC were more often seen in female patients (27/32，84.4%) with a relative high age (mean age, 51.0±10.8 years old).…”

“…After a thorough literature searching, we found that most of the articles published were about the pathological characteristics of WVPTCs [8,[17][18][19]. It is widely accepted that WVPTC is morphologically characterized by a papillary architecture with an oncocytic epithelial lining and lymphoplasmacytic core infiltrate.…”

“…Two radiologists were invited to search the database of surgical pathology and to retrieve all the records of WVPTCs. Criteria for diagnosing WVPTC were as follows [8]: 1) papillary growth pattern, 2) oncocytic cytoplasm, 3) nuclear feature of PTC and 4) heavy lymphoplasmacytic infiltration. Between 2006 December and 2018 September, 35 records were hit among 25659 surgeries for papillary carcinomas, representing 0.14%.…”

Interleukin-17 and vascular endothelial growth factor: new biomarkers for the diagnosis of papillary thyroid carcinoma in patients with Hashimoto’s thyroiditis

“… 3 , 4 There is thus a close relationship between the pathogeneses of these two diseases. Although the exact mechanism linking these diseases is not clear, there are currently three main hypotheses: 1) HT is a precancerous lesion of PTC; 2 , 23 2) the hypothesis of chronic inflammation; and 3) HT and PTC have common causes, potentially including immune factors (both thyroid globulin antibody and microsomal antibody have been found in the blood of HT and PTC patients), 24 – 26 endocrine factors (HT can cause hypothyroidism and increase reactive thyrotropin, which can in turn cause carcinogenesis), 27 – 31 and radioactive factors (exposure to X-rays can lead to thyroid inflammation and carcinogenesis, via the same mechanism). 32 – 37 …”

The Analysis of Clinical Biological and Pathological Features in Papillary Thyroid Carcinoma

“…In recent years, the incidence of HT combined with PTC has also increased significantly as the incidence of HT and PTC has increased year by year, and the correlation between the two has also become a hot spot in medical research [17]. Some scholars studied the pathological tissue sections of PTC and found that the surrounding area of PTC was often accompanied by infiltration of immune inflammatory cells such as macrophages, mast cells, and lymphocytes [18]. HT and PTC coexist frequently and both have immune inflammatory cell infiltration, which proves that there is a certain immunological relationship between them.…”