Warthin Tumor-Like Papillary Thyroid Carcinoma with a Minor Dedifferentiated Component: Report of a Case with Clinicopathologic Considerations

Abstract

Warthin tumor-like papillary thyroid carcinoma is an uncommon variant of papillary thyroid carcinoma. We report a rare case of Warthin tumor-like variant of papillary thyroid carcinoma with a dedifferentiated component consisting of a solid tumor area composed of neoplastic cells with a spindle to tall cell morphology associated with marked nuclear pleomorphism, atypical mitoses, and foci of necrosis. Although our patient presented with a locally aggressive disease (T3 N1b Mo), she is disease-free without radioiodine therapy after a 23-month follow-up period. We emphasize that Warthin tumor-like papillary thyroid carcinoma, like other morphological variants of papillary carcinoma, may occasionally undergo dedifferentiation. As this component may be only focally detectable, we suggest an extensive sampling of all large-sized (>3 cm) papillary thyroid carcinoma. Recognition of any dedifferentiated component in a Warthin tumor-like papillary thyroid carcinoma should be reported, including its percentage, because it may reflect a more aggressive clinical course.

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

“…In 1995, a new variant of papillary thyroid cancer was described and it was called Warthin-like tumor of the thyroid (WALTT), for its histologic resemblance to Warthin tumor of salivary glands (3). WALTT is a rarely seen variant of thyroid cancer and single case reports and small case series have been reported recently in the Anglo-Saxon publications (4). In this study, …”

“…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.…”

“…It has been shown that WALTT is a sub-type of a welldifferentiated conventional papillary thyroid carcinoma, depending on its RET/PTC gene expression (5). Many authors argued that WALTT has a better prognosis than many other papillary thyroid cancer variants by evaluating its clinicopathological features (3)(4)(5). Thus, it seems that it is important to distinguish WALTT from other variants, especially from tall cell papillary carcinoma (PC) and Hurthle cell PC.…”

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

“…There were large epithelium-lining papillae with eosinophilic and granular cytoplasm, and frequently, some features of PTC (nuclear grooves, intranuclear pseudoinclusions and chromatin cleaning) could be recognized (Fig. 1B) is also a stronger predominance of females (3,9). The mean age of the 58 patients reviewed was 49 years and only 6 of those were males (10.3%) (Table 1).…”

“…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).…”