Warthin-like papillary thyroid carcinoma: A rare tumor of the thyroid

Öz

Warthin-like papillary thyroid carcinoma is a rare variant of papillary thyroid carcinoma with favorable prognosis. The tumor is named “Warthin-like papillary thyroid carcinoma” because of bearing a striking morphological resemblance to Warthin\'s tumor occurring in the salivary glands. Thy­roid ultrasonography of 65 years old female patient with a history of bilateral subtotal thyroidectomy 30 years ago in another center with unknown histopathological diagnosis revealed a 20 mm isoechoic solid nodule in the left lobe and this nodule was hypoactive in thyroid scintigraphy. Grossly, a grey-tan colored, solid nodule with 1 cm di­ameter was seen in the left lobe. Histologically, the tu­mor was composed of papillary structures surrounded by marked lymphocytic stroma and oncocytic cells with papillary carcinoma\'s nuclear features were lining the papillae. Hashimoto\'s thyroiditis was present throughout the thyroid. Immunohistochemically, tumor cells exhib­ited cytokeratin 19, Thyroid transcription factor-1 (TTF-1), Galectin-3, HBME-1(Mesothelioma antibody) and thyro­globulin positivity, proliferative index with Ki-67 was low. Warthin-like papillary thyroid carcinoma is a rare variant of papillary thyroid carcinoma and other oncocytic cell le­sions especially Hurthle cell carcinoma should be kept in mind in the differential diagnosis of this neoplasm.

Anahtar Kelimeler

• Thyroid, carcinoma, Warthin-like tumor

Warthin benzeri papiller tiroid karsinomu: Nadir bir tiroid tümörü

Öz

Warthin benzeri papiller tiroid karsinomu, iyi prognozlu nadir görülen papiller karsinom varyantıdır. Tümör, ismini tükrük bezinin Warthin tümörüne morfolojik olarak benzer­liğinden almaktadır. Başka bir merkezde 30 yıl önce bila­teral subtotal tiroidektomi uygulanan ancak histopatolojik tanısı bilinmeyen 65 yaşındaki kadın hastanın yapılan ti­roid ultrasonografisinde, sol lobta 20 mm çapında izoeko­ik solid nodül ve tiroid sintigrafisinde aynı lokalizasyonda hipoaktif nodül görüldü. Makroskopik olarak, sol lobta 1cm çapında kirli beyaz renkli, solid kıvamda nodüler lez­yon tespit edildi. Mikroskopik olarak, sol lobta lenfositten zengin stroma ile çevrili papiller yapıları döşeyen, papiller karsinomun nükleer özelliklerine sahip, onkositik sitoplaz­malı hücrelerden meydana gelen tümör izlendi. Tümör dışı tiroid dokusunda Hashimoto tiroiditi mevcuttu. İmmüno­histokimyasal çalışmalarda tümörde sitokeratin19, TTF-1 (Thyroid transcription factor-1), Galektin3, HBME-1 (Me­sothelioma antibody) ve tiroglobulin ile pozitiflik mevcuttu, Ki-67 proliferatif indeksi düşüktü. Warthin benzeri papiller tiroid karsinomu nadir görülen papiller karsinom varyantı olup, ayırıcı tanıda diğer onkositik hücreli lezyonlar ve de özellikle Hürthle hücreli karsinom akılda tutulmalıdır.

Anahtar Kelimeler

• Tiroid, karsinoma, Warthin benzeri tumor

Kaynakça

1. Sarkady E, S´api Z, T´ oth V, Kiss S. “Warthin-like tumor of the thyroid-a case report”. Pathol Oncol Res 1999; 5(4): 315-7.
2. Chang Sig Choi SHC, Kim YS. Warthin-like tumor variant of papillary thyroid carcinoma - A case report. Korean J Pathol 2004; 38(3): 200-3.
3. Apel RL, Asa SL, LiVolsi VA. “Papillary Hurthle cell car- cinoma with lymphocytic stroma: “Warthin-like tumor” of the thyroid”. Am J Surg Pathol 1995; 19(7): 810-4.
4. Amico P, Lanzafame S, Li Destri G, et al. Warthin tumor-like papillary thyroid carcinoma with a minor dedifferentiated component: Report of a case with clinicopathologic consid- erations. Case Reports in Medicine 2010 PMID 495281, 5 pages doi:10.1155/2010/495281
5. Montone KT, Baloch ZW, LiVolsi VA. “The thyroid Hurthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review”. Arch Pathol Lab Med 2008; 132(8):1241-50.
6. LiVolsi VA. Papillary neoplasms of the thyroid. Pathologic and prognostic features. Am J Clin Pathol 1992; 97(3): 426- 34.
7. Astor FC, Hanft KL, Rooney P, Benson CA, Flores CT, La- vertu P. Extraparotid Warthin’s tumor: clinical manifesta- tions, challenges, and controversies. Otolaryngol Head Neck Surg 1996; 114(6): 732-5.