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

Ning, Chun ping; Koo, Ja Seung; Kim, Min Jung; Lee, Suji

doi:10.11152/mu-1870

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…Almost all nodules were solid or nearly solid (97%) and highly hypoechoic (78.8%). They were also wider in shape than tall (81.8%) ( 30 ). These findings agree with those reported by Kim et al., who encountered that the majority of WLPTC nodules were solid (62.5%), hypoechoic (75%), and wider in shape than tall (100%) ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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BackgroundPapillary Thyroid Carcinoma (PTC) is the most frequent endocrine malignancy with a variety of histological presentations. Warthin-like Papillary Thyroid Carcinoma (WLPTC) is an uncommon neoplasm that is recognized as a distinct subtype of PTC in the WHO classification of thyroid tumors. In this report, we present a novel case of WLPTC in a female patient and provide an in-depth review of the available literature on its clinical, pathological, and therapeutic characteristics.Case presentationA 27-year-old female patient was referred for neck swelling. Ultrasound showed two suspicious thyroid nodules leading to a thyroidectomy. She was diagnosed with intermediate-risk bifocal foci of classic PTC and WLPTC, arising from a background of chronic lymphocytic thyroiditis (CLT). This pT1b(m) N1b M0 malignancy was treated with adjuvant isotopic ablation and suppressive thyroxine therapy. The 1-year outcomes were favorable.Literature reviewIt covered articles published from 1995 to 2022, by searching PubMed and Google Scholar using specific terms. Out of 148 articles reviewed by two authors, 25 relevant articles were selected, including 13 case reports and 12 case series. The study included 150 cases of WLPTC. Data related to clinical presentation, imaging, histological features, management, and outcomes, were extracted. The mean age of diagnosis was 39 years, with a female predominance. The most common clinical presentation was neck swelling. Thyroid autoimmunity was positive in 71.6% of patients. Lymph node metastases were present in 28% of cases, with no reported distant metastases. Overall, the outcomes were favorable.ConclusionWLPTC shares similar clinical and radiological presentations as classic PTC. The hallmark histological features of WLPTC are papillae lined with oncocytic tumor cells with papillary nuclear changes and lymphoid stroma. WLPTC is almost constantly associated with CLT. The management of WLPTC aligns with that of classic PTC with comparable stage and risk category, often resulting in favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

“…The initial symptom is often a painless cervical swelling, which was present in about half of the cases ( 15 , 20 , 30 ). The availability of imaging techniques has led to increased incidental diagnoses of WLPTC.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Conducting a study, Ning et al pointed out some features of WLV-PTC nodules among 32 cases. The author determined that in 97% of the cases, nodules were solid or nearly solid, and in 78.8% they were hypoechoic [ 9 ]. In our report, these assumptions were confirmed.…”

Section: Discussionmentioning

confidence: 99%

Warthin-like variant of papillary thyroid carcinoma with lymph node metastases: a case report and review of the literature

Hryshchyshyn,

Bahrii,

Botsun

et al. 2024

J Med Case Reports

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Background We present a rare case of thyroid lesion marked as the Warthin-like variant of papillary thyroid carcinoma (WLV-PTC) with lymph node metastases. A proper preoperative identification is difficult because of unspecific cytology features and common ultrasound characteristics of this malignant tumor. The long-term prognosis cannot be thoroughly described due to the scarcity of data. The purpose of the presentation is to show common characteristics and long-term survival rates of an uncommon variant of differentiated thyroid cancer (DTC). Therefore, the data represented in this article can make a significant contribution to future investigations. Case presentation A 40-year-old Ukrainian woman had a lesion in the thyroid gland, which was accidentally diagnosed during medical checkup. Ultrasound (US) features were similar to the common suspicious nodule. It had typical signs of suspicion for malignancy (TI-RADS-4) on the background of thyroiditis. A thorough investigation of the neck showed lymph nodes with nonspecific US features on both lateral compartments. Lymph nodes were hypoechoic, oval-shaped and 10 mm wide, with regular contours, low central vascularity, with preserving hilar fat, without cystic formation. The patient did not have any complaints or changes in the hormone status. No hereditary findings linked with cancer were discovered. The woman had been living for a long time in the country with a high level of insolation, which was atypical for the ordinary environment of the patient. Fine-needle aspiration (FNA) of the lesion was done and the Bethesda system 6 result was obtained. Total thyroidectomy with central lymph node dissection was accomplished. The histological conclusion was WLV-PTC on the background of lymphocytic infiltration of the gland with metastasis to the lymph nodes. The inpatient radioactive iodine (RAI) ablation (100 mCi) was subsequently performed. Hormone withdrawal was used followed by RAI. In one year after the surgery the level of thyroglobulin (Tg) was 0.2 ng/ml. Up to the present time the five-year follow-up has not demonstrated any signs of recurrence relying on a level of Tg (< 0.04 ng/ml), Tg antibodies (< 14 IU/ml), neck US without any structural disease. Conclusion WLV-PTC resembles salivary gland tumors with similar histological features. This variant is not well known, but often associated with a stroma lymphocytic infiltration and a low risk of lymph node metastases. It is regarded that this rare subtype has similar long-term survival rates as classic papillary thyroid cancer (PTC).

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“…In this variant, BRAF V600E mutations are less frequent than in the classic variant (65% vs. 84%) [12], but BRAF mutation is still the most common genetic driver. The most common US features of WV PTCs are a solid composition, hypoechogenicity, and taller-than-wide shape [34,35]. The US pattern of nodules harboring BRAF V600E mutations may differ depending on the presence of Hashimoto’s thyroiditis.…”

Section: Genetic Drivers and Sonographic Pattern Of Different Varimentioning

confidence: 99%

Correlations between Molecular Landscape and Sonographic Image of Different Variants of Papillary Thyroid Carcinoma

Lewiński

Adamczewski

Zygmunt

et al. 2019

JCM

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Papillary thyroid carcinoma (PTC), the most common thyroid cancer, is predominantly driven by mutations in BRAF (primarily p. V600E) and RAS oncogenes. Ultrasound (US) examination provides significant diagnostic data in the management of thyroid nodules, as many sonographic features of thyroid lesions are correlated with the potential risk of thyroid carcinoma. The aim of the study was to analyze the current literature in regard to the potential associations between genetic landscape and sonographic features of PTC. Based on the current literature, sonographic features of PTCs correlate with their molecular drivers, particularly between tumors harboring BRAFV600E versus activating RAS mutations, although many of these findings appear to be dependent on the tumor variant. Suspicious US findings, such as hypoechogenicity, spiculated/microlobulated margins, non-parallel orientation/taller-than-wide shape, and the presence of microcalcifications, are typical for PTC positive for BRAFV600E mutations. On the contrary, tumors with RAS mutations are most frequently hypo- or isoechoic and ovoid-to-round in shape, with smooth margins and without calcifications. There are also some US features typical for PTCs harboring other mutations, including BRAFK601E, RET/PTC rearrangements, PAX8-PPARγ, CTNNB1, and APC. However, further research is necessary, as some rare PTC variants still cannot be reliably analyzed due to the scarce published data.

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

Cited by 6 publications

References 21 publications

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

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

Warthin-like variant of papillary thyroid carcinoma with lymph node metastases: a case report and review of the literature

Correlations between Molecular Landscape and Sonographic Image of Different Variants of Papillary Thyroid Carcinoma

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