Warthin-Like Papillary Thyroid Carcinoma Associated with Lymphadenopathy and Hashimoto’s Thyroiditis

Abstract

Defining the histologic variant of thyroid carcinoma is an important clinical implication as their progression, recurrence, aggressiveness, and prognosis differ. Warthin-like variant is one of the rarest histologic variants of papillary thyroid cancer. A 36-year-old female sought consult for assessment of a painless right neck tumor. High-resolution neck ultrasound revealed a right hypoechoic, 1.71 × 1.05 cm thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy report was a Bethesda grade III. Thyroid function tests showed Hashimoto's thyroiditis. The patient underwent right hemithyroidectomy. Microscopically, the tumor was composed of papillae lined by cells with eosinophilic cytoplasm, nuclear chromatin clearing, grooves, and pseudoinclusions and a characteristic lymphoplasmacytic infiltrate of the papillae cores. Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer. Warthin-like variant is an uncommon and relatively unknown variant of papillary thyroid carcinoma that has been usually associated with an excellent prognosis. Interestingly, BRAF mutations have been reported to be present in up to 75% of the patients. It is frequently associated with Hashimoto's thyroiditis and presents unique morphological features that make it recognizable on histologic examination. The cytological diagnosis is difficult to assess due to the overlap in its findings with the classical variant and Hashimoto's thyroiditis.

Solid papillary thyroid carcinoma with Hashimoto’s thyroiditis: description of a further case with challenging cytological features

“…We were perplexed by this case because, despite the evident lymphocytic infiltration, which indicated concurrent Hashimoto’s disease, this neoplasms, unlike the so-called ‘Warthin-like’ PTC,18–25 did not display lymphocytic infiltration of the papillary stalks of the carcinomatous component, as these latter were completely absent. In this aspect, the deep mingling of the lymphoid component with the carcinomatous component was, instead, somewhat more reminiscent of some lymphoepithelial carcinomas of other organs.…”

Thyroid Warthin-Like Cancer Concurrent With Multiple Sclerosis: A Case Report

“…Often, changes seen in Warthin-like PTC are associated to autoimmune thyroiditis (88%) [ 10 ]; its presence is considered a favorable prognostic factor. WLPTC in AT has lower rates of lymph node metastasis, extra-thyroidal extension and recurrence [ 11 ].…”

Cytomorphology of Warthin‐like variant of papillary thyroid carcinoma: A diagnosis not to be missed

“…The Warthin‐like variant of PTC is a rare variant of PTC, comprising of about 9% of all PTCs, and is most commonly reported in middle‐aged women. The tumour is so named because of its striking resemblance to the Warthin tumour of the salivary gland 1,2 . It is necessary to identify the different variants of PTC since some of them behave more aggressively than others.…”