Papillary Thyroid Carcinomas with Warthin and Tall Cell Features: A Review of 21 Patients.
Kathleen T Montone, Zubair W Baloch, Virginia A LiVolsi. University of Pennsylvania, Philadelphia
Background: The Warthin-like variant of papillary thyroid carcinoma (WLV-PTC), is characterized by the presence of a papillary proliferation of oncocytic follicular epithelium showing nuclear cytology of PTC; the cells are arranged on fibrovascular cores containing a dense lymphoplasmacytic infiltrate. The prognosis of these lesions is excellent. We describe the clinicopathologic features characteristics of a cohort of patients in which WLV-PTC was intimately associated with tall cell variant (TCV) of PTC, a known aggressive variant.
Design: The computerized pathology case archives and the authors' consultation files (from 1985 -2010) were searched for cases with a diagnosis of WLV-PTC and PTC with WL areas. The available histologic slides were evaluated and clinical information obtained.
Results: Seventy-seven patients (age range 17-85; median age 51 yr and female to male ratio 5:1) met the search criteria. WL areas comprised from <5% to 100% of the lesions. 97% of patients had a background of chronic lymphocytic thyroiditis. 73% (56/77) showed classic WLV while 27% (21/77) showed WL areas admixed with TC areas (7 with WLV with <10 percent TC change at the periphery, 8 with variable mixture of WL and TC areas, and 4 with TCV with focal (often <10%) WL areas).The last 2 cases showed WL features, peripheral TCV and anaplastic carcinoma with extensive nodal as well as visceral metastases in one patient. In the 56 patients with pure WLV, ipsilateral nodal metastases, extrathyroidal extension and vascular invasion were noted in 10 (18%), 8 (14%) and 2 (3.5%) patients respectively. Of the 21 patients whose tumors showed TC differentiation, 15 (71%) showed extrathyroidal extension, 14 (68%) had nodal metastases and 6 (29%) showed angioinvasion. One patient with TC features had nodal metastases with necrosis and solid growth consistent with poorly differentiated carcinoma.
Conclusions: Pure WLV-PTC is associated with an excellent outcome. Some of WLV-PTC also have TC differentiation. These patients have a higher incidence of extrathyroidal extension, lymph node metastases and angioinvasion. In addition, rare examples of WLV-PTC with TC areas may show dedifferentiation to anaplastic carcinoma. The findings in our series suggests that the relationship between WLV and TCV of PTC deserves further study.
Category: Head & Neck
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 137, Wednesday Morning