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Review
. 2023 Jul 11:14:1210943.
doi: 10.3389/fendo.2023.1210943. eCollection 2023.

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

Abdel Mouhaymen Missaoui  1   2 , Fatma Hamza  2   3 , Wafa Belabed  1   2 , Manel Mellouli  2   4 , Mohamed Maaloul  2   3 , Slim Charfi  2   4 , Issam Jardak  2   3 , Tahya Sellami-Boudawara  2   4 , Nabila Rekik  1   2 , Mohamed Abid  1   2
Affiliations
Review

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

Abdel Mouhaymen Missaoui et al. Front Endocrinol (Lausanne). .

Abstract

Background: Papillary 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 presentation: A 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 review: It 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.

Conclusion: WLPTC 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.

Keywords: case report; chronic lymphocytic thyroiditis; papillary thyroid carcinoma; review of the literature; thyroid neoplasms; thyroid nodule; warthin-like papillary thyroid carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Histopathological analysis of a bifocal mixed presentation of papillary thyroid carcinoma with classic and warthin-like histology in our reported patient. Nodule A: Warthin-like papillary thyroid carcinoma (A1-A4). (A1) Histological examination revealed the presence of branching papillae composed of oncocytic tumor cells amidst a reactive lymphoid stroma (yellow star) (HEx50). (A2) A prominent lymphoplasmacytic infiltrate was identified within the cores of the papillae (→) (HEx100). (A3) The tumor cells exhibited nuclear enlargement, chromatin clearing, and nuclear groove (→) (HEx400). (A4) Pseudoinclusions were observed in the nuclei of the tumor cells (→) (HEx400). Nodule B: Classic papillary thyroid carcinoma (B1-B4). (B1) Classic papillary thyroid carcinoma (black star) was identified invading the thyroid parenchyma (blue star) (HEx50). (B2) The tumor featured a proliferation of complex papillae (HEx100). (B3) The cores of the papillae were identified as fibrovascular without a background of reactive lymphoid stroma (HEx200). (B4) The tumor cells exhibited distinctive papillary nuclear features such as nuclear enlargement and chromatin clearing (→) (HEx400).
Figure 2
Figure 2
Microscopic findings of lymph node metastases. Histological examination of lymph node metastases revealed the typical histopathological features of conventional papillary thyroid carcinoma (indicated by the black star) (HE x100).
Figure 3
Figure 3
A graphical depiction of the data research and selection process in our comprehensive review of the literature. WLPTC, Warthin-Like Papillary Thyroid Carcinoma.
See this image and copyright information in PMC

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