title: 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.
authors.affiliation: Pathology Department, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Karla Judith
authors.initials: KJ
authors.lastname: González-Colunga
authors.affiliation: Pathology Department, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Abelardo
authors.initials: A
authors.lastname: Loya-Solis
authors.affiliation: Pathology Department, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Luis Ángel
authors.initials: LÁ
authors.lastname: Ceceñas-Falcón
authors.affiliation: Pathology Department, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: Oralia
authors.initials: O
authors.lastname: Barboza-Quintana
authors.affiliation: Endocrinology Division, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.
authors.forename: René
authors.initials: R
authors.lastname: Rodríguez-Gutiérrez
references.citation: Am J Surg Pathol. 1995 Jul;19(7):810-4
references.pmid: 7793479
references.citation: Endocr Rev. 2007 Dec;28(7):742-62
references.pmid: 17940185
references.citation: Cancer. 1994 Jan 15;73(2):424-31
references.pmid: 8293410
references.citation: Cancer. 2003 Mar 1;97(5):1181-5
references.pmid: 12599223
references.citation: Turk Patoloji Derg. 2013;29(2):150-5
references.pmid: 23661355
references.citation: Thyroid. 2007 Jul;17(7):655-61
references.pmid: 17696836
references.citation: Korean J Pathol. 2014 Apr;48(2):170-3
references.pmid: 24868234
references.citation: Thyroid. 2009 Nov;19(11):1167-214
references.pmid: 19860577
references.citation: Cancer. 1998 Feb 15;82(4):740-53
references.pmid: 9477108
references.citation: J Endocrinol. 2004 Nov;183(2):249-56
references.pmid: 15531713
references.citation: Case Rep Oncol Med. 2012;2012:689291
references.pmid: 23243533
references.citation: Am J Surg Pathol. 1996 Aug;20(8):964-74
references.pmid: 8712296
references.citation: Cancer Res. 2003 Apr 1;63(7):1454-7
references.pmid: 12670889
references.citation: Case Rep Med. 2010;2010:495281
references.pmid: 20593036
references.citation: Thyroid. 2008 Nov;18(11):1179-81
references.pmid: 18925842
references.citation: Best Pract Res Clin Endocrinol Metab. 2008 Dec;22(6):955-69
references.pmid: 19041825
references.citation: Cancer Res. 2005 May 15;65(10):4238-45
references.pmid: 15899815
references.citation: J Pathol. 2004 Feb;202(2):247-51
references.pmid: 14743508
references.citation: Pathol Oncol Res. 1999;5(4):315-7
references.pmid: 10607928
references.citation: Pathol Res Pract. 1998;194(5):341-7
references.pmid: 9651947