NURAY CAN, Fulya PUYAN ÖZ, Feriha ÖZ, FİLİZ ÖZYILMAZ, Şemsi ALTANER, Zeynep PEHLİVANOĞLU, A. Kemal KUTLU

Warthin-like papillary thyroid carcinoma: A rare tumor of the thyroid

Warthin benzeri papiller tiroid karsinomu, iyi prognozlu nadir görülen papiller karsinom varyantıdır. Tümör, ismini tükrük bezinin Warthin tümörüne morfolojik olarak benzerliğinden almaktadır. Başka bir merkezde 30 yıl önce bilateral subtotal tiroidektomi uygulanan ancak histopatolojik tanısı bilinmeyen 65 yaşındaki kadın hastanın yapılan tiroid ultrasonografisinde, sol lobta 20 mm çapında izoekoik solid nodül ve tiroid sintigrafisinde aynı lokalizasyonda hipoaktif nodül görüldü. Makroskopik olarak, sol lobta 1cm çapında kirli beyaz renkli, solid kıvamda nodüler lezyon tespit edildi. Mikroskopik olarak, sol lobta lenfositten zengin stroma ile çevrili papiller yapıları döşeyen, papiller karsinomun nükleer özelliklerine sahip, onkositik sitoplazmalı hücrelerden meydana gelen tümör izlendi. Tümör dışı tiroid dokusunda Hashimoto tiroiditi mevcuttu. İmmünohistokimyasal çalışmalarda tümörde sitokeratin19, TTF-1 (Thyroid transcription factor-1), Galektin3, HBME-1 (Mesothelioma antibody) ve tiroglobulin ile pozitiflik mevcuttu, Ki-67 proliferatif indeksi düşüktü. Warthin benzeri papiller tiroid karsinomu nadir görülen papiller karsinom varyantı olup, ayırıcı tanıda diğer onkositik hücreli lezyonlar ve de özellikle Hürthle hücreli karsinom akılda tutulmalıdır.

Warthin benzeri papiller tiroid karsinomu: Nadir bir tiroid tümörü

Warthin-like papillary thyroid carcinoma is a rare variant of papillary thyroid carcinoma with favorable prognosis. The tumor is named “Warthin-like papillary thyroid carcinoma” because of bearing a striking morphological resemblance to Warthin’s tumor occurring in the salivary glands. Thyroid ultrasonography of 65 years old female patient with a history of bilateral subtotal thyroidectomy 30 years ago in another center with unknown histopathological diagnosis revealed a 20 mm isoechoic solid nodule in the left lobe and this nodule was hypoactive in thyroid scintigraphy. Grossly, a grey-tan colored, solid nodule with 1 cm diameter was seen in the left lobe. Histologically, the tumor was composed of papillary structures surrounded by marked lymphocytic stroma and oncocytic cells with papillary carcinoma’s nuclear features were lining the papillae. Hashimoto’s thyroiditis was present throughout the thyroid. Immunohistochemically, tumor cells exhibited cytokeratin 19, Thyroid transcription factor-1 (TTF-1), Galectin-3, HBME-1(Mesothelioma antibody) and thyroglobulin positivity, proliferative index with Ki-67 was low. Warthin-like papillary thyroid carcinoma is a rare variant of papillary thyroid carcinoma and other oncocytic cell lesions especially Hurthle cell carcinoma should be kept in mind in the differential diagnosis of this neoplasm.

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