Endocrine Abstracts

Introduction: Warthin-like papillary thyroid carcinoma (WLPTC) is a rare variant of thyroid papillary carsinoma (TPC). We present these cases to point out this rare variant.

Case reports: Case 1: A 38-year-old woman admitted to outpatient clinic with a thyroid nodule. Ultrasonography of thyroid gland revealed bilateral multinodular goiter with microcalcifications. Thyroid autoantibodies were elevated. Thyroid function tests (TFT) were normal. Fine-needle aspiration (FNA) was suspicious for papillary carcinoma. She underwent total thyroidectomy and regional lymph node dissection. Histopathological diagnosis was bilateral, multifocal WLPTC. Microscopically, three tumor foci were detected on severe chronic lymphocytic thyroiditis (CLT) background. The largest tumor was 10 mm in right lobe. Lymphovascular invasion and extrathyroidal extension were absent. Postoperative stimulated thyroglobulin (Tg) levels were elevated (50.2 ng/ml). Suppressed Tg levels were under 0.2 ng/ml. Radioactive iodine treatment wasn’t performed. The patient was followed with neck ultrasonography for a year and no metastases were detected.

Case 2: A 28-year-old woman admitted to outpatient clinic with a thyroid nodule. Thyroid ultrasonography showed a 12×8×6 mm nodule with microcalcification on right thyroid lobe. Thyroid autoantibodies were elevated. TFT were normal. FNA cytology of thyroid nodule was reported as suspicious for malignancy. Total thyroidectomy was performed. Histopathological diagnosis was locally invasive WLPTC underlying severe CLT in right lobe. Tumor diameter was 13 mm. There was local capsular invasion but not vascular invasion, lymph node metastasis or extrathyroidal extention. Stimulated Tg levels were under 0.2 ng/ml. Radioactive iodine treatment was not performed. She was followed with neck ultrasonography for a year and no metastasis was detected.

Conclusions: WLPTC is a variant of TPC with good prognosis. Low risk patients can be followed with reserving RAI treatment for only selected cases.