Endocrine Abstracts

Introduction

A rarely reported histologic subtype of the papillary thyroid cancer is the Warthin-like variant (WLPTC). This carcinoma resembles the Warthin tumour of the salivary gland by virtue of a papillary pattern of eosinophilic tumour cells associated with a rich lymphoplasmacytic infiltrate in the cores of the papillae. Due to the its rarity, the pathological characteristics and clinical behavior of WLPTC are not well documented.

Case report

We report a case of a 51 year old female patient, with no relevant personal history and no familial history of thyroid disease. Due to the presence of palpable thyroid nodules the patient underwent a thyroid ultrasound scan. The exam documented the presence of an heterogeneous thyroid, hypoechogenic in nature, with multiple millimetric hypoechogenic nodules, favoring the diagnosis of thyroiditis. Of particular interest a 28 mm hypoechogenic solid nodule was identified on the left thyroid lobe, and two strongly hypoechogenic nodules on the right thyroid gland (13 mm and 15 mm), surrounded by multiple punctiform hyperechogenic foci. The fine-needle aspiration cytology of the largest right lobe nodule was compatible with papillary carcinoma while the left lobe largest nodule was benign. Thyroid function exams were normal and anti-thyroid antibodies were positives. The patient underwent complete thyroidectomy. The histology revealed the diagnosis of WLPTC, two foci on the right lobe, 25 mm and 5 mm in size, with no angioinvasion nor extrathyroidal extension, associated to Hashimoto thyroiditis, with large lymphoid follicles and normofollicular nodular hyperplasia. After a follow-up of six months, there is no evidence of disease.

Discussion

The Warthin-like variant of papillary carcinoma thyroid is a rare and relatively unknown variant of papillary thyroid carcinoma. This variant is frequently associated with Hashimoto’s thyroiditis and it is classically diagnosed in females over the age of 50 years. The prognosis is expected to be similar to that of classic papillary thyroid carcinoma.