Warthin tumor with mucoepidermoid carcinoma-like mucous metaplasia

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  • KUMAGAE Takato
    Department of Diagnostic Pathology, Kurume University Hospital
  • KAWAHARA Akihiko
    Department of Diagnostic Pathology, Kurume University Hospital
  • ABE Hideyuki
    Department of Diagnostic Pathology, Kurume University Hospital
  • TAKASE Yorihiko
    Department of Diagnostic Pathology, Kurume University Hospital
  • MURATA Kazuya
    Department of Diagnostic Pathology, Kurume University Hospital
  • MAKINO Ryo
    Department of Diagnostic Pathology, Kurume University Hospital
  • FURUTA Takuya
    Department of Diagnostic Pathology, Kurume University Hospital
  • NAITO Yoshiki
    Department of Clinical Laboratory Medicine, Kurume University Hospital
  • AKIBA Jun
    Department of Diagnostic Pathology, Kurume University Hospital

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  • 粘液化生を伴うワルチン腫瘍の 1 例
  • ―A case report―

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Abstract

<p>Background : Salivary gland tumors are known to sometimes exhibit various metaplastic changes. Mucous metaplasia is rare in Warthin tumors, and the cytological distinction between the Warthin-like variant of mucoepidermoid carcinomas (MEC) and a Warthin tumor with mucous metaplasia can be challenging. Here we report a case of Warthin tumor with mucous metaplasia of the parotid gland.</p><p>Case : A male in his 60 s with a history of smoking presented with a painless mass in the right parotid gland that measured about 30 mm in diameter. Fine-needle aspiration cytology revealed sheet clusters of bland epithelial cells containing pale light-green cytoplasm with mucous metaplastic cells in the focal lymphocytic background. The typical oncocytic epithelium of a Warthin tumor was observed in focal areas, but none of the intermediate/squamous and mucous cells that are characteristic findings in MEC were seen in the smears. The tumor was a typical Warthin tumor with bilayered oncocytic epithelium and basal cells with a lymphoid stroma, and mucous metaplastic cells were found in both the cysts and solid area. Fluorescence in situ hybridization of the surgically resected specimen did not show any evidence of MAML2 (mastermind-like transcriptional coactivator 2) gene rearrangements.</p><p>Conclusion : Knowledge of the cytological characteristics of Warthin tumors with mucous metaplastic cells resembling low-grade MEC enables accurate diagnosis of these salivary gland tumors.</p>

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