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Nielson KJ, Lorenzo G, Agarwal S. Salivary Duct Carcinoma Arising in a Warthin Tumor of the Parotid Gland: A Rare Case Report with Review of Literature and PD-L1 Expression. Head Neck Pathol 2023; 17:1042-1051. [PMID: 37831429 PMCID: PMC10739639 DOI: 10.1007/s12105-023-01587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
Warthin's tumor is the second most common neoplasm of the parotid gland and consists of 2 components, including lymphoid stroma and glandular epithelium. Malignant transformation in this tumor is mostly seen in the lymphoid component; however, the carcinomatous transformation of the epithelial component is extremely rare. Cases of latter reported in the literature include squamous cell carcinoma, adenocarcinoma, mucoepidermoid carcinoma, oncocytic carcinoma, Merkel cell carcinoma, and undifferentiated carcinoma. We describe an extremely rare case of salivary duct carcinoma arising in a Warthin tumor in a 64-year-old male. Patient presented with an enlarging left parotid mass, biopsy of which showed salivary duct carcinoma. He subsequently underwent left parotidectomy along with left level II-IV lymph node dissection. Histology revealed both in situ as well as invasive salivary duct carcinoma arising from Warthin tumor. Immunohistochemistry showed tumor cells positive for CK7, AR, and GATA3, while p63 highlighted the myoepithelial cell layer in the in situ component. Her2 was 2+ by immunohistochemistry. In addition, PD-L1 IHC revealed positive expression with a combined positive score of 20%.
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Affiliation(s)
- Kaitlyn J Nielson
- Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, 1 University of New Mexico, Albuquerque, NM, 87131, USA
- Pathology, Mayo clinic, Rochester, USA
| | - Gamaliel Lorenzo
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Shweta Agarwal
- Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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Shou L, Chen X, Yang J, Jiang Y. Malignant transformation of Warthin's tumor into squamous cell carcinoma: A case report. Oncol Lett 2022; 24:201. [PMID: 35720470 PMCID: PMC9178688 DOI: 10.3892/ol.2022.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022] Open
Abstract
Malignant transformation of Warthin's tumor into squamous cell carcinoma is rare. The present study reported on a case of a 67-year-old male patient diagnosed with this condition. Microscopically, the tumor was mainly composed of squamous cell carcinoma and lymphoid stroma. Furthermore, the squamous cell carcinoma cells were arranged in a solid flake-like, papillary and cystic shape. Local bleeding was observed in the mass and a large number of lymphoid stroma-associated centers were observed between the cancer cells. The expression of cytokeratin (CK)5/6, P40, CK7, CK18, CK8 and MutS protein homolog 2 was detected by immunohistochemistry, in addition to Epstein-Barr encoding region in situ hybridization (−), Ki-67 (epithelial 25% +) and p53 (wild-type). The diagnosis of malignant transformation of Warthin's tumor into squamous cell carcinoma depends on the histopathology. The microscopic diagnosis is based on the dynamic process of scaling, atypical hyperplasia and cancerization of the eosinophilic columnar epithelium. Of note, it is also necessary to differentiate it from cervical malignant tumors such as lymphoepithelial carcinoma. The main clinical treatment is surgical resection with negative margins.
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Affiliation(s)
- Leyi Shou
- Department of Pathology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang 311200, P.R. China
| | - Xiaodan Chen
- Department of Pathology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang 311200, P.R. China
| | - Junjie Yang
- Department of Pathology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang 311200, P.R. China
| | - Yiqian Jiang
- Department of Radiotherapy, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang 311200, P.R. China
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Hellquist H, Paiva-Correia A, Vander Poorten V, Quer M, Hernandez-Prera JC, Andreasen S, Zbären P, Skalova A, Rinaldo A, Ferlito A. Analysis of the Clinical Relevance of Histological Classification of Benign Epithelial Salivary Gland Tumours. Adv Ther 2019; 36:1950-1974. [PMID: 31209701 PMCID: PMC6822986 DOI: 10.1007/s12325-019-01007-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, for several reasons, this has not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour. METHODS A search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically. RESULTS Pleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur. CONCLUSIONS A correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types of basal cell adenoma can occasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.
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Affiliation(s)
- Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Faro, Portugal.
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Centre (ABC), Faro, Portugal.
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
| | - António Paiva-Correia
- Epigenetics and Human Disease Laboratory, Faro, Portugal
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Centre (ABC), Faro, Portugal
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
- Histopathology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
| | - Miquel Quer
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Peter Zbären
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - Alena Skalova
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzeň, Czech Republic
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Multifocal Warthin's Tumor: An Uncommon Presentation of Bilateral Cervical Lymphadenopathy. Case Rep Otolaryngol 2018; 2018:3791825. [PMID: 30254781 PMCID: PMC6140128 DOI: 10.1155/2018/3791825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022] Open
Abstract
Warthin's tumor is the second most common benign lesion of the parotid gland. It is most commonly encountered in male smokers in the fifth to seventh decades of life. Uniquely, among benign lesions of the parotid gland, it can be seen bilaterally in 7–10% of cases. Very rarely, Warthin's tumor can also mimic malignant or metastatic disease by presenting within cervical lymph nodes. We present a rare case of a 71-year old male smoker with bilateral parotid lesions in addition to progressively enlarging cervical and mediastinal lymphadenopathy. Excisional biopsy of a cervical lymph node ultimately revealed Warthin's tumor.
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Yu C, Song Z, Xiao Z, Lin Q, Dong X. Mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland: Clinicopathological characteristics and immunophenotypes. Sci Rep 2016; 6:30149. [PMID: 27417276 PMCID: PMC4945913 DOI: 10.1038/srep30149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC), an extremely rare tumor, arises from the epithelial component of preexisting parotid Warthin tumors (WT). Among the 309 cases of surgically resected WTs in Chinese PLA General Hospital and Beijing Shijitan Hospital of Capital Medical University, 5 cases (1.6%) fulfilled the criteria for MECs transformed from WTs. Clinicopathological characteristics of MECs was demonstrated in order to avoid misdiagnosis of this rare type of tumor. All the 5 patients, 3 males and 2 females, presented painless masses in the parotid gland. MECs were located inside or at the edge of WTs, with an obvious transitional zone between WT and MEC. Basal cells of WTs and epidermoid cells of MECs were strongly positive for cytokeratin CK5/6, CK34βE12, and P63; whereas negative for CK7, CK20, and CEA. Mucous cells of MECs were positive for CK7, CEA, as well as periodic acid-Schiff (PAS), whereas negative for CK5/6, CK34βE12, CK20, and P63. MECs patients were followed up for 25–69 months after surgery, presenting no evidence of recurrence or metastasis. Collectively, MECs arising from WT is very rare. The pathological diagnosis was based on histological morphology, especially the transitional zone between WT and MEC.
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Affiliation(s)
- Chunkai Yu
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P. R. China
| | - Zhigang Song
- Department of Pathology, The Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Zhibo Xiao
- Department of Plastic Surgery, The Second Affiliated Hospital of Harbin Medical University, P. R. China
| | - Qiushi Lin
- Department of Gastroenterology, Stephenson Cancer Center, Department of Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, USA
| | - Xiaoqun Dong
- Department of Gastroenterology, Stephenson Cancer Center, Department of Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, USA
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Kim HJ, Yoo YS, Park K, Kwon JE, Kim JY, Monzon FA. Genomic aberrations in salivary duct carcinoma arising in Warthin tumor of parotid gland: DNA microarray and HER2 fluorescence in situ hybridization. Arch Pathol Lab Med 2011; 135:1088-91. [PMID: 21877991 DOI: 10.5858/2010-0428-crr1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Carcinoma arising from Warthin tumor is extremely rare. A 79-year-old man was admitted for a firm, well-defined, 5-cm left infra-auricular mass. Aspiration cytology showed many lymphohistiocytes and oncocytes in a proteinaceous background, compatible with Warthin tumor. A left superficial parotidectomy showed a solid mass around the cyst wall. The tumor cells of the solid area were arranged as infiltrative ducts with a few foci of malignant transformation. Virtual karyotyping disclosed a complex pattern of genetic aberrations with a focal amplification in 12q14-q21.2. This chromosomal region contains the MDM2 (murine double minute) gene, which regulates p53 inactivation. HER2 fluorescence in situ hybridization showed a focal amplification. Subsequently, the patient underwent total parotidectomy and ipsilateral neck dissection for a recurrence. To our knowledge, this is the first case of salivary duct carcinoma arising from Warthin tumor. The essential molecular pathway has not been reported, we presume an important role of MDM2 amplification- P53 inactivation.
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Affiliation(s)
- Hyun-Jung Kim
- Department of Pathology, Inje University, Sanggye Paik Hospital, Seoul, Korea.
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Hall JE, Statham MM, Sheridan RM, Wilson KM. Multifocal synchronous ipsilateral Warthin tumors: case report and review of the literature. EAR, NOSE & THROAT JOURNAL 2011; 89:E1-3. [PMID: 20859854 DOI: 10.1177/014556131008900901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 73-year-old woman who presented with an enlarging superficial parotid mass, a concomitant ipsilateral deep-lobe parotid mass, and associated upper jugular lymphadenopathy. The clinical presentation and radiographic imaging were suggestive of malignancy, and the patient was treated with total parotidectomy with upper jugular lymph node sampling. Pathologic examination revealed two distinct masses, one in the superficial lobe and one in the deep lobe of the parotid gland, both consistent with synchronous Warthin tumors. Analysis of the upper jugular lymph nodes was consistent with reactive lymphoid hyperplasia. Although the true incidence of multicentricity in ipsilateral Warthin tumors may be underappreciated and underreported, this entity should remain in the differential diagnosis for unilateral parotid masses.
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Affiliation(s)
- Joseph E Hall
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, University Hospital, Cincinnati, OH 45267, USA
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Bell D, Luna MA. Warthin adenocarcinoma: analysis of 2 cases of a distinct salivary neoplasm. Ann Diagn Pathol 2008; 13:201-7. [PMID: 19433301 DOI: 10.1016/j.anndiagpath.2008.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Carcinomas arising in or from the epithelial component of preexisting parotid Warthin tumors (WTs) are rare; the other histologic types of carcinoma found to arise from WTs are adenocarcinoma not otherwise specified, undifferentiated, mucoepidermoid, squamous cell, and oncocytic. The aim of this study is to describe the clinicopathologic features of a distinct salivary gland neoplasm, previously undescribed, with a striated duct phenotype arising from WT. We have designated this neoplasm "Warthin adenocarcinoma" (WA). In this retrospective study, we searched the surgical pathology files of the Department of Pathology at The University of Texas M.D. Anderson Cancer Center for cases of malignant WT and salivary adenocarcinoma not otherwise specified diagnosed from January 1, 1985, through December 31, 2006, and evaluated patients' medical records and pathologic material. We obtained tissue sections and immunohistochemically stained them with antibodies against p63; Bcl-2; cytokeratin (CK)903, CK7, CK14, and CK18; antimitochondrial antibody (AMA); smooth muscle actin; calponin; S-100; and Ki-67. We identified 2 cases of WA; both patients were women, 44 and 60 years of age, with 4.0- and 4.5-cm tumors in the left parotid gland. Histologically, the tumors were composed of bilayered duct-like structures: The inner layer was formed by a single row of columnar oxyphilic cells expressing CK7, CK14, CK18, and AMA. The outer layer was composed of multiple layers of small round dark cells with scanty cytoplasm that expressed p63, Bcl-2, and CK903 and were focally positive for AMA and negative for myoepithelial markers. The Ki-67 proliferative indices were 20%; and 25%. A residual WT with transition to carcinoma was identified in both cases. Treatment had consisted of total parotidectomy with postoperative irradiation. Patients were free of disease 1 and 3 years after treatment. Warthin adenocarcinoma is a unique salivary gland carcinoma representing the malignant epithelial counterpart of WT. The identification of additional cases would help to better elucidate the line of differentiation of the tumor and further define its natural history.
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Affiliation(s)
- Diana Bell
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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