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Vol. 57, No. 3, 2013
Issue release date: May – June

Warthin Tumor with Signet-Ring Cell Features as a Pitfall in Salivary Gland Cytopathology

Bellevicine C. · Iaccarino A. · Malapelle U. · Troncone G.
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Abstract

Background: Warthin tumor (WT) is a common parotid lesion reliably diagnosed by fine-needle aspiration (FNA). Worrisome metaplastic changes may occur in WT. Their interpretation as mucoepidermoid carcinoma represents a diagnostic pitfall. Moreover, WT and mucoepidermoid carcinoma may coexist, making this distinction difficult. So it is worthwhile to report unusual WT features. We describe a WT with signet-ring cells (SRCs). Case: A 61-year-old male presenting with a 3.6-cm right parotid gland mass underwent FNA with rapid on-site evaluation. DiffQuik-stained smears showed groups of oncocytic cells with abundant granular cytoplasm in a background rich with debris, foamy macrophages and lymphoid cells. SRCs were observed on Papanicolaou-stained smears prepared from a second pass. A WT with SRC features was diagnosed. Histology revealed a WT with post-FNA infarctual changes. Conclusion: To avoid false-positive diagnoses, the cytopathologist should be aware that SRC features may occur in WT. The concomitant presence of oncocytes and SRCs is useful to correctly diagnose this unusual WT variant.



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References

  1. Parwani AV, Ali SZ: Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer 2003;99:166-171.
  2. Flezar M, Pogacnik A: Warthin's tumour: unusual vs. common morphological findings in fine needle aspiration biopsies. Cytopathology 2002;13:232-241.
  3. Layfield LJ, Glasgow BJ: Diagnosis of salivary gland tumors by fine-needle aspiration cytology: a review of clinical utility and pitfalls. Diagn Cytopathol 1991;7:267-272.
  4. Kaur J, Mannan R, Duggal P, Bhasin TS, Manjari M: Fine needle aspiration diagnosis of ipsilateral synchronous neoplasm - mucoepidermoid carcinoma with Warthin tumor in parotid gland. Gulf J Oncolog 2012;1:75-78.
  5. Srivastava S, Nadelman C: Synchronous ipsilateral Warthin tumor encased by a separate mucoepidermoid carcinoma of the parotid gland: a case report and review of the literature. Diagn Cytopathol 2010;38:533-537.
  6. Viguer JM, Vicandi B, Jimenez-Heffernan JA, Lopez-Ferrer P, Gonzalez-Peramato P, Castillo C: Role of fine needle aspiration cytology in the diagnosis and management of Warthin's tumour of the salivary glands. Cytopathology 2010;21:164-169.
  7. Howlett DC, Kesse KW, Hughes DV, Sallomi DF: The role of imaging in the evaluation of parotid disease. Clin Radiol 2002;57:692-701.
  8. Ragazzi M, Carbonara C, Rosai J: Nonneoplastic signet-ring cells in the gallbladder and uterine cervix. A potential source of overdiagnosis. Hum Pathol 2009;40:326-331.
  9. Wang K, Weinrach D, Lal A, Musunuri S, Ramirez J, Ozer O, Keh P, Rao MS: Signet-ring cell change versus signet-ring cell carcinoma: a comparative analysis. Am J Surg Pathol 2003;27:1429-1433.
  10. Foschini MP, Baldovini C, Pennesi MG, Cocchi R, Simpson RH: Signet ring cell tumor of the minor salivary gland exhibiting benign behavior. Hum Pathol 2012;43:303-306.
  11. Zamecnik M, Gogora M: Signet-ring cells simulating carcinoma in minor salivary gland of the lip. Pathol Res Pract 1999;195:723-724.
  12. Michal M, Hrabal P, Skalova A: Oncocytic cystadenoma of the parotid gland with prominent signet-ring cell features. Pathol Int 1998;48:629-633.
  13. Schwerer MJ, Kraft K, Baczako K, Maier H: Cytokeratin expression and epithelial differentiation in Warthin's tumour and its metaplastic (infarcted) variant. Histopathology 2001;39:347-352.
  14. Guerrero-Medrano J, Delgado R, Albores-Saavedra J: Signet-ring sinus histiocytosis: a reactive disorder that mimics metastatic adenocarcinoma. Cancer 1997;80:277-285.
  15. Iezzoni JC, Mills SE: Nonneoplastic endometrial signet-ring cells. Vacuolated decidual cells and stromal histiocytes mimicking adenocarcinoma. Am J Clin Pathol 2001;115:249-255.
  16. Laforga JB: Foamy macrophages in pylorocardiac gastric carcinoma: a source of confusion with signet ring cell carcinoma. Histopathology 2003;43:98-100.
  17. Di Palma S, Simpson RH, Skalova A, Michal M: Metaplastic (infarcted) Warthin's tumour of the parotid gland: a possible consequence of fine needle aspiration biopsy. Histopathology 1999;35:432-438.


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