Primary Warthin's-like adenocarcinoma of the lung: A clinicopathological, immunohistochemical, and molecular analysis of three cases.

Three cases of primary pulmonary adenocarcinoma with prominent lymphoid stroma and papillary features mimicking Warthin's tumor are presented. The patients are two women and one man ages 52, 62, and 74 years respectively. Clinically, the patients presented with non-specific symptoms of cough, dyspnea, and chest pain. Imaging showed the presence of an intrapulmonary mass in the right lower, right upper and left lower lobe. All patients underwent lobectomy. Histologically, the tumors were characterized by the presence of and oncocytic papillary growth pattern embedded in a lymphoid rich background. Immunohistochemical stains for TTF-1, keratin 7, and beta-catenin were positive in the epithelial component, while CD20 showed strong positive staining in the lymphoid component. In addition, CD4 and CD8 also showed positive staining in a ratio of 3-4:1, EBER was negative. Kras mutations with wild type EGFR were identified in one case. Clinical follow-up ranging from 8 to 24 months was obtained showing that all patients are alive without recurrence. The cases herein presented represent an unusual histological variant of primary lung adenocarcinoma, which closely mimics Warthin's tumor.

Values of fine-needle aspiration cytology of parotid gland tumors: A review of 996 cases at a single institution.

BACKGROUND: We evaluated the diagnostic accuracy of fine-needle aspiration cytology (FNAC) in a large series of benign and malignant parotid tumors. METHODS: The FNAC diagnosis of 821 benign and 175 malignant parotid tumors managed at our department between 1999 and 2017 was correlated with the final histology. RESULTS: FNAC made a correct histopathological diagnosis in 72% of the benign parotid tumors; however, FNAC provided a correct grade in only 34% of the malignant tumors. FNAC correctly identified the histology of 94% of pleomorphic adenomas subsequently confirmed by histopathological examination. The sensitivity, specificity, and diagnostic accuracy of FNAC for detecting malignancy were 82.3%, 98.7%, and 95.9%, respectively. CONCLUSION: FNAC generally provided the correct histological diagnosis for benign tumors. However, the histological evaluation and grading of malignant tumors were poor. Although FNAC showed good sensitivity, specificity, and accuracy, its sensitivity decreased when nondiagnostic cases were included in the analysis.

Parotid tumors: a 10-year experience.

PURPOSE: The aim of the present study was to analyze the clinical presentation, histopathology, and complications of parotid tumors, as well as the management of malignant parotid tumors. METHODS: We retrospectively reviewed the medical records of 271 patients who underwent parotidectomy from August 1996 to July 2006. Data including age, sex, clinical signs and symptoms, histologic findings, complications, malignant tumor stage, and prognosis were collected from medical charts. RESULTS: Of the 271 patients who underwent parotidectomy, 229 (85%) had benign tumors, 33 (12%) had malignant tumors, and 9 had chronic inflammatory disease (3%). The most common benign tumor was pleomorphic adenoma (51%), and the most common malignant tumor was mucoepidermoid carcinoma (3%). The 5-year overall survival rate was 42%, and the disease-specific survival rate for malignant tumor was 72%. Only disease stage was the statistically significant prognostic factor of malignancy. The most common complication of parotidectomy was transient facial palsy (18%). CONCLUSIONS: Standardized superficial and total parotidectomy are safe procedures for treating parotid tumors. Management of malignant tumors depends on tumor stage and histologic grade. Advanced tumor stage is a predictor of poor outcome.

Conservative management of warthin tumour.

BACKGROUND: Warthin tumour (WT) is usually treated by surgery to establish a histologic diagnosis. Conservative management is considered appropriate for patients with significant comorbidities, making anesthesia high risk. Preoperative fine-needle aspiration cytology (FNAC) is useful in diagnosing WT, making conservative management an option. In our institution, patients with an FNAC diagnostic of WT have the option of conservative management. METHOD: Retrospective review of cases of WT over 10 years (1996-2006) to study the demographics of patients treated conservatively and surgically and to establish the accuracy of FNAC. RESULTS: Eighty-six cases of WT were identified during the study period for which FNAC was diagnostic, of which 58 cases (67.4%) were treated conservatively and 28 cases (32.6%) were treated by superficial parotidectomy. A further seven cases of WT were diagnosed on histology as the corresponding FNAC was incorrect in two cases and nondiagnostic in five cases. With regard to WT, FNAC in our unit had a sensitivity of 80% and a specificity of 100%. Females accounted for 54.7% of cases, which is much higher than previously reported and likely reflects the high prevalence of smoking among females in Liverpool. CONCLUSION: Conservative management for WT on the basis of a diagnostic FNAC was employed in 67.4% of cases. This included young patients who preferred to avoid surgery. Conservative management is a viable option if reliable cytologic reporting is available.