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Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi

Year 2023, Volume: 2 Issue: 1, 4 - 8, 30.03.2023
https://doi.org/10.57221/izmirtip.1213788

Abstract

Amaç: Warthin tümörü (WT) ikinci en sık benign tükürük bezi tümörüdür ve en sık parotiste yerleşir. Literatürde WT’ünde müsinöz metaplazi (MüM) ile ilgili sınırlı sayıda çalışma bulunmaktadır. Ayrıca yakın zamanda tanımlanan “WT benzeri mukoepidermoid karsinom (MEK)” ile WT’de MüM ayrımı da özel bir önem arz etmektedir. Burada 50 vakalık WT serimizde MüM değerlendirilmiş, kantitatif olarak skorlanmış ve MüM’nin klinik parametrelerle ilişkisi araştırılmıştır. Gereç ve Yöntem: Hastanemizde WT tanısı alan 50 olgu çalışmaya alındı. Olgulara ait hemotoksilen eozin (H&E) kesitler tekrar değerlendirildi. MüM izlenen olgulara müsikarmen histokimyasal boyası uygulanarak metaplazi derecelendirildi. Derecelendirme; mukus hücrelerin dağılımı (<10,≥10 hücre grubu), kolumnar hücrelere göre yüzdesi (<%1,≥%1-5,≥%5) ve x100 büyütmedeki mukus hücre sayısına (<50,≥50) göre yapıldı ve puanlamaya göre hafif, orta, şiddetli şeklinde gruplandırıldı. Bulgular: Toplam 50 olgunun 14’ü (%28) kadın, 36’sı (%72) erkekti. Olguların yaş ortalaması 61.3 idi. Olguların 18’inde (%36) MüM mevcuttu. Metaplazi tümörlerin 13’ünde (%72) hafif, 4’ünde (%23) orta, birinde (%5) şiddetli olarak derecelendirildi. Bu olguların 14’ü (%78) erkek, 4’ü (%22) kadındı. Cinsiyet ile MüM varlığı arasında istatistiksel olarak anlamlı ilişki görülmedi. MüM derecesi ile cinsiyet arasındaki ilişki tekrar değerlendirildi. Buna göre erkeklerin 12’si hafif, 1’i orta, 1’i şiddetli, kadınların 1’i hafif, 3’ü orta şiddetli olarak derecelendirildi. İstatistiksel olarak MüM derecesi ile cinsiyet arasında anlamlı bir ilişki görüldü (p=0.040). Yaş ve tümör boyutu ile MüM varlığı arasında anlamlı bir ilişki izlenmedi. Olgulara operasyon öncesi ince iğne aspirasyon yapılması ve tümör odak sayısı ile MüM varlığı arasında da anlamlı istatistiksel ilişki görülmedi. Sonuç: WT de MüM varlığı değişken oranlarda izlenmekte olup rutin incelemeler sırasında rahatlıkla gözden kaçabilmektedir. Özellikle yoğun MüM izlenen tümörlerde, WT ile örtüşen morfolojik özelliklere sahip “Warthin benzeri mukoepidermoid karsinom” ayırıcı tanıya alınmalı ve gerekirse moleküler incelemeler ile desteklenmelidir.

References

  • Referans1. Barnes, L. World Health Organization classification of tumours. Pathology and genetics of head and neck tumours; 2017.
  • Referans2. Zhang, X, Baloch ZW, Cooper K, Zhang PJ, Puthiyavettill R, LiVolsi VA. The significance of mucinous metaplasia in Warthin tumor: a frequent occurrence and potential pitfall. Human Pathology. 2020;99:13-26.
  • Referans3. Yorita K, Nakagawa H, Miyazaki K, Fukuda J, Ito S, Kosai M. Infarcted Warthin tumor with mucoepidermoid carcinoma-like metaplasia: a case report and review of the literature. J Med Case Rep. 2019 Jan 14;13(1):12.
  • Referans4.García, JJ, Hunt JL, Weinreb I, McHugh JB, Barnes EL, Cieply K et al. Fluorescence in situ hybridization for detection of MAML2 rearrangements in oncocytic mucoepidermoid carcinomas: utility as a diagnostic test. Hum Pathol. 2011;42:2001-9. Referans5. Foote FW, Frazell EL. Tumors of the major salivary glands. Cancer. 1953;6:1065-133.
  • Referans6. Ihrler S, Zietz C, Sendelhofert A, Lang S, Blasenbreu-Vogt S, Löhrs U. A morphogenetic concept of salivary duct regeneration and metaplasia. Virchows Archiv. 2002;440:519-26.
  • Referans7. Tirado Y, Williams MD, Hanna EY, Kaye FJ, Batsakis JG, El-Naggar AK. CRTC1/MAML2 fusion transcript in high grade mucoepidermoid carcinomas of salivary and thyroid glands and Warthin’s tumors: implications for histogenesis and biologic behavior. Genes Chromosomes Cancer. 2007;46:708-15.
  • Referans8. Rotellini M, Paglierani M, Pepi M, Franchi A. MAML2 rearrangement in Warthin’s tumour: a fluorescent in situ hybridisation study of metaplastic variants. J Oral Pathol Med. 2012;41:615-20.
  • Referans9. Skálová A, Vanecek T, Simpson RH, Vazmitsel MA, Majewska H, Mukensnabl P et al. CRTC1-MAML2 and CRTC3-MAML2 fusions were not detected in metaplastic Warthin tumor and metaplastic pleomorphic adenoma of salivary glands. Am J Surg Pathol. 2013;37:1743–50.
  • Referans10. Ishibashi K, Ito Y, Masaki A, Fujii K, Beppu S, Sakakibara T et al. Warthin-like mucoepidermoid carcinoma: a combined study offFluorescence in situ hybridization and whole-slide imaging. Am J Surg Pathol. 2015;39:1479-87.

Evaluation of Mucinous Metaplasia (MUM) in Warthin Tumor

Year 2023, Volume: 2 Issue: 1, 4 - 8, 30.03.2023
https://doi.org/10.57221/izmirtip.1213788

Abstract

Aim: Warthin tumor (WT) is the second most common benign salivary gland tumor and is most commonly located in the parotid. There is a limited number of studies in the literature on mucinous metaplasia (MUM) in WT. In addition, the distinction between the recently described “WT-like mucoepidermoid carcinoma (MEC)” and MUM in WT is of particular importance. Here, in our WT series of 50 cases, MU was evaluated, scored quantitatively, and the relationship of MU with clinical parameters was investigated. Materials and Methods: Fifty cases diagnosed with WT in our hospital were included in the study. Hematoxylin eosin (H&E) sections of the cases were re-evaluated. Metaplasia was graded by applying mucicarmen histochemical stain to cases with MUM. Rating; The distribution of mucous cells (<10,≥10 cell groups) was based on the percentage of columnar cells (<1%, ≥1-5%, ≥5%) and the number of mucus cells at x100 magnification (<50, ≥50) and according to scoring grouped as mild, moderate, and severe. Results: Of the total 50 cases, 14 (28%) were female and 36 (72%) were male. The mean age of the cases was 61.3. MUM was present in 18 (36%) of the cases. Metaplasia was graded as mild in 13 (72%), moderate in 4 (23%) and severe in one (5%) tumors. Of these cases, 14 (78%) were male and 4 (22%) were female. There was no statistically significant relationship between gender and the presence of MUM. The relationship between the degree of MUM and gender was re-evaluated. Accordingly, 12 of the men were graded as mild, 1 of them moderate, 1 of them severe, 1 of the women as mild and 3 of them as moderate. A statistically significant correlation was found between the degree of IMI and gender (p=0.040). No significant correlation was observed between age and tumor size and the presence of MUM. There was no statistically significant correlation between preoperative FNA and the number of tumor foci and the presence of MUM. Conclusion: The presence of MUM in WT is observed at variable rates and can easily be overlooked during routine examinations. Especially in tumors with intense MUM, “Warthin-like mucoepidermoid carcinoma” with morphological features overlapping with WT should be included in the differential diagnosis and supported by molecular studies if necessary.

References

  • Referans1. Barnes, L. World Health Organization classification of tumours. Pathology and genetics of head and neck tumours; 2017.
  • Referans2. Zhang, X, Baloch ZW, Cooper K, Zhang PJ, Puthiyavettill R, LiVolsi VA. The significance of mucinous metaplasia in Warthin tumor: a frequent occurrence and potential pitfall. Human Pathology. 2020;99:13-26.
  • Referans3. Yorita K, Nakagawa H, Miyazaki K, Fukuda J, Ito S, Kosai M. Infarcted Warthin tumor with mucoepidermoid carcinoma-like metaplasia: a case report and review of the literature. J Med Case Rep. 2019 Jan 14;13(1):12.
  • Referans4.García, JJ, Hunt JL, Weinreb I, McHugh JB, Barnes EL, Cieply K et al. Fluorescence in situ hybridization for detection of MAML2 rearrangements in oncocytic mucoepidermoid carcinomas: utility as a diagnostic test. Hum Pathol. 2011;42:2001-9. Referans5. Foote FW, Frazell EL. Tumors of the major salivary glands. Cancer. 1953;6:1065-133.
  • Referans6. Ihrler S, Zietz C, Sendelhofert A, Lang S, Blasenbreu-Vogt S, Löhrs U. A morphogenetic concept of salivary duct regeneration and metaplasia. Virchows Archiv. 2002;440:519-26.
  • Referans7. Tirado Y, Williams MD, Hanna EY, Kaye FJ, Batsakis JG, El-Naggar AK. CRTC1/MAML2 fusion transcript in high grade mucoepidermoid carcinomas of salivary and thyroid glands and Warthin’s tumors: implications for histogenesis and biologic behavior. Genes Chromosomes Cancer. 2007;46:708-15.
  • Referans8. Rotellini M, Paglierani M, Pepi M, Franchi A. MAML2 rearrangement in Warthin’s tumour: a fluorescent in situ hybridisation study of metaplastic variants. J Oral Pathol Med. 2012;41:615-20.
  • Referans9. Skálová A, Vanecek T, Simpson RH, Vazmitsel MA, Majewska H, Mukensnabl P et al. CRTC1-MAML2 and CRTC3-MAML2 fusions were not detected in metaplastic Warthin tumor and metaplastic pleomorphic adenoma of salivary glands. Am J Surg Pathol. 2013;37:1743–50.
  • Referans10. Ishibashi K, Ito Y, Masaki A, Fujii K, Beppu S, Sakakibara T et al. Warthin-like mucoepidermoid carcinoma: a combined study offFluorescence in situ hybridization and whole-slide imaging. Am J Surg Pathol. 2015;39:1479-87.
There are 9 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Ceren Enç 0000-0001-6464-9317

Esra Canan Kelten Talu 0000-0001-8767-4275

Ülkü Küçük 0000-0003-2916-0123

Publication Date March 30, 2023
Submission Date December 3, 2022
Published in Issue Year 2023 Volume: 2 Issue: 1

Cite

APA Enç, C., Kelten Talu, E. C., & Küçük, Ü. (2023). Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi. İzmir Tıp Fakültesi Dergisi, 2(1), 4-8. https://doi.org/10.57221/izmirtip.1213788
AMA Enç C, Kelten Talu EC, Küçük Ü. Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi. İzmir Tıp Fak. Derg. March 2023;2(1):4-8. doi:10.57221/izmirtip.1213788
Chicago Enç, Ceren, Esra Canan Kelten Talu, and Ülkü Küçük. “Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi”. İzmir Tıp Fakültesi Dergisi 2, no. 1 (March 2023): 4-8. https://doi.org/10.57221/izmirtip.1213788.
EndNote Enç C, Kelten Talu EC, Küçük Ü (March 1, 2023) Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi. İzmir Tıp Fakültesi Dergisi 2 1 4–8.
IEEE C. Enç, E. C. Kelten Talu, and Ü. Küçük, “Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi”, İzmir Tıp Fak. Derg., vol. 2, no. 1, pp. 4–8, 2023, doi: 10.57221/izmirtip.1213788.
ISNAD Enç, Ceren et al. “Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi”. İzmir Tıp Fakültesi Dergisi 2/1 (March 2023), 4-8. https://doi.org/10.57221/izmirtip.1213788.
JAMA Enç C, Kelten Talu EC, Küçük Ü. Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi. İzmir Tıp Fak. Derg. 2023;2:4–8.
MLA Enç, Ceren et al. “Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi”. İzmir Tıp Fakültesi Dergisi, vol. 2, no. 1, 2023, pp. 4-8, doi:10.57221/izmirtip.1213788.
Vancouver Enç C, Kelten Talu EC, Küçük Ü. Warthin Tümöründe Müsinöz Metaplazi Değerlendirilmesi. İzmir Tıp Fak. Derg. 2023;2(1):4-8.