Einstein (Sao Paulo, Brazil) · 2026
Preliminary diagnostic criteria for distinguishing metaplastic Warthin tumors from mucoepidermoid carcinomas rich in lymphoid stroma.
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Bonfitto João Felipe Leite, Scarini João Figueira, Ferreira Iara Vieira, de Lima-Souza Reydson Alcides, Egal Erika Said Abu, Altemani Albina, Mariano Fernanda Viviane
Аннотация
OBJECTIVE: This study aimed to analyze the clinicopathological and immunohistochemical profiles of unconventional Warthin tumors and mucoepidermoid carcinomas.
METHODS: Eleven low-grade salivary gland tumors with Warthin-like features were analyzed. Group A (n=6) showed a double-layered oncocytic epithelium in less than 50% of the epithelial cells, whereas Group B (n=5) lacked this feature. Additionally, five conventional Warthin tumors and ten conventional mucoepidermoid carcinomas were analyzed as reference groups. Immunohistochemical staining was performed for cytokeratins (types 5/6, 7, and 14), p63, mitochondrial antigens, and Ki-67. Expression patterns were compared between groups.
RESULTS: Group A exhibited an oncocytic epithelium arranged in a double-layered pattern, with mitochondrial antigens strongly staining the luminal oncocytic cells. Cytokeratin 7 expression in Warthin tumors was predominantly luminal. In contrast, Group B showed glandular and cystic structures with diffuse mitochondrial antigen and cytokeratin 7 positivity. Immunohistochemical analysis revealed significant differences, with Warthin tumors showing distinct double-layered epithelial structures, and mucoepidermoid carcinomas displaying diffuse staining patterns.
CONCLUSION: Distinct immunohistochemical profiles, including mitochondrial antigen and cytokeratin 7 expression, along with morphological differences, support the classification of Group A as metaplastic Warthin tumors and Group B as Warthin-like variants of mucoepidermoid carcinoma. These findings highlight the importance of molecular and immunohistochemical analyses for accurate classification of these tumors.
METHODS: Eleven low-grade salivary gland tumors with Warthin-like features were analyzed. Group A (n=6) showed a double-layered oncocytic epithelium in less than 50% of the epithelial cells, whereas Group B (n=5) lacked this feature. Additionally, five conventional Warthin tumors and ten conventional mucoepidermoid carcinomas were analyzed as reference groups. Immunohistochemical staining was performed for cytokeratins (types 5/6, 7, and 14), p63, mitochondrial antigens, and Ki-67. Expression patterns were compared between groups.
RESULTS: Group A exhibited an oncocytic epithelium arranged in a double-layered pattern, with mitochondrial antigens strongly staining the luminal oncocytic cells. Cytokeratin 7 expression in Warthin tumors was predominantly luminal. In contrast, Group B showed glandular and cystic structures with diffuse mitochondrial antigen and cytokeratin 7 positivity. Immunohistochemical analysis revealed significant differences, with Warthin tumors showing distinct double-layered epithelial structures, and mucoepidermoid carcinomas displaying diffuse staining patterns.
CONCLUSION: Distinct immunohistochemical profiles, including mitochondrial antigen and cytokeratin 7 expression, along with morphological differences, support the classification of Group A as metaplastic Warthin tumors and Group B as Warthin-like variants of mucoepidermoid carcinoma. These findings highlight the importance of molecular and immunohistochemical analyses for accurate classification of these tumors.