Autopsy and Case Reports
Autopsy and Case Reports
Article / Clinical Case Report

Warthin-like mucoepidermoid carcinoma of the parotid gland: a diagnostic and therapeutic dilemma

Vigneshwaran Balasubiramaniyan; Mahesh Sultania; Mukund Sable; Dillip Muduly; Madhabananda Kar

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Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor. Although the parotid gland is the most common site of involvement, other major salivary glands and the minor salivary glands—most commonly of the palate—also can be involved. The management of mucoepidermoid carcinoma depends on the grade of the tumor and the adequacy of resection. We present the case of a 56-year-old female presenting a painless progressive cheek mass over 2 months. Imaging and fine-needle aspiration cytology provided the diagnosis of Mucoepidermoid carcinoma. A superficial parotidectomy was done, and the histopathology revealed a predominantly cystic tumor with a bilayered epithelium of oncocytic and basal cells. Moderate nuclear pleomorphism with infiltration of atypical squamous cells in few glandular cysts was seen. Special staining revealed the presence of intracellular mucin. A diagnosis of Warthin-like variant of MEC was made, based on these findings. After the surgical procedures, the patient is disease-free at 8 months of follow-up. The Warthin-like variant is a rare variant of MEC with fewer than 10 cases described in the English literature. Various differential diagnoses include the malignant transformation of Wartin tumor (WT), squamous metaplasia of WT, and metastasis from a distant primary. We emphasize the role of routine microscopy in identifying rare variants of common malignancies. Even though translocation studies are helpful in diagnosis, the typical histopathological findings should confirm it.


Salivary Gland Neoplasms, Carcinoma, Mucoepidermoid, Parotid Neoplasm


Subhashraj K. Salivary gland tumors: a single institution experience in India. Br J Oral Maxillofac Surg. 2008;46(8):635-8. 10.1016/j.bjoms.2008.03.020.18620785

Ishibashi K, Ito Y, Masaki A, et al. Warthin-like mucoepidermoid carcinoma: a combined study of fluorescence in situ hybridization and whole-slide imaging. Am J Surg Pathol. 2015;39(11):1479-87. 10.1097/PAS.0000000000000507.26457352

Lamelas J, Terry JH Jr, Alfonso AE. Warthin’s tumor: multicentricity and increasing incidence in women. Am J Surg. 1987;154(4):347-51. 10.1016/0002-9610(89)90002-0.3661835

Smółka W, Markowski J, Piotrowska-Seweryn A, Paleń P, Dobrosz Z, Dziubdziela W. Mucoepidermoid carcinoma in Warthin tumor of the parotid gland. Arch Med Sci. 2015;11(3):691-5. 10.5114/aoms.2015.52379.26170867

Williamson JD, Simmons BH, El-Naggar A, Medeiros LJ. Mucoepidermoid carcinoma involving Warthin tumor: a report of five cases and review of the literature. Am J Clin Pathol. 2000;114(4):564-70. 10.1309/GUT1-F58A-V4WV-0D8P.11026102

Citak EC, Yilmaz EB, Sagcan F, Bozkurt F, Arpaci RB, Vayisoglu Y. Mucoepidermoid carcinoma in Warthin tumor of the parotis in childhood: a case report and review of the literature. J Pediatr Hematol Oncol. 2019;41(6):494-7. 10.1097/MPH.0000000000001303.30198962

Seifert G, Bull HG, Donath K. A histologic subclassification of the cystadenolymphoma of the parotid gland. Virchows Arch A Pathol Anat Histol. 1980;388(1):13-38.7467121

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;13(1):12. 10.1186/s13256-018-1941-3.30636634

Rotellini M, Paglierani M, Pepi M, Franchi A. MAML2 rearrangement in Warthin’s tumor: a fluorescent in situ hybridisation study of metaplastic variants. J Oral Pathol Med. 2012;41(8):615-20. 10.1111/j.1600-0714.2012.01159.x.22582766

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(1):30149. 10.1038/srep30149.27417276

Heatley N, Harrington KJ, Thway K. Warthin tumor-like mucoepidermoid carcinoma. Int J Surg Pathol. 2018;26(1):31-3. 10.1177/1066896917724889.28793830

Hang JF, Shum CH, Ali SZ, Bishop JA. Cytological features of the Warthin-like variant of salivary mucoepidermoid carcinoma. Diagn Cytopathol. 2017;45(12):1132-6. 10.1002/dc.23785.28755513

Boahene DK, Olsen KD, Lewis JE, Pinheiro AD, Pankratz VS, Bagniewski SM. Mucoepidermoid carcinoma of the parotid gland: the Mayo clinic experience. Arch Otolaryngol Head Neck Surg. 2004;130(7):849-56. 10.1001/archotol.130.7.849.15262762




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