Objective: Although Warthin’s tumor (WT) is one of a few salivary gland tumors that have distinct cytologic findings, it can be confused with malignant tumors at times. We assessed the overall accuracy, unusual features, and diagnostic points of fine-needle aspiration (FNA) of WT. Study Design: We retrospectively collected histologically confirmed WT from 21 patients and reviewed preoperative FNA slides. Smears were subject to immunocytochemical staining for carcinoembryonic antigen (CEA) and c-kit and compared to metastatic squamous cell carcinoma. Results: All of the cases were in the parotid gland; the mean size was 3.6 ± 1.2 cm. Of 21 patients, 19 were male (age 59.7 ± 9.4 years) and had a history of smoking. The initial FNA diagnoses were WT (11 patients, 52.4%), benign lesion (7 patients, 33.3%), and malignant neoplasm (3 patients, 14.3%). Only 6 patients (28.6%) showed typical FNA features of WT. The dominant cell types in the smears were macrophages (76.2%), squamous-like cells (66.7%), oncocytes (61.9%), and lymphoid cells (57.1%). Some showed atypical degenerated features, a necrotic background, and inflammatory cells, leading to misdiagnosis. CEA positivity and c-kit positivity in WT were noted in 0 and 75.0% of cases, respectively, whereas metastatic squamous cell carcinoma showed positive rates of 16.7 and 0%, respectively. Conclusion: Awareness of potential sources of misdiagnosis together with combination of c-kit/CEA immunostaining may result in an increased diagnostic rate of WT in FNA.

Veder LL, Kerrebijn JD, Smedts FM, den Bakker MA: Diagnostic accuracy of fine-needle aspiration cytology in Warthin tumors. Head Neck 2010;32:1635–1640.
Pilloni L, Bianco P, Difelice E, Cabras S, Castellanos ME, Atzori L, Ferreli C, Mulas P, Nemolato S, Faa G: The usefulness of c-Kit in the immunohistochemical assessment of melanocytic lesions. Eur J Histochem 2011;55:e20.
Terada T: Mutations and protein expression of KIT and PDGFRA genes in ipsilateral testicular seminomas: an immunohistochemical and molecular genetic study. Appl Immunohistochem Mol Morphol 2011;19:450–453.
Teresa P, Grazia ZM, Doriana M, Irene P, Michele S: Malignant effusion of chromophobe renal-cell carcinoma: cytological and immunohistochemical findings. Diagn Cytopathol 2012;40:56–61.
Pan Y, Zhao X, Yang J, Deng J, Zhan Z, Luo Y, Li Q, Guo Y, Zhai Q, Sun B: Absence of gene mutations in KIT-positive carcinoma showing thymus-like elements of the thyroid. Hum Pathol 2012;43:350–355.
Miiji LN, Petrilli AS, Di Cesare S, Odashiro AN, Burnier MN Jr, de Toledo SR, Garcia RJ, Alves MT: C-kit expression in human osteosarcoma and in vitro assays. Int J Clin Exp Pathol 2011;4:775–781.
Petersson F, Sima R, Grossmann P, Michal M, Kuroda N, Hora M, Yang X, Kinkor Z, Trivunic S, Zalud R, Sperga M, Jaunmuktane Z, Branzovsky J, Ferda J, Hes O: Renal small cell oncocytoma with pseudorosettes: a histomorphologic, immunohistochemical, and molecular genetic study of 10 cases. Hum Pathol 2011;42:1751–1760.
Sukpan K, Settakorn J, Khunamornpong S, Cheewakriangkrai C, Srisomboon J, Siriaunkgul S: Expression of survivin, CD117, and C-erbB-2 in neuroendocrine carcinoma of the uterine cervix. Int J Gynecol Cancer 2011;21:911–917.
Oba J, Nakahara T, Abe T, Hagihara A, Moroi Y, Furue M: Expression of c-Kit, p-ERK and cyclin D1 in malignant melanoma: an immunohistochemical study and analysis of prognostic value. J Dermatol Sci 2011;62:116–123.
Carvalho JC, Wasco MJ, Kunju LP, Thomas DG, Shah RB: Cluster analysis of immunohistochemical profiles delineates CK7, vimentin, S100A1 and C-kit (CD117) as an optimal panel in the differential diagnosis of renal oncocytoma from its mimics. Histopathology 2011;58:169–179.
Vandenput I, Debiec-Rychter M, Capoen A, Verbist G, Vergote I, Moerman P, Amant F: Kit gene in endometrial carcinoma: an immunohistochemical and mutational analysis. Int J Gynecol Cancer 2011;21:203–205.
Zhang L, Lohse CM, Dao LN, Smyrk TC: Proposed histopathologic grading system derived from a study of KIT and CK19 expression in pancreatic endocrine neoplasm. Hum Pathol 2011;42:324–331.
Shibuya M, Kondo F, Sano K, Takada T, Asano T: Immunohistochemical study of hepatocyte, cholangiocyte and stem cell markers of hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 2011;18:537–543.
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.
Kim JY, Cho H, Rhee BD, Kim HY: Expression of CD44 and cyclin D1 in fine needle aspiration cytology of papillary thyroid carcinoma. Acta Cytol 2002;46:679–683.
Klijanienko J, Vielh P: Fine-needle sampling of salivary gland lesions. 2. Cytology and histology correlation of 71 cases of Warthin’s tumor (adenolymphoma). Diagn Cytopathol 1997;16:221–225.
Parwani AV, Ali SZ: Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer 2003;99:166–171.
Flezar M, Pogacnik A: Warthin’s tumour: unusual vs. common morphological findings in fine needle aspiration biopsies. Cytopathology 2002;13:232–241.
Verma K, Kapila K: Salivary gland tumors with a prominent oncocytic component: cytologic findings and differential diagnosis of oncocytomas and Warthin’s tumor on fine needle aspirates. Acta Cytol 2003;47:221–226.
Klijanienko J, Vielh P: Fine-needle sampling of salivary gland lesions. 6. Cytological review of 44 cases of primary salivary squamous-cell carcinoma with histological correlation. Diagn Cytopathol 1998;18:174–178.
Maeno S, Kondo F, Sano K, Takada T, Asano T: Morphometric and immunohistochemical study of cholangiolocellular carcinoma: comparison with non-neoplastic cholangiole, interlobular duct and septal duct. J Hepatobiliary Pancreat Sci 2011.
Xu J, Sasaki M, Harada K, Sato Y, Ikeda H, Kim JH, Yu E, Nakanuma Y: Intrahepatic cholangiocarcinoma arising in chronic advanced liver disease and the cholangiocarcinomatous component of hepatocellular cholangiocarcinoma share common phenotypes and cholangiocarcinogenesis. Histopathology 2011;59:1090–1099.
Klijanienko J, Vielh P: Fine-needle sampling of salivary gland lesions. 4. Review of 50 cases of mucoepidermoid carcinoma with histologic correlation. Diagn Cytopathol 1997;17:92–98.
Klijanienko J, Vielh P: Fine-needle sample of salivary gland lesions. 5. Cytology of 22 cases of acinic cell carcinoma with histologic correlation. Diagn Cytopathol 1997;17:347–352.
Lewis DR, Webb AJ, Lott MF, Brookes ST, Farndon JR: Improving cytological diagnosis and surgical management of parotid adenolymphoma. Br J Surg 1999;86:1275–1279.
Ballo MS, Shin HJ, Sneige N: Sources of diagnostic error in the fine-needle aspiration diagnosis of Warthin’s tumor and clues to a correct diagnosis. Diagn Cytopathol 1997;17:230–234.
Raymond MR, Yoo JH, Heathcote JG, McLachlin CM, Lampe HB: Accuracy of fine-needle aspiration biopsy for Warthin’s tumours. J Otolaryngol 2002;31:263–270.
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