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Characterizing Warthin-Like Mucoepidermoid Carcinoma: Clinicopathologic Features and MAML2 Rearrangements in 14 Latin
Ricardo Anderson de Oliveira Vasconcelos1, Isaac Santos Araújo1, Luiz Miguel Ferreira1
1Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Avenida Limeira 901, Areião, Piracicaba, São Paulo, 13414-900, Brazil.
Head and Neck Pathology
|May 29, 2026
Summary
Warthin-like mucoepidermoid carcinoma (WL-MEC) is a rare salivary gland tumor. This study confirms its typical presentation, low-grade behavior, and favorable prognosis, with MAML2 rearrangement aiding diagnosis.
Area of Science:
- Head and Neck Pathology
- Salivary Gland Neoplasms
- Oncology
Background:
- Warthin-like mucoepidermoid carcinoma (WL-MEC) is a rare, low-grade variant of mucoepidermoid carcinoma (MEC).
- Its distinct features include a multicystic pattern and lymphoid stroma, often mimicking Warthin tumor (WT).
- Limited case reports hinder a thorough understanding of WL-MEC.
Purpose of the Study:
- To conduct a comprehensive clinical, histopathologic, and molecular analysis of newly identified WL-MEC cases.
- To elucidate the defining characteristics and diagnostic markers of WL-MEC.
- To differentiate WL-MEC from Warthin tumor (WT).
Main Methods:
- Analysis of 14 WL-MEC cases from Latin America.
- Assessment of clinicopathologic features, including demographics, tumor site, grading, and follow-up.
- Histological examination, immunohistochemistry (CK5/6, p63, p40, CK7, CK14, Ki67, HER2), and fluorescence in situ hybridization (FISH) for MAML2 rearrangement and HER2 amplification.
Main Results:
- All 14 cases (100%) exhibited MAML2 rearrangement, confirming the diagnosis of WL-MEC.
- HER2 amplification was not detected in the 9 cases tested.
- Typical presentation involved the parotid gland in middle-aged females, with low-grade behavior and no recurrences reported post-surgery.
Conclusions:
- WL-MEC typically presents in the parotid gland of middle-aged females and demonstrates low-grade behavior.
- Surgical excision is associated with a favorable prognosis.
- MAML2 rearrangement detection is a crucial diagnostic marker for distinguishing WL-MEC from WT.