Florid squamous and focal mucinous metaplasia in Warthin’s tumor mimicking low grade mucoepidermoid carcinoma: A diagnostic dilemma on fine needle aspiration cytology

Background: Lack of typical cytological features of Warthin’s tumor (WT) on fine needle aspiration cytology (FNAC) added by presence of atypical features in the form of metaplastic or atypical squamous cells on a necrotic background may mimic carcinoma leading to pre-operative diagnostic dilemma. Case Presentation: An interesting case of WT in a 53 year old female is being reported with a history of sudden increase in the size, along with evidence of level I and II lymph nodes on CT scan. FNAC prompted a diagnosis of WT with florid squamous metaplasia with low grade mucoepidermoid carcinoma as a differential diagnosis. Histopathology confirmed the diagnoses of WT with vast areas of florid squamous metaplasia and focal areas showing mucinous metaplasia. Conclusion: Awareness of potential source of erroneous diagnoses, especially the squamous component of the lesion coupled with awareness of typical features of the lesion may result in higher accuracy rate thereby helping in proper management.