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Histologically, the tumor displays tall columnar oncocytic cells, arranged into two cell-thick layers lining variably cystic glands within an organoid lymphoid stroma. Tumors with exuberant squamous metaplasia in response to FNA-induced or other types of tissue injury\/infarction have been referred to as \u201c<jats:italic>metaplastic WTs<\/jats:italic>.\u201d However, the same terminology was used for tumors with variable mucinous cell and solid or stratified epidermoid proliferations (occasionally mimicking mucoepidermoid carcinoma), although the \u201cmetaplasia concept\u201d has never been proven for the latter. We herein investigated 22 WTs showing prominent mucoepidermoid-like or solid oncocytoma-like proliferations without prior FNA or histological evidence\u00a0of infarction\/ trauma using the TruSight Tumor 15 gene panel and <jats:italic>KRAS<\/jats:italic> pyrosequencing. As a control, we tested 11 conventional WTs. No statistically significant differences were observed between the two subcohorts regarding patient\u2019s age and tumor size. Six of 22 (27%) proliferating\/ metaplastic WTs revealed oncogenic <jats:italic>KRAS<\/jats:italic> mutations clustering at codon 12 (exon 2), while all conventional tumors lacked these mutations. Our findings are in line with a neoplastic nature of the epidermoid\/\u00a0mucoepidermoid proliferations in non-injured \u201cmetaplastic\u201d Warthin tumors. We propose the descriptive term \u201cde novo\u00a0proliferating Warthin tumor\u201d for this variant to distinguish it from infarcted\/inflamed genuine metaplastic Warthin tumor.<\/jats:p>","DOI":"10.1007\/s00428-023-03504-x","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T10:00:33Z","timestamp":1675850433000},"page":"839-848","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["KRAS codon 12 mutations characterize a subset of de novo proliferating \u201cmetaplastic\u201d Warthin tumors"],"prefix":"10.1007","volume":"482","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-8161","authenticated-orcid":false,"given":"Abbas","family":"Agaimy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Mantsopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinrich","family":"Iro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stoehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,8]]},"reference":[{"key":"3504_CR1","unstructured":"Simpson RHW, Di Palma S, Faquin WC, Pasricha S (2022) Warthin tumour. 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