Three cases of macrofollicular variant of papillary thyroid carcinoma

Raddaoui, Emad; Maha, Arafah; Kfoury, Hala; Al-Sheikh, Abdul Malik; Zaidi, Shaesta Naseem

doi:10.4103/0256-4947.87104

Cited by 13 publications

(3 citation statements)

References 14 publications

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“…The follicular variant was more common in women, thus indicating that this behavior could be associated with hormonal factors, as has been reported in the literature (22,23). However, men present more aggressive phenotypes, as seen in the percentage of men with some risk variant or combined pattern which came to 45.58%; this concurs with previous studies on papillary thyroid carcinoma in Japan (11,35).…”

Section: Discussionsupporting

confidence: 81%

“…As there is no universal consensus about the criteria for including a case in a particular PTC variant (1,9,13,(21)(22)(23)(24)(25)(26)(27), and considering that the assessment of cell percentage is often subjective, we defined "combined pattern" as the presence of two or more histological variants in the same case. Each of the composing variants must be represented at least in 30% of tumoral cells.…”

Section: Variant Definitionmentioning

confidence: 99%

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Variantes histológicas y factores pronósticos del carcinoma papilar de tiroides en el Instituto Nacional de Cancerología de Colombia, 2006-2012

et al. 2015

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Introduction: Thyroid cancer is the most common endocrine neoplasia and the papillary subtype is the most frequent; there are histological and clinical factors associated with a higher risk of recurrence and metastasis. Objective: The aim of this study was to examine the histological, prognostic and clinical characteristics of papillary thyroid carcinomas diagnosed at the National Cancer Institute of Colombia. Materials and methods: A retrospective cohort study was carried out on 619 patients with papillary thyroid carcinoma between 2006 and 2012; we analyzed the sociodemographic, histological, prognostic and clinical characteristics. Results: 87.7% of cases were women. The presence of two or more variants in the same case was considered a particular variant, which we called combined pattern. Combined pattern was then the most frequent (50.9%), followed by the follicular variant (23.4%) including subtypes encapsulated and unencapsulated, and the classic variant (22.1%). Mean tumor size was 20.8 mm. More than half of the cases had capsular invasion, extrathyroidal invasion and lymph node involvement. When compared with the other variants, the combined pattern carcinomas had a higher risk of invasion of the thyroid capsule, extraganglionar invasion and metastasis. Conclusions: Our results are in many aspects similar to those already reported. However, the presence of the combined pattern implied a higher risk for capsular invasion, nodal involvement, extranodal involvement and metastasis in comparison with those which had just one variant. Further studies are necessary to confirm these results.

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Section: Discussionsupporting

confidence: 81%

Section: Variant Definitionmentioning

confidence: 99%

Variantes histológicas y factores pronósticos del carcinoma papilar de tiroides en el Instituto Nacional de Cancerología de Colombia, 2006-2012

et al. 2015

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“…Variants of PTC with a similar prognosis and level of differentiation to conventional PTC, like macrofollicular and Warthin-like type, had a similar staining pattern. To our knowledge, there is no study of HBME-1 staining in the Warthin-like variant of PTC, while there are only two reports concerning its expression in the macrofollicular variant of PTC with findings similar to ours [14,31]. The macrofollicular variant of PTC is an uncommon tumour that can be confused with nodular goiter or follicular adenoma [32].…”

Section: Discussionsupporting

confidence: 47%

Strong Expression of HBME-1 Associates with High-Risk Clinicopathological Factors of Papillary Thyroid Carcinoma

Denčić

Savin

Šelemetjev

et al. 2015

Pathol. Oncol. Res.

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Thyroid cancer comprises a heterogeneous group of lesions with great diversity of biological behaviour. Markers which could help clinicians to identify high-risk patients for tailored optimization of clinical management are of crucial importance. HBME-1 protein level was analysed immunohistochemically using routinely prepared archival tissue sections of a broad range of papillary thyroid carcinoma (PTC) variants and in corresponding lymph node metastases (LNM). The results were evaluated in comparison with clinicopathological features of PTC. Positive immunoreaction was noticed in most classical (83/92; 90.2 %), follicular (60/71; 84.5 %) and trabecular (4/5; 80.0 %) variants of PTC. All cases of macrofollicular, Warthin-like and diffuse sclerosing PTC variants were HBME-1 positive (4/4, 3/3, 2/2; 100 % respectively). Tall cell and solid PTC variants showed diversity of staining (2/3; 66.67 % and 13/23; 56.52 % respectively), while PTCs with mixed histological pattern containing insular areas were mainly weakly positive (2/5; 40.0 %). A single case of clear cell PTC variant showed no reaction. Moreover, all matched metastatic PTC into lymph nodes (LNM) were HBME-1 positive (17/17; 100 %) and expressed HBME-1 in a similar pattern to the matched primary tumour. We also found a statistically significant association between high HBME-1 expression and the presence of lymph node metastasis, advanced pT status and pTNM stage (P < 0.05), but only a tendency for association with extrathyroidal invasion of the tumour (P = 0.058). Therefore, we recommend using immunoexpression of HBME-1 as useful mean to increase the likelihood of detecting most PTC variants and to predict some unfavourable clinical parameters in these patients.

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Macrofollicular Variant of Papillary Thyroid Carcinoma with Extensive Lymph Node Metastases

Yeo

Bae

et al. 2014

Endocr Pathol

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The macrofollicular variant of papillary thyroid carcinoma is a rare subtype of the follicular variant of papillary thyroid carcinoma and is usually characterized by an indolent clinical course. The tumors are prone to be misdiagnosed as benign due to their macrofollicular architecture and bland cytologic features. We report a rare case of the macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases. The patient was a 48-year-old female with a right thyroid nodule and multiple enlarged lymph nodes in the right neck. It was not possible to make a definitive diagnosis of malignancy on fine-needle aspiration cytology and intraoperative frozen section. She underwent total thyroidectomy with right modified radical neck dissection. The surgical specimen showed a 2.5 × 1.5 × 10 cm, well-circumscribed macrofollicular variant of papillary thyroid carcinoma in the right lobe and multiple central and right lateral neck lymph node metastases. Molecular testing for BRAF, NRAS, HRAS, and KRAS was all negative. We then reviewed the demographic and clinicopathologic characteristics of 71 patients with the macrofollicular variant of papillary thyroid carcinoma. The cytologic or histopathologic diagnosis of macrofollicular variant of papillary thyroid carcinoma can be difficult. Extensive lymph node metastases caused by the macrofollicular variant of papillary thyroid carcinoma may occur even in the absence of capsular or lymphovascular invasion. This review will help to better understand the nature of the macrofollicular variant of papillary thyroid carcinoma.

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Three cases of macrofollicular variant of papillary thyroid carcinoma

Cited by 13 publications

References 14 publications

Variantes histológicas y factores pronósticos del carcinoma papilar de tiroides en el Instituto Nacional de Cancerología de Colombia, 2006-2012

Variantes histológicas y factores pronósticos del carcinoma papilar de tiroides en el Instituto Nacional de Cancerología de Colombia, 2006-2012

Strong Expression of HBME-1 Associates with High-Risk Clinicopathological Factors of Papillary Thyroid Carcinoma

Macrofollicular Variant of Papillary Thyroid Carcinoma with Extensive Lymph Node Metastases

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