Diffuse Sclerosing Variant Of Papillary Thyroid Carcinoma: A Pitfall In Clinicopathological Diagnosis

Abstract

Diffuse sclerosing variant is an uncommon variant of papillary thyroid carcinoma. The biological behavior and prognostic outcome of this variant are still controversial. The aim of this report is to analyse the features of this entity. A 32-year-old male patient who presented with the complaint of palpitations was diagnosed with hyperthyroidism by clinical evaluation. Hyperechoic heterogeneous microcalcifications were detected in the right lobe on ultrasound radiography. Fine needle aspiration was performed from the right lobe and the lymph node. Abundant psammomatous calcification and follicular epithelial cell groups that suggest the nuclear properties of papillary carcinoma were observed. It was reported as malignant cytology. Bilateral total thyroidectomy was planned. In the macroscopic evaluation, irregularly limited nodule-like area, the largest size of which was about 35 millimeters, was noticed in the right lobe. Histopathological examination revealed a diffuse-widespread lymphocytic infiltration and intense psammomatous calcification, which holds the entire lobe. Micropapillary groups showing nuclear properties of papillary carcinoma were observed, especially in areas rich in connective tissue, with marked dilated lymphatic and lymphatic-like spaces. Very few areas had typical papillary carcinoma features. With the current findings, the case was diagnosed with diffuse sclerosing variant papillary thyroid carcinoma. The patient is healthy for 15 months after the treatment. Although the papillary carcinoma of the thyroid generally has a good prognosis, the diffuse sclerosing variant has an aggressive course and poor prognosis. The correct identification of this variant, which can cause differential diagnosis problems with benign thyroid lesions both cytopathologically and histopathologically, is very important in terms of appropriate treatment

Keywords

• Thyroid
• papillary carcinoma
• diffuse sclerosing variant
• clinicopathological diagnosis

Tiroid Papiller Karsinom Diffüz Sklerozan Varyant: Klinikopatolojik Tanıda Tuzak

Abstract

Papiller tiroid karsinomu, diffüz sklerozan varyant (PTK-DSV) papiller tiroid karsinomunun nadir bir varyantıdır. Bu varyantın biyolojik davranışı ve prognostik önemi hala tartışmalıdır. Bu olgu sunumunun amacı, bu antitenin özelliklerini analiz etmektir. Çarpıntı şikayeti ile başvuran 32 yaşında erkek hastada klinik değerlendirme ile hipertiroidi saptandı. Ultrason grafisinde, sağ lobta hiperekoik heterojen yapıda mikrokalsifikasyonlar saptandı. Sağ lobtan ve lenf nodundan ince iğne aspirasyon sitolojisi (İİAS) yapıldı. Zeminde bol psammomatöz kalsifikasyon ve arada papiller karsinomun nükleer özelliklerini düşündüren follikül epitel hücre grupları izlendi. Malign sitoloji olarak raporlandı. Bilateral total tiroidektomi yapılması planlandı. Makroskopik değerlendirmede sağ lobda, en büyük boyutu yaklaşık 35 milimetre olan düzensiz sınırlı nodül benzeri alan dikkati çekti. Histopatolojik incelemede tüm lobu diffüz-yaygın şekilde tutan lenfositik infiltrasyon ve yoğun psammomatöz kalsifikasyon içeren görünüm vardı. Özellikle bağ dokudan zengin alanlarda belirgin dilate lenfatik ve lenfatik benzeri boşluklar içinde papiller karsinom nükleer özelliklerini gösteren mikropapiller yapıda gruplar görüldü. Çok az alanda tipik papiller karsinom özellikleri belirgindi. Mevcut bulgular ile olgu PTK-DSV varyant tanısı aldı. Tedavi sonrası 15 aydır sağ ve sağlıklıdır. Tiroidin papiller karsinomu genelde iyi prognozlu olsa da, diffüz sklerozan varyantı agresif seyirli ve kötü prognozludur. Hem sitopatolojik hem de histopatolojik olarak benign tiroid lezyonları ile ayırıcı tanı sorunu yaratabilen bu varyantın doğru tanımlaması uygun tedavi açısından çok önemlidir.

Keywords

• Tiroid, papiller karsinom, diffüz sklerozan varyant, klinikopatolojik tanı
• Tiroid
• papiller karsinom
• diffüz sklerozan varyant
• klinikopatolojik tanı

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