Columnar cell variant of papillary thyroid carcinoma: A case report and review of the literature

Abstract

The columnar cell variant of papillary carcinoma (CCVPC) of the thyroid is a very rare variant of thyroid papillary carcinoma (PTC). These tumors have more potential for metastasis than PTC and show poor prognosis. These tumors, sharing histopathologic characteristics different from those of PTC, are characterized by columnar epithelium lining papillary and/or follicular structures and marked nuclear stratification. But the tumors rarely may contain classic nuclear features of PTC and histologic changes reminiscent of those in early secretory endometrium and can be confused with metastatic adenocarcinomas. Our case was a 40 year old woman presenting with bilateral solid thyroid nodules. Fine needle aspiration of these nodules was diagnosed as papillary carcinoma. On gross examination, there were multiple solid nodules, the biggest one is 2 cm in diameter and encapsulated and the others with irregular margins in right lobe, isthmus, and left lobe. The histopathologic examination showed a mixture of papillary and follicular patterns lined by pseudostratified columnar epithelium and classical nuclear features of PTC were focally present in the tumor. In addition to capsular invasion, vascular invasion and widespread extension of the tumor to the perithyroideal soft tissue were present. In immunohistochemical study, the tumor cells showed diffuse TTF-1 positivity whereas CEA was negative. Therefore, metastatic adenocarcinomnas were not considered in the differential diagnosis. We think it is worthy to report this case because of its very rare occurrence, confusable with metastases and aggressive behavior.

Keywords

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Kolumnar hücreli varyant papiller tiroid karsinomu: Olgu sunumu ve literatürün gözden geçirilmesi

Öz

Kolumnar hücreli varyant papiller tiroid karsinomu (KHVPTK) papiller tiroid karsinomunun (PTK) oldukça nadir görülen bir varyantıdır. Metastaz yapma potansiyelleri PTK’dan daha fazladır ve genellikle kötü prognozla seyrederler. PTK’dan farklı histopatolojik özellikleri paylaşan bu tümörler histopatolojik incelemede papiller ve/veya folliküler yapıları döşeyen kolumnar epitelde belirgin nükleer stratifikasyon ile karakterlidir. Ancak nadiren PTK’nın klasik nükleer özelliklerini ya da erken sekretuar endometriuma benzer değişiklikleri içerebilirler, bazen de metastatik adenokarsinomlarla karıştırılabilirler. Bizim vakamız, bilateral solid tiroid nodülleri ile başvuran 40 yaşında bir kadın hasta idi. Bu nodüllerden yapılan ince iğne aspirasyonu sitolojisi papiller karsinom olarak rapor edildi. Makroskopik incelemede tiroid sağ lob, sol lob ve istmusta en büyüğü 2 cm çapında ve kapsüllü, diğerleri düzensiz sınırlı çok sayıda solid nodül izlendi. Histopatolojik inceleme tümörün psödostratifiye kolumnar epitel ile döşeli papiller ve folliküler yapılardan oluştuğunu ve fokal odaklar halinde PTK’nın klasik bazı nükleer özelliklerini içerdiğini gösterdi. Ayrıca kapsül invazyonu yanı sıra intratiroideal yayılım, vasküler invazyonlar ve tiroid çevresi yumuşak dokuda yaygın tümör infiltrasyonu mevcuttu. İmmünohistokimyasal çalışmada tümör hücreleri TTF-1 ile diffüz pozitiflik gösterirken CEA ile negatif olup ayırıcı tanıda metastatik adenokarsinomlar düşünülmedi. Oldukça nadir görülmesi, metastazlarla karışabilmesi ve agresif davranış sergileyebilmesi nedeni ile vakamızı bildiriye değer bulduk.

Anahtar Kelimeler

• Tiroid, papiller karsinom, kolumnar hücreli varyant

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