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

Yıl 2011, , 304 - 307, 01.09.2011

Uğur Fırat Ayşenur Keleş Bülent Mızrak

https://doi.org/10.5799/ahinjs.01.2011.03.0060

Öz

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.

Anahtar Kelimeler

-

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

Kaynakça

• DeLellis RA., Lloyd RV., Heitz PU., Eng C. World Health Organization Classification of Tumours. Pathology and Ge- netics of Tumours of Endocrine Organs. IARC Press: Lyon 2004
• Randolph GW. Follicular carcinoma of the thyroid. Saun- ders: Philadelphia 2003.
• Ferreiro JA, Hay ID, Lloyd RV: Columnar cell carcinoma of the thyroid: Report of three additional cases. Hum Pathol. 1996;27(11):1156-60
• Johnson TL, Lloyd RV, Thompson NW, et al. Prognostic im- plications of the tall cell variant of papillary thyroid carci- noma. Am J Surg Pathol 1998;12(1):22-7.
• Vickery AL, Carcangiu ML, Johannessen JV, et al. Papillary carcinoma. Semin Diagn Pathol 1985;2(1):90-100.
• Wenig BM, Thompson LDR, Adair CF, Shmookler B, Heffess CS. Thyroid papillary carcinoma of columnar cell type: A clinicopathologic study of 16 cases. Cancer 1998;82(6):740-53.
• Evans HL. Columnar-cell carcinoma of the thyroid: A report of two cases of an aggressive variant of thyroid carcinoma. Am J Clin Pathol 1986;85(1):77-80.
• Sobrinho-Simoes M, Nesland JM, Johannessen JV. Colum- nar-cell carcinoma: Another variant of poorley differentiated carcinoma of the tyroid. Am J Clin Pathol 1988;89:264-7.
• Hui P-K, Chan JKC, Cheung PSY, et al. Columnar cell car- cinoma of the thyroid: Fine needle aspiration findings in a case. Acta Cytol. 1990;34(3):355-8
• Mizukami Y, Nonomura A, Michigishi T, et al. Columnar cell carcinoma of the thyroid gland: A case report and re- view of the literature. Hum Pathol 1994;25(10):1098-101.
• Berends D, Mouthaan PJ. Columnar cell carcinoma of the thyroid gland. Histopathology 1992;20(3):360-2.
• Gaertner EM, Davidson M, Wenig BM. The columnar cell variant of thyroid papillary carcinoma: Case report and dis- cussion of an unusually aggressive thyroid papillary carci- noma. Am J Surg Pathol 1995;19(8):940-7
• Wenig BM, Thompson LDR, Adair CF, et al. Colum- nar cell variant of thyroid cell carcinoma. Mod Pathol 1995;8(1):56A.
• Carling T, Ocal IT, Udelsman R. Special variants of differ- entiated thyroid cancer: Does it alter the extent of surgery versus well-differentiated thyroid cancer? World J Surg 2007;31(8):916-23.
• Barton III CP, Brennan JA, Lowry TR, Russell MJ. Colum- nar cell variant of papillary thyroid carcinoma. ENT- Ear, Nose & Throat Journal 2006;85(6):640-3.
• Khan AR, Abu-Eshy SA. Variants of papillary carcinoma of the thyroid: experience at Asir Central Hospital. J R Coll Surg Edinb 1998;43(1):20-5.
• Akslen LA, Varhaug JE. Thyroid carcinoma with mixed tall-cell and columnar-cell features. Am J Clin Pathol 1990;94(3):442-5.
• Rosai J, Carcangiu ML, DeLellis RA: Tumors of the Thy- roid Gland, (fascicle 5, third series). Washington, DC, Armed Forces Institute of Pathology, 1992
• Hedinger C, Williams ED, Sobin LH. Histological typing of thyroid tumours. In: World Health Organization classifica- tion of tumours. Berlin: Springer-Verlag, 1988:9-11.
• Cady B, Rossy R. An expanded view of risk group defi- nition in differentiated thyroid carcinoma. Surgery 1988;104(8):947-53.
• Loree TR. Therapeutic implication of prognostic factors in differentiated carcinoma of the thyroid gland. Semin Surg Oncol 1995;11(3):246-55.