Difference between revisions of "Papillary thyroid carcinoma"

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Papillary thyroid carcinoma (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Papillary_thyroid_microcarcinoma_-_high_mag.jpg
| Image      = Papillary_thyroid_microcarcinoma_-_high_mag.jpg  
| Width      =
| Width      =
| Caption    = Papillary thyroid carcinoma. [[H&E stain]].
| Caption    = Papillary thyroid carcinoma. [[H&E stain]].
| Micro      = nuclear changes: nuclear membrane irregularities (e.g. raisinoid shape), +/-nuclear grooves, +/-[[nuclear pseudoinclusions]], +/-nuclear clearing, nuclear enlargement (usu. mild), nucleoli; architectural changes: overlap of nuclei, papillae (not required), +/-[[psammoma bodies]]
| Micro      = nuclear changes: nuclear membrane irregularities (e.g. raisinoid shape), +/-nuclear grooves, +/-[[nuclear pseudoinclusions]], +/-nuclear clearing, nuclear enlargement (usu. mild), nucleoli; architectural changes: overlap of nuclei, papillae (not required), +/-[[psammoma bodies]]
| Subtypes  = [[Papillary thyroid carcinoma tall cell variant|tall cell variant]], [[Papillary thyroid carcinoma columnar cell variant|columnar cell variant]], [[Papillary thyroid carcinoma follicular variant|follicular variant]], [[Papillary thyroid carcinoma cribriform-morular variant|cribriform-morular variant]], [[Papillary thyroid carcinoma diffuse sclerosing variant|diffuse sclerosing variant]], [[Papillary thyroid carcinoma Warthin-like variant|Warthin-like variant]], [[Papillary thyroid carcinoma solid variant|solid variant]], [[Papillary thyroid carcinoma oncocytic variant|oncocytic variant]], others
| Subtypes  = [[Papillary thyroid carcinoma tall cell variant|tall cell variant]], [[Papillary thyroid carcinoma columnar cell variant|columnar cell variant]], [[Papillary thyroid carcinoma follicular variant|follicular variant]], [[Papillary thyroid carcinoma cribriform-morular variant|cribriform-morular variant]], [[Papillary thyroid carcinoma diffuse sclerosing variant|diffuse sclerosing variant]], [[Papillary thyroid carcinoma Warthin-like variant|Warthin-like variant]], [[Papillary thyroid carcinoma solid variant|solid variant]], [[Papillary thyroid carcinoma oncocytic variant|oncocytic variant]], others
| LMDDx      = [[lymphocytic thyroiditis]] ([[Graves disease]], [[Hashimoto thyroiditis]]), [[solid cell nest of thyroid]], [[follicular thyroid carcinoma]], [[follicular thyroid adenoma]], [[adenomatoid nodule]]
| LMDDx      = [[lymphocytic thyroiditis]] ([[Graves disease]], [[Hashimoto thyroiditis]]), [[solid cell nest of thyroid]], [[follicular thyroid carcinoma]], [[follicular thyroid adenoma]], [[adenomatoid nodule]], [[noninvasive follicular thyroid neoplasm with papillary-like nuclear features]] (NIFTP)
| Stains    =
| Stains    =
| IHC        = HBME-1 +ve, CK19 +ve, Galectin-3 +ve, thyroglobulin +ve, TTF-1 +ve
| IHC        = HBME-1 +ve, [[CK19]] +ve, Galectin-3 +ve, thyroglobulin +ve, TTF-1 +ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
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| Gross      =
| Gross      =
| Grossing  =
| Grossing  =
| Staging    = [[thyroid cancer staging]]
| Site      = [[thyroid gland]]
| Site      = [[thyroid gland]]
| Assdx      =
| Assdx      =
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*Nuclear inclusions are quite rare and not required to make the diagnosis -- but a very convincing feature if seen.
*Nuclear inclusions are quite rare and not required to make the diagnosis -- but a very convincing feature if seen.
*Papillae may be seen in Graves disease.
*Papillae may be seen in Graves disease.
*Thyroid tissue lateral to the jugular vein (often referred to as ''[[lateral aberrant thyroid tissue]]'') is generally considered metastatic thyroid carcinoma (papillary thyroid carcinoma) even if it looks benign.<ref name=pmid14452106>{{Cite journal  | last1 = JOHNSON | first1 = RW. | last2 = SAHA | first2 = NC. | title = The so-called lateral aberrant thyroid. | journal = Br Med J | volume = 1 | issue = 5293 | pages = 1668-9 | month = Jun | year = 1962 | doi =  | PMID = 14452106 | PMC = 1958877 }}</ref>
**This dictum is disputed.<ref name=pmid17319317>{{Cite journal  | last1 = Escofet | first1 = X. | last2 = Khan | first2 = AZ. | last3 = Mazarani | first3 = W. | last4 = Woods | first4 = WG. | title = Lessons to be learned: a case study approach. Lateral aberrant thyroid tissue: is it always malignant? | journal = J R Soc Promot Health | volume = 127 | issue = 1 | pages = 45-6 | month = Jan | year = 2007 | doi =  | PMID = 17319317 }}</ref>
**The level VI and VII [[lymph nodes]] are medial to the jugular.


DDx:
DDx:
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DDx:
DDx:
*[[Noninvasive follicular thyroid neoplasm with papillary-like nuclear features]] (NIFTP).
*[[Follicular thyroid carcinoma]] - has a fibrous capsule and invasion though it.
*[[Follicular thyroid carcinoma]] - has a fibrous capsule and invasion though it.
*[[Follicular thyroid adenoma]] - surrounded by a fibrous capsule.
*[[Follicular thyroid adenoma]] - surrounded by a fibrous capsule.
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Images:
Images:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=2008080217023776 PTC follicular variant (surgicalpathologyatlas.com)].
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=2008080216593186 PTC follicular variant (surgicalpathologyatlas.com)].
*[http://www.thyroidcancercanada.org/userfiles/images/Follicular_slide.jpg PTC follicular variant (thyroidcancercanada.org)].<ref>URL: [http://www.thyroidcancercanada.org/types-of-thyroid-cancer.php?lang=en http://www.thyroidcancercanada.org/types-of-thyroid-cancer.php?lang=en]. Accessed on: 9 January 2013.</ref>


====Papillary thyroid carcinoma cribriform-morular variant====
===Papillary thyroid carcinoma cribriform-morular variant===
=====General=====
=====General=====
*Associated with [[familial adenomatous polyposis]] (FAP).<ref name=pmid18612695>{{cite journal |author=Groen EJ, Roos A, Muntinghe FL, ''et al.'' |title=Extra-intestinal manifestations of familial adenomatous polyposis |journal=Ann. Surg. Oncol. |volume=15 |issue=9 |pages=2439–50 |year=2008 |month=September |pmid=18612695 |pmc=2518080 |doi=10.1245/s10434-008-9981-3 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518080/?tool=pubmed}}</ref>
*Associated with [[familial adenomatous polyposis]] (FAP).<ref name=pmid18612695>{{cite journal |author=Groen EJ, Roos A, Muntinghe FL, ''et al.'' |title=Extra-intestinal manifestations of familial adenomatous polyposis |journal=Ann. Surg. Oncol. |volume=15 |issue=9 |pages=2439–50 |year=2008 |month=September |pmid=18612695 |pmc=2518080 |doi=10.1245/s10434-008-9981-3 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518080/?tool=pubmed}}</ref>
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=====Microscopic=====
=====Microscopic=====
Features:
Features:
*Cribriform architectural pattern.
*Circumscribed or even encapsulated neoplasm.
*Morules - balls of tissue.
*Morules - interspersed balls of squamoid cells
**No keritinization or intercellular bridges.
**Homogenous, lightly eosinophilic glassy nuclei (biotin accumulation).
*Follicles
**[[Cribriform]], papillary, trabecular and solid patterns.
**Columnar or cuboidal cells.
**Little colloid
**Papillary carcinoma nuclear features.
 
<gallery>
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant MP3 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - Medium power (SKB)
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant HP2 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - High power (SKB)
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant HP3 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - high power]]
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant P16 HP3 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - High power (SKB)
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant CDX2 HP 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - CDX2 (SKB)
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant P16 HP 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - p16 (SKB)
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant ER HP 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - ER (SKB)
Image:Thyroid PapillaryCarcinoma CribriformMorularVariant betaCatenin HP 13BR***.jpg|Thyroid - Papillary Carcinoma Cribriform Morular Variant - beta catenin (SKB)
</gallery>
 
 
DDX:
*Papillary thyroid carcinoma
*Papillary thyroid carcinoma, tall cell variant
 
=====IHC=====
*CDX2 - Highlights the morules (CDX2 is positive in the biotin rich nuclei associated with morule formation in a variety of situations)<ref>{{Cite journal  | last1 = Wani | first1 = Y. | last2 = Notohara | first2 = K. | last3 = Nakatani | first3 = Y. | last4 = Matsuzaki | first4 = A. | title = Aberrant nuclear Cdx2 expression in morule-forming tumours in different organs, accompanied by cytoplasmic reactivity. | journal = Histopathology | volume = 55 | issue = 4 | pages = 465-8 | month = Oct | year = 2009 | doi = 10.1111/j.1365-2559.2009.03382.x | PMID = 19817898 }}</ref>
*CD10 - Highlights the morules <ref>{{Cite journal  | last1 = Cameselle-Teijeiro | first1 = J. | last2 = Alberte-Lista | first2 = L. | last3 = Chiarelli | first3 = S. | last4 = Buriticá | first4 = C. | last5 = Gonçalves | first5 = L. | last6 = González-Cámpora | first6 = R. | last7 = Nogales | first7 = FF. | title = CD10 is a characteristic marker of tumours forming morules with biotin-rich, optically clear nuclei that occur in different organs. | journal = Histopathology | volume = 52 | issue = 3 | pages = 389-92 | month = Feb | year = 2008 | doi = 10.1111/j.1365-2559.2007.02911.x | PMID = 18081818 }}</ref>
*Beta-catenin - nuclear and cytoplasmic - all tumour cells.
*Estrogen receptor - positive
*TTF-1 - positive
 
=====Molecular=====
*Up-regulating disturbances in the Wnt signaling pathway promote formation of morules with optically clear biotin rich nuclei <ref>{{Cite journal  | last1 = Gamachi | first1 = A. | last2 = Kashima | first2 = K. | last3 = Daa | first3 = T. | last4 = Nakatani | first4 = Y. | last5 = Tsujimoto | first5 = M. | last6 = Yokoyama | first6 = S. | title = Aberrant intranuclear localization of biotin, biotin-binding enzymes, and beta-catenin in pregnancy-related endometrium and morule-associated neoplastic lesions. | journal = Mod Pathol | volume = 16 | issue = 11 | pages = 1124-31 | month = Nov | year = 2003 | doi = 10.1097/01.MP.0000092953.20717.48 | PMID = 14614052 }}</ref>
**Mutation of the beta-catenin gene
**Mutation in APC
*Examples
***Well-differentiated fetal adenocarcinoma
***Papillary thyroid carcinoma, cribriform morular variant (mutation in APC in familial variants)
***Pancreatoblastoma


====Papillary thyroid carcinoma diffuse sclerosing variant====
====Papillary thyroid carcinoma diffuse sclerosing variant====
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Note:
Note:
*CK19 +ve -- though ''not'' specific or sensitive.
*CK19 +ve -- though ''not'' specific or sensitive.
<gallery>
Image: Papillary thyroid carcinoma oncocytic variant -- low mag.jpg | PTC oncocytic - low mag. (WC)
Image: Papillary thyroid carcinoma oncocytic variant -- intermed mag.jpg | PTC oncocytic - intermed mag. (WC)
Image: Papillary thyroid carcinoma oncocytic variant -- high mag.jpg | PTC oncocytic - high mag. (WC)
Image: Papillary thyroid carcinoma oncocytic variant -- very high mag.jpg | PTC oncocytic - very high mag. (WC)
</gallery>


===IHC===
===IHC===
Thyroid versus something else:
Thyroid versus something else:
*Thyroglobulin +ve.
*Thyroglobulin +ve.<ref name=pmid23637102>{{Cite journal  | last1 = Sathiyamoorthy | first1 = S. | last2 = Maleki | first2 = Z. | title = Cytomorphologic overlap of differentiated thyroid carcinoma and lung adenocarcinoma and diagnostic value of TTF-1 and TGB on cytologic material. | journal = Diagn Cytopathol | volume = 42 | issue = 1 | pages = 5-10 | month = Jan | year = 2014 | doi = 10.1002/dc.22997 | PMID = 23637102 }}</ref>
*TTF-1 (thyroid transcription factor-1) +ve.
*TTF-1 ([[thyroid transcription factor-1]]) +ve.
*CD15 +ve.{{fact}}
*CD15 +ve.{{fact}}


PTC versus benign:<ref>{{Cite journal  | last1 = Mataraci | first1 = EA. | last2 = Ozgüven | first2 = BY. | last3 = Kabukçuoglu | first3 = F. | title = Expression of cytokeratin 19, HBME-1 and galectin-3 in neoplastic and nonneoplastic thyroid lesions. | journal = Pol J Pathol | volume = 63 | issue = 1 | pages = 58-64 | month = Mar | year = 2012 | doi =  | PMID = 22535608 }}</ref>
PTC versus benign:<ref>{{Cite journal  | last1 = Mataraci | first1 = EA. | last2 = Ozgüven | first2 = BY. | last3 = Kabukçuoglu | first3 = F. | title = Expression of cytokeratin 19, HBME-1 and galectin-3 in neoplastic and nonneoplastic thyroid lesions. | journal = Pol J Pathol | volume = 63 | issue = 1 | pages = 58-64 | month = Mar | year = 2012 | doi =  | PMID = 22535608 }}</ref>
*HBME-1 +ve (strong, diffuse).
*HBME-1 +ve (strong, diffuse).
*CK19 +ve (strong, diffuse).
*[[CK19]] +ve (strong, diffuse).
*Galectin-3 +ve (strong, diffuse).
*Galectin-3 +ve (strong, diffuse).


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- PAPILLARY THYROID MICROCARCINOMA.
- PAPILLARY THYROID MICROCARCINOMA.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- TUMOUR SIZE ~ 1 MM.
-- TUMOUR SIZE ~ 1 MILLIMETRE.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-- NEGATIVE FOR PERINEURAL INVASION.
-- NEGATIVE FOR PERINEURAL INVASION.
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B. LYMPH NODES, LEVEL 6 AND 7, LYMPH NODE DISSECTION:
B. LYMPH NODES, LEVEL 6 AND 7, LYMPH NODE DISSECTION:
- TWO LYMPH NODES, NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 2 ).
- TWO LYMPH NODES, NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 2 ).
</pre>
<pre>
THYROID GLAND, TOTAL THYROIDECTOMY:
- INCIDENTAL PAPILLARY THYROID MICROCARCINOMA.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- TUMOUR SIZE ~ 1 MILLIMETRE.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-- NEGATIVE FOR PERINEURAL INVASION.
- NODULAR HYPERPLASIA.
- ONE PARATHYROID GLAND.
</pre>
</pre>


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The sections show lymph nodes with tumour that has a papillary architecture.  The
The sections show lymph nodes with tumour that has a papillary architecture.  The
tumour cell nuclei are enlarged and overlap. They also have nuclear grooves, nucleoli  
tumour cell nuclei are enlarged and overlap. They also have nuclear grooves, nucleoli  
and abundant pseudoinclusions. The chromatin is powdery.
and abundant pseudoinclusions. The chromatin of the tumour cells has a powdery  
appearance.


==See also==
==See also==
Brigitte
30

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