30
edits
Difference between revisions of "Papillary thyroid carcinoma"
Jump to navigation
Jump to search
m
Papillary thyroid carcinoma (view source)
Revision as of 12:57, 26 April 2018
, 12:57, 26 April 2018→Microscopic
m (→Microscopic) |
|||
| (19 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{ 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, | | IHC = HBME-1 +ve, [[CK19]] +ve, Galectin-3 +ve, thyroglobulin +ve, TTF-1 +ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 14: | Line 14: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Staging = [[thyroid cancer staging]] | |||
| Site = [[thyroid gland]] | | Site = [[thyroid gland]] | ||
| Assdx = | | Assdx = | ||
| Line 76: | Line 77: | ||
*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: | ||
| Line 146: | Line 150: | ||
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. | ||
| Line 151: | Line 156: | ||
Images: | Images: | ||
===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> | ||
| Line 161: | Line 163: | ||
=====Microscopic===== | =====Microscopic===== | ||
Features: | Features: | ||
* | *Circumscribed or even encapsulated neoplasm. | ||
*Morules - balls of | *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==== | ||
| Line 221: | Line 262: | ||
===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). | ||