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LETTER TO EDITOR
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 59-60

Papillary thyroid carcinoma and its variants: The day to day thyroid problem


1 Department of Pathology, MediCiti Institute of Medical Sciences, Ghanpur, Medchal, Hyderabad, India
2 Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India

Date of Web Publication13-Jan-2015

Correspondence Address:
Kanyakumari
Department of Pathology, Medi Citi Institute of Medical Sciences, Ghanpur, Medchal, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.149279

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How to cite this article:
Kanyakumari, Srikanth S. Papillary thyroid carcinoma and its variants: The day to day thyroid problem. Int J Health Allied Sci 2015;4:59-60

How to cite this URL:
Kanyakumari, Srikanth S. Papillary thyroid carcinoma and its variants: The day to day thyroid problem. Int J Health Allied Sci [serial online] 2015 [cited 2019 Sep 21];4:59-60. Available from: http://www.ijhas.in/text.asp?2015/4/1/59/149279

Sir,

Papillary thyroid carcinoma represents 1% of all malignancies [1] and represents 70-80% of all thyroid cancers. Several factors are associated with the development of this neoplasm, including genetic alterations, growth factors, and radiation. [2] The prognosis of this tumor is strongly associated with various clinical variables as follows: Age, tumor size, and histological parameters such as extracapsular extension, extrathyroidal extension, lymph node invasion, distant metastasis, and histological variants.

A hospital-based retrospective and prospective study was done for a period of 3 years. The information obtained from the patient records and consultation correspondence included sex, age, clinical presentation, size of tumor, location of tumor, previous diagnoses, extent of surgery (partial vs. total thyroidectomy), vascular invasion, lymph node status, and size and location of metastasis.

In the present study, we included only the histopathological cases as fine-needle aspiration cytology was not done for all cases. In the present study, we searched surgical pathology records of all the cases submitted to thyroidectomy. We reviewed only those cases in which a diagnosis of papillary carcinoma was made. We noted gross findings of each case and sections were stained with hematoxylin and eosin. The microscopic slides were examined, and papillary carcinomas were further subclassified based on histological pattern.

During the study period, 34 thyroid malignancies were diagnosed. Of them, 31 (91.1%) of these malignancies were papillary thyroid carcinoma (PTC). Two (5.88%) were diagnosed as follicular carcinoma. One (2.44%) was medullary carcinoma.

The following results were obtained when these papillary carcinomas were subclassified into the variants: Classic papillary - 14 (45.1%), follicular - 8 (25.8%), micropapillary (occult) - 4 (12.9%), diffuse sclerosing - 2 (6.45%), tall cell - 2 (6.45%), insular - 1 (3.22%), all these variants share common features of PTC. Majority of the cases presented with a solitary nodule thyroid 25 (80.6%) and 6 cases (19.3%) with diffuse thyroid swelling.

Papillary thyroid carcinoma is the most common form of thyroid cancer. They can occur at any age, but most often in the 20's to forties and account for the majority of thyroid carcinomas associated with previous exposure to ionizing radiation. Majority of the thyroid neoplasms are seen in females as it is related to the expression of estrogen receptors on neoplastic thyroid epithelium.

Classic form of PTC which accounts the majority of the cases in our study, grossly show well-circumscribed lesion some showing papillary projections [Figure 1]a. Microscopically show tumor arranged in branching papillary pattern with fibrovascular core, nuclei showing optically clearing (orphan Annie eye nuclei), nuclear grooving, crowding and overlapping [Figure 1]b.
Figure 1: (a) Gross showing cut section of the tumor with small papillae like projections. (b) Section showing tumor arranged in branching papillae with clearing of nuclei. Classic papillary thyroid carcinoma

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Follicular variant of PTC composed of follicles of variable sizes [Figure 2]. The colloid is usually darker, or hypereosinophilic compared to the colloid in the adjacent nonneoplastic thyroid and may show scalloping "bubble gum" appearance. Occasional multinucleated giant cells are present within the follicles. [3],[4] Micro papillary (occult) variant is usually found incidentally and measure <1 cm in diameter. Diffuse sclerosing papillary carcinoma of the thyroid is a rare variant malignancy, recently reported to account for 0.8% of PTC. [5],[6] Patients present with a diffuse goiter and are mostly clinically euthyroid, but can also be hypothyroid or hyperthyroid. It occurs most frequently in young females and may be mistaken clinically for benign disease particularly thyroiditis. [7],[8],[9] Most patients have lymph node metastases at the time of diagnosis and lung metastases are common. Cerebral metastases have also been reported. [10]
Figure 2: (a) Gross showing well-circumscribed tumor, grey white in appearance with adjacent normal thyroid tissue. (b) Section showing tumor arranged in follicles with nucleus showing features of papillary thyroid carcinoma (PTC). Follicular variant of PTC

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The overall outcome of patients with papillary carcinoma is excellent. We present this study to highlight the various variants of PTC and its course. Age group between 31-40 years contributed the highest number of cases and classical variant with the highest number of cases and the insular variant with the least number of cases in the present study.

 
  References Top

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Kukora JS. Thyroid cancer. In: Cameron JL, editor. Current Surgical Treatment. 2001. p. 583-9.  Back to cited text no. 1
    
2.
Erdem H, Gündogdu C, Sipal S. Correlation of E-cadherin, VEGF, COX-2 expression to prognostic parameters in papillary thyroid carcinoma. Exp Mol Pathol 2011;90:312-7.  Back to cited text no. 2
    
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Khan A, Nose V. In: Lloyd RV, editor. Endocrine Pathology: Differential Diagnosis and Molecular Advances. 2 nd ed. New York: Springer; 2010. p. 181-236.  Back to cited text no. 3
    
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DeLellis RA, Lloyd RV, Heitz PU, Eng C, editors. Pathology and Genetics of Tumours of Endocrine Organs. In: Kleihues P, Sobrin LH, series editors. World Health Organization Classification of Tumours. Lyon: IARC Press; 2004.  Back to cited text no. 4
    
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Vickery AL Jr, Carcangiu ML, Johannessen JV, Sobrinho-Simoes M. Papillary carcinoma. Semin Diagn Pathol 1985;2:90-100.  Back to cited text no. 5
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Chow SM, Chan JK, Law SC, Tang DL, Ho CM, Cheung WY, et al. Diffuse sclerosing variant of papillary thyroid carcinoma - Clinical features and outcome. Eur J Surg Oncol 2003;29:446-9.  Back to cited text no. 6
    
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Carcangiu ML, Bianchi S. Diffuse sclerosing variant of papillary thyroid carcinoma. Clinicopathologic study of 15 cases. Am J Surg Pathol 1989;13:1041-9.  Back to cited text no. 7
    
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Fujimoto Y, Obara T, Ito Y, Kodama T, Aiba M, Yamaguchi K. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Clinical importance, surgical treatment, and follow-up study. Cancer 1990;66:2306-12.  Back to cited text no. 8
    
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Wu PS, Leslie PJ, McLaren KM, Toft AD. Diffuse sclerosing papillary carcinoma of thyroid: A wolf in sheep′s clothing. Clin Endocrinol (Oxf) 1989;31:535-40.  Back to cited text no. 9
    
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Imamura Y, Kasahara Y, Fukuda M. Multiple brain metastases from a diffuse sclerosing variant of papillary carcinoma of the thyroid. Endocr Pathol 2000;11:97-108.  Back to cited text no. 10
    


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