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Cameselle-García S, Abdulkader-Nallib I, Sánchez-Ares M, Cameselle-Teijeiro JM. Cribriform morular thyroid carcinoma: Clinicopathological and molecular basis for both a preventive and therapeutic approach for a rare tumor (Review). Oncol Rep 2024; 52:119. [PMID: 39027989 PMCID: PMC11292300 DOI: 10.3892/or.2024.8778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
Cribriform morular thyroid carcinoma (CMTC) has been included within the group of thyroid tumors of uncertain histogenesis in the recent World Health Organization classification of endocrine tumors. Most CMTCs occur in young euthyroid women with multiple (and bilateral) thyroid nodules in cases associated with familial adenomatous polyposis (FAP) or as single nodules in sporadic cases. CMTC generally behaves indolently, while aggressiveness and mortality are associated with high‑grade CMTC. This tumor histologically displays a distinctive combination of growth patterns with morular structures. Strong diffuse nuclear and cytoplasmic immunostaining for β‑catenin is the hallmark of CMTC. Tumor cells are also positive for thyroid transcription factor‑1 and for estrogen and progesterone receptors, but negative for thyroglobulin and calcitonin. It is possible that the CMTC phenotype could result from blockage in the terminal/follicular differentiation of follicular cells (or their precursor cells) secondary to the permanent activation of the Wnt/β‑catenin pathway. In CMTC, the activation of the Wnt/β‑catenin pathway is the central pathogenetic event, which in FAP‑associated cases results from germline mutations of the APC regulator of WNT signaling pathway (APC) gene, and in sporadic cases from somatic inactivating mutations in the APC, AXIN1 and CTNNB1 genes. Estrogens appear to play a tumor‑promoting role by stimulating both the PI3K/AKT/mTOR and the RAS/RAF/MAPK signaling pathways. Additional somatic mutations (i.e. RET rearrangements, or KRAS, phosphatidylinositol‑4,5‑bisphosphate 3‑kinase catalytic subunit α, telomerase reverse transcriptase or tumor protein 53 mutations) may further potentiate the development and progression of CMTC. While hemithyroidectomy would be the treatment of choice for sporadic cases without high‑risk data, total thyroidectomy would be indicated in FAP‑associated cases. There is insufficient clinical data to propose therapies targeting the Wnt/β‑catenin pathway, but multikinase or selective inhibitors could be used in a manner analogous to that of conventional thyroid tumors. It is also unknown whether adjuvant antiestrogenic therapy could be useful in the subgroup of women undergoing surgery with high‑risk CMTC, as well as when there is tumor recurrence and/or metastasis.
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Affiliation(s)
- Soledad Cameselle-García
- Department of Medical Oncology, University Hospital Complex of Ourense, Galician Healthcare Service (SERGAS), 32005 Ourense, Spain
| | - Ihab Abdulkader-Nallib
- Department of Pathology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), 15706 Santiago de Compostela, Spain
- School of Medicine, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - María Sánchez-Ares
- Department of Pathology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), 15706 Santiago de Compostela, Spain
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), 15706 Santiago de Compostela, Spain
- School of Medicine, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
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2
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Kuenstner W, Zhao P, Lee W, Garcia C, Burman KD, Shobab L. A Rare Case of Persistent Multifocal Cribriform-Morular Thyroid Carcinoma. AACE Clin Case Rep 2024; 10:63-66. [PMID: 38523848 PMCID: PMC10958640 DOI: 10.1016/j.aace.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 03/26/2024] Open
Abstract
Background/Objective Cribriform-morular thyroid carcinoma (CMTC) was considered a variant of papillary thyroid carcinoma (PTC) but is a separate entity in the 2022 World Health Organization classification. CMTC has an association with familial adenomatous polyposis (FAP). Our objective is to report a case of CMTC who was subsequently diagnosed with FAP, to highlight these associated entities and implications for management. Case Report A 15-year-old female with a history of iron-deficiency anemia and alpha-gal syndrome presented with several years of goiter and dysphagia. She also noted unintentional weight loss, abdominal pain, melena and hematochezia, and symptomatic anemia. Physical examination was significant for multiple thyroid nodules. Laboratory results revealed normal thyroid function and iron deficiency. Multiple nodules were visualized on thyroid ultrasound, and fine needle aspiration biopsy was consistent with PTC. Total thyroidectomy was performed with a revised diagnosis of multifocal CMTC, with administration of adjuvant radioactive iodine due to persistent disease. Genetic testing confirmed FAP and she was referred for upper endoscopy, colonoscopy, and an evaluation for colectomy. Discussion There are no best practice guidelines for management of CMTC. Management of CMTC is guided by FAP status; sporadic cases can be managed with hemithyroidectomy, while FAP-associated cases are better managed with total thyroidectomy. Recurrence is usually managed with surgical resection. The decision to treat with adjuvant radioactive iodine is often extrapolated from management of classic PTC. Conclusion Thyroid carcinoma in the setting of extensive family history of colorectal carcinoma should arouse suspicion for CMTC. Patients with CMTC should receive a referral for colonoscopy and genetic testing for FAP.
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Affiliation(s)
| | - Po Zhao
- MedStar Georgetown University Hospital, Washington, D.C
| | - Wen Lee
- MedStar Washington Hospital Center, Washington, D.C
| | | | | | - Leila Shobab
- MedStar Washington Hospital Center, Washington, D.C
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3
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Han Y, Wu JQ, Hou XJ, Sun JW, Piao ZY, Teng F, Wang XL. Strain Imaging in the Evaluation of Thyroid Nodules: The Associated Factors Leading to Misdiagnosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3372-3383. [PMID: 34538708 DOI: 10.1016/j.ultrasmedbio.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/13/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
This study analyzed which imaging characteristics may contribute to misdiagnosis of benign and malignant thyroid nodules (TNs) through strain imaging (SI). We analyzed SI parameters and conventional ultrasound (CUS) characteristics of 264 nodules with histopathology results and we applied binary logistic regression analysis to select independent variables for incorrect SI results. The elastography imaging (EI) score and the virtual touch tissue imaging (VTI) score of malignant TNs were remarkably higher than that in benign TNs. VTI, of which the false-positive rate (FPR), the false-negative rate (FNR), and the cutoff value were 47.6% (39/82), 17.6% (32/182) and 3.5, presented higher diagnostic performance than EI. Aspect ratio (odd ratio [OR]: 14.208) and intra-nodular calcification (OR: 20.384) were significantly associated with false-positive VTI findings, while posterior acoustic feature (OR: 30.424) was significantly associated with false-negative VTI findings. Sex (OR: 0.221) and aspect ratio (OR: 0.268) were negatively associated with false-negative EI findings. In conclusion, sex and aspect ratio significantly affect the accuracy of EI results, while aspect ratio, intra-nodular calcification and posterior acoustic features notably affect the accuracy of VTI results. These CUS features of TNs should not be ignored before explaining SI examination results.
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Affiliation(s)
- Ye Han
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Jia-Qi Wu
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Xiu-Juan Hou
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Jia-Wei Sun
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Zhen-Ya Piao
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Fei Teng
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China
| | - Xiao-Lei Wang
- In-patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Surgeon's Hall, No. 246, Xuefu Road, Nangang District, Harbin City, Heilongjiang prov, China..
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Enomoto K, Tamagawa S, Kumashiro N, Warigaya K, Takeda S, Gunduz M, Murata SI, Hotomi M. A rare case of the recurrent surgery for cribriform-morular variant of papillary thyroid carcinoma. Int J Surg Case Rep 2019; 66:385-389. [PMID: 31954984 PMCID: PMC6970130 DOI: 10.1016/j.ijscr.2019.11.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/23/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) is an uncommon subtype of PTC, and it is associated with familial adenomatous polyposis (FAP). PRESENTATION OF CASE We describe a 32-year-old female who presented recurrent CMV-PTC with FAP. Surgery performed after the recurrent disease resulted in left recurrent laryngeal nerve palsy due to formation of strong scar after initial operation. The histopathological examination revealed the recurrent CMV-PTC without thyroid capsular invasion in remnant thyroid tissue of berry ligament. In addition, the immunohistochemical analysis showed that β-Catenin was diffusely positive in both cytoplasm and nucleus in CMV-PTC tissue. CONCLUSION Total thyroidectomy in CMV-PTC with FAP should be performed at initial surgery due to high recurrence.
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Affiliation(s)
- Keisuke Enomoto
- Departments of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tamagawa
- Departments of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Naoko Kumashiro
- Departments of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kenji Warigaya
- Departments of Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Saori Takeda
- Departments of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mehmet Gunduz
- Departments of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shin-Ichi Murata
- Departments of Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Muneki Hotomi
- Departments of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan.
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Ito Y, Ishikawa H, Kihara M, Hirokawa M, Kiyota N, Kasahara T, Miyauchi A. Control of Lung Metastases and Colon Polyposis with Lenvatinib Therapy in a Patient with Cribriform-Morular Variant of Papillary Thyroid Carcinoma and an APC Gene Mutation: A Case Study. Thyroid 2019; 29:1511-1517. [PMID: 31317827 DOI: 10.1089/thy.2019.0121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The cribriform-morular variant (CMV) is a rare subtype of papillary thyroid carcinoma (PTC), and is often associated with familial adenomatous polyposis (FAP). This variant is generally indolent, but some aggressive cases have been reported. Patient Findings: We present the case of a 24-year-old woman who underwent total thyroidectomy with prophylactic central lymph node dissection and modified radical neck dissection for CMV-PTC. No distant metastases were identified preoperatively. However, multiple large lung metastases were detected three and half years after surgery. She also had FAP with a germline APC gene mutation. Summary: She was started on lenvatinib because of the metastatic disease. One month after the initiation of lenvatinib (24 mg), her lung metastases reduced significantly. She has continued lenvatinib for 24 months (present dose, 10 mg). The lung metastases have not progressed during this period. Only a few small polyps were newly detected on endoscopy after lenvatinib administration. This number was considerably higher before therapy, when an average of 21-75 polyps were resected at each endoscopy session. Conclusions: This is the first report of the use of lenvatinib for the treatment of distant metastases from CMV-PTC. In addition to the efficacy in treating metastatic lesions of this rare variant of PTC, lenvatinib shows promise in the management of associated FAP. This treatment strategy may be useful in the management of recurrent CMV-PTC and in those with FAP who refuse colectomy.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | | | | | | | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
- Cancer Center, Kobe University Hospital, Kobe, Japan
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6
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Perez A, Findeis S, Agarwal A, Berry J, King K. Cribriform-morular variant of papillary thyroid carcinoma and its association with familial adenomatous polyposis. Proc (Bayl Univ Med Cent) 2019; 32:399-401. [PMID: 31384200 DOI: 10.1080/08998280.2019.1616865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022] Open
Abstract
The cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) is an uncommon variant of papillary thyroid carcinoma. CMV-PTC can be associated with familial adenomatous polyposis (FAP), an autosomal-dominant polyposis syndrome caused by a mutation in the APC gene that leads to a disruption of the Wnt/beta-catenin pathway. Understanding the relation between CMV-PTC and FAP is a diagnostic tool for both pathologists and clinicians, because FAP has several implications for patients and their families.
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Affiliation(s)
| | - Sarah Findeis
- Department of Pathology, Baylor University Medical CenterDallasTexas
| | - Atin Agarwal
- Department of Pathology, Baylor University Medical CenterDallasTexas
| | - Julia Berry
- Department of Pathology, Baylor University Medical CenterDallasTexas
| | - Katie King
- Department of Pathology, Baylor University Medical CenterDallasTexas
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7
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Akaishi J, Kondo T, Sugino K, Ogimi Y, Masaki C, Hames KY, Yabuta T, Tomoda C, Suzuki A, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Katoh R, Ito K. Cribriform-Morular Variant of Papillary Thyroid Carcinoma: Clinical and Pathological Features of 30 Cases. World J Surg 2018; 42:3616-3623. [PMID: 29696324 DOI: 10.1007/s00268-018-4644-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) is rare; it may occur in cases of familial adenomatous polyposis (FAP) or be sporadic. To clarify the clinicopathological features of CMV-PTC, the medical records of these patients were investigated retrospectively. MATERIALS AND METHODS Between 1979 and 2016, a total of 17,062 cases with PTC underwent initial surgery at Ito Hospital. Of these, 30 (0.2%) cases histologically diagnosed with CMV-PTC were reviewed. RESULT The patients were all women, with a mean age at the time of surgery of 24 years. Seven (23%) cases were thought to have FAP because they had colonic polyposis or a family history of FAP or APC gene mutation. The remaining 23 (77%) were thought to be sporadic. Multiple tumors were detected in 6 cases, with a solitary tumor in 24. One patient had lung metastasis at diagnosis. Eleven patients underwent total thyroidectomy or subtotal thyroidectomy, and 19 underwent lobectomy. Twenty-six (87%) patients underwent neck lymph node dissection. Three patients had tumor metastasis in central lymph nodes, but these were incidentally detected metastatic classical PTC (cPTC) based on histological examination. In this series, there were no cases of LN metastases of CMV-PTC. During a mean follow-up of 15 years, one patient had new cPTC in the remnant thyroid after initial surgery, and the other patients showed no signs of recurrence. CONCLUSION CMV-PTC occurred in young women, their long-term prognosis was excellent. Total thyroidectomy is recommended for FAP-associated CMV-PTC, but modified neck lymph node dissection is not necessary.
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Affiliation(s)
- Junko Akaishi
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Tetsuo Kondo
- Department of Pathology, Yamanashi Hospital, Yamanashi, Japan
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Yuna Ogimi
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Chie Masaki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kiyomi Y Hames
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Tomonori Yabuta
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Chisato Tomoda
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Akifumi Suzuki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Ryohei Katoh
- Department of Pathology, Yamanashi Hospital, Yamanashi, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
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8
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Fujimoto T, Hirokawa M, Suzuki A, Ota H, Oshita M, Kudo T, Fukushima M, Kobayashi K, Miyauchi A. Re-Evaluation of 162 Malignant Thyroid Nodules that were Interpreted as Benign Based on Ultrasound Findings. Ultrasound Int Open 2018; 4:E110-E116. [PMID: 30370399 PMCID: PMC6202066 DOI: 10.1055/a-0732-5795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/19/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose The goal of this study was to estimate the risk of malignant thyroid nodules being interpreted as benign based on ultrasound findings and to clarify the pathological features of these malignant nodules. Materials and Methods
We retrospectively re-evaluated ultrasound and pathological findings for 162 malignant thyroid nodules that were initially interpreted as benign based on ultrasound findings at Kuma Hospital between April 2012 and June 2015.
Results The incidences of malignancy among “benign” thyroid nodules were 0.5% overall and 6.2% among resected nodules. In addition, 82.7% of thyroid nodules that were originally judged to have low or very low suspicion patterns were subsequently re-categorized as having high or intermediate suspicion patterns. The incidences of irregular margins (63.6%) and low echogenicity (36.4%) were higher than those of punctate microcalcification (17.9%) and the taller-than-wide shape (20.4%). Among microcarcinomas, the incidences were 65.7% for irregular margins and 51.4% for low echogenicity. Rim calcification with small extrusive soft tissue components and extrathyroidal extensions were not observed. After re-evaluation, 40.0% of papillary thyroid carcinomas remained benign based on their variants, such as the encapsulated, follicular, macrofollicular, and oxyphilic cell variants. Conclusion We conclude that more careful observation, especially for lesions with irregular margins and low echogenicity, can help improve the diagnostic accuracy of thyroid ultrasonography. Furthermore, greater care may decrease the incidence of malignancy among thyroid nodules with low or very low suspicion patterns. Some variants of papillary thyroid carcinoma can have benign ultrasound findings.
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Affiliation(s)
- Tomoko Fujimoto
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | | | - Ayana Suzuki
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | - Hisashi Ota
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | - Maki Oshita
- Kuma Hospital, Department of Clinical Laboratory, Kobe, Japan
| | - Takumi Kudo
- Kuma Hospital, Internal Medicine, Kobe, Japan
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9
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Cameselle-Teijeiro JM, Peteiro-González D, Caneiro-Gómez J, Sánchez-Ares M, Abdulkader I, Eloy C, Melo M, Amendoeira I, Soares P, Sobrinho-Simões M. Cribriform-morular variant of thyroid carcinoma: a neoplasm with distinctive phenotype associated with the activation of the WNT/β-catenin pathway. Mod Pathol 2018; 31:1168-1179. [PMID: 29785019 DOI: 10.1038/s41379-018-0070-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/09/2022]
Abstract
Cribriform-morular variant of thyroid carcinoma is classically associated with familial adenomatous polyposis but, it can also occur as a sporadic neoplasm. This neoplasm is much more frequently observed in women than in men (ratio of 61:1). In familial adenomatous polyposis patients, tumors are generally multifocal and/or bilateral (multinodular appearance), whereas in the sporadic cases tumors tend to occur as single nodules. The tumors are well delimited, and characteristically show a blending of follicular, cribriform, papillary, trabecular, solid, and morular patterns. Neoplastic cells are tall or cuboidal with the occasional nuclear features of classic papillary thyroid carcinoma. The morules include cells with peculiar nuclear clearing and show positivity for CDX2 and CD10. Angioinvasion and capsular invasion have been described in about 30 and 40% of cases, respectively, with lymph node metastases in less than 10% of patients and distant metastases in 6%. Although this tumor has good prognosis, neuroendocrine and/or poor differentiation have been associated with aggressive behavior. Tumor cells can be focally positive or negative for thyroglobulin, but are always positive for TTF-1, estrogen and progesterone receptors, and negative for calcitonin and cytokeratin 20. Nuclear and cytoplasmic staining for β-catenin is the hallmark of this tumor type; this feature plays a role in fine needle aspiration biopsy. Cribriform-morular variant of thyroid carcinoma has a peculiar endodermal (intestinal-like) type phenotype, activation of the WNT/β-catenin signaling pathway, and belongs to the non-BRAF-non-RAS subtype of the molecular classification of thyroid tumors. Elevated expression of estrogen and progesterone receptors and activation of the WNT/β-catenin pathway may prove useful as putative therapeutic targets in cases that do not respond to conventional therapy. Clinicians should be alerted to the possibility of familial adenomatous polyposis when a diagnosis of cribriform-morular variant of thyroid carcinoma is made. Instead of being considered as a variant of papillary thyroid carcinoma its designation as cribriform-morular thyroid carcinoma seems more appropriate.
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Affiliation(s)
- José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain. .,Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Javier Caneiro-Gómez
- Department of Pathology, Clinical University Hospital, Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain.,Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Sánchez-Ares
- Department of Pathology, Clinical University Hospital, Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain
| | - Ihab Abdulkader
- Department of Pathology, Clinical University Hospital, Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain.,Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Catarina Eloy
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal
| | - Miguel Melo
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Unit of Endocrinology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Isabel Amendoeira
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
| | - Paula Soares
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal.,Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
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10
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Stember JN, Liu M, Poliak D, Hecht E, Laifer-Narin S. The Distal Acoustic Spotlight: a novel method to visualize the distal acoustic space on ultrasound. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Lam AKY, Saremi N. Cribriform-morular variant of papillary thyroid carcinoma: a distinctive type of thyroid cancer. Endocr Relat Cancer 2017; 24:R109-R121. [PMID: 28314770 DOI: 10.1530/erc-17-0014] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
The aim of this systematic review is to study the features of cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) by analysing the 129 documented cases in the English literature. The disease occurred almost exclusively in women. The median age of presentation for CMV-PTC was 24 years. Slightly over half of the patients with CMV-PTC had familial adenomatous polyposis (FAP). CMV-PTC presented before the colonic manifestations in approximately half of the patients with FAP. Patients with FAP often have multifocal tumours in the thyroid. Microscopic examination of CMV-PTC revealed predominately cribriform and morular pattern of cancer cells with characteristic nuclear features of papillary thyroid carcinoma. Psammoma body is rare. On immunohistochemical studies, β-catenin is diffusely positive in CMV-PTC. The morular cells in CMV-PTC are strongly positive for CD10, bcl-2 and E-cadherin. Pre-operative diagnosis of CMV-PTC by fine-needle aspiration biopsy could be aided by cribriform architecture, epithelial morules and β-catenin immunostaining. Mutations of APC gene are found in the patients with CMV-PTC associated with FAP. In addition, mutations in CTNNB1, RET/PTC rearrangement and PI3K3CA mutations have been reported. BRAF mutation is negative in all CMV-PTC tested. Compared to conventional papillary thyroid carcinoma, CMV-PTC had a lower frequency of lymph node metastases at presentation (12%) and distant metastases (3%) as well as lower recurrence rates (8.5%) and patients' mortality rates (2%). To conclude, patients with CMV-PTC have distinctive clinical, pathological and molecular profiles when compared to conventional papillary thyroid carcinoma.
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Affiliation(s)
- Alfred King-Yin Lam
- Cancer Molecular PathologySchool of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Nassim Saremi
- Cancer Molecular PathologySchool of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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