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Sahu A, Shahin M, Jain P, Sultania M, Ayyanar P. Cribriform Morular Thyroid Carcinoma: A Rare Case and Associated Uncommon Features. Int J Surg Pathol 2024; 32:1009-1016. [PMID: 37880965 DOI: 10.1177/10668969231206572] [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] [Indexed: 10/27/2023]
Abstract
Cribriform morular thyroid carcinoma has been added under tumors of uncertain histogenesis. Its peculiar clinical, histomorphological pattern, and immunohistochemical profile have been proved different from papillary thyroid carcinoma. A 59-year-old female patient had a lesion in the left lobe of the thyroid. Fine needle aspiration cytology was reported as medullary thyroid carcinoma. The total thyroidectomy specimen showed a predominantly solid tumor of size 9.5 cm in the left lobe. Microscopy showed a mixed growth pattern with the dominant cribriform and solid morular area. Nuclear features of papillary carcinoma were not seen. Squamoid morules had nuclear clearing. Marked stromal hyalinization and calcification were noted. Extrathyroidal extension, lymphovascular invasion, and lymph node metastasis were not identified. Immunohistochemically the tumor cells were diffuse and strong nuclear positive for β-catenin, TTF1, PAX8, estrogen receptor, focal, and weak positivity for CD5. Synaptophysin, calcitonin, thyroglobulin, and CDX2 were negative. We report this rare cribriform morular thyroid carcinoma case with its associated uncommon histological and immunohistochemical features.
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Affiliation(s)
- Ajit Sahu
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mohammed Shahin
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Priyansh Jain
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mahesh Sultania
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Pavithra Ayyanar
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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Rao A, Needleman L, Lalakea ML, Hsu E. A Case of Cribriform-Morular Thyroid Carcinoma Presenting Without Thyroid Nodule. JCEM CASE REPORTS 2024; 2:luae062. [PMID: 38638335 PMCID: PMC11025625 DOI: 10.1210/jcemcr/luae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Indexed: 04/20/2024]
Abstract
Cribriform-morular thyroid carcinoma is a rare type of thyroid cancer. It has a strong association with familial adenomatous polyposis (FAP), a hereditary genetic disorder that predisposes individuals to the development of numerous polyps in the colon and rectum. We describe the case of a young female patient who presented with an enlarging goiter, notably without detectable thyroid nodules or masses on ultrasound, who after total thyroidectomy was found to have cribriform-morular thyroid carcinoma. This diagnosis led to genetic testing and diagnosis of FAP syndrome. We demonstrate that this rare thyroid carcinoma may present with nonsuspicious findings on sonographic evaluation while being a valuable harbinger in the diagnosis of FAP syndrome.
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Affiliation(s)
- Angela Rao
- Division of Endocrinology, School of Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Leor Needleman
- Division of Endocrinology, School of Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - M Lauren Lalakea
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94304, USA
- Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| | - Emory Hsu
- Division of Endocrinology, School of Medicine, Stanford University, Palo Alto, CA 94304, USA
- Santa Clara Valley Medical Center, San Jose, CA 95128, USA
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Lahbacha B, Chaabane A, Nechi S, Mfarrej MK, Douggaz A, Kharrat G, Chelbi E. Cribriform-morular thyroid carcinoma: A case report with review of the literature. EAR, NOSE & THROAT JOURNAL 2023:1455613231152332. [PMID: 36640171 DOI: 10.1177/01455613231152332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cribriform-morular thyroid carcinoma (CM-TC) is a rare entity that usually occurs in association with familial adenomatous polyposis (FAP) but may be sporadic. Herein, we present a new case of cribriform-morular thyroid carcinoma occurring in a 28-year-old woman with no history of FAP.
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Affiliation(s)
- Bahaeddine Lahbacha
- Department of Pathology, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
- University of Monastir Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Abir Chaabane
- Department of Pathology, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Salwa Nechi
- Department of Pathology, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Mohamed Karim Mfarrej
- Department of Pathology, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Amel Douggaz
- Department of Pathology, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Ghada Kharrat
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
- Department of Otorhinolaryngology-Head and Neck surgery, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| | - Emna Chelbi
- Department of Pathology, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia
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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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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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