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Nagarjun BR, Mehta S, Gandhi J, Trivedi P, Rathod P. When to settle for SETTLE! A lesson learned from our cases. Thyroid Res 2024; 17:6. [PMID: 38438897 PMCID: PMC10913219 DOI: 10.1186/s13044-023-00189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/27/2023] [Indexed: 03/06/2024] Open
Abstract
Spindle epithelial tumor with thymic like elements (SETTLE) is a biphasic tumor composed of epithelial and spindle cell components. It is an uncommon indolent tumor arising in the thyroid gland and most commonly affects the children and young adults. This entity is mostly overlooked because of its rarity and diagnostic difficulty on morphology. We discuss two cases of SETTLE with varied presentation, diagnostic challenges and lessons learnt from them.SETTLE should be considered as a differential especially when dealing with a thyroid lesion in young and adolescent. The article discusses the histologic details and common mimickers to be borne in mind aiding in arrival at the final diagnosis on biopsy specimens.
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Affiliation(s)
| | - Shailee Mehta
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - Jahnavi Gandhi
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Priyank Rathod
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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2
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Le HT, Nguyen TPX, Hirokawa M, Katoh R, Mitsutake N, Matsuse M, Sako A, Kondo T, Vasan N, Kim YM, Liu Y, Hassell L, Kakudo K, Vuong HG. Primary Thyroid Mucoepidermoid Carcinoma (MEC) Is Clinically, Prognostically, and Molecularly Different from Sclerosing MEC with Eosinophilia: A Multicenter and Integrated Study. Endocr Pathol 2023; 34:100-111. [PMID: 36394696 DOI: 10.1007/s12022-022-09741-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
Mucoepidermoid carcinoma (MEC) and sclerosing MEC with eosinophilia (SMECE) are rare primary thyroid carcinomas. In this study, we aimed to present our multicenter series of MEC and SMECE and integrated our data with published literature to further investigate the clinicopathological characteristics and prognoses of these tumors. We found 2 MECs and 4 SMECEs in our multicenter archives. We performed fluorescence in situ hybridization (FISH) to determine the MAML2 gene rearrangement. We screened for mutations in BRAF, TERT promoter, and RAS mutations using Sanger sequencing and digital polymerase chain reaction. Histopathologically, MECs and SMECEs were composed of two main cell types including epidermoid and mucin-secreting cells, arranged in cords, nests, and tubules. SMECEs were characterized by a densely sclerotic stroma with abundant eosinophils. We did not detect any MAML2 fusion in any of our cases. Two MEC cases harbored concomitant BRAF p.V600E and TERT C228T mutations. RAS mutations were absent in all cases. Concurrent foci of another thyroid malignancy were more commonly seen in MECs (p < 0.001), whereas SMECEs were associated with chronic lymphocytic thyroiditis (p < 0.001). MECs and SMECEs had equivalent recurrence-free survival (RFS) but MECs conferred significantly dismal disease-specific survival (DSS) as compared to SMECEs (p = 0.007). In conclusion, MECs and SMECEs not only shared some similarities but also demonstrated differences in clinicopathological characteristics, prognoses, and molecular profiles. SMECEs had a superior DSS in comparison to MECs, suggesting that they are low-grade cancers. This could help clinicians better evaluate patient outcomes and decide appropriate treatment plans.
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Affiliation(s)
- Hieu Trong Le
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700-000, Vietnam
| | - Truong P X Nguyen
- Department of Pathology, Chulalongkorn University, Krung Thep Maha Nakhon , Bangkok, 10300, Thailand
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Ryohei Katoh
- Department of Pathology, Ito Hospital, Shibuya, Tokyo, 150-8308, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Michiko Matsuse
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Ayaka Sako
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, 409-3821, Japan
| | - Nilesh Vasan
- Department of Otolaryngology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Young Mi Kim
- Genetics Laboratory, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ying Liu
- Genetics Laboratory, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Lewis Hassell
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
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3
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López F, Al Ghuzlan A, Zafereo M, Vander Poorten V, Robbins KT, Hamoir M, Nixon IJ, Tufano RP, Randolph G, Pace-Asciak P, Angelos P, Coca-Pelaz A, Khafif A, Ronen O, Rodrigo JP, Sanabria Á, Palme CE, Mäkitie AA, Kowalski LP, Rinaldo A, Ferlito A. Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology. Cancers (Basel) 2023; 15:cancers15041255. [PMID: 36831604 PMCID: PMC9954150 DOI: 10.3390/cancers15041255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer.
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Affiliation(s)
- Fernando López
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
- Correspondence: ; Tel.: +34-985108000
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Gustave Roussy Cancer Campus, University Paris-Saclay, 91190 Villejuif, France
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- European Reference Network for Rare Adult Solid Cancers (EURACAN), 69008 Lyon, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium
| | - Iain J. Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh EH1 3EG, UK
| | - Ralph P. Tufano
- FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, FL 34239, USA
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA 02138, USA
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON M5S, Canada
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA
| | - Andrés Coca-Pelaz
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv 8410501, Israel
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan Pablo Rodrigo
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Álvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 01246-903, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, 35125 Padua, Italy
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Baloch ZW, Asa SL, Barletta JA, Ghossein RA, Juhlin CC, Jung CK, LiVolsi VA, Papotti MG, Sobrinho-Simões M, Tallini G, Mete O. Overview of the 2022 WHO Classification of Thyroid Neoplasms. Endocr Pathol 2022; 33:27-63. [PMID: 35288841 DOI: 10.1007/s12022-022-09707-3] [Citation(s) in RCA: 394] [Impact Index Per Article: 197.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
This review summarizes the changes in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors that relate to the thyroid gland. The new classification has divided thyroid tumors into several new categories that allow for a clearer understanding of the cell of origin, pathologic features (cytopathology and histopathology), molecular classification, and biological behavior. Follicular cell-derived tumors constitute the majority of thyroid neoplasms. In this new classification, they are divided into benign, low-risk, and malignant neoplasms. Benign tumors include not only follicular adenoma but also variants of adenoma that are of diagnostic and clinical significance, including the ones with papillary architecture, which are often hyperfunctional and oncocytic adenomas. For the first time, there is a detailed account of the multifocal hyperplastic/neoplastic lesions that commonly occur in the clinical setting of multinodular goiter; the term thyroid follicular nodular disease (FND) achieved consensus as the best to describe this enigmatic entity. Low-risk follicular cell-derived neoplasms include non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), thyroid tumors of uncertain malignant potential, and hyalinizing trabecular tumor. Malignant follicular cell-derived neoplasms are stratified based on molecular profiles and aggressiveness. Papillary thyroid carcinomas (PTCs), with many morphological subtypes, represent the BRAF-like malignancies, whereas invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent the RAS-like malignancies. This new classification requires detailed subtyping of papillary microcarcinomas similar to their counterparts that exceed 1.0 cm and recommends not designating them as a subtype of PTC. The criteria of the tall cell subtype of PTC have been revisited. Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC. The term "Hürthle cell" is discouraged, since it is a misnomer. Oncocytic carcinoma is discussed as a distinct entity with the clear recognition that it refers to oncocytic follicular cell-derived neoplasms (composed of > 75% oncocytic cells) that lack characteristic nuclear features of PTC (those would be oncocytic PTCs) and high-grade features (necrosis and ≥ 5 mitoses per 2 mm2). High-grade follicular cell-derived malignancies now include both the traditional poorly differentiated carcinoma as well as high-grade differentiated thyroid carcinomas, since both are characterized by increased mitotic activity and tumor necrosis without anaplastic histology and clinically behave in a similar manner. Anaplastic thyroid carcinoma remains the most undifferentiated form; squamous cell carcinoma of the thyroid is now considered as a subtype of anaplastic carcinoma. Medullary thyroid carcinomas derived from thyroid C cells retain their distinct section, and there is a separate section for mixed tumors composed of both C cells and any follicular cell-derived malignancy. A grading system for medullary thyroid carcinomas is also introduced based on mitotic count, tumor necrosis, and Ki67 labeling index. A number of unusual neoplasms that occur in the thyroid have been placed into new sections based on their cytogenesis. Mucoepidermoid carcinoma and secretory carcinoma of the salivary gland type are now included in one section classified as "salivary gland-type carcinomas of the thyroid." Thymomas, thymic carcinomas and spindle epithelial tumor with thymus-like elements are classified as "thymic tumors within the thyroid." There remain several tumors whose cell lineage is unclear, and they are listed as such; these include sclerosing mucoepidermoid carcinoma with eosinophilia and cribriform-morular thyroid carcinoma. Another important addition is thyroblastoma, an unusual embryonal tumor associated with DICER1 mutations. As in all the WHO books in the 5th edition, mesenchymal and stromal tumors, hematolymphoid neoplasms, germ cell tumors, and metastatic malignancies are discussed separately. The current classification also emphasizes the value of biomarkers that may aid diagnosis and provide prognostic information.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Virginia A LiVolsi
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Manuel Sobrinho-Simões
- Department of Pathology, Institute of Molecular Pathology and Immunology, IPATIMUP, University of Porto, Porto, Portugal
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
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5
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Purkait S, Sethy M, Parida PK, Mitra S. Cytology of mucoepidermoid carcinoma of thyroid. Cytopathology 2021; 32:836-839. [PMID: 34086373 DOI: 10.1111/cyt.13018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/24/2021] [Accepted: 05/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Suvendu Purkait
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | - Madhusmita Sethy
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
| | | | - Suvradeep Mitra
- Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, India
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6
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Lee K, Mirza O, Dobbs S, Jayaram S. Poorly differentiated mucoepidermoid carcinoma of the thyroid. BMJ Case Rep 2020; 13:13/12/e236539. [PMID: 33318270 PMCID: PMC7737045 DOI: 10.1136/bcr-2020-236539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mucoepidermoid carcinomas (MECs) are the most common malignant tumour of the salivary glands. MECs have also been reported to occur in atypical sites. Primary MECs of the thyroid gland are extremely rare, accounting for 0.5% of thyroid malignancies with approximately 48 cases reported in the literature. In most cases, these are low-grade neoplasms with good long-term prognosis. We present the case of a 74-year-old patient with poorly differentiated MEC of the thyroid gland, which behaved aggressively resulting in rapid decline and death of the patient. The exact pathophysiology of the disease remains unclear and there is no consensus on the optimal treatment for this histological subtype. Recognition and diagnosis of this rare neoplasm are important as this can help guide optimal treatment, although in high-grade poorly differentiated cases, treatment options remain limited.
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Affiliation(s)
| | - Omar Mirza
- ENT, North Manchester General Hospital, Manchester, UK
| | - Sian Dobbs
- ENT, Fairfield General Hospital, Bury, UK
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7
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Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M. Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. Endocr Pathol 2020; 31:197-217. [PMID: 32632840 PMCID: PMC7395918 DOI: 10.1007/s12022-020-09638-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
Thyroid pathology encompasses a heterogenous group of clinicopathological entities including rare and diagnostically challenging neoplasms. The review is focused on morphological, immunohistochemical, and molecular features of rare thyroid neoplasms that can pose diagnostic problems. The tumors are organized based on growth patterns including thyroid neoplasms with predominantly papillary, follicular, solid, and spindle cell growth pattern, as well as neoplasms with distinct cytological characteristics. A special section is also dedicated to rare thyroid tumors with peculiar patterns including thyroid carcinoma with Ewing family tumor elements and intrathyroidal thymic-related neoplasms.
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Affiliation(s)
- José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain.
- Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain.
- Department of Anatomic Pathology, Clinical University Hospital, Travesía Choupana s/n, 15706, 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
| | - 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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8
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Salivary-Like Tumors of the Thyroid: A Comprehensive Review of Three Rare Carcinomas. Head Neck Pathol 2020; 15:212-224. [PMID: 32562215 PMCID: PMC8010008 DOI: 10.1007/s12105-020-01193-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
Abstract
Thyroid carcinomas represent 3.2% of all new cases of cancer in the United States. Whereas most thyroid tumors arise from follicular cells or, less commonly, parafollicular cells, the derivation of some rare primary thyroid carcinoma subtypes is less clear and represents an area of evolving knowledge. Primary thyroid carcinomas that resemble neoplasms characteristic of the salivary glands ("salivary-like" primary thyroid carcinomas) arguably represent some of the most unusual primary thyroid tumors. Herein, we have undertaken a review of the literature in order to present a comprehensive overview of salivary-like primary thyroid carcinomas including: mucoepidermoid carcinoma, sclerosing mucoepidermoid carcinoma with eosinophilia, and secretory carcinoma. Awareness of these unusual, distinct primary tumors is important for timely diagnosis and optimal patient management. This review highlights these three salivary-like carcinomas, with special emphasis on developments since publication of the World Health Organization (WHO) 2017 Classification of Tumours of Endocrine Organs.
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Activating BRAF mutation in sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland: two case reports and review of the literature. J Med Case Rep 2019; 13:385. [PMID: 31882020 PMCID: PMC6935143 DOI: 10.1186/s13256-019-2288-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
Background Sclerosing mucoepidermoid carcinoma with eosinophilia is a rare form of thyroid carcinoma. The underlying molecular mechanisms of sclerosing mucoepidermoid carcinoma with eosinophilia tumorigenesis remain unknown. Case presentation We present two cases of sclerosing mucoepidermoid carcinoma with eosinophilia, both with a concurrent papillary thyroid carcinoma. Patient 1, a 70-year-old Caucasian woman, presented with sclerosing mucoepidermoid carcinoma with eosinophilia with distant renal metastasis and coexisting papillary thyroid carcinoma. Patient 2, a 74-year-old Caucasian woman with a remote history of thyroid cancer treated with thyroidectomy, presented with locoregionally invasive sclerosing mucoepidermoid carcinoma with eosinophilia and recurrent papillary thyroid carcinoma in the thyroid bed. BRAF mutation studies were performed on the sclerosing mucoepidermoid carcinoma with eosinophilia tumors. In both cases, sclerosing mucoepidermoid carcinoma with eosinophilia was positive for the BRAF V600E mutation by polymerase chain reaction. Patient 1 is the first reported case of sclerosing mucoepidermoid carcinoma with eosinophilia with renal metastasis, to the best of our knowledge. Conclusions Our findings suggest, for the first time, to our knowledge, involvement of the RAS-RAF-MEK-ERK signaling pathway in the pathogenesis of sclerosing mucoepidermoid carcinoma with eosinophilia. Thus, BRAF inhibitors may prove to be a useful targeted medical therapy in the treatment of a subset of patients with aggressive sclerosing mucoepidermoid carcinoma with eosinophilia tumors who exhibit BRAF activating mutation.
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10
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Le QV, Ngo DQ, Ngo QX. Primary Mucoepidermoid Carcinoma of the Thyroid: A Report of a Rare Case with Bone Metastasis and Review of the Literature. Case Rep Oncol 2019; 12:248-259. [PMID: 31011324 PMCID: PMC6465688 DOI: 10.1159/000498917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
Abstract
Mucoepidermoid carcinomas (MECs) are generally found in salivary gland, but they have also been mentioned in other organs such as the larynx, esophagus, breast. MECs are considered to be a low-grade carcinoma and their occurrence in the thyroid is extremely rare. We present a 54-year-old male patient admitted to our clinic, complaining about having back pains for approximately three months. A lumbosacral spine MRI and a PET/CT scan revealed multiple lesions in the L4, L5, S1 vertebra bodies, sacral bone and left pelvis bone, suggesting of a metastatic disease. The result of thyroid FNA was carcinoma and a biopsy of the vertebra bone confirmed the presence of a metastatic carcinoma. A total thyroidectomy and level VI neck dissection was conducted followed by palliative external beam radiotherapy (30 Gy) to the vertebra bodies, sacral bone and left pelvis bone. In pathological studies, the diagnosis of thyroid mucoepidermoid carcinoma was confirmed. Six months after treatment, the patient died due to severe pain and fatigue caused by the disease. Here, we report a rare case with bone metastasis as the first symptom of MEC and a brief review of published literature on the subject.
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Affiliation(s)
- Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
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11
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Wiles AB, Kraft AO, Mueller SM, Powers CN. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: Case report of a rare lesion with novel genetic mutation. Diagn Cytopathol 2019; 47:589-593. [DOI: 10.1002/dc.24148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Adele O. Kraft
- Department of PathologyVCU School of Medicine Richmond Virginia
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12
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Shah AA, La Fortune K, Miller C, Mills SE, Baloch Z, LiVolsi V, Dacic S, Mahaffey AL, Nikiforova M, Nikiforov YE, Seethala RR. Thyroid sclerosing mucoepidermoid carcinoma with eosinophilia: a clinicopathologic and molecular analysis of a distinct entity. Mod Pathol 2017; 30:329-339. [PMID: 27910944 PMCID: PMC5497311 DOI: 10.1038/modpathol.2016.180] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 01/15/2023]
Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia is a rare thyroid neoplasm of uncertain pathogenesis that resembles salivary gland mucoepidermoid carcinoma. This multi-institutional study characterizes the clinicopathologic and molecular features of this tumor by utilizing next-generation sequencing to assess common mutations and gene fusions involved in thyroid carcinogenesis as well as fluorescence in-situ hybridization for MAML2 translocations typical of salivary gland mucoepidermoid carcinoma. Nine cases (6 females and 3 males, mean age: 59 years, range 30-77 years) were identified. All cases were comprised of nests and strands of tumor cells with both squamous and mucinous differentiation embedded in a fibrohyaline stroma with an inflammatory infiltrate replete with eosinophils. All cases were p63 positive, thyroglobulin negative and showed variable expression of TTF-1. All nine cases were negative for MAML2 rearrangements. Five cases successfully tested by next-generation sequencing (ThyroSeq v.2 assay) were negative for mutations and translocations commonly involved in thyroid carcinogenesis. NTRK1 showed overexpression but no evidence of translocation. On follow-up, one patient died of persistent disease, whereas one of four remaining patients with available follow-up (mean: 7.3 years, range 4-11 years) demonstrated recurrence at 4 years. Thus, we show that sclerosing mucoepidermoid carcinoma with eosinophilia appears molecularly and morphologically distinct from follicular and C-cell-derived thyroid tumors as well as from salivary gland mucoepidermoid carcinoma. The overall and recurrence-free survival for these patients may be lower than for other well-differentiated thyroid cancers.
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Affiliation(s)
- Akeesha A Shah
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristin La Fortune
- Department of Pathology and Laboratory Medicine, Indiana University Medical Center, Indianapolis, IN, USA
| | - Caitlyn Miller
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stacey E Mills
- Department of Pathology, University of Virginia Health Science Center, Charlottesville, VA, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia LiVolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alyssa L Mahaffey
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marina Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Dettloff J, Seethala RR, Stevens TM, Brandwein-Gensler M, Centeno BA, Otto K, Bridge JA, Bishop JA, Leon ME. Mammary Analog Secretory Carcinoma (MASC) Involving the Thyroid Gland: A Report of the First 3 Cases. Head Neck Pathol 2016; 11:124-130. [PMID: 27400918 PMCID: PMC5429265 DOI: 10.1007/s12105-016-0741-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/24/2016] [Indexed: 11/21/2022]
Abstract
Salivary gland-type tumors have been rarely described in the thyroid gland. Mammary Analog Secretory Carcinoma (MASC) is a recently defined type of salivary gland carcinoma characterized by a t(12;15)(p13;q25) resulting in an ETV6-NTRK3 fusion gene. We report 3 cases of MASC involving the thyroid gland without clinical evidence of a salivary gland or breast primary; the clinico-pathologic characteristics are reviewed. Assessment for rearrangement of the ETV6 (12p13) locus was conducted by fluorescence in situ hybridization (FISH) on representative FFPE sections using an ETV6 break apart probe (Abbott Molecular, Des Plaines, IL, USA). The patients were two females (52 and 55 years-old) and 1 male (74 years-old). The tumors were poorly circumscribed solid white tan nodules involving the thyroid. Histologically, they were invasive and showed solid, microcystic, cribriform, and tubular growth patterns composed of variably bland polygonal eosinophilic cells with vesicular nuclear chromatin and conspicuous nucleoli. All three cases showed metastasis to lymph nodes; one case showed lateral neck involvement. The tumor cells were positive for S100 and mammaglobin. GATA-3 and PAX-8 were positive in 2 cases, one of which only focally so. All three cases were negative for TTF-1 and thyroglobulin. Rearrangement of the ETV6 locus was confirmed in all cases and a diagnosis of MASC rendered for each case. A site of origin distinct from the thyroid gland was not identified, with a median follow up of 24 months. MASC may rarely involve the thyroid gland. The origin of these lesions is unknown; while an origin from ectopic salivary gland-type cells is entertained, a metastatic origin from an occult primary cannot be definitively excluded at this time. Given the histologic (follicular-like microcystic pattern with colloid-like secretions and papillary pattern), immunophenotypic (PAX-8), and even molecular overlap, MASC can be mistaken for papillary thyroid carcinoma and should be considered in the differential diagnosis of a thyroid mass.
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Affiliation(s)
- Jennifer Dettloff
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612 USA
| | - Raja R. Seethala
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Todd M. Stevens
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Margaret Brandwein-Gensler
- Department of Pathology and Anatomical Sciences, University at Buffalo The State University of New York, Buffalo, NY USA ,Department of Pathology, Erie County Medical Center, Buffalo, NY USA
| | - Barbara A. Centeno
- Department of Anatomic Pathology, Head and Neck Pathology and Cytopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 USA ,Department of Oncologic Sciences, Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Kristen Otto
- Head and Neck Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 USA
| | - Julia A. Bridge
- Departments of Pathology/Microbiology and Pediatrics and Orthopaedic Surgery, Nebraska Medical Center, Omaha, NE 68198-3135 USA
| | - Justin A. Bishop
- Departments of Pathology, Oncology, and Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21231 USA
| | - Marino E. Leon
- Department of Anatomic Pathology, Head and Neck Pathology and Cytopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 USA ,Head and Neck Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 USA ,Department of Oncologic Sciences, Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, 12902 Magnolia Drive, Tampa, FL 33612 USA
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14
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Pantola C, Kala S, Athar M, Thakur S. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: A cytological dilemma. J Cytol 2016; 33:37-9. [PMID: 27011441 PMCID: PMC4782402 DOI: 10.4103/0970-9371.175511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid is a rare primary thyroid tumor arising in a background of Hashimoto's/lymphocytic thyroiditis and has been recently introduced in the World Health Organization (WHO) classification of thyroid tumors. It is characterized by extensive sclerosis, squamous and glandular differentiation, and inflammatory infiltrate rich in eosinophil. Here, we are discussing the cytological features of this rare case in a 35-year-old female presented with thyroid swelling and lymph-node enlargement.
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Affiliation(s)
- Chayanika Pantola
- Department of Pathology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Sanjay Kala
- Department of Surgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Mohd Athar
- Department of Surgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Sudeep Thakur
- Department of Pathology, Sudeep's Biopsy and Pathology Centre, Kanpur, Uttar Pradesh, India
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15
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Taconet S, Bosq J, Hartl D, Schlumberger M, Leboulleux S, Scoazec JY, Al-Ghuzlan A. Composite Mucoepidermoid Carcinoma and Columnar Cell Variant of Papillary Carcinoma of the Thyroid: A Case Report and Review of the Literature. Int J Surg Pathol 2016; 24:336-40. [PMID: 26755714 DOI: 10.1177/1066896915626281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary mucoepidermoid carcinoma (MEC) of the thyroid and columnar cell variant of papillary carcinoma of the thyroid (PCT) are uncommon neoplasms. We report the first case of composite MEC and columnar cell variant of PCT. An 86-year-old man consulted for a 47-mm thyroid nodule, cytologically compatible with PCT. Total thyroidectomy was performed. Histological diagnosis, with support of histochemistry and immunohistochemistry, was mixed primary carcinoma of the thyroid, associating an MEC component with predominantly columnar cell variant of PCT. Sixteen months after surgery and external beam radiation therapy, the patient was free of recurrence or distant metastasis. This case report offers an opportunity to highlight the potential pitfalls concerning the interpretation of mucin histochemistry in thyroid tumors.
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Affiliation(s)
- Sarah Taconet
- Service de Pathologie Morphologique, Gustave Roussy Cancer Campus, Villejuif, France Universite Paris Nord Sorbonne Cite, UFR Médecine Santé Biologie humaine, Bobigny, France
| | - Jacques Bosq
- Service de Pathologie Morphologique, Gustave Roussy Cancer Campus, Villejuif, France
| | - Dana Hartl
- Unité de chirurgie thyroïdienne, Gustave Roussy Cancer Campus, Villejuif, France
| | - Martin Schlumberger
- Service de médecine nucléaire, Gustave Roussy Cancer Campus, Villejuif, France Université Paris Saclay, Université Paris Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Sophie Leboulleux
- Service de médecine nucléaire, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Yves Scoazec
- Service de Pathologie Morphologique, Gustave Roussy Cancer Campus, Villejuif, France Université Paris Saclay, Université Paris Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Abir Al-Ghuzlan
- Service de Pathologie Morphologique, Gustave Roussy Cancer Campus, Villejuif, France
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16
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Squillaci S, Pitino A, Spairani C, Ferrari M, Carlon E, Cosimi MF. Mucinous Variant of Follicular Carcinoma of the Thyroid Gland: Case Report and Review of the Literature. Int J Surg Pathol 2015; 24:170-6. [PMID: 26582770 DOI: 10.1177/1066896915617026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The rare reports of mucinous variant of follicular carcinoma of the thyroid gland have not provided enough evidence to support the recognition of these tumors as a distinct clinicopathologic entity or to understand their etiopathogenesis. We report the fourth case of mucinous variant of follicular carcinoma displaying a minimally invasive tumor with diffuse expression of thyroglobulin, TTF-1, CD56, PAX-8, cytokeratins 7 and 19, in the absence of monoclonal carcinoembryonic antigen (CEA), cytokeratin 20, chromogranin, HBME-1, P63 expression, and BRAF gene mutation, in a 51-year-old woman who is alive without signs of disease 13 months after total thyroidectomy, bilateral neck dissection, and radioactive iodine. Herein, fine-needle aspiration cytology disclosed "worrisome" cytologic features consisting of large epithelial cells arranged in clusters or singularly, with high nucleocytoplasmic ratio, nuclear grooves and evident nucleoli which were shared by those of mucin-producing papillary thyroid carcinoma. Therefore, knowledge of the cytological and histopathological spectrum of this lesion is important to avoid misdiagnosis. The morphologic clues leading to the correct diagnosis of mucinous variant of follicular neoplasm have been correlated with the data of the literature, and the differential diagnosis is briefly discussed.
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Affiliation(s)
- Salvatore Squillaci
- Division of Anatomic Pathology, Hospital of Vallecamonica, Esine (Bs), Italy
| | - Antonio Pitino
- Division of Anatomic Pathology, Hospital "San Giacomo", Novi Ligure (AL), Italy
| | - Cinzia Spairani
- Division of Anatomic Pathology, Hospital "San Giacomo", Novi Ligure (AL), Italy
| | - Mauro Ferrari
- Division of Anatomic Pathology, Hospital "San Giacomo", Novi Ligure (AL), Italy
| | - Eugenio Carlon
- Division of Radiology, Hospital of Acqui Terme (AL), Italy
| | - Maria Fabia Cosimi
- Division of Anatomic Pathology, Hospital "San Giacomo", Novi Ligure (AL), Italy
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17
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Ciliated muconodular papillary tumors of the lung: a clinicopathologic analysis of 10 cases. Am J Surg Pathol 2015; 39:753-60. [PMID: 25803171 DOI: 10.1097/pas.0000000000000414] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Ciliated muconodular papillary tumors (CMPTs) are rare peripheral nodules of the lung first described in 2002. Because of their rarity and nonstandardized diagnostic terminology, CMPTs have been poorly recognized among pathologists. To better characterize these lesions, we undertook a detailed clinicopathologic and immunohistochemical study of 10 archival cases. Ten CMPTs occurred in 7 men and 3 women with a median age of 62 years. All were small peripheral nonendobronchial nodules with a mean diameter of 1.0 cm. All but 1 tumor were incidentally detected by computed tomography-based screening, all of which were radiologically interpreted as adenocarcinomas. Although limited surgery treated all but 1 CMPT, they followed a benign course with no recurrence at a mean follow-up of 43 months (range: 2 to 88 mo). Histologically, CMPTs showed glandular and/or papillary architecture, comprising a vaguely organized mixture of nonatypical ciliated columnar cells, mucous cells, and basal cells, often enveloped by copious intra-alveolar mucin. Micropapillary tufts of ciliated cells and seemingly discontinuous growth along alveolar walls were occasionally present, mimicking adenocarcinomas. Ciliated cells and basal cells were immunopositive for TTF-1 and p40, respectively, whereas mucous cells lacked HNF4α expression. CMPTs are rare, likely benign, underrecognized processes of the lung that should be distinguished from adenocarcinomas.
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18
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Warner E, Ofo E, Connor S, Odell E, Jeannon JP. Mucoepidermoid carcinoma in a thyroglossal duct remnant. Int J Surg Case Rep 2015; 13:43-7. [PMID: 26101054 PMCID: PMC4529606 DOI: 10.1016/j.ijscr.2015.04.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/20/2015] [Accepted: 04/26/2015] [Indexed: 11/30/2022] Open
Abstract
Thyroglossal duct remnants should be surgically excised, if possible due to the risk of malignant transformation. Mucoepidermoid carcinomas can present in diverse locations outside of salivary glands. A high index of suspicion for malignancy is required with neck masses in adults, especially following a period of rapid growth. If aggressively treated, patients with mucoepidermoid carcinoma outside of salivary glands may still have a favourable prognosis.
Introduction Thyroglossal duct cysts (TDC) are common midline neck swellings resulting from embryological remnants of the thyroglossal duct. They often contain ectopic thyroid tissue and malignant transformation has been reported, most commonly to papillary thyroid carcinoma. Mucoepidermoid carcinoma (MEC) usually occurs in the salivary glands and only rarely in the thyroid. This is the first case of a MEC occurring within a thyroglossal duct remnant. Presentation of a case A 73 year old lady presented with a thyroglossal duct cyst. She declined surgical excision, as she was adamant she wanted to avoid surgery. The neck mass rapidly enlarged at two years following initial diagnosis. Fine needle aspiration cytology was suspicious for carcinoma. She underwent total thyroidectomy and selective central compartment neck dissection with adjuvant radiotherapy. She remains alive and well two years post treatment. Discussion Mucoepidermoid carcinoma is the most common malignant neoplasm of salivary glands, although it has rarely been reported in diverse locations including the thyroid, lung and pancreas. To the best of our knowledge, this is the first reported case of mucoepidermoid carcinoma arising from a thyroglossal duct remnant. Conclusion This case adds weight to the literature favouring surgical excision of thyroglossal duct remnants due to the risk of malignant transformation.
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Affiliation(s)
- E Warner
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK.
| | - E Ofo
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - S Connor
- Head and Neck Radiology, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - E Odell
- Head and Neck Pathology, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - J P Jeannon
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
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19
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Nath V, Parks GE, Baliga M, Hartle EO, Geisinger KR, Shenoy V. Mucoepidermoid carcinoma of the thyroid with concomitant papillary carcinoma: comparison of findings on fine-needle aspiration biopsy and histology. Endocr Pathol 2014; 25:427-32. [PMID: 25307114 DOI: 10.1007/s12022-014-9338-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report two cases of mucoepidermoid carcinoma (MEC) of the thyroid gland coexisting with, and possibly arising in, papillary thyroid carcinoma (PTC). In the first case, CT-guided fine-needle aspiration (FNA) was performed on a paratracheal mass representing extrathyroidal invasion of a right thyroid lobe tumor. The aspirate showed papillary fronds and cells in honeycombed arrangements with fine chromatin, enlarged nuclei, nuclear grooves, and intranuclear inclusions in a background of mucus and blood; a diagnosis of PTC was rendered initially. However, examination of histologic sections of the mass showed nests of malignant squamous cells with interspersed mucous cells and extracellular mucin, concordant with MEC, as well as PTC. A retrospective review of the FNA specimen identified MEC. In the second case, ultrasound-guided FNA was performed on a right thyroid lobe nodule. The aspirate contained two populations of epithelial cells: larger cells showing foci of both squamous and glandular differentiation that were interpreted as MEC and smaller follicular cells with nuclear changes characteristic of PTC; both were addressed in the diagnostic report. Primary MEC of the thyroid is a rare neoplasm typically exhibiting indolent clinical behavior, although our first case demonstrated extensive local invasion. It is thought to arise from squamous metaplasia associated with PTC, Hashimoto thyroiditis, or other inflammatory or neoplastic processes. In thyroid FNAs, the presence of neoplastic mucous cells and extracellular mucin plus malignant squamous cells is diagnostic of MEC. As MEC is thought to arise in PTC, the finding of the latter in these aspiration specimens is not unexpected.
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Affiliation(s)
- Vikas Nath
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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20
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Farhat NA, Faquin WC, Sadow PM. Primary mucoepidermoid carcinoma of the thyroid gland: a report of three cases and review of the literature. Endocr Pathol 2013; 24:229-33. [PMID: 24096806 DOI: 10.1007/s12022-013-9267-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mucoepidermoid carcinoma is the most common salivary gland malignancy and it may arise anywhere that salivary tissue is present. Mucoepidermoid carcinoma has been reported to arise de novo within the thyroid gland, and here, we describe three cases of primary mucoepidermoid carcinoma of the thyroid, including clinical presentation, diagnostic evaluation, and clinical follow-up, along with a discussion of tumor origin and a review of the literature.
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Affiliation(s)
- Nada A Farhat
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
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21
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A poor prognostic case of mucoepidermoid carcinoma of the thyroid: a case report. Case Rep Endocrinol 2012; 2012:862545. [PMID: 22970393 PMCID: PMC3437277 DOI: 10.1155/2012/862545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 07/17/2012] [Indexed: 11/17/2022] Open
Abstract
Mucoepidermoid carcinoma (MEC) of the thyroid is very rare and low-grade indolent neoplasm. In past reports of the thyroid MEC, only seven cases were described as poor prognosis. A 91-year-old woman presented with a rapidly growing mass of the left upper neck. She was followed thyroid papillary carcinoma (PC) without operation for two years. Fine needle aspiration cytology (FNAC) showed undifferentiated cells. Total thyroidectomy and bilateral neck dissection were performed. In pathological findings, the tumor had two areas of MEC and PC. The boundary of them was mixed. She died of multiple lung metastases only after four months from the operation. We report a rare case of thyroid MEC which had an aggressive behavior and poor prognosis. This case is a precious in that thyroid MEC occurred during observation of PC and suggests a possibility of the transformation from PC to MEC.
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Prichard RS, Lee JC, Gill AJ, Sywak MS, Fingleton L, Robinson BG, Sidhu SB, Delbridge LW. Mucoepidermoid carcinoma of the thyroid: a report of three cases and postulated histogenesis. Thyroid 2012; 22:205-9. [PMID: 22224821 DOI: 10.1089/thy.2011.0276] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Primary mucoepidermoid carcinoma (MEC) of the thyroid is a rare clinical and pathological entity that accounts for <0.5% of all thyroid malignancies. Although the histogenesis has been controversial, most investigators now favor it as arising from either metaplasia of thyroid follicular epithelium or heterologous de-differentiation from papillary thyroid carcinoma (PTC). We report three cases of thyroid MEC found in continuity with, and clearly arising from de-differentiation of, well-differentiated thyroid carcinomas (WDTCs). PATIENT FINDINGS AND SUMMARY The cases presented here included two women (aged 22 and 52) and one man (aged 58). One of these cases arose in conjunction with PTC, one with follicular thyroid carcinoma (FTC), and one with Hurthle cell carcinoma (HCC). In all three cases, there was a gradual transition in morphology between the areas of typical WDTC and the areas showing MEC differentiation. In addition, immunohistochemistry demonstrated a gradual loss of thyroid specific markers (thyroid transcription factor-1, thyroglobulin) mirroring the change in morphology. CONCLUSION We conclude that thyroid MEC can arise from metaplastic de-differentiation of WDTC, including FTC or HCC in addition to PTC. Currently, we recommend that after excision, each of the WDTC and MEC components of these tumors be treated with targeted adjuvant therapies, which may involve radioactive-iodine ablation, thyrotropin suppression, and external beam radiotherapy.
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Affiliation(s)
- Ruth S Prichard
- Department of Endocrine and Oncology Surgery, Royal North Shore Hospital, Sydney, Australia
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24
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Jung YH, Kang MS. Composite follicular variant of papillary carcinoma and mucoepidermoid carcinoma of thyroid gland: a case report. J Korean Med Sci 2010; 25:1683-7. [PMID: 21060764 PMCID: PMC2967012 DOI: 10.3346/jkms.2010.25.11.1683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/17/2010] [Indexed: 11/22/2022] Open
Abstract
A 50-yr-old male presented a thyroid mass with dysphasia and hoarseness. He underwent total thyroidectomy and neck node dissection. Pathologically, the tumor had two distinct tumor components with intermingled areas: follicular variant of papillary carcinoma and mucoepidermoid carcinoma. Mucoepidermoid carcinoma composed of columnar cells, mucocytes, and squamoid cells showing solid and cystic lesion. Several small cysts lined by benign ciliated columnar epithelia suggesting that this tumor had originated from solid cell nest were seen around the tumor. By immunohistochemistry, columnar cells and squamoid cells in mucoepidermoid carcinoma were positive for cytokeratin but negative for thyroglobulin, TTF-1 and calcitonin. Positivity of p63 was seen in squamoid cells and basal cells of cysts. Some mucocytes are CEA positive. Tumor cells of papillary carcinoma are positive for TTF-1, thyroglobulin but negative for CEA, calcitonin and p63.
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Affiliation(s)
- Yong Han Jung
- Department of Pathology, Pusan Paik Hospital, Inje University, Busan, Korea
| | - Mi Seon Kang
- Department of Pathology, Pusan Paik Hospital, Inje University, Busan, Korea
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25
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Ando M, Nakanishi Y, Asai M, Maeshima A, Matsuno Y. Mucoepidermoid carcinoma of the thyroid gland showing marked ciliation suggestive of its pathogenesis. Pathol Int 2008; 58:741-4. [DOI: 10.1111/j.1440-1827.2008.02303.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Sclerosing mucoepidermoid carcinoma of the thyroid gland: cytohistological findings of a case. Hematol Oncol Stem Cell Ther 2008; 1:62-5. [PMID: 20063531 DOI: 10.1016/s1658-3876(08)50063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Tirado Y, Williams MD, Hanna EY, Kaye FJ, Batsakis JG, El-Naggar AK. CRTC1/MAML2 fusion transcript in high grade mucoepidermoid carcinomas of salivary and thyroid glands and Warthin's tumors: implications for histogenesis and biologic behavior. Genes Chromosomes Cancer 2007; 46:708-15. [PMID: 17437281 DOI: 10.1002/gcc.20458] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We analyzed 55 primary salivary gland tumors including 22 mucoepidermoid carcinomas (MECs) to determine the association of MECT1/TORC1/CRTC1-MAML2 fusion transcript to tumor types, level of MEC differentiation and clinicopathologic parameters. Our primary salivary gland tumors were composed of 22 MECs, 11 Warthin's tumors, 10 adenoid cystic carcinomas, two basaloid carcinomas, five salivary duct carcinomas, and five adenocarcinomas, not otherwise specified. We also included, for the first time, three primary MECs of the thyroid gland. We used nested RT-PCR and subsequent sequencing techniques for detection and verification of the fusion transcript in fresh and archival specimens. Eighteen (81%) of the 22 primary salivary and one of the three thyroid glands with MEC were positive for the fusion transcript. The transcript was detected equally in low, intermediate and high grade as well as low and high stage MECs. Significant correlation between fusion negative tumors and distant metastasis was noted (P = 0.005). Four (36%) of the 11 Warthin's tumors were also positive for the transcript. None of the 22 primary non-MEC gland salivary carcinomas were positive for the transcript. We conclude that the CRTC1/MAML2 transcript may be detected in both low and high grade MEC, that fusion negative tumors may define a subset of biologically aggressive MEC's tumors, that the fusion is present in primary MECs of the thyroid gland and is also detectable in Warthin's tumor, and that a subset of MECs can be targeted for therapeutic intervention.
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Affiliation(s)
- Yamilet Tirado
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA
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28
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Murakami S, Sakata H, Okubo K, Tsuji Y, Kayano H. Thyroid Adenoma with Extensive Extracellular Mucin Deposition: Report of a Case. Surg Today 2007; 37:226-9. [PMID: 17342362 DOI: 10.1007/s00595-006-3388-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 08/29/2006] [Indexed: 10/23/2022]
Abstract
A thyroid tumor with extensive extracellular mucin deposition is extremely rare. We herein describe a case of a thyroid adenoma with prominent myxoid stroma. A 63-year-old man presented with a mass in his right anterior neck. Radiological examinations showed this mass to be a thyroid tumor with a cystic component. The histopathological findings showed the stroma of this tumor to consist of abundant myxoid materials which stained gray-bluish for hematoxylin-eosin. The myxoid material was positive for alcian blue, whereas periodic acid-Schiff did not stain this material. No intracytoplasmic mucin was identified. In an immunohistochemical study, the tumor cells were negative for cytokeratin 19. Furthermore, positive staining was observed for thyroglobulin while a negative finding was seen for calcitonin.
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Affiliation(s)
- Saburo Murakami
- Department of Surgery, Saitama Medical School, 38 Morohongo, Moroyama-machi, Iruma-gunn, Saitama 350-0495, Japan
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29
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França SR, Caldas D, Alcebíades V, de Oliveira CAB. [Mucoepidermoid carcinoma of the thyroid: a case report and literature review]. ACTA ACUST UNITED AC 2006; 50:968-76. [PMID: 17160225 DOI: 10.1590/s0004-27302006000500022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 08/08/2006] [Indexed: 11/21/2022]
Abstract
The mucoepidermoid carcinoma is a neoplasia that usually occurs at salivary glands, breast, pancreas and gastrointestinal tract. The primary occurrence on thyroid gland is rare and only 33 cases were previously published. Although the majority of cases of mucoepidermoid carcinoma of the thyroid (MECT) show a benign evolution, this paper describes a patient with an aggressive tumor. A literature review over clinical, histopathological, immunohistochemical features and histogenetic origin was discussed.
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30
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Musso-Lassalle S, Butori C, Bailleux S, Santini J, Franc B, Hofman P. A diagnostic pitfall: Nodular tumor-like squamous metaplasia with Hashimoto's thyroiditis mimicking a sclerosing mucoepidermoid carcinoma with eosinophilia. Pathol Res Pract 2006; 202:379-83. [PMID: 16488086 DOI: 10.1016/j.prp.2005.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 12/05/2005] [Indexed: 11/20/2022]
Abstract
Nodular tumor-like squamous metaplasia with Hashimoto's thyroiditis is an exceptional, benign condition presenting diagnostic difficulties for the pathologist. The main differential diagnosis is a sclerosing mucoepidermoid carcinoma (SMC) with eosinophilia. One case arising in a 50-year-old Caucasian man is reported. Histologically, the nodule consisted of large nests of squamous cells surrounded by connective tissue in Hashimoto's thyroiditis. We present the different histological criteria, allowing us to eliminate an SMC and other neoplastic tumors of the thyroid. The etiology of this tumor-like lesion, which is still under debate, is discussed.
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Affiliation(s)
- Sandra Musso-Lassalle
- Laboratory of Clinical and Experimental Pathology, 30 avenue de la voie romaine, Louis Pasteur Hospital, 06002 Nice, France
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31
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Ryska A, Ludvíková M, Rydlová M, Cáp J, Zalud R. Massive squamous metaplasia of the thyroid gland – Report of three cases. Pathol Res Pract 2006; 202:99-106. [PMID: 16376021 DOI: 10.1016/j.prp.2005.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 11/01/2005] [Indexed: 10/25/2022]
Abstract
Three cases of massive squamous cell metaplasia in Hashimoto's thyroiditis are reported. The patients were two men and one woman aged 24, 52, and 55 years, respectively. In all three patients, the glandular parenchyma was replaced by hypocellular fibrous tissue with scattered chronic inflammatory infiltrate. Follicular cells were almost absent; the majority of residual epithelial cells formed squamous nests that were partly solid and partly cystic. There were three types of epithelial cells - squamous, basaloid, and follicular, with oncocytic differentiation. The squamous and basaloid cells showed strong positivity high molecular weight (HMW) cytokeratin, moderate to strong expression of galectin-3 (2/3), and nuclear expression of p63 protein (2/3). The staining pattern of p63 was identical to that of HMW, with predominant positivity at the periphery of cell nests. In one case, weak but unequivocal positivity of thyroid transcription factor-1 also was present. We believe that metaplasia was caused by Hashimoto's thyroiditis. The cases presented here are extremely rare, and only two convincing similar cases have been reported in the English literature so far. They may represent a diagnostic pitfall and should not be misdiagnosed as a malignancy, in particular as squamous cell or mucoepidermoid carcinoma.
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Affiliation(s)
- Ales Ryska
- Department of Pathology, Charles University Faculty of Medicine and Faculty Hospital, CZ-500 05 Hradec Králové, Czech Republic.
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32
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Albores-Saavedra J, Wu J. The many faces and mimics of papillary thyroid carcinoma. Endocr Pathol 2006; 17:1-18. [PMID: 16760576 DOI: 10.1385/ep:17:1:1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 12/22/2022]
Abstract
This article provides an overview of the 15 histologic variants of papillary thyroid carcinoma listed by the 2004 World Health Organization (WHO) monograph on endocrine tumors. The histologic features, differential diagnosis, and clinical course of each variant are discussed in some detail. The follicular variants (conventional and macrofollicular) constitute a morphologic challenge because the majority of these tumors are encapsulated and, also, because, in many tumors, not all neoplastic cells show the nuclear features considered to be diagnostic of papillary carcinoma. As a result, most of these tumors are missed even by experienced pathologists. Moreover, hyperplastic thyroid lesions, follicular adenomas, and Hashimoto's thyroiditis may contain cells with clear nuclei resembling those of papillary carcinoma. Papillary carcinomas composed entirely of hyperchromatic cells have been overlooked. The WHO monograph defines papillary carcinoma with focal spindle and giant cell carcinoma components but its clinical behavior is unknown. Papillary carcinoma with an insular pattern that does not show the artifactual separation of the cell nests has been misinterpreted as the solid variant of papillary carcinoma. Papillary microcarcinomas include not only the conventional type and the follicular variants but also the tall cell and columnar cell variants.
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Affiliation(s)
- Jorge Albores-Saavedra
- The Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, USA.
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33
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Abstract
OBJECTIVES The aim of the study was to report a recent case of mucoepidermoid carcinoma (MEC) of the thyroid, review the pertinent literature, and highlight the importance of multimodal treatment in this potentially aggressive malignancy. STUDY DESIGN The study comprise a case report and a review of literature. METHODS A 42-year-old woman had initially presented to another hospital with a painful left neck mass. She subsequently underwent left hemithyroidectomy. Surgical pathology was significant for lymphocytic thyroiditis and MEC. One month later, she presented to us with a right neck mass. RESULTS The patient underwent completion thyroidectomy and selective neck dissection, including level 6, for high-grade MEC. Operative findings included 3 lymph nodes positive for metastasis and tumor invasion of the transverse cervical vein. Postoperative chemoradiation therapy was administered in 2 cycles separated by 1 month. The patient remains disease-free 22 months after the last treatment. CONCLUSION Mucoepidermoid carcinoma is a rare malignancy of the thyroid with less than 35 cases reported to date. The origins of this tumor are not completely understood, with debate regarding whether it arises from solid cell nests of the ultimobranchial apparatus or from follicular epithelium. Although MEC of the thyroid has frequently been reported as low grade, the aggressive presentation in our patient suggests the appropriateness of multimodal therapy.
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Affiliation(s)
- Naveen D Bhandarkar
- Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, OH, USA
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34
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Thompson LDR, Wieneke JA, Heffess CS. Diffuse sclerosing variant of papillary thyroid carcinoma: a clinicopathologic and immunophenotypic analysis of 22 cases. Endocr Pathol 2005; 16:331-48. [PMID: 16627920 DOI: 10.1385/ep:16:4:331] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/11/2022]
Abstract
BACKGROUND The diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) is an uncommon tumor making up about 2% of all papillary thyroid carcinomas. Previous studies have not comprehensively evaluated these tumors in a large series of patients. DESIGN Twenty-two cases of DSV-PTC diagnosed between 1970 and 2000 were identified in the files of the AFIP. Histologic and immunohistochemical features were evaluated and patient follow-up was obtained. RESULTS The tumors affected 14 females and 8 males, aged 6 to 49 yr (mean, 18 yr), with males presenting at a mean older age than females (24 vs 14 yr). Symptoms included an enlarging mass in the thyroid, present for a mean of 9.5 mo. While a dominant tumor was identified in a single lobe, bilateral disease was common (n = 16). The dominant mass ranged in size from 1.7 to 5.8 cm in diameter (mean, 3.8 cm). Histologically, all cases demonstrated a papillary carcinoma (conventional, solid, or follicular pattern) diffusely involving the gland. Extrathyroidal extension, lymphocytic thyroiditis, squamous metaplasia, increased fibrosis/sclerosis, and psammoma bodies were present to a variable degree. Both the papillary carcinoma and squamous metaplasia cells were strongly immunoreactive with CK19, thyroglobulin, and TTF-1. An increased number of S-100 protein immunoreactive dendritic cells were recognized. p53 was increased (>15%) in the tumor cells in 12 patients, while Ki-67 was increased in the tumor cells in two patients. Perithyroidal and cervical lymph node metastasis occurred in 18 (82%) patients. All metastases demonstrated histologic features similar to the primary. Complete resection (thyroidectomy in 18 patients) with lymph node dissection, yielded a 95% 5-yr survival without evidence of disease. One patient died of disease after a malignant transformation of the squamous metaplasia into squamous cell carcinoma. CONCLUSIONS The recognition of DSV-PTC can be made with the following features: classic to solid foci of PTC, lymphocytic thyroiditis, squamous metaplasia, increased fibrosis, and innumerable psammoma bodies. DSV-PTC is more biologically aggressive than conventional PTC, but the patients' survival is not significantly different. This diagnosis should lead the clinician to aggressively manage these patients (thyroidectomy and lymph node dissection) in an effort to achieve an excellent long-term clinical outcome.
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Affiliation(s)
- Lester D R Thompson
- Southern California Permanente Medical Group, Woodland Hills Medical Center, Department of Pathology, Woodland Hills, CA 91365, USA.
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35
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Burstein DE, Nagi C, Wang BY, Unger P. Immunohistochemical detection of p53 homolog p63 in solid cell nests, papillary thyroid carcinoma, and hashimoto's thyroiditis: A stem cell hypothesis of papillary carcinoma oncogenesis. Hum Pathol 2004; 35:465-73. [PMID: 15116328 DOI: 10.1016/j.humpath.2003.10.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most models suggest that the cell of origin of papillary carcinoma is the mature thyroid follicular epithelial cell. In a recent study, p63 was detected in papillary carcinoma, Hashimoto's thyroiditis, and in squamoid aggregates and solid cell nests (SCNs), embryonic remnants found sporadically in the fully developed thyroid. In the present study, the relationship between solid cell nests and papillary carcinoma was investigated further. Four-micrometer sections from 88 routinely fixed and processed archival thyroidectomy specimens were pretreated with citric acid pH 6.0 for antigen retrieval, then incubated overnight with anti-p63 monoclonal antibody 4A4. Slides were stained with a streptavidin-biotin kit and diaminobenzidine as chromogen and were counterstained with hematoxylin. Squamoid aggregates or SCNs were noted in 21 specimens. Several morphologic variants of SCNs were found, all of which displayed p63 positivity. These included undifferentiated SCNs and those displaying commitment toward squamoid and ciliated glandular differentiation. Small, morphologically inconspicuous aggregates of p63-positive cells were commonly found in Hashimoto's thyroiditis. Commitment of p63-positive undifferentiated cells toward thyroid follicular epithelial differentiation was occasionally noted. One SCN variant, also associated with Hashimoto's thyroiditis, was a floretlike arrangement of p63-positive cells with fusiform nuclei. p63 staining was strong and uniform in some SCNs, but in other SCNs it was compartmentalized and homologous to stem cell-staining patterns in normal squamous or bronchial epithelia. Stem cell-like staining, associated with compartmentalized p63 staining or p63-positive undifferentiated cells, was noted in 7 of 27 papillary carcinomas. p63 immunostaining is a highly sensitive means of detecting SCNs. p63 expression patterns in SCNs and a subset of papillary carcinomas are closely homologous to stem cell-associated p63 staining patterns that have been described elsewhere in squamous and bronchial epithelia. We propose a stem-cell-associated model of papillary carcinoma oncogenesis that suggests that (1) p63-positive embryonal remnants rather than mature follicular cells are the cells of origin of a subset of papillary carcinomas; (2) these p63-positive cells are pluripotent and may stay undifferentiated or undergo benign squamoid or glandular maturation, may undergo thyroid follicular epithelial differentiation, may undergo oncogenic change leading to papillary carcinoma, or may trigger an immune reaction, resulting in lymphoid infiltration and Hashimoto's thyroiditis; and (3) Hashimoto's thyroiditis and papillary carcinoma may therefore be linked etiologically, because both disorders may be initiated by the same population of pluripotent p63-positive embryonal stem cell remnants.
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Affiliation(s)
- David E Burstein
- Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, New York, USA
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36
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Shehadeh NJ, Vernick J, Lonardo F, Madan SK, Jacobs JR, Yoo GH, Kim HE, Ensley JF. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: a case report and review of the literature. Am J Otolaryngol 2004; 25:48-53. [PMID: 15011206 DOI: 10.1016/s0196-0709(03)00096-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present the clinical and histopathologic findings of a 38-year-old woman recently diagnosed with sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid (SMECE). This case is of particular interest because of its extremely aggressive clinical course. After total thyroidectomy, there was extensive bilateral thyroid lobe involvement with extension into perithyroidal soft tissues and the modified radical neck dissection contained 35 of 35 positive lymph nodes. This patient underwent 2 further surgeries; the first was a second right neck and supraclavicular surgery for lymph node metastases in which 8 of 11 were positive, followed a few months later by posterior neck surgery in which multiple lymph nodes were positive. Tumor was also documented by histological review from a right axillary lymph node. Imaging evidence of tumor in the lungs and liver was also present. Establishing the correct diagnosis of SMECE involves an awareness of the cyto- and histomorphologic features of this rare malignancy. As evidence that the biologic behavior of this neoplasm may well be more aggressive than previously considered, we briefly present the clinical and biologic course of this patient's neoplasm and a review of the literature.
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Affiliation(s)
- Nasfat J Shehadeh
- Department of Internal Medicine, Barbara Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
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37
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Albores-Saavedra J, Gu X, Luna MA. Clear cells and thyroid transcription factor I reactivity in sclerosing mucoepidermoid carcinoma of the thyroid gland. Ann Diagn Pathol 2003; 7:348-53. [PMID: 15018117 DOI: 10.1016/j.anndiagpath.2003.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clear cells have been described in mucoepidermoid carcinoma of the salivary glands, but to our knowledge these cells have not been recognized as a distinctive component of sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland. We report four examples in which sclerosing mucoepidermoid carcinoma of the thyroid gland contained a minor component (10% to 30%) of clear cells. The four tumors occurred in women with Hashimoto's thyroiditis whose ages ranged from 38 to 52 years. All four patients presented with thyroid nodules, but two also had enlarged cervical lymph nodes. Although two tumors metastasized to multiple cervical lymph nodes and one recurred in the soft tissues of the neck, all four patients are disease-free 6 months to 6 years after surgical treatment. The locally aggressive behavior of the first three tumors was probably related to their size, rather than to the presence of clear cells. Microscopically, these tumors showed the classical features of sclerosing mucoepidermoid carcinoma with eosinophilia, as well as nests of clear cells that appeared to be glycogen-rich squamous cells. Although the four tumors were thyroglobulin negative, two were immunoreactive to thyroid transcription factor 1 (TTF-1), supporting the idea that they originated from squamous metaplasia of follicular epithelium rather than from solid cell nests of the ultimobranchial body.
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Affiliation(s)
- Jorge Albores-Saavedra
- Department of Pathology, Louisiana State University Health Sciences Center School of Medicine, Shreveport, LA 71130, USA
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38
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Abstract
Mucoepidermoid carcinoma of the lacrimal sac is a rare entity. We report a case of mucoepidermoid carcinoma arising in the lacrimal sac of a 30-year-old man who presented with an inner canthal mass. To our knowledge this is the first example of the cytopathology of this neoplasm in this anatomic site.
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Affiliation(s)
- JoAnna D Williams
- Department of Pathology, The Ohio State University College of Medicine, Columbus 43210, USA
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39
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Minagawa A, Iitaka M, Suzuki M, Yasuda S, Kameyama K, Shimada S, Kitahama S, Wada S, Katayama S. A case of primary mucoepidermoid carcinoma of the thyroid: molecular evidence of its origin. Clin Endocrinol (Oxf) 2002; 57:551-6. [PMID: 12354139 DOI: 10.1046/j.1365-2265.2002.01599.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary mucoepidermoid carcinoma (MEC) of the thyroid is very rare, and its origin has not been fully determined. We report a case of MEC, the origin of which was demonstrated by thyroid specific genes expressed in a metastatic lymph node. A 52-year-old male presented with chest pain, weight loss and diffuse goitre. Ultrasonography showed the thyroid to be diffusely enlarged with numerous small calcifications. The tumour was found to be infiltrating the thyroid, lung, lymph nodes and first thoracic vertebra. A variant type of papillary thyroid carcinoma was suspected by fine needle aspiration cytology of the thyroid. An open biopsy specimen from an axillary lymph node revealed the tumour to be composed of three distinct cell types: mucin-producing cells, intermediate cells and a small amount of epidermoid cells with scattered psammoma bodies. Immunohistochemical studies showed the tumour cells to be negative for thyroglobulin and calcitonin, but positive for CEA. To examine the primary origin of the tumour, the expression of thyroid specific genes in the lymph node specimen was examined by RT-PCR. TTF-1, TTF-2, Pax-8, Na-I symporter and thyroid peroxidase mRNA were detected. The presence of these thyroid-specific mRNAs indicates that this MEC originated from thyroid follicular epithelium. This is the first molecular evidence of dedifferentiation from thyroid follicular cells to MEC.
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Affiliation(s)
- Akinobu Minagawa
- Department of Internal Medicine 4, Saitama Medical School, 38 Morohongo, Moroyama, Iruma-gun, Saitama 350-0495, Japan
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40
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Locati LD, Quattrone P, Pizzi N, Fior A, Cantù G, Licitra L. Primary high-grade mucoepidermoid carcinoma of the minor salivary glands with cutaneous metastases at diagnosis. Oral Oncol 2002; 38:401-4. [PMID: 12076708 DOI: 10.1016/s1368-8375(01)00082-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mucoepidermoid carcinoma (MEC) represents 15% of all salivary glands malignancies. Metastatic disease at diagnosis is observed in less than 5% of the cases. The lung is the most commonly involved site. This is the first reported case of high-grade MEC of the salivary gland with skin metastases at diagnosis. This feature was associated with a chemoresistant and aggressive behaviour. Differential diagnosis between metastatic MEC and primary skin MEC is essential for therapeutic management and prognosis.
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Affiliation(s)
- L D Locati
- Department of Medical Oncology, Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
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41
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Steele SR, Royer M, Brown TA, Porter C, Azarow KS. Mucoepidermoid Carcinoma of the Thyroid Gland: A Case Report and Suggested Surgical Approach. Am Surg 2001. [DOI: 10.1177/000313480106701014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Mucoepidermoid carcinoma (MEC) of the thyroid gland is a rare neoplasm with 40 cases reported in the world literature to date. Controversy surrounds the treatment of this rare neoplasm. It has been described as a low-grade indolent tumor that rarely metastasizes and only recurs locally without morbidity. Suggested treatment has consisted of a lobectomy or subtotal thyroidectomy. We report a case of a 63-year-old woman with a 15-year history of a multinodular goiter with a dominant left lobe nodule. Fine-needle aspiration was inconclusive. The patient opted for a total thyroidectomy. Final pathology yielded a diagnosis of mucoepidermoid carcinoma. We propose that despite its low-grade appearance the morbidity and mortality associated with its ability to locally recur and metastasize justify the need for more aggressive surgical therapy.
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Affiliation(s)
- Scott R. Steele
- Departments of General Surgery, Madigan Army Medical Center, Fort Lewis, Washington
| | - Michael Royer
- Departments of Pathology, Madigan Army Medical Center, Fort Lewis, Washington
| | - Tommy A. Brown
- Departments of Department of General Surgery, Ireland Army Community Hospital, Fort Knox, Kentucky
| | - Clifford Porter
- Departments of General Surgery, Madigan Army Medical Center, Fort Lewis, Washington
| | - Kenneth S. Azarow
- Departments of General Surgery, Madigan Army Medical Center, Fort Lewis, Washington
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42
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Lam KY, Lo CY, Liu MC. Primary squamous cell carcinoma of the thyroid gland: an entity with aggressive clinical behaviour and distinctive cytokeratin expression profiles. Histopathology 2001; 39:279-86. [PMID: 11532039 DOI: 10.1046/j.1365-2559.2001.01207.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS Primary squamous cell carcinoma of the thyroid gland is uncommon. This study aims to identify the clinicopathological features and the pattern of expression of cytokeratins and oncoproteins in this tumour. METHODS AND RESULTS Histological slides from Chinese patients with thyroid cancer treated in our institution from 1980 to 1999 were reviewed. Patients with primary squamous cell carcinoma of the thyroid were identified and their clinical records were analysed. The expression of cytokeratins (CKs), p53 and p21 in these cases were also studied by an immunohistochemical method. Four women (mean age 71 years) with squamous cell carcinoma of thyroid were found. The main presenting features were signs and symptoms of airway obstruction in three patients and neck swelling in one. The tumours were located at the right lobe (n=2), left lobe (n=1) or in both lobes of the thyroid (n=1). One patient died shortly after admission and the other three died within 4 months after thyroidectomy. The p53 protein was positive in 50% (2/4) of the tumours and p53+ tumours were poorly differentiated. The tumours were negative for p21. CK19 was expressed in all the tumours while CK7 expression was noted in 3/4 of the tumours. One carcinoma showed focal positivity to CK18. The tumours were negative for CKs 1, 4, 6, 10/13 and 20. The pattern of cytokeratin expression in squamous cell carcinoma of the thyroid gland was different from carcinoma showing thymus-like differentiation (CASTLE) of the thyroid gland and oesophageal squamous cell carcinoma. CONCLUSIONS Squamous cell carcinoma of the thyroid has aggressive clinical behaviour and characteristic CK expression pattern. p53 over-expression in these tumours was associated with tumour differentiation.
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Affiliation(s)
- K Y Lam
- University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
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43
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Kardon DE, Thompson LD, Przygodzki RM, Heffess CS. Adenosquamous carcinoma of the pancreas: a clinicopathologic series of 25 cases. Mod Pathol 2001; 14:443-51. [PMID: 11353055 DOI: 10.1038/modpathol.3880332] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adenosquamous carcinoma is a rare aggressive subtype of pancreatic adenocarcinoma. We describe the clinical, pathologic, and molecular characteristics of 25 of these lesions, the largest series to date. METHODS Twenty-five cases of adenosquamous carcinoma of the pancreas diagnosed between 1961 and 1994 were retrieved from the files of the Endocrine Registry of the Armed Forces Institute of Pathology. Histologic features were reviewed, histochemical, immunohistochemical, and molecular (k-ras) studies were performed, and patient follow-up was obtained. RESULTS The patients included 17 men and eight women, aged 28 to 82 years (mean, 65.4 y). The patients usually experienced weight loss (n = 17) or painless jaundice (n = 11), while also presenting with other abdominal symptoms. The tumors affected the head most frequently (n = 17), followed by the tail (n = 9) or body (n = 4). Five cases involved more than one anatomic region of the pancreas. Microscopically, all tumors demonstrated dual differentiation toward adenocarcinoma and squamous cell carcinoma. All cases tested were immunoreactive with keratin (AE1:AE3 and CK1), whereas other keratin markers were variably expressed: CK5/6 (88%), CK7 (68%), Cam5.2 (41%), and CK20(26%). CA-19-9 (84%) and CEA (74%) were positive in the majority of the cases. K-ras oncogene mutations were identified in seven of 13 cases. All patients died from their disease an average of 5.8 months after diagnosis (range, 1 to 33 months). CONCLUSIONS Adenosquamous carcinoma of the pancreas represents a distinct clinical and pathologic entity, demonstrating the expected immunoprofile and k-ras oncogene mutation of a ductal origin, with a worse prognosis than ductal adenocarcinoma.
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Affiliation(s)
- D E Kardon
- Department of Endocrine and Otorhinolaryngic-Head & Neck Pathology, Armed Forces Institute of Pathology, Washington, DC. 20306-6000, USA
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44
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45
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Baloch ZW, Solomon AC, LiVolsi VA. Primary mucoepidermoid carcinoma and sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland: a report of nine cases. Mod Pathol 2000; 13:802-7. [PMID: 10912941 DOI: 10.1038/modpathol.3880140] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mucoepidermoid carcinoma is a rare primary thyroid tumor with indolent biologic potential. Two types of tumors have been described under this category: mucoepidermoid carcinoma (MEC) and sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE). The MEC shows both squamous and glandular differentiation in a background of a noninflamed gland, whereas SMECE is characterized by extensive sclerosis, squamous and glandular differentiation, a concomitant inflammatory infiltrate rich in eosinophils, and a background of lymphocytic thyroiditis. We present nine cases of these entities: five MEC and four SMECE. All tumors occurred in women (age 27 to 73 years). Five tumors showed extrathyroidal invasion and multiple lymph node metastases. One case of MEC showed a concomitant tall cell variant of papillary carcinoma with vascular invasion, and two cases showed intimately associated areas of usual papillary carcinoma. One of the latter cases also showed areas of transformation to anaplastic carcinoma. In all cases of SMECE and in only one case of MEC, the uninvolved thyroid tissue showed lymphocytic thyroiditis. Follow-up information was available in four of the nine cases (3 months to 7 years). Two patients with SMECE are alive with no evidence of disease. One patient with MEC and tall cell variant of papillary carcinoma died of disease after 3 months, and the patient with anaplastic carcinoma died after 5 months with lung metastasis. Both MEC and SMECE were positive for cytokeratin and negative for calcitonin. All cases of MEC were positive for thyroglobulin, whereas all cases of SMECE were negative. The immunohistochemical findings suggest that both MEC and SMECE have different histogenesis.
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Affiliation(s)
- Z W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
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Affiliation(s)
- K B Ain
- Veterans Affairs Medical Center, Division of Endocrinology and Molecular Medicine, Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky 40536-0298, USA.
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Solomon AC, Baloch ZW, Salhany KE, Mandel S, Weber RS, LiVolsi VA. Thyroid sclerosing mucoepidermoid carcinoma with eosinophilia: mimic of Hodgkin disease in nodal metastases. Arch Pathol Lab Med 2000; 124:446-9. [PMID: 10705405 DOI: 10.5858/2000-124-0446-tsmcwe] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the clinical and pathologic findings of a case of sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid in a 39-year-old woman. This particular case is notable because it initially presented as a cervical lymph node metastasis, and the initial clinical and histologic impression was Hodgkin disease, nodular sclerosis type. Sclerosing mucoepidermoid carcinoma with eosinophilia is a differentiated malignant neoplasm of the thyroid that can be confused with anaplastic carcinoma, medullary carcinoma, squamous cell carcinoma, or, as in this case, Hodgkin disease. A correct diagnosis of sclerosing mucoepidermoid carcinoma with eosinophilia involves awareness of this entity and appropriate immunohistochemical analysis. In this article, we briefly review the literature and stress the histologic and cytologic findings characteristic of sclerosing mucoepidermoid with eosinophilia of the thyroid.
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Affiliation(s)
- A C Solomon
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA
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Sim SJ, Ro JY, Ordonez NG, Cleary KR, Ayala AG. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: report of two patients, one with distant metastasis, and review of the literature. Hum Pathol 1997; 28:1091-6. [PMID: 9308735 DOI: 10.1016/s0046-8177(97)90064-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a recently recognized malignant neoplasm of the thyroid gland. Two additional cases of this condition which occurred in a 70-year-old woman and a 69-year-old woman are presented. The case of the 70-year-old woman (patient 1) is the first report of distant metastasis, besides lymph node metastasis, for this type of tumor. The patient initially presented with a thyroid mass, and the thyroid gland with surrounding cervical lymph nodes was removed. Because of focal keratin "pearl" formation, the tumor was misinterpreted as a metastatic squamous cell carcinoma to the thyroid. Approximately 4 years later, the patient developed a left supraclavicular mass and lung densities. A pathological fracture of the right humeral head followed, and the left supraclavicular mass recurred along with newly developed subcutaneous nodules on the chest wall and arm. Open lung and bone biopsies revealed metastatic SMECE, which was morphologically identical to that of the thyroid mass. The 69-year-old woman (patient 2) had, in 1983, undergone thyroidectomy with left radical neck dissection; this had been diagnosed as follicular carcinoma of the thyroid with lymph node involvement. After multiple isolated lymph nodes metastases, the patient developed locally extensive, recurrent tumor that showed microscopic features of SMECE. Review of the previous thyroid tumor and lymph nodes revealed the same type of histology. To our knowledge, only a single report containing eight cases of this distinctive carcinoma of the thyroid has been published. Herein we describe characteristic morphological features of two additional cases of this rare malignancy, one with distant metastasis, and we review the related literature.
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Affiliation(s)
- S J Sim
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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Wenig BM, Adair CF, Heffess CS. To the editor. Hum Pathol 1996. [DOI: 10.1016/s0046-8177(96)90465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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