1
|
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.
Collapse
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
| |
Collapse
|
2
|
Abstract
The application of immunohistochemistry to the diagnosis of thyroid lesions has increased as new biomarkers have emerged. In this review, we discuss the biomarkers that are critical for accurate diagnosis, prognosis, and management. Immunohistochemical markers are used to confirm that an unusual tumor in the thyroid is indeed of thyroid origin, either of follicular epithelial or C-cell differentiation; the various mimics include nonthyroidal lesions such as parathyroid tumors, paragangliomas, thymic neoplasms, and metastatic malignancies. Tumors of thyroid follicular epithelial cells can be further subclassified using a number of immunohistochemical biomarkers that can distinguish follicular-derived from C-cell lesions and others that support malignancy in borderline cases. The use of mutation-specific antibodies can distinguish papillary carcinomas harboring a BRAFV600E mutation from RAS-like neoplasms. Immunostains have been developed to further identify molecular alterations underlying tumor development, including some rearrangements. Altered expression of several biomarkers that are known to be epigenetically modified in thyroid cancer can be used to assist in predicting more aggressive behavior such as a propensity to develop locoregional lymphatic spread. Immunohistochemistry can assist in identifying lymphatic and vascular invasion. Biomarkers can be applied to determine dedifferentiation and to further classify poorly differentiated and anaplastic carcinomas. The rare tumors associated with genetic predisposition to endocrine neoplasia can also be identified using some immunohistochemical stains. The application of these ancillary tools allows more accurate diagnosis and better understanding of pathogenesis while improving prediction and prognosis for patients with thyroid neoplasms.
Collapse
Affiliation(s)
- Zubair Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ozgur Mete
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Sylvia L Asa
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Sobrinho-Simões M, Eloy C, Vinagre J, Soares P. Molecular pathology of thyroid tumors: diagnostic and prognostic relevance. Int J Surg Pathol 2010; 18:209S-212S. [PMID: 20484293 DOI: 10.1177/1066896910370886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Manuel Sobrinho-Simões
- Institute of Molecular Pathology and Immunology, Medical Faculty of the University of Porto, Porto, Portugal.
| | | | | | | |
Collapse
|
4
|
Sobrinho-Simões M, Magalhães J, Fonseca E, Amendoeira I. Diagnostic pitfalls of thyroid pathology. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cdip.2004.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
5
|
Orlandi F, Chiefari E, Caraci P, Mussa A, Gonzatto I, De Giuli P, Giuffrida D, Angeli A, Filetti S. RET proto-oncogene mutation in a mixed medullary-follicular thyroid carcinoma. J Endocrinol Invest 2001; 24:51-5. [PMID: 11227733 DOI: 10.1007/bf03343809] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A case of a patient with an uncommon thyroid carcinoma, showing histological and immunohistochemical features of both follicular and parafollicular cells is described. Somatic point mutation (ATG to ACG heterozygotic mutation at codon 918) of the RET proto-oncogene was detected in tumor tissue, as confirmed by immunohistochemical expression of RET oncoprotein. Our findings suggest that constitutive RET proto-oncogene activation may be involved in the development of mixed medullary-follicular thyroid carcinoma.
Collapse
Affiliation(s)
- F Orlandi
- Department of Clinical and Biological Sciences, University of Torino, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Volante M, Papotti M, Roth J, Saremaslani P, Speel EJ, Lloyd RV, Carney JA, Heitz PU, Bussolati G, Komminoth P. Mixed medullary-follicular thyroid carcinoma. Molecular evidence for a dual origin of tumor components. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 155:1499-509. [PMID: 10550306 PMCID: PMC1866972 DOI: 10.1016/s0002-9440(10)65465-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mixed medullary-follicular carcinomas (MMFCs) are tumors of the thyroid that display morphological and immunohistochemical features of both medullary and follicular neoplasms. The histogenetic origin and possible molecular mechanisms leading to MMFCs are still unclear. To address these questions, we have isolated the two histological components of 12 MMFCs by (laser-based) microdissection, analyzed them for mutations in the RET proto-oncogene and allelic losses of nine loci on six chromosomes, and studied the clonal composition of MMFCs in female patients. Our results provide strong evidence that the follicular and medullary components in MMFCs are not derived from a single progenitor cell, because the seven tumors amenable for analysis consistently exhibited a different pattern of mutations, allelic losses, and clonal composition. We also demonstrate that follicular structures in MMFCs are often oligo/polyclonal and more frequently exhibit hyperplastic than neoplastic histological features, indicating that at least a subset of MMFCs are composed of a medullary thyroid carcinoma containing hyperplastic follicles.
Collapse
Affiliation(s)
- M Volante
- Department of Biomedical Sciences, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Matias-Guiu X. Mixed medullary and follicular carcinoma of the thyroid. On the search for its histogenesis. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 155:1413-8. [PMID: 10550294 PMCID: PMC1866975 DOI: 10.1016/s0002-9440(10)65453-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/1999] [Indexed: 11/21/2022]
Affiliation(s)
- X Matias-Guiu
- Department of Pathology, Hospital Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| |
Collapse
|
8
|
Papotti M, Sambataro D, Pecchioni C, Bussolati G. The Pathology of Medullary Carcinoma of the Thyroid: Review of the Literature and Personal Experience on 62 Cases. Endocr Pathol 1996; 7:1-20. [PMID: 12114676 DOI: 10.1007/bf02739911] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of the present review is to analyze the numerous pathological patterns of medullary carcinoma of the thyroid (MCT) and discuss the problems of differential diagnosis with other thyroid and nonthyroid tumors. In addition, morphological parameters and phenotypic features were related to the clinical outcome. The recent literature was reviewed and compared with the features of 62 MCTs observed at our institution. The most common patterns of growth are trabecular, alveolar and spindle cells, but MCT can mimic virtually all other primary thyroid tumors and some nonthyroid neoplasms. This heterogeneity has no proven implications for prognosis, but is of relevance for diagnostic purposes, as the differential diagnosis of MCT can be difficult in nonclassical cases. In agreement also with the literature data, no relationship between histopathological parameters and outcome was found in our series, although clinically aggressive tumors had a more advanced stage at presentation. Immunocytochemica demonstration of calcitonin is apparently the only valid criterion for a correct typing of MCT. Chromogranin A is an additional sensitive marker of MCT and parallels calcitonin expression in the majority of cases.
Collapse
|
9
|
Abstract
In this review article we consecutively address the following issues: differential diagnosis of follicular adenomas and minimally invasive follicular carcinomas, with a special emphasis on the hyalinizing trabecular tumours; differential diagnosis of benign and malignant papillary lesions; individualization of the variants of papillary carcinoma that carry a guarded prognosis; differential diagnosis of differentiated thyroid carcinomas exhibiting foci of other types of thyroid carcinoma, namely mucoepidermoid and poorly differentiated carcinoma; and, finally, the diagnostic problems raised by the so-called mixed medullary-follicular carcinomas.
Collapse
Affiliation(s)
- E Fonseca
- Department of Pathology, Medical Faculty of Porto, Portugal
| | | |
Collapse
|
10
|
|
11
|
Cameselle-Teijeiro J, Varela-Durán J, Varela-núñez R, Sambade C, Sobrinho-Simoes M, Villanueva JP. To the editor. Hum Pathol 1995. [DOI: 10.1016/0046-8177(95)90074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Matias-Guiu X, Caixas A, Costa I, Cabezas R, Prat J. Compound medullary-papillary carcinoma of the thyroid: true mixed versus collision tumour [corrected]. Histopathology 1994; 25:183-5. [PMID: 7982684 DOI: 10.1111/j.1365-2559.1994.tb01578.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- X Matias-Guiu
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Spain
| | | | | | | | | |
Collapse
|
13
|
Kovacs CS, Masé RM, Kovacs K, Nguyen GK, Chik CL. Thyroid medullary carcinoma with thyroglobulin immunoreactivity in sporadic multiple endocrine neoplasia type 2-B. Cancer 1994; 74:928-32. [PMID: 7913660 DOI: 10.1002/1097-0142(19940801)74:3<928::aid-cncr2820740321>3.0.co;2-e] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Thyroid carcinomas historically have been divided into two groups according to their presumedly separate embryonic origins: those of neuroectodermal derivation (parafollicular or medullary carcinoma [MCT]) and those of foregut endodermal origin (follicular and papillary carcinomas). The validity of this concept has been questioned by the recognition that some MCT may show immunocytochemical and ultrastructural evidence of follicular components, and display features of follicular function (e.g., organification of iodine, immunoreactivity for thyroglobulin). METHODS A 14-year-old boy presented with the physical features of multiple endocrine neoplasia type 2-B (MEN 2B) and a thyroid mass. His thyroid lesion was studied by light microscopy; electron microscopy; immunohistochemistry using antisera to calcitonin, thyroglobulin, and other peptides; and in situ hybridization. RESULTS The tumor was identified as an MCT by light microscopy. It stained positively with calcitonin, thyroglobulin, chromogranin, neuron-specific enolase, and serotonin. At the ultrastructural level, the tumor cells contained numerous neurosecretory granules and showed evidence of follicular differentiation (luminal microvilli, follicle formation, and tight junctions), suggesting a dual neuroendocrine and follicular differentiation. CONCLUSIONS The morphologic findings suggest that a small number of MCTs arise from a common stem cell (possibly the ultimobranchial body) that may give rise to both MCT and follicular carcinoma. This patient and patients in similar cases documented in the literature challenge the classic concept of separate pathways of embryogenesis for these two cell types.
Collapse
Affiliation(s)
- C S Kovacs
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Canada
| | | | | | | | | |
Collapse
|