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Mahjabin F, Gonsalves C, Drew PA, Mukhtar F, Leon ME. Understanding and Overcoming the Pitfalls in Cytopathological Diagnosis of Hyalinizing Trabecular Tumor of Thyroid. Int J Surg Pathol 2024; 32:91-96. [PMID: 37050854 DOI: 10.1177/10668969231166295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Hyalinizing trabecular tumor (HTT), a rare low-malignant-potential thyroid neoplasm, is usually treated with conservative surgery. However, cytomorphological diagnosis of HTT is challenging due to the significant overlap of nuclear features with more common malignancies such as papillary thyroid carcinoma (PTC), which usually requires more radical surgical intervention. To avoid unnecessary overtreatment, a precise diagnosis of HTT is therefore essential. Advances in molecular diagnostics provide the opportunity to overcome the limitations of cytological analysis. We present a case of HTT in a 71-year-old male who was initially suspected to be PTC based on cytopathology. However, further molecular analysis revealed PAX8::GLIS3 gene fusion, classifying the lesion as HTT and preventing surgical overtreatment. We discuss the diagnostic pitfall of cytopathology in HTT and suggest using emerging molecular genetic tools to avoid it.
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Affiliation(s)
- Fnu Mahjabin
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine Gonsalves
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Peter A Drew
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Faisal Mukhtar
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Marino E Leon
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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Wang F, Liu Y. Cytomorphological traits of fine-needle aspirates of hyalinizing trabecular tumor of the thyroid gland: A brief report. INDIAN J PATHOL MICR 2024; 67:128-132. [PMID: 38358201 DOI: 10.4103/ijpm.ijpm_405_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background The incidence of thyroid tumor is increasing, and preoperative diagnosis of hyalinizing trabecular tumor (HTT) is difficult. Aim To investigate the cytological features of HTT of the thyroid gland. Settings and Design A retrospective observational study. Materials and Methods Ultrasonography, preoperative needle aspiration cytology, postoperative histopathology, immunohistochemistry, and BRAF V600E gene test were performed in five patients with HTT to analyze the pathological characteristics of the patients and review the relevant literature. Results Four female and one male patients with HTT were recruited. Fine-needle aspiration cytology (FNAC) showed bloodstained background tumor cells with multiple morphologies. The tumor cells exhibited ovoid nuclei, abundant cytoplasm, fine chromatin, nuclear crowding and overlapping, and small nucleoli. Focal nuclear pseudoinclusions and grooves were present. No papillary structures or psammoma bodies were observed. In all cases, tumor cells were radially distributed around the eosinophilic extracellular matrix. In 40% (2 in 5) of cases, trabecular patterns of elongated tumor cells were present, with their nuclei staggered along the longitudinal axis of tumor cells in the trabeculae. FNAC suggested two cases of HTT and three cases of papillary thyroid cancer. Post-operational biopsy indicated they were HTT cases. Conclusion HTT is a rare thyroid tumor with non-specific clinical manifestations. It can be misinterpreted as papillary thyroid carcinoma by FNAC. However, its cytomorphological traits are helpful in the diagnosis. In combination with FNAC, immunohistochemistry, and molecular testing, HTT can be accurately diagnosed.
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Affiliation(s)
- Fei Wang
- Department of Pathology, Yichang Central People's Hospital, Institute of Pathology of China Three Gorges University, Yichang, Hubei Province, China
| | - Yufei Liu
- Department of Pathology, Yichang Central People's Hospital, Institute of Pathology of China Three Gorges University, Yichang, Hubei Province, China
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Basili T, Dopeso H, Kim SH, Ferrando L, Pareja F, Da Cruz Paula A, da Silva EM, Stylianou A, Maroldi A, Marchiò C, Rubin BP, Papotti M, Weigelt B, Moreira Ferreira CG, Lapa E Silva JR, Reis-Filho JS. Oncogenic properties and signaling basis of the PAX8-GLIS3 fusion gene. Int J Cancer 2020; 147:2253-2264. [PMID: 32383186 DOI: 10.1002/ijc.33040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/01/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Hyalinizing trabecular tumors of the thyroid are rare and mostly benign epithelial neoplasms of follicular cell origin, which have recently been shown to be underpinned by the PAX8-GLIS3 fusion gene. In our study, we sought to investigate the potential oncogenic mechanisms of the PAX8-GLIS3 fusion gene. Forced expression of PAX8-GLIS3 was found to increase proliferation, clonogenic potential and migration of human nonmalignant thyroid (Nthy-ori 3-1) and embryonic kidney (HEK-293) cells. Moreover, in xenografts, Nthy-ori 3-1 PAX8-GLIS3 expressing cells generated significantly larger and more proliferative tumors compared to controls. These oncogenic effects were found to be mediated through activation of the Sonic Hedgehog (SHH) pathway. Targeting of smoothened (SMO), a key protein in the SHH pathway, using the small molecule inhibitor Cyclopamine partially reversed the increased proliferation, colony formation and migration in PAX8-GLIS3 expressing cells. Our data demonstrate that the oncogenic effects of the PAX8-GLIS3 fusion gene are, at least in part, due to an increased activation of the SHH pathway.
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Affiliation(s)
- Thais Basili
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Higinio Dopeso
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah H Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lorenzo Ferrando
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arnaud Da Cruz Paula
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edaise M da Silva
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthe Stylianou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ana Maroldi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Caterina Marchiò
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Brian P Rubin
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mauro Papotti
- Department of Oncology, University of Turin, at Città della Salute Hospital, Torino, Italy
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlos Gil Moreira Ferreira
- Oncoclinicas Institute for Research and Education, Sao Paulo, Brazil
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Dell’Aquila M, Gravina C, Cocomazzi A, Capodimonti S, Musarra T, Sfregola S, Fiorentino V, Revelli L, Martini M, Fadda G, Pantanowitz L, Larocca LM, Rossi ED. A large series of hyalinizing trabecular tumors: Cytomorphology and ancillary techniques on fine needle aspiration. Cancer Cytopathol 2019; 127:390-398. [DOI: 10.1002/cncy.22139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Marco Dell’Aquila
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Carmen Gravina
- Division of Endocrine‐Surgery Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Alessandra Cocomazzi
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Stefania Sfregola
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Luca Revelli
- Division of Endocrine‐Surgery Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Liron Pantanowitz
- Department of Pathology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
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Takada N, Hirokawa M, Ohbayashi C, Nishikawa T, Itoh T, Imagawa N, Oyama T, Handa T, Hasegawa T, Sugita S, Murata A, Miyauchi A. Re-evaluation of MIB-1 immunostaining for diagnosing hyalinizing trabecular tumour of the thyroid: semi-automated techniques with manual antigen retrieval are more accurate than fully automated techniques. Endocr J 2018; 65:239-244. [PMID: 29199205 DOI: 10.1507/endocrj.ej17-0413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hyalinizing trabecular tumour (HTT) immunohistochemically shows cell membranous immunoreactivity for MIB-1. This aberrant immunoreactivity is an important factor for the diagnosis of HTT. However, fully automated stainers frequently fail to confirm the immunoreactivity. The aim of this study is to investigate the cause of false negative cell membranous immunoreactivity for MIB-1 in HTT using fully automated stainers, to determine potential reasons for the problem, and to establish methods confirming cell membranous immunoreactivity for MIB-1 in HTT. Six participating institutions examined immunoreactivity for MIB-1 in 10 HTT cases using two approaches: fully automated and semi-automated methods. In the latter, antigen retrieval was carried out using manual methods adopted for routine assays at each institute. The autostainers used included the BOND-MAX, BOND-III, Benchmark XT, and Omnis systems. Using fully automated methods, institute E showed cell membranous MIB-1 positivity in all HTT cases. In contrast, at institute D, all HTT cases were negative. The positive rates of the remaining four institutes ranged from 10% to 20%. The incidence of positive cases using semi-automated methods was 100%, 90%, 90%, 30%, 80%, and 100% at institutes A, B, C, D, E, and F, respectively. We assert that antigen retrieval should be conducted manually for diagnosis of HTT; furthermore, definitively diagnosed HTT should be prepared as the external positive control.
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Affiliation(s)
- Nami Takada
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Takeshi Nishikawa
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Naoko Imagawa
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, 370-8511, Japan
| | - Tadashi Handa
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, 370-8511, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan
| | - Akiko Murata
- Department of Technical Development, Genostaff Co. Ltd., Bunkyo-ku, Tokyo 113-0032, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
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Liu Y, Huang X, Hu Y, Wang F, Du T, He W, Chen L, Lang B, Pu Q, Chen H. Hyalinizing trabecular tumor of the thyroid: a clinicopathological analysis of four cases and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:7616-7626. [PMID: 31966606 PMCID: PMC6965282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/01/2017] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore the clinicopathological features, diagnosis and differential diagnosis of hyalinizing trabecular tumor (HTT) of the thyroid. METHODS The four HTT specimens were collected including demographics, clinical information, relevant images, the extent of thyroidectomy, the follow-up and representative pathological data of tumors were available for analysis. In addition, the immumohistochemical staining related to the tumor as well as the BRAF and N-ras mutation analysis were analysed. RESULTS The mean age of four patients was 47 years old and the mean size of the tumor was 2.8 cm. Most of the patients were asymptomatic, while detecting incidentally by using neck ultrasound test. Ultrasound imaging of all cases showed demarcated substantial hypoechoic nodules in ipsilateral thyroid lobe. Computed Tomography (CT) showed a clear low density shadow in the affected thyroid lobe. Tumors of three cases were located at the left, but the other one was located at the right thyroid gland with a complete fibrous capsule. The cytological features resembled papillary thyroid carcinoma (PTC). The histological test indicated that the tumors had characteristic of trabecular growth pattern with hyalinizing material. The tumor cells were in shape of polygonal, oval or high columnar with an acidophilic or clear cytoplasm. The nuclei were oval with inconspicuous small nucleoli, prominent grooves and pseudoinclusion body in cell nucleus. Mitosis and psammoma bodies were rare to be observed. Cytoplasmic "yellow bodies" were frequently observed. The hyaline material was prominent, with positive periodic acid-Schiff (PAS) and negative Congo red staining. Immunohistochemically, tumor cells were positive for thyroglobulin (Tg), thyroid transcription factor-1 (TTF-1), CD56 and negative for calcitonin, cytokeratin 19 (CK19), HBME-1, S-100 and synaptophysin (SyN). Chromogranin A (CgA) and galectin-3 were expressed weakly in some cases. Staining with the MIB-1 antibody showed membranous/cytoplasmic immunoreactivity. Whereas, another clone of Ki-67 (SP6) showed a common nuclear pattern with an index of <1%. None of the four cases exhibited the BRAF V600E protein reactivity. Gene mutation analysis demonstrated no BRAF and N-ras mutation. There was no evidence of local recurrence or metastasis after 6 to 36 months of follow-up. CONCLUSIONS HTT is an uncommon thyroid tumor with very low malignant potential. It has no particular clinical features, so it's often misdiagnosed in fine needle aspiration cytology (FNAC)/Ultrasonography-guided fine needle aspiration cytology (US-FNAC) and frozen section (FS). Its final diagnosis mainly relies on typical histopathological features and characteristic expression pattern of MIB-1 immunohistochemical staining.
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Affiliation(s)
- Yufei Liu
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Xin Huang
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Yuchang Hu
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Fei Wang
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Tingting Du
- Department of Pathology, Zigui County Hospital of Traditional Chinese MedicineZigui, P. R. China
| | - Weiwen He
- Department of Pathology, Wufeng People’s Hospital of Tujia Autonomous CountyWufeng, P. R. China
| | - Lu Chen
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Bojuan Lang
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Qinxue Pu
- Institute of Pathology, China Three Gorges UniversityYichang, P. R. China
- Department of Pathology, Yichang Central People’s HospitalYichang, P. R. China
| | - Honglei Chen
- Department of Pathology, Medical College of Wuhan UniversityWuhan, P. R. China
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