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A non-invasive encapsulated macrofollicular variant of papillary thyroid carcinoma presenting with gross lymph node metastasis: a case report and literature review.
MedLine Citation:
PMID:  23544872     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: The follicular variant of papillary thyroid carcinoma (FV-PTC) without vascular or capsular invasion is considered to have virtually no metastatic potential or recurrence risk. The macrofollicular variant of papillary thyroid carcinoma (MFV-PTC) is a very rare variant of FV-PTC, with fewer than 100 described cases, and whose behavior appears to be similar to FV-PTC. Here, we report a case of encapsulated non-invasive MFV-PTC that presented with gross lymph node metastasis, and we also review the literature. Patient: The patient was an 80-year-old male. A right thyroid nodule was incidentally found by a CT scan. Ultrasonography detected a 3.7 x 3.6 x 3.3 cm thyroid nodule with calcifications in the right lobe and a 2.2 x 2 x 1.3 cm right jugular (level 3) lymphadenopathy with macrocalcifications. Fine needle aspiration biopsies of both the thyroid nodule and the lymphadenopathy were performed, and the results were consistent with PTC. The patient underwent a total thyroidectomy with central and right (level 3 and level 4) lymph node dissection. Results: Histopathological examination revealed that the thyroid nodule was completely surrounded by a thick and focally calcified capsule. There was no evidence of vascular or capsular invasion. The nodule was predominantly macrofollicular, with minor areas composed of smaller follicles. The cells lining the macrofollicles were often attenuated and without the typical nuclear features of PTC. In contrast, the cells lining the smaller follicles of the nodule were more cuboidal and had the typical nuclear features of PTC. Numerous intratumoral calcifications and psammoma bodies were observed. Two lymph node metastases were found. The larger one measured 2.4 cm and looked similar to the primary tumor, being composed predominantly of macrofollicles. Conclusions: MFV-PTC is a rare variant of FV-PTC, which may present with gross lymph node metastasis, even in the absence of adverse features, such as capsular or vascular invasion. Further studies are required to determine whether MFV-PTC behaves differently from FV-PTC and whether a conservative treatment (lobectomy) is sufficient for patients with encapsulated, non-invasive MFV-PTC.
Authors:
Marc Pusztaszeri; Jean-Claude Pache; Wolfram Karenovics; Romain Kohler; Frederic Triponez; Massimo Bongiovanni
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-2
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  -     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Geneva University Hospital, Pathology, 1 rue Michel Servet, Geneva, Switzerland, 1211, 41795531202 ; Marc.Pusztaszeri@hcuge.ch.
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