Journal of Cytology
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LETTER TO EDITOR  
Year : 2020  |  Volume : 37  |  Issue : 4  |  Page : 214-215
Cytological clues to the diagnosis of solid variant of papillary thyroid carcinoma


Department of Pathology, University College of Medical Sciences, Dilshad Garden, Delhi, India

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Date of Submission28-May-2020
Date of Decision26-Aug-2020
Date of Acceptance18-Sep-2020
Date of Web Publication31-Oct-2020
 

How to cite this article:
Diwan H, Tanveer N, Kashyap S. Cytological clues to the diagnosis of solid variant of papillary thyroid carcinoma. J Cytol 2020;37:214-5

How to cite this URL:
Diwan H, Tanveer N, Kashyap S. Cytological clues to the diagnosis of solid variant of papillary thyroid carcinoma. J Cytol [serial online] 2020 [cited 2020 Nov 27];37:214-5. Available from: https://www.jcytol.org/text.asp?2020/37/4/214/299713




Sir,

The solid variant of papillary thyroid carcinoma (PTC) accounts for 3% of all cases of PTC. It constituted a disproportionately higher percentage of PTC diagnosed in children in the first decade after the Chernobyl tragedy.[1],[2]

A 14-year-old girl presented with thyroid swelling measuring 2 × 2 cm to the Otorhinolaryngology Outpatient Department. She did not give any history of hyper or hypothyroidism or radiation exposure. She had noticed the swelling 6 months back. Fine-needle aspiration (FNA) cytology performed from the swelling in the left lobe of the thyroid showed thyroid follicular cells with nuclear clearing, grooving, and pseudo inclusions in a single cell and trabecular pattern. A few microfollicles and an occasional solid fragment were also noted. [Figure 1]a to [Figure 1]d The FNA report was Bethesda category V (suspicious of PTC). The patient underwent contrast-enhanced computed tomography of the neck which showed a well-defined hypodense lesion with high vascularity and microcalcification measuring 2 × 2 cm in the left lobe suggestive of PTC with evidence of heteroechoic lymph nodes in bilateral level IV region. The patient underwent total thyroidectomy with bilateral lateral neck dissection. On gross examination, the tumor was gray-white, partly encapsulated with calcification, and measured 2.1 × 2.0 × 1.8 cm in the left lobe [Figure 2]a. On histopathology, the tumor was arranged predominantly in a trabecular and nesting pattern with nuclear clearing, grooving, and pseudoinclusions. The tumor margins were infiltrative with extrathyroidal extension. The tumor was immunonegative for chromogranin and synaptophysin. No necrosis, frequent mitosis, or nuclear atypia were seen [Figure 2]b to [Figure 2]d. The final diagnosis given was a solid variant of papillary thyroid carcinoma. A total of seven regional lymph nodes were found to have metastasis out of 18 lymph nodes examined. The patient was referred to the oncology center for postoperative radioiodine therapy and was lost to follow-up.
Figure 1: Fine-needle aspiration cytology of the tumor. Follicular epithelial cells are arranged in a trabecular pattern and small clusters with nuclear clearing, grooving, and pseudoinclusions (a and b, Papanicolaou stain, 400×). Single-cell pattern with nuclear features of papillary thyroid carcinoma (c, Papanicolaou stain, 400×). Occasional solid fragment of follicular epithelial cells (d, May Grunwald Giemsa, 400×)

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Figure 2: Gross appearance of the tumor-gray white with calcification (a). Histopathology of the tumor showed a tumor arranged in a follicular and trabecular pattern with nuclear clearing, grooving, and intranuclear pseudoinclusions. (hematoxylin and eosin,b-100x,c-400x). The tumor was immunonegative for chromogranin (d-400x)

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A papillary variant of medullary thyroid carcinoma (MTC) has been reported. Although very rare with only a few cases been reported in literature, it is to be kept in the differential diagnosis. In these cases, the nuclear features of PTC are seen in 20 to 25% of tumor cells.[3] In MTC, the cells are often round to oval to spindle-shaped with salt and pepper chromatin and eccentric nuclei. In the absence of these features, single cell, nesting, and trabecular pattern with solid fragments and nuclear features of PTC should alert one to the possibility of a solid variant of PTC.[1] The presence of amyloid and pink intracytoplasmic granules on the May-Grunwald-Giemsa stain would help in making a diagnosis of MTC. The amyloid needs to be differentiated from the chewing gum colloid of PTC.

Higuchi et al. reported the following cytological features to be most frequent in histologically proven cases of a solid variant of PTC-grooved nuclei, intranuclear cytoplasmic inclusion, ground glass chromatin, solid clusters, and small papillary clusters and irregularly shaped nuclei.[4]

To conclude, the overlapping nuclear features of PTC and architectural features of MTC in a thyroid aspirate should alert the pathologist to the possibility of a solid variant of PTC even in absence of a history of radiation exposure. However, the solid variant of PTC is a histological diagnosis and in cytology – a diagnosis of PTC is adequate.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Giorgadze TA, Scognamiglio T, Yang GC. Fine-needle aspiration cytology of the solid variant of Papillary thyroid carcinoma: A study of 13 cases with clinical, histologic, and ultrasound correlations. Cancer Cytopathol 2015;123:71-81.  Back to cited text no. 1
    
2.
LiVolsi VA, Abrosimov AA, Bogdanova T, Fadda G, Hunt JL, Ito M, et al. The Chernobyl thyroid cancer experience: Pathology. Clin Oncol 2011;23:261-7.  Back to cited text no. 2
    
3.
Shukla S, Awasthi NP, Husain N. Papillary variant of medullary carcinoma thyroid. Indian J Pathol Microbiol 2014;57:151-2.  Back to cited text no. 3
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4.
Higuchi M, Hirokawa M, Suzuki A, Takada N, Yamao N, Kuma S, et al. Cytological features of solid variants of papillary thyroid carcinoma: A fine needle aspiration cytology study of 18 cases. Cytopathology 2017;28:268-72.  Back to cited text no. 4
    

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Correspondence Address:
Dr. Nadeem Tanveer
Department of Pathology, University College of Medical Sciences, Dilshad Garden, Delhi-110095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_84_20

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