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Warthin-Like Papillary Thyroid Carcinoma Associated with Lymphadenopathy and Hashimoto's Thyroiditis.

González-Colunga KJ, Loya-Solis A, Ceceñas-Falcón LÁ, Barboza-Quintana O, Rodríguez-Gutiérrez R - Case Rep Endocrinol (2015)

Bottom Line: Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer.It is frequently associated with Hashimoto's thyroiditis and presents unique morphological features that make it recognizable on histologic examination.The cytological diagnosis is difficult to assess due to the overlap in its findings with the classical variant and Hashimoto's thyroiditis.

View Article: PubMed Central - PubMed

Affiliation: Pathology Department, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.

ABSTRACT
Defining the histologic variant of thyroid carcinoma is an important clinical implication as their progression, recurrence, aggressiveness, and prognosis differ. Warthin-like variant is one of the rarest histologic variants of papillary thyroid cancer. A 36-year-old female sought consult for assessment of a painless right neck tumor. High-resolution neck ultrasound revealed a right hypoechoic, 1.71 × 1.05 cm thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy report was a Bethesda grade III. Thyroid function tests showed Hashimoto's thyroiditis. The patient underwent right hemithyroidectomy. Microscopically, the tumor was composed of papillae lined by cells with eosinophilic cytoplasm, nuclear chromatin clearing, grooves, and pseudoinclusions and a characteristic lymphoplasmacytic infiltrate of the papillae cores. Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer. Warthin-like variant is an uncommon and relatively unknown variant of papillary thyroid carcinoma that has been usually associated with an excellent prognosis. Interestingly, BRAF mutations have been reported to be present in up to 75% of the patients. It is frequently associated with Hashimoto's thyroiditis and presents unique morphological features that make it recognizable on histologic examination. The cytological diagnosis is difficult to assess due to the overlap in its findings with the classical variant and Hashimoto's thyroiditis.

No MeSH data available.


Related in: MedlinePlus

Neck ultrasound showing a hypoechoic nodule in the inferior pole of the right thyroid lobe, measuring 1.71 × 1.05 cm, characterized by irregular margins and accompanied by microcalcifications.
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fig1: Neck ultrasound showing a hypoechoic nodule in the inferior pole of the right thyroid lobe, measuring 1.71 × 1.05 cm, characterized by irregular margins and accompanied by microcalcifications.

Mentions: Physical examination revealed painless, nonfixed, regular, and hard nodule of 1 × 2 cm in the inferior right thyroid lobe (zone VI). Dyspnea, dysphagia, and dysphonia were denied and cervical lymphadenopathy was absent. High-resolution neck ultrasound revealed a right hypoechoic, 1.71 × 1.05 cm thyroid nodule with irregular margins, central vascularity, incomplete halo, and microcalcifications (Figure 1). Ultrasound-guided fine-needle aspiration biopsy was performed and the cytology report was a Bethesda grade III (atypia of undetermined significance) (Figure 2) [2]. Thyroid function tests showed subclinical hypothyroidism, TSH = 5.19 mlUI/ml (0.27–4.2 mlUI/ml), free T4 of 1.24 ng/dl (0.93–1.7 ng/dl), normal total T3 and T4, and positive thyroperoxidase antibodies (Hashimoto's thyroiditis). Full thyroid hormone replacement therapy was initiated and surgery was planned. The patient underwent right hemithyroidectomy with intraoperative cytology and frozen section evaluation, which reported a papillary carcinoma (Figure 3). In view of the intraoperative diagnosis, a total thyroidectomy was performed. Gross pathological analysis of the thyroid showed solid, infiltrative, and ill-defined white tumor of 1.7 cm in its greatest diameter localized in the inferior pole of the right thyroid lobe. Microscopically the tumor was composed of papillae lined by cells with eosinophilic cytoplasm, nuclear chromatin clearing, grooves, and pseudoinclusions and a characteristic lymphoplasmacytic infiltrate of the papillae cores (Figure 4). Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer. Based on these findings the diagnosis was Warthin-like variant of a papillary thyroid carcinoma. There were no postoperative complications and the patient was discharged three days after admission. Two months later she underwent I-131 radioablative therapy (100 mCi) with a 7-day posttreatment tracing that showed scarce uptake of radioiodine in the thyroid area. At 12-month follow-up the patient was asymptomatic, neck ultrasound was negative for recurrences, and stimulated thyroglobulin was within expected goals.


Warthin-Like Papillary Thyroid Carcinoma Associated with Lymphadenopathy and Hashimoto's Thyroiditis.

González-Colunga KJ, Loya-Solis A, Ceceñas-Falcón LÁ, Barboza-Quintana O, Rodríguez-Gutiérrez R - Case Rep Endocrinol (2015)

Neck ultrasound showing a hypoechoic nodule in the inferior pole of the right thyroid lobe, measuring 1.71 × 1.05 cm, characterized by irregular margins and accompanied by microcalcifications.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4363874&req=5

fig1: Neck ultrasound showing a hypoechoic nodule in the inferior pole of the right thyroid lobe, measuring 1.71 × 1.05 cm, characterized by irregular margins and accompanied by microcalcifications.
Mentions: Physical examination revealed painless, nonfixed, regular, and hard nodule of 1 × 2 cm in the inferior right thyroid lobe (zone VI). Dyspnea, dysphagia, and dysphonia were denied and cervical lymphadenopathy was absent. High-resolution neck ultrasound revealed a right hypoechoic, 1.71 × 1.05 cm thyroid nodule with irregular margins, central vascularity, incomplete halo, and microcalcifications (Figure 1). Ultrasound-guided fine-needle aspiration biopsy was performed and the cytology report was a Bethesda grade III (atypia of undetermined significance) (Figure 2) [2]. Thyroid function tests showed subclinical hypothyroidism, TSH = 5.19 mlUI/ml (0.27–4.2 mlUI/ml), free T4 of 1.24 ng/dl (0.93–1.7 ng/dl), normal total T3 and T4, and positive thyroperoxidase antibodies (Hashimoto's thyroiditis). Full thyroid hormone replacement therapy was initiated and surgery was planned. The patient underwent right hemithyroidectomy with intraoperative cytology and frozen section evaluation, which reported a papillary carcinoma (Figure 3). In view of the intraoperative diagnosis, a total thyroidectomy was performed. Gross pathological analysis of the thyroid showed solid, infiltrative, and ill-defined white tumor of 1.7 cm in its greatest diameter localized in the inferior pole of the right thyroid lobe. Microscopically the tumor was composed of papillae lined by cells with eosinophilic cytoplasm, nuclear chromatin clearing, grooves, and pseudoinclusions and a characteristic lymphoplasmacytic infiltrate of the papillae cores (Figure 4). Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer. Based on these findings the diagnosis was Warthin-like variant of a papillary thyroid carcinoma. There were no postoperative complications and the patient was discharged three days after admission. Two months later she underwent I-131 radioablative therapy (100 mCi) with a 7-day posttreatment tracing that showed scarce uptake of radioiodine in the thyroid area. At 12-month follow-up the patient was asymptomatic, neck ultrasound was negative for recurrences, and stimulated thyroglobulin was within expected goals.

Bottom Line: Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer.It is frequently associated with Hashimoto's thyroiditis and presents unique morphological features that make it recognizable on histologic examination.The cytological diagnosis is difficult to assess due to the overlap in its findings with the classical variant and Hashimoto's thyroiditis.

View Article: PubMed Central - PubMed

Affiliation: Pathology Department, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo Leon, Madero and Gonzalitos s/n, 64460 Monterrey, Nuevo León, Mexico.

ABSTRACT
Defining the histologic variant of thyroid carcinoma is an important clinical implication as their progression, recurrence, aggressiveness, and prognosis differ. Warthin-like variant is one of the rarest histologic variants of papillary thyroid cancer. A 36-year-old female sought consult for assessment of a painless right neck tumor. High-resolution neck ultrasound revealed a right hypoechoic, 1.71 × 1.05 cm thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy report was a Bethesda grade III. Thyroid function tests showed Hashimoto's thyroiditis. The patient underwent right hemithyroidectomy. Microscopically, the tumor was composed of papillae lined by cells with eosinophilic cytoplasm, nuclear chromatin clearing, grooves, and pseudoinclusions and a characteristic lymphoplasmacytic infiltrate of the papillae cores. Extension into the perithyroidal soft tissue and 3 ipsilateral lymph nodes was found to be positive for cancer. Warthin-like variant is an uncommon and relatively unknown variant of papillary thyroid carcinoma that has been usually associated with an excellent prognosis. Interestingly, BRAF mutations have been reported to be present in up to 75% of the patients. It is frequently associated with Hashimoto's thyroiditis and presents unique morphological features that make it recognizable on histologic examination. The cytological diagnosis is difficult to assess due to the overlap in its findings with the classical variant and Hashimoto's thyroiditis.

No MeSH data available.


Related in: MedlinePlus