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Radiologic and Pathologic Findings of a Follicular Variant of Papillary Thyroid Cancer with Extensive Stromal Fat: A Case Report.

Choi JW, Kim TH, Roh HG, Moon WJ, Lee SH, Hwang TS, Park KS - Korean J Radiol (2015)

Bottom Line: The mass was hyperechoic and ovoid in shape with a smooth margin on ultrasonography.On computed tomography, the mass had markedly low attenuation suggestive of fat, and fine reticular and thick septa-like structures.The mass was finally diagnosed as a follicular variant of papillary thyroid cancer with massive stromal fat.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.

ABSTRACT
Thyroid cancer may have small adipose structures detected by microscopy. However, there are no reports of thyroid cancer with gross fat evaluated by radiological methods. We reported a case of a 58-year-old woman with a fat containing thyroid mass. The mass was hyperechoic and ovoid in shape with a smooth margin on ultrasonography. On computed tomography, the mass had markedly low attenuation suggestive of fat, and fine reticular and thick septa-like structures. The patient underwent a right lobectomy. The mass was finally diagnosed as a follicular variant of papillary thyroid cancer with massive stromal fat.

No MeSH data available.


Related in: MedlinePlus

58-year-old woman diagnosed with follicular variant of papillary thyroid cancer with mature fat.A. Longitudinal image of right thyroid using gray-scale ultrasonography shows hyperechoic, ovoid mass with smooth margin. Peripheral portion of mass is more echogenic than central area. Curtain-like hyperechoic shadowing was observed posterior to mass. Perithyroidal fat, muscle, and vertebral bodies were therefore not clearly visualized. B-D. Pre-contrast computed tomography (CT) shows fatty (mean CT number, -80 Hounsfield units, HU), well-defined mass in parenchyma of right mid-to-upper portion of thyroid (B). Mass has several fine reticular and thick septa-like soft tissue lesions, which show contrast enhancement. Post-contrast CT shows higher enhancement in early phase (C, at 40 seconds; mean CT number, 16 HU) of tumor than in delayed phase (D, 90 seconds; mean CT number, -13 HU). Tumor is lobular in appearance in axial plane (B-D), ovoid in longitudinal direction, and completely located in thyroid parenchyma without evidence of extrathyroidal extension. E. High-power magnification (1:400, hematoxylin and eosin staining) reveals tumor cells with enlarged nuclei, chromatin clearing, and nuclear grooves. Tumor cells are surrounded by mature adipose tissue.
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Figure 1: 58-year-old woman diagnosed with follicular variant of papillary thyroid cancer with mature fat.A. Longitudinal image of right thyroid using gray-scale ultrasonography shows hyperechoic, ovoid mass with smooth margin. Peripheral portion of mass is more echogenic than central area. Curtain-like hyperechoic shadowing was observed posterior to mass. Perithyroidal fat, muscle, and vertebral bodies were therefore not clearly visualized. B-D. Pre-contrast computed tomography (CT) shows fatty (mean CT number, -80 Hounsfield units, HU), well-defined mass in parenchyma of right mid-to-upper portion of thyroid (B). Mass has several fine reticular and thick septa-like soft tissue lesions, which show contrast enhancement. Post-contrast CT shows higher enhancement in early phase (C, at 40 seconds; mean CT number, 16 HU) of tumor than in delayed phase (D, 90 seconds; mean CT number, -13 HU). Tumor is lobular in appearance in axial plane (B-D), ovoid in longitudinal direction, and completely located in thyroid parenchyma without evidence of extrathyroidal extension. E. High-power magnification (1:400, hematoxylin and eosin staining) reveals tumor cells with enlarged nuclei, chromatin clearing, and nuclear grooves. Tumor cells are surrounded by mature adipose tissue.

Mentions: Ultrasonography revealed an ovoid lesion with a smooth margin of approximately 2.9 × 2 × 1.3 cm in size. The nodule was generally hyperechoic, with the peripheral portion more hyperechoic than the central area. Posterior to the mass, curtain-like hyperechoic shadowing was observed. The perithyroidal fat, muscle, and vertebral bodies were therefore not clearly visualized (Fig. 1A). Doppler US did not show any vascular signals in the nodule. Based on these findings, a diagnosis of an indeterminate nodule was made. A board-certified radiologist performed US-guided fine needle aspiration using a freehand technique with a 23-gauge needle and a 5-mL disposable plastic syringe. Cytologic smears were made on glass slides and immediately fixed in 95% alcohol for both Papanicolaou staining and May-Grunwald-Giemsa staining. Cytology revealed atypia of undetermined significance or a follicular lesion of undetermined significance with negative for BRAF mutations and positive for an NRAS 61 mutation.


Radiologic and Pathologic Findings of a Follicular Variant of Papillary Thyroid Cancer with Extensive Stromal Fat: A Case Report.

Choi JW, Kim TH, Roh HG, Moon WJ, Lee SH, Hwang TS, Park KS - Korean J Radiol (2015)

58-year-old woman diagnosed with follicular variant of papillary thyroid cancer with mature fat.A. Longitudinal image of right thyroid using gray-scale ultrasonography shows hyperechoic, ovoid mass with smooth margin. Peripheral portion of mass is more echogenic than central area. Curtain-like hyperechoic shadowing was observed posterior to mass. Perithyroidal fat, muscle, and vertebral bodies were therefore not clearly visualized. B-D. Pre-contrast computed tomography (CT) shows fatty (mean CT number, -80 Hounsfield units, HU), well-defined mass in parenchyma of right mid-to-upper portion of thyroid (B). Mass has several fine reticular and thick septa-like soft tissue lesions, which show contrast enhancement. Post-contrast CT shows higher enhancement in early phase (C, at 40 seconds; mean CT number, 16 HU) of tumor than in delayed phase (D, 90 seconds; mean CT number, -13 HU). Tumor is lobular in appearance in axial plane (B-D), ovoid in longitudinal direction, and completely located in thyroid parenchyma without evidence of extrathyroidal extension. E. High-power magnification (1:400, hematoxylin and eosin staining) reveals tumor cells with enlarged nuclei, chromatin clearing, and nuclear grooves. Tumor cells are surrounded by mature adipose tissue.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644758&req=5

Figure 1: 58-year-old woman diagnosed with follicular variant of papillary thyroid cancer with mature fat.A. Longitudinal image of right thyroid using gray-scale ultrasonography shows hyperechoic, ovoid mass with smooth margin. Peripheral portion of mass is more echogenic than central area. Curtain-like hyperechoic shadowing was observed posterior to mass. Perithyroidal fat, muscle, and vertebral bodies were therefore not clearly visualized. B-D. Pre-contrast computed tomography (CT) shows fatty (mean CT number, -80 Hounsfield units, HU), well-defined mass in parenchyma of right mid-to-upper portion of thyroid (B). Mass has several fine reticular and thick septa-like soft tissue lesions, which show contrast enhancement. Post-contrast CT shows higher enhancement in early phase (C, at 40 seconds; mean CT number, 16 HU) of tumor than in delayed phase (D, 90 seconds; mean CT number, -13 HU). Tumor is lobular in appearance in axial plane (B-D), ovoid in longitudinal direction, and completely located in thyroid parenchyma without evidence of extrathyroidal extension. E. High-power magnification (1:400, hematoxylin and eosin staining) reveals tumor cells with enlarged nuclei, chromatin clearing, and nuclear grooves. Tumor cells are surrounded by mature adipose tissue.
Mentions: Ultrasonography revealed an ovoid lesion with a smooth margin of approximately 2.9 × 2 × 1.3 cm in size. The nodule was generally hyperechoic, with the peripheral portion more hyperechoic than the central area. Posterior to the mass, curtain-like hyperechoic shadowing was observed. The perithyroidal fat, muscle, and vertebral bodies were therefore not clearly visualized (Fig. 1A). Doppler US did not show any vascular signals in the nodule. Based on these findings, a diagnosis of an indeterminate nodule was made. A board-certified radiologist performed US-guided fine needle aspiration using a freehand technique with a 23-gauge needle and a 5-mL disposable plastic syringe. Cytologic smears were made on glass slides and immediately fixed in 95% alcohol for both Papanicolaou staining and May-Grunwald-Giemsa staining. Cytology revealed atypia of undetermined significance or a follicular lesion of undetermined significance with negative for BRAF mutations and positive for an NRAS 61 mutation.

Bottom Line: The mass was hyperechoic and ovoid in shape with a smooth margin on ultrasonography.On computed tomography, the mass had markedly low attenuation suggestive of fat, and fine reticular and thick septa-like structures.The mass was finally diagnosed as a follicular variant of papillary thyroid cancer with massive stromal fat.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.

ABSTRACT
Thyroid cancer may have small adipose structures detected by microscopy. However, there are no reports of thyroid cancer with gross fat evaluated by radiological methods. We reported a case of a 58-year-old woman with a fat containing thyroid mass. The mass was hyperechoic and ovoid in shape with a smooth margin on ultrasonography. On computed tomography, the mass had markedly low attenuation suggestive of fat, and fine reticular and thick septa-like structures. The patient underwent a right lobectomy. The mass was finally diagnosed as a follicular variant of papillary thyroid cancer with massive stromal fat.

No MeSH data available.


Related in: MedlinePlus