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The Diffuse Sclerosing Variant of Papillary Thyroid Cancer Presenting as Innumerable Diffuse Microcalcifications in Underlying Adolescent Hashimoto's Thyroiditis

View Article: PubMed Central - PubMed

ABSTRACT

Hashimoto's thyroiditis is the most common diffuse thyroid disease and is characterized by diffuse lymphocytic infiltration. However, the ultrasonographic findings of papillary thyroid carcinomas that arise from Hashimoto's thyroiditis in the pediatric and adolescent population are not well known.

We report a rare ultrasonographic finding in a 22-year-old woman diagnosed with the diffuse sclerosing variant of papillary thyroid carcinoma that arose from underlying Hashimoto's thyroiditis: innumerable diffuse microcalcifications instead of a typical malignant-appearing nodule.

No MeSH data available.


Related in: MedlinePlus

Serial ultrasonography of a 22-year-old woman who had been diagnosed with Hashimoto's thyroiditis. At the age of 13 years old, initial ultrasonography of the neck revealed diffusely heterogeneous and enlarged thyroid lobes bilaterally, with diffusely increased vascularity without any focal mass or calcifications. This was compatible with thyroiditis (A, B). Three years later, follow-up ultrasonography revealed more heterogeneous parenchymal echogenicity compared with the previous examination (C). At the age of 22, innumerable microcalcifications were detected, with an ill-defined hypoechoic lesion replacing almost the entire left lobe of the thyroid gland and increased vascularity (D, E). Histopathological sections showed lymphocytic follicles with activated germinal centers and aggregates of tumor cells and several psammoma bodies (white arrows) (hematoxylin-eosin [H&E] stain, × 100) (F). Tumor cell aggregates (black arrow) were present in the lymphatic spaces, and a few concentric calcified psammoma bodies (white arrows) were noted (H&E stain, × 100) (G).
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Figure 1: Serial ultrasonography of a 22-year-old woman who had been diagnosed with Hashimoto's thyroiditis. At the age of 13 years old, initial ultrasonography of the neck revealed diffusely heterogeneous and enlarged thyroid lobes bilaterally, with diffusely increased vascularity without any focal mass or calcifications. This was compatible with thyroiditis (A, B). Three years later, follow-up ultrasonography revealed more heterogeneous parenchymal echogenicity compared with the previous examination (C). At the age of 22, innumerable microcalcifications were detected, with an ill-defined hypoechoic lesion replacing almost the entire left lobe of the thyroid gland and increased vascularity (D, E). Histopathological sections showed lymphocytic follicles with activated germinal centers and aggregates of tumor cells and several psammoma bodies (white arrows) (hematoxylin-eosin [H&E] stain, × 100) (F). Tumor cell aggregates (black arrow) were present in the lymphatic spaces, and a few concentric calcified psammoma bodies (white arrows) were noted (H&E stain, × 100) (G).

Mentions: A 22-year-old woman was followed and diagnosed with Hashimoto's thyroiditis at the age of 13 years old. She had no family history of thyroid cancer. At the age of 13, ultrasonography of the neck revealed diffusely enlarged thyroid lobes bilaterally, with diffusely increased vascularity but no focal masses or calcifications (Figure 1A and B). We diagnosed this as compatible with thyroiditis. Three years later, follow-up ultrasonography (Figure 1C) showed diffuse low parenchymal echogenicity compared with the previous examination.


The Diffuse Sclerosing Variant of Papillary Thyroid Cancer Presenting as Innumerable Diffuse Microcalcifications in Underlying Adolescent Hashimoto's Thyroiditis
Serial ultrasonography of a 22-year-old woman who had been diagnosed with Hashimoto's thyroiditis. At the age of 13 years old, initial ultrasonography of the neck revealed diffusely heterogeneous and enlarged thyroid lobes bilaterally, with diffusely increased vascularity without any focal mass or calcifications. This was compatible with thyroiditis (A, B). Three years later, follow-up ultrasonography revealed more heterogeneous parenchymal echogenicity compared with the previous examination (C). At the age of 22, innumerable microcalcifications were detected, with an ill-defined hypoechoic lesion replacing almost the entire left lobe of the thyroid gland and increased vascularity (D, E). Histopathological sections showed lymphocytic follicles with activated germinal centers and aggregates of tumor cells and several psammoma bodies (white arrows) (hematoxylin-eosin [H&E] stain, × 100) (F). Tumor cell aggregates (black arrow) were present in the lymphatic spaces, and a few concentric calcified psammoma bodies (white arrows) were noted (H&E stain, × 100) (G).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4998389&req=5

Figure 1: Serial ultrasonography of a 22-year-old woman who had been diagnosed with Hashimoto's thyroiditis. At the age of 13 years old, initial ultrasonography of the neck revealed diffusely heterogeneous and enlarged thyroid lobes bilaterally, with diffusely increased vascularity without any focal mass or calcifications. This was compatible with thyroiditis (A, B). Three years later, follow-up ultrasonography revealed more heterogeneous parenchymal echogenicity compared with the previous examination (C). At the age of 22, innumerable microcalcifications were detected, with an ill-defined hypoechoic lesion replacing almost the entire left lobe of the thyroid gland and increased vascularity (D, E). Histopathological sections showed lymphocytic follicles with activated germinal centers and aggregates of tumor cells and several psammoma bodies (white arrows) (hematoxylin-eosin [H&E] stain, × 100) (F). Tumor cell aggregates (black arrow) were present in the lymphatic spaces, and a few concentric calcified psammoma bodies (white arrows) were noted (H&E stain, × 100) (G).
Mentions: A 22-year-old woman was followed and diagnosed with Hashimoto's thyroiditis at the age of 13 years old. She had no family history of thyroid cancer. At the age of 13, ultrasonography of the neck revealed diffusely enlarged thyroid lobes bilaterally, with diffusely increased vascularity but no focal masses or calcifications (Figure 1A and B). We diagnosed this as compatible with thyroiditis. Three years later, follow-up ultrasonography (Figure 1C) showed diffuse low parenchymal echogenicity compared with the previous examination.

View Article: PubMed Central - PubMed

ABSTRACT

Hashimoto's thyroiditis is the most common diffuse thyroid disease and is characterized by diffuse lymphocytic infiltration. However, the ultrasonographic findings of papillary thyroid carcinomas that arise from Hashimoto's thyroiditis in the pediatric and adolescent population are not well known.

We report a rare ultrasonographic finding in a 22-year-old woman diagnosed with the diffuse sclerosing variant of papillary thyroid carcinoma that arose from underlying Hashimoto's thyroiditis: innumerable diffuse microcalcifications instead of a typical malignant-appearing nodule.

No MeSH data available.


Related in: MedlinePlus