J Korean Med Sci.  2013 Mar;28(3):480-484. 10.3346/jkms.2013.28.3.480.

Diffuse Follicular Variant of Papillary Thyroid Carcinoma in a 69-Year-old Man with Extensive Extrathyroidal Extension: A Case Report

• Cha YJ
• Chang HS
• Hong SW

• KMID: 1786950
• DOI: http://doi.org/10.3346/jkms.2013.28.3.480

Abstract

Diffuse follicular variant papillary thyroid carcinoma (DFVPTC) is a rare variant papillary thyroid carcinoma. DFVPTC typically occurs in young females, extensively involves one lobe or both lobes entirely with frequent nodal metastasis and vascular invasion. In contrast to the other subtypes of follicular variant, DFVPTC has biologically aggressive behavior. We present a case of DFVPTC arising in a 69-yr-old male patient. He presented hoarseness for a few months. Following diagnosis of malignancy on aspiration cytology, total thyroidectomy with neck dissection was performed. The tumor involved both lobes of thyroid, encroaching the surrounding structures including tracheal cartilage and esophagus. Multiple lymph node metastasis and vascular invasion were also found. The patient passed away due to the unexplained bleeding of surgical site.

Keyword

Thyroid Neoplasm; Papillary Carcinoma; Metastasis

MeSH Terms

Aged
Antigens, CD56/metabolism
Carcinoma, Papillary, Follicular/*diagnosis/pathology/surgery
Galectin 3/metabolism
Humans
Immunohistochemistry
Keratin-19/metabolism
Lymph Nodes/pathology
Lymphatic Metastasis
Male
Thyroid Neoplasms/*diagnosis/pathology/surgery
Thyroidectomy
Tomography, X-Ray Computed
Antigens, CD56
Galectin 3
Keratin-19

Figure

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  Fig. 1 CT scan showed ill-defined irregular mass in thyroid gland with tracheal wall invasion. (A) Cut section of the left thyroid showed white tan, vaguely nodular and infiltrative tumor that was almost replacing the thyroid parenchyma. (B) Focal calcification and whitish sclerosing fibrosis were seen.

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  Fig. 2 Histopathology of the thyroid tumor (H&E stained). (A) Tumor was infiltrating in nodular growth pattern, composed of macro- and microfollicles, × 40. (B) Collagenous fibrotic stroma was evident without significant inflammation, × 40. (C) The tumor cells had nuclear features of conventional papillary thyroid carcinoma, such as nuclear clearing and grooves, but papillary architecture and pseudoinclusion were rarely found, × 400. (D) Six lymph nodes had metastatic carcinoma that revealed same histologic features with thyroidal lesion, × 12.5, × 200 inlet.

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  Fig. 3 Histopathology of adjacent structures of the thyroid. (A) Tracheal subepithelial stroma, (B) tracheal cartilage, and (C) esophagus were infiltrated.

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  Fig. 4 Immunohistochemical staining for the tumor tissue (left side of hatched markings) compared with normal thyroid tissue (right side of hatched markings). (A) Diffuse positivity for galectin-3, × 40. (B) Positive for CK19, × 40. (C) Negative CD56 reactivity, × 40. (D) Thyroglobulin is relatively decreased in tumor area, × 40.

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