Papillary Thyroid Carcinoma with Nodular Fasciitis-like Stroma

Lee, Yong Sang; Hong, Soon Won; Yoon, Ji Sup; Jeong, Jong Ju; Nam, Kee Hyun; Chung, Woong Youn; Park, Cheong Soo

Abstract

The morphologic spectrum of papillary thyroid carcinoma (PTC) is wide, and many different variants have been recognized. Papillary thyroid carcinoma with nodular fasciitis-like stroma (PTC-NFS) is one of the rare variants of a papillary thyroid carcinoma. Because of the rarity of PTC-NFS, the pathogenesis and clinicopathological significance are still unknown. We recently experienced a case of papillary thyroid carcinoma with extensive nodular fasciitis-like stroma. A 45-year-old female was admitted due to thyroid incidentaloma. An sonographic examination revealed well-demarcated nodules in the right lobe of the thyroid. Fine-needle aspiration cytology showed a finding suspicious for PTC, but was not diagnostic. The patient underwent a right hemithyroidectomy with central compartment node dissection. On gross examination, a well-demarcated white solid ovoid mass measuring 1.0 x 1.0 cm was seen at the upper pole of the right thyroid gland. An intraoperative frozen section also was unable to differentiate between a benign and malignant lesion. An histopathological test showed prominent stromal cell proliferation, exuberant myofibroblastic proliferation associated with deposition of dense bands of collagen, and an area of papillary carcinoma merging with the desmoplastic stroma. Finally, the patent was diagnosed as having a papillary thyroid carcinoma with nodular fasciitis-like stroma.