Encapsulated Papillary Thyroid Tumor with Delicate Nuclear Changes and a KRAS Mutation as a Possible Novel Subtype of Borderline Tumor

Although papillary thyroid carcinoma (PTC)-type nuclear changes are the most reliable morphological feature in the diagnosis of PTC, the nuclear assessment used to identify these changes is highly subjective. Here, we report a noninvasive encapsulated thyroid tumor with a papillary growth pattern me...

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Bibliographic Details
Published in:Journal of pathology and translational medicine 2019, 53(2), , pp.136-141
Main Authors: Ohba, Kenji, Mitsutake, Norisato, Matsuse, Michiko, Rogounovitch, Tatiana, Nishino, Nobuhiko, Oki, Yutaka, Goto, Yoshie, Kakudo, Kennichi
Format: Article
Language:English
Subjects:
Case Study
Classification
Cloning
Family medical history
Morphology
Mutation
Patients
Terminology
Thyroid cancer
Tumors
병리학
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Summary:Although papillary thyroid carcinoma (PTC)-type nuclear changes are the most reliable morphological feature in the diagnosis of PTC, the nuclear assessment used to identify these changes is highly subjective. Here, we report a noninvasive encapsulated thyroid tumor with a papillary growth pattern measuring 23 mm at its largest diameter with a nuclear score of 2 in a 26-year-old man. After undergoing left lobectomy, the patient was diagnosed with an encapsulated PTC. However, a second opinion consultation suggested an alternative diagnosis of follicular adenoma with papillary hyperplasia. When providing a third opinion, we identified a low MIB-1 labeling index and a heterozygous point mutation in the KRAS gene but not the BRAF gene. We speculated that this case is an example of a novel borderline tumor with a papillary structure. Introduction of the new terminology "noninvasive encapsulated papillary RAS-like thyroid tumor (NEPRAS)" without the word "cancer" might relieve the psychological burden of patients in a way similar to the phrase "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)."
ISSN:2383-7837
2383-7845
DOI:10.4132/jptm.2018.12.07