Aggressive Behavior of an Underdiagnosed Tall-Cell Variant of Papillary Thyroid Carcinoma After Total Thyroidectomy and Radioactive I-131 Ablation

Abstract Objectives The tall-cell variant of papillary thyroid carcinoma (TCV-PTC) has been known for its aggressive biological behavior; however, this aggressive variant of PTC is usually underdiagnosed due to its rarity and difficult diagnosis, and there are no clinical features that can accuratel...

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Bibliographic Details
Published in:American journal of clinical pathology 2018-09, Vol.150 (suppl_1), p.S15-S16
Main Authors: Xiang, Yan, Li, Li, Hammad, Azzam
Format: Article
Language:English
Subjects:
Ablation
Hemoptysis
Iodine
Metastases
Neoplasia
Nodules
Papillary thyroid carcinoma
Patients
Positron emission tomography
Thyroglobulin
Thyroid
Thyroid cancer
Thyroidectomy
Tumor cells
Tumors
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Summary:Abstract Objectives The tall-cell variant of papillary thyroid carcinoma (TCV-PTC) has been known for its aggressive biological behavior; however, this aggressive variant of PTC is usually underdiagnosed due to its rarity and difficult diagnosis, and there are no clinical features that can accurately diagnose it. Methods and Results A 76-year-old African American man had an incidental finding of a thyroid nodule during a physical exam in 2007. A fine-needle aspiration (FNA) at that time showed follicular neoplasm with Hurthle cell changes. He subsequently underwent total thyroidectomy in 2008, followed by I-131 treatment. In 2017, he began having hemoptysis and an increase in thyroglobulin level. FDG-PET and CTA studies showed a density in the right lung, a 2.1-cm adrenal nodule, lesions in bones, and an anterior-midline neck mass with cervical lymphoadenopathy. The patient received I-131 ablation, but the lesion continued to grow. He presented to our hospital for the resection of the midline pretracheal neck mass in March 2018. Grossly, the mass weighed 56 g and measured 8.5 × 4.6 × 2.6 cm. Careful histopathological examination showed that >50% of the tumor cells were tall and fulfilled the previously mentioned diagnostic criteria for TCV-PTC. Follicular and solid/trabecular variants were also noted. Immunostains showed the tumor cells to be positive for TTF-1, PAX-8, and thyroglobulin but negative for Napsin-A. Conclusion On tissue specimens, even small foci (
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqy090.038