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Macrofollicular Variant of Papillary Thyroid Carcinoma with Extensive Lymph Node Metastases

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Abstract

The macrofollicular variant of papillary thyroid carcinoma is a rare subtype of the follicular variant of papillary thyroid carcinoma and is usually characterized by an indolent clinical course. The tumors are prone to be misdiagnosed as benign due to their macrofollicular architecture and bland cytologic features. We report a rare case of the macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases. The patient was a 48-year-old female with a right thyroid nodule and multiple enlarged lymph nodes in the right neck. It was not possible to make a definitive diagnosis of malignancy on fine-needle aspiration cytology and intraoperative frozen section. She underwent total thyroidectomy with right modified radical neck dissection. The surgical specimen showed a 2.5 × 1.5 × 10 cm, well-circumscribed macrofollicular variant of papillary thyroid carcinoma in the right lobe and multiple central and right lateral neck lymph node metastases. Molecular testing for BRAF, NRAS, HRAS, and KRAS was all negative. We then reviewed the demographic and clinicopathologic characteristics of 71 patients with the macrofollicular variant of papillary thyroid carcinoma. The cytologic or histopathologic diagnosis of macrofollicular variant of papillary thyroid carcinoma can be difficult. Extensive lymph node metastases caused by the macrofollicular variant of papillary thyroid carcinoma may occur even in the absence of capsular or lymphovascular invasion. This review will help to better understand the nature of the macrofollicular variant of papillary thyroid carcinoma.

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Authors and Affiliations

  1. Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 137-701, Republic of Korea

    Min-kyung Yeo, Woo Jin Oh, Gyeong Sin Park & Chan Kwon Jung

  2. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Ja Seong Bae

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  1. Min-kyung Yeo
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Correspondence to Chan Kwon Jung.

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Fig. 1

A. The right thyroid gland presents a 14 x 12 mm sized well-defined lesion in the upper portion. B. The tumor has a well circumscribed margin without fibrous capsule. C. Discrete areas of fibrosis are focally noted. D. The follicular cells lining the macrofollicles show enlarged nuclei with ground-glass opacity. Dense eosinophilic colloid shows peripheral scalloping. E. One metastatic lymph node shows bland looking macrofollicles. (JPEG 87 kb)

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Yeo, Mk., Bae, J.S., Oh, W.J. et al. Macrofollicular Variant of Papillary Thyroid Carcinoma with Extensive Lymph Node Metastases. Endocr Pathol 25, 265–272 (2014). https://doi.org/10.1007/s12022-014-9306-y

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  • DOI: https://doi.org/10.1007/s12022-014-9306-y

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