Skip to main content
SpringerLink
Log in
Book cover

Common Diagnostic Pitfalls in Thyroid Cytopathology pp 137–180Cite as

Variants of Papillary Thyroid Carcinoma

  • Chapter
  • First Online:

  • 942 Accesses

Abstract

Papillary thyroid carcinomas are the most common thyroid cancers and constitute more than 70 % of thyroid malignancies. The most common variants are the conventional type. However, many other uncommon variants have been described; the classification of these variants is based on the architectural patterns, such as follicular, solid, and cribriform-morular variants; the cell types, such as oncocytic, tall cell, and columnar cell variants; and the stromal reaction such as diffuse sclerosing, Warthin-like, and those with nodular fasciitis-like stroma. The common denominator for all the variants is the presence of nuclear features of PTC. The cytology may not be representative of the major morphologic pattern because of sampling error. In addition, a definitive cytologic diagnosis of PTC can sometimes be challenging if the typical nuclear changes of PTC were subtle or not readily apparent. It is advantageous in recognizing certain variants, namely, those with more aggressive clinical course, preoperatively since it may help the clinicians to plan for more aggressive treatment.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Berho M, Suster S. The oncocytic variant of papillary carcinoma of the thyroid: a clinicopathologic study of 15 cases. Hum Pathol. 1997;28:47–53.

    Article  CAS  PubMed  Google Scholar 

  2. Beckner ME, Heffess CS, Oertel JE. Oxyphilic papillary thyroid carcinomas. Am J Clin Pathol. 1995;103:280–7.

    Article  CAS  PubMed  Google Scholar 

  3. Chen KT. Fine-needle aspiration cytology of papillary Hurthle-cell tumors of thyroid: a report of three cases. Diagn Cytopathol. 1991;7:53–6.

    Article  CAS  PubMed  Google Scholar 

  4. Renshaw AA. Fine-needle aspirations of papillary carcinoma with oncocytic features: an expanded cytologic and histologic profile. Cancer Cytopathol. 2011;119:247–53.

    Article  PubMed  Google Scholar 

  5. Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology. New York, NY: Springer; 2010.

    Book  Google Scholar 

  6. Carcangiu ML, Sibley RK, Rosai J. Clear cell change in primary thyroid tumors. A study of 38 cases. Am J Surg Pathol. 1985;9:705–22.

    Article  CAS  PubMed  Google Scholar 

  7. Schroder S, Bocker W. Clear-cell carcinomas of thyroid gland: a clinicopathological study of 13 cases. Histopathology. 1986;10:75–89.

    Article  CAS  PubMed  Google Scholar 

  8. Civantos F, Albores-Saavedra J, Nadji M, Morales AR. Clear cell variant of thyroid carcinoma. Am J Surg Pathol. 1984;8:187–92.

    Article  CAS  PubMed  Google Scholar 

  9. Apel RL, Asa SL, LiVolsi VA. Papillary Hurthle cell carcinoma with lymphocytic stroma. “Warthin-like tumor” of the thyroid. Am J Surg Pathol. 1995;19:810–4.

    Article  CAS  PubMed  Google Scholar 

  10. Baloch ZW, LiVolsi VA. Fine-needle aspiration cytology of papillary Hurthle cell carcinoma with lymphocytic stroma “Warthin-like tumor” of the thyroid. Endocr Pathol. 1998;9:317–23.

    Article  PubMed  Google Scholar 

  11. Fadda G, Mule A, Zannoni GF, Vincenzoni C, Ardito G, Capelli A. Fine needle aspiration of a warthin-like thyroid tumor. Report of a case with differential diagnostic criteria vs. other lymphocyte-rich thyroid lesions. Acta Cytol. 1998;42:998–1002.

    Article  CAS  PubMed  Google Scholar 

  12. Yousef O, Dichard A, Bocklage T. Aspiration cytology features of the warthin tumor-like variant of papillary thyroid carcinoma. A report of two cases. Acta Cytol. 1997;41:1361–8.

    Article  CAS  PubMed  Google Scholar 

  13. Baloch ZW, LiVolsi VA. Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med. 2000;124:1192–5.

    CAS  PubMed  Google Scholar 

  14. Chan JK, Carcangiu ML, Rosai J. Papillary carcinoma of thyroid with exuberant nodular fasciitis-like stroma. Report of three cases. Am J Clin Pathol. 1991;95:309–14.

    Article  CAS  PubMed  Google Scholar 

  15. Lee YS, Nam KH, Hong SW, Yun JS, Chung WY, Park CS. Papillary thyroid carcinoma with nodular fasciitis-like stroma. Thyroid. 2008;18:577–8.

    Article  CAS  PubMed  Google Scholar 

  16. Leal II, Carneiro FP, Basilio-de-Oliveira CA, et al. Papillary carcinoma with nodular fasciitis-like stroma—a case report in pregnancy. Diagn Cytopathol. 2008;36:139–41.

    Article  PubMed  Google Scholar 

  17. Yang YJ, LiVolsi VA, Khurana KK. Papillary thyroid carcinoma with nodular fasciitis-like stroma. Pitfalls in fine-needle aspiration cytology. Arch Pathol Lab Med. 1999;123:838–41.

    CAS  PubMed  Google Scholar 

  18. Albores-Saavedra J, Gould E, Vardaman C, Vuitch F. The macrofollicular variant of papillary thyroid carcinoma: a study of 17 cases. Hum Pathol. 1991;22:1195–205.

    Article  CAS  PubMed  Google Scholar 

  19. Bongiovanni M, Gremaud M, Moulin CS, Scheidegger C, Biton C, Clement S. Macrofollicular variant of follicular thyroid carcinoma: a clinical, cytologic, morphologic, and image analysis study of a unique case. Ann Diagn Pathol. 2009;13:101–5.

    Article  PubMed  Google Scholar 

  20. Chung D, Ghossein RA, Lin O. Macrofollicular variant of papillary carcinoma: a potential thyroid FNA pitfall. Diagn Cytopathol. 2007;35:560–4.

    Article  PubMed  Google Scholar 

  21. Fadda G, Fiorino MC, Mule A, LiVolsi VA. Macrofollicular encapsulated variant of papillary thyroid carcinoma as a potential pitfall in histologic and cytologic diagnosis. A report of three cases. Acta Cytol. 2002;46:555–9.

    Article  PubMed  Google Scholar 

  22. Lugli A, Terracciano LM, Oberholzer M, Bubendorf L, Tornillo L. Macrofollicular variant of papillary carcinoma of the thyroid: a histologic, cytologic, and immunohistochemical study of 3 cases and review of the literature. Arch Pathol Lab Med. 2004;128:54–8.

    PubMed  Google Scholar 

  23. Mesonero CE, Jugle JE, Wilbur DC, Nayar R. Fine-needle aspiration of the macrofollicular and microfollicular subtypes of the follicular variant of papillary carcinoma of the thyroid. Cancer. 1998;84:235–44.

    Article  CAS  PubMed  Google Scholar 

  24. Policarpio-Nicolas ML, Sirohi D. Macrofollicular variant of papillary carcinoma, a potential diagnostic pitfall: a report of two cases including a review of literature. Cytojournal. 2013;10:16.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lam AK, Lo CY. Diffuse sclerosing variant of papillary carcinoma of the thyroid: a 35-year comparative study at a single institution. Ann Surg Oncol. 2006;13:176–81.

    Article  PubMed  Google Scholar 

  26. Thompson LD, Wieneke JA, Heffess CS. Diffuse sclerosing variant of papillary thyroid carcinoma: a clinicopathologic and immunophenotypic analysis of 22 cases. Endocr Pathol. 2005;16:331–48.

    Article  PubMed  Google Scholar 

  27. Carcangiu ML, Bianchi S. Diffuse sclerosing variant of papillary thyroid carcinoma. Clinicopathologic study of 15 cases. Am J Surg Pathol. 1989;13:1041–9.

    Article  CAS  PubMed  Google Scholar 

  28. Sen A, Nalwa A, Mathur SR, Jain D, Iyer VK. Cytomorphology of columnar cell variant of papillary carcinoma thyroid: a case report and review of the literature. Cytojournal. 2014;11:27.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Martin-Perez E, Larranaga E, Serrano P. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Eur J Surg. 1998;164:713–5.

    Article  CAS  PubMed  Google Scholar 

  30. Soares J, Limbert E, Sobrinho-Simoes M. Diffuse sclerosing variant of papillary thyroid carcinoma. A clinicopathologic study of 10 cases. Pathol Res Pract. 1989;185:200–6.

    Article  CAS  PubMed  Google Scholar 

  31. Bongiovanni M, Triponez F, McKee TA, Kumar N, Matthes T, Meyer P. Fine-needle aspiration of the diffuse sclerosing variant of papillary thyroid carcinoma masked by florid lymphocytic thyroiditis; a potential pitfall: a case report and review of the literature. Diagn Cytopathol. 2009;37:671–5.

    Article  PubMed  Google Scholar 

  32. Lee JY, Shin JH, Han BK, et al. Diffuse sclerosing variant of papillary carcinoma of the thyroid: imaging and cytologic findings. Thyroid. 2007;17:567–73.

    Article  CAS  PubMed  Google Scholar 

  33. Odashiro DN, Nguyen GK. Diffuse sclerosing variant papillary carcinoma of the thyroid: report of four cases with fine-needle aspirations. Diagn Cytopathol. 2006;34:247–9.

    Article  PubMed  Google Scholar 

  34. Kumarasinghe MP. Cytomorphologic features of diffuse sclerosing variant of papillary carcinoma of the thyroid. A report of two cases in children. Acta Cytol. 1998;42:983–6.

    Article  CAS  PubMed  Google Scholar 

  35. Takagi N, Hirokawa M, Nobuoka Y, Higuchi M, Kuma S, Miyauchi A. Diffuse sclerosing variant of papillary thyroid carcinoma: a study of fine needle aspiration cytology in 20 patients. Cytopathology. 2014;25:199–204.

    Article  CAS  PubMed  Google Scholar 

  36. Akslen LA, LiVolsi VA. Prognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma. Cancer. 2000;88:1902–8.

    Article  CAS  PubMed  Google Scholar 

  37. Carcangiu ML, Zampi G, Pupi A, Castagnoli A, Rosai J. Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer. 1985;55:805–28.

    Article  CAS  PubMed  Google Scholar 

  38. Nikiforov YE, Erickson LA, Nikiforova MN, Caudill CM, Lloyd RV. Solid variant of papillary thyroid carcinoma: incidence, clinical-pathologic characteristics, molecular analysis, and biologic behavior. Am J Surg Pathol. 2001;25:1478–84.

    Article  CAS  PubMed  Google Scholar 

  39. Nguyen GK, Lee MW. Solid/trabecular variant papillary carcinoma of the thyroid: report of three cases with fine-needle aspiration. Diagn Cytopathol. 2006;34:712–4.

    Article  PubMed  Google Scholar 

  40. Giorgadze TA, Scognamiglio T, Yang GC. Fine-needle aspiration cytology of the solid variant of papillary thyroid carcinoma: a study of 13 cases with clinical, histologic, and ultrasound correlations. Cancer Cytopathol. 2015;123(2):71–81.

    Article  PubMed  Google Scholar 

  41. Ghossein R, Livolsi VA. Papillary thyroid carcinoma tall cell variant. Thyroid. 2008;18:1179–81.

    Article  CAS  PubMed  Google Scholar 

  42. Kazaure HS, Roman SA, Sosa JA. Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients. Ann Surg Oncol. 2012;19:1874–80.

    Article  PubMed  Google Scholar 

  43. Urano M, Kiriyama Y, Takakuwa Y, Kuroda M. Tall cell variant of papillary thyroid carcinoma: its characteristic features demonstrated by fine-needle aspiration cytology and immunohistochemical study. Diagn Cytopathol. 2009;37:732–7.

    Article  PubMed  Google Scholar 

  44. LiVolsi VA. Papillary carcinoma tall cell variant (TCV): a review. Endocr Pathol. 2010;21:12–5.

    Article  PubMed  Google Scholar 

  45. Lee SH, Jung CK, Bae JS, Jung SL, Choi YJ, Kang CS. Liquid-based cytology improves preoperative diagnostic accuracy of the tall cell variant of papillary thyroid carcinoma. Diagn Cytopathol. 2014;42:11–7.

    Article  PubMed  Google Scholar 

  46. Guan H, Vandenbussche CJ, Erozan YS, et al. Can the tall cell variant of papillary thyroid carcinoma be distinguished from the conventional type in fine needle aspirates? A cytomorphologic study with assessment of diagnostic accuracy. Acta Cytol. 2013;57:534–42.

    Article  PubMed  Google Scholar 

  47. Solomon A, Gupta PK, LiVolsi VA, Baloch ZW. Distinguishing tall cell variant of papillary thyroid carcinoma from usual variant of papillary thyroid carcinoma in cytologic specimens. Diagn Cytopathol. 2002;27:143–8.

    Article  PubMed  Google Scholar 

  48. Ozaki O, Ito K, Mimura T, Sugino K, Hosoda Y. Papillary carcinoma of the thyroid. Tall-cell variant with extensive lymphocyte infiltration. Am J Surg Pathol. 1996;20:695–8.

    Article  CAS  PubMed  Google Scholar 

  49. Wenig BM, Thompson LD, Adair CF, Shmookler B, Heffess CS. Thyroid papillary carcinoma of columnar cell type: a clinicopathologic study of 16 cases. Cancer. 1998;82:740–53.

    Article  CAS  PubMed  Google Scholar 

  50. Ylagan LR, Dehner LP, Huettner PC, Lu D. Columnar cell variant of papillary thyroid carcinoma. Report of a case with cytologic findings. Acta Cytol. 2004;48:73–7.

    Article  PubMed  Google Scholar 

  51. Perez F, Llobet M, Garijo G, Barcelo C, Castro P, Bernado L. Fine-needle aspiration cytology of columnar-cell carcinoma of the thyroid: report of two cases with cytohistologic correlation. Diagn Cytopathol. 1998;18:352–6.

    Article  CAS  PubMed  Google Scholar 

  52. Jayaram G. Cytology of columnar-cell variant of papillary thyroid carcinoma. Diagn Cytopathol. 2000;22:227–9.

    Article  CAS  PubMed  Google Scholar 

  53. Hui PK, Chan JK, Cheung PS, Gwi E. Columnar cell carcinoma of the thyroid. Fine needle aspiration findings in a case. Acta Cytol. 1990;34:355–8.

    CAS  PubMed  Google Scholar 

  54. Harach HR, Williams GT, Williams ED. Familial adenomatous polyposis associated thyroid carcinoma: a distinct type of follicular cell neoplasm. Histopathology. 1994;25:549–61.

    Article  CAS  PubMed  Google Scholar 

  55. Ng SB, Sittampalam K, Goh YH, Eu KW. Cribriform-morular variant of papillary carcinoma: the sporadic counterpart of familial adenomatous polyposis-associated thyroid carcinoma. A case report with clinical and molecular genetic correlation. Pathology. 2003;35:42–6.

    CAS  PubMed  Google Scholar 

  56. Cameselle-Teijeiro J, Chan JK. Cribriform-morular variant of papillary carcinoma: a distinctive variant representing the sporadic counterpart of familial adenomatous polyposis-associated thyroid carcinoma? Mod Pathol. 1999;12:400–11.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Yale University School of Medicine, New Haven, CT, USA

    Adebowale J. Adeniran

  2. Department of Pathology, Mount Sinai Health System, New York, NY, USA

    David Chhieng

Authors
  1. Adebowale J. Adeniran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Chhieng
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Adeniran, A.J., Chhieng, D. (2016). Variants of Papillary Thyroid Carcinoma. In: Common Diagnostic Pitfalls in Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-31602-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31602-4_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31600-0

  • Online ISBN: 978-3-319-31602-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation