Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2018.083
Autopsy and Case Reports
Article / Clinical Case Report

Multifocal papillary carcinoma of the thyroid with heterotopic ossification and extramedullary hematopoiesis associated with a lipomatous follicular nodule

José Cândido Caldeira Xavier-Júnior; Deolino João Camilo-Júnior; Sebastião Conrado-Neto; Ana Cláudia Severo de Castro Lippe; Neivio José Mattar

Downloads: 1
Views: 1374

Abstract

Heterotopic ossification has been described in papillary thyroid carcinoma in association with high incidence of extrathyroidal invasion, multifocality, lymph node metastasis, and older age. Nevertheless, it has not been described as a specific subtype of papillary thyroid carcinoma, because of its rarity. We described the case of an 80-year-old female patient, with familial history of papillary thyroid carcinoma. In the annual screening examination, she was diagnosed with thyroid nodules. The patient was submitted to a thyroidectomy because the fine needle aspiration cytology was positive for malignancy according to the Bethesda classification. The surgical specimen analyses showed a multifocal papillary carcinoma with one major lesion in the left lobe measuring 0.9 cm, and two small lesions (0.4 cm and 0.2 cm) in the right lobe. Only the biggest lesion in the right lobe had the osteoid matrix with rare osteoclasts and fat metaplasia with progenitor cells. There was perineural invasion, but vascular invasion was not identified. The margins were free and there was no extrathyroidal extension. In the left lobe there was an oncocytic nodule and a lipomatous follicular nodule. In recent years there has been a significant increase in the diagnosis of thyroid cancer, mainly because of the finding of microcarcinomas as a result of many requests for cervical image exams. Future studies may define (i) whether papillary thyroid carcinoma with heterotopic ossification is a true histological variant; (ii) the causes of that alteration; and (iii) eventual follow-up implications.

Keywords

Thyroid Gland, Thyroid Neoplasms, Ossification, Heterotopic, Carcinoma, Papillary

References

American Joint Committee on Cancer (AJCC). American Joint Committee on Cancer staging manual. 8th ed. Chicago: Springer; 2017.

Instituto Nacional do Câncer José de Alencar Gomes da Silva (INCA). Estimate/2016: cancer incidence in Brazil. Rio de Janeiro; 2015. Portuguese.

Lloyd RV, Osamura RY, Kloppel G, et al, editors. WHO classification of tumours of endocrine organs. 4th ed. Lyon: IARC; 2017.

Ali SZ, Cibas ES. The Bethesda system for thyroid cytopathology. New York: Springer; 2009.

Bai Y, Zhou G, Nakamura M, et al. Survival impact of psammoma body, stromal calcification and bone formation in papillary thyroid carcinoma. Mod Pathol. 2009;22(7):887-94. [https://doi.org/10.1038/modpathol.2009.38]. [PMID:19305382]

Na KY, Kim HS, Lee SK, et al. Papillary thyroid carcinoma with bone formation. Pathol Res Pract. 2013;209(1):14-8. [https://doi.org/10.1016/j.prp.2012.10.001]. [PMID:23177617]

Takeda M, Mikami T, Numata CY, Okamoto M, Okayasu I. Papillary thyroid carcinoma with heterotopic ossification is a special subtype with extensive progression. Am J Clin Pathol. 2013;139(5):587-98. [https://doi.org/10.1309/AJCPQZQN50HKIAHA]. [PMID:23596110]

Anil G, Hegde A, Chong FH. Thyroid nodules: risk stratification for malignancy with ultrasound and guided biopsy. Cancer Imaging. 2011;11:209-23. [PMID:22203727]

Aurora N, Hashmi I, Misra S, Aydin N. A rare presentation: a case report of osseous metaplasia and mature bone formation in a follicular adenoma of the thyroid. Int J Surg Case Rep. 2017;37:83-6. [https://doi.org/10.1016/j.ijscr.2017.06.031]. [PMID:28648877]

Pontikides N, Botsios D, Kariki E, Vassiliadis K, Krassas GE. Extramedullary hematopoiesis in a thyroid nodule with extensive bone metaplasia and mature bone formation. Thyroid. 2003;13(9):877-80. [https://doi.org/10.1089/105072503322401087]. [PMID:14588103]

Been LC, Ogden L, Traweek ST. Extramedullary hematopoiesis involving the thyroid: fine-needle aspiration features and literature review. J Am Soc Cytopathol. 2016;5(3):133-8. [https://doi.org/10.1016/j.jasc.2015.10.002].

Gnepp DR, Ogorzalek JM, Heffess CS. Fat-containing lesions of the thyroid gland. Am J Surg Pathol. 1989;13(7):605-12. [https://doi.org/10.1097/00000478-198907000-00009]. [PMID:2660611]

Kitagawa W, Kameyama K, Tamai S, et al. Adenolipoma of the thyroid gland: report of a case. Surg Today. 2004;34(7):593-6. [https://doi.org/10.1007/s00595-004-2772-y]. [PMID:15221553]

Guarda V, Pickhard A, Boxberg M, Specht K, Buchberger AMS. Liposarcoma of the thyroid: a case report with a review of the literature. Eur Thyroid J. 2018;7(2):102-8. [https://doi.org/10.1159/000486333]. [PMID:29594062]

 

 

 


Publication date:
04/05/2019

5ca78d300e8825ec074fa92c autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections