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Extremely Well-Differentiated Papillary Thyroid Carcinoma Resembling Adenomatous Hyperplasia Can Metastasize to the Skull: A Case Report

 Ju Yeon Pyo  ;  Jisup Kim  ;  Sung-eun Choi  ;  Eunah Shin  ;  Seok-Woo Yang  ;  Cheong Soo Park  ;  Seok-Mo Kim  ;  SoonWon Hong 
 YONSEI MEDICAL JOURNAL, Vol.58(1) : 255-258, 2017 
Journal Title
Issue Date
Adenocarcinoma, Follicular/pathology ; Adenocarcinoma, Follicular/secondary ; Adult ; Carcinoma, Papillary, Follicular/pathology ; Carcinoma, Papillary, Follicular/secondary* ; Female ; Galectin 3/analysis ; Humans ; Hyperplasia/pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Skull Neoplasms/secondary* ; Thyroid Neoplasms/pathology*
CD56, immunohistochemistry ; adenomatous hyperplasia ; extremely well-differentiated ; follicular epithelial dysplasia ; papillary thyroid carcinoma ; well-differentiated tumors of uncertain malignant potential
We describe herein histologic, immunohistochemical, and molecular findings and clinical manifestations of a rare case of an extremely well differentiated papillary thyroid carcinoma (EWD-PTC). Similarly, it is also difficult to diagnose follicular variant papillary thyroid carcinoma (FVPTC), whose diagnosis is still met with controversy. A recently reported entity of well-differentiated tumor of uncertain malignant potential (WDT-UMP) is added to the diagnostic spectrum harboring EWD-PTC and FVPTC. We report this case, because EWD-PTC is different from FVPTC in its papillary architecture, and also from WDT-UMP in its recurrence and metastatic pattern. These morphologically deceptive entities harbored diagnostic difficulties in the past because the diagnosis depended solely on histology. However, they are now diagnosed with more certainty by virtue of immunohistochemical and molecular studies. We experienced a case of EWD-PTC, which had been diagnosed as adenomatous hyperplasia 20 years ago and manifested recurrence with lymph node (LN) metastasis 7 years later. After another 7 years of follow-up, a new thyroid lesion had developed, diagnosed as FVPTC, with LN metastasis of EWD-PTC. One year later, the patient developed metastatic FVPTC in the skull. Immunohistochemically, the EWD-PTC was focally positive for CK19, negative for galectin-3, and focally negative for CD56. Molecular studies revealed BRAF-positivity and K-RAS negativity. The FVPTC in the left thyroid showed both BRAF and K-RAS negativity. In conclusion, EWD-PTC and FVPTC share similar histologic features, but they are different tumors with different molecular biologic and clinical manifestations. A large cohort of EWD-PTC should be included in further study.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seok Mo(김석모) ORCID logo https://orcid.org/0000-0001-8070-0573
Kim, Jisup(김지섭) ORCID logo https://orcid.org/0000-0002-0742-5517
Park, Cheong Soo(박정수)
Choi, Sung Eun(최성은) ORCID logo https://orcid.org/0000-0002-6955-658X
Hong, Soon Won(홍순원) ORCID logo https://orcid.org/0000-0002-0324-2414
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