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Presented by Justin A. Bishop, M.D. and prepared by Mark Samols, M.D., Ph.D.
Case 1: A 40 year old woman with a 1 cm thyroid mass.
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1. Question
Week 510: Case 1
A 40 year old woman with a 1 cm thyroid mass. FNA diagnosis was papillary carcinoma with features of the tall cell variant.images/samols/0507121a.jpg
images/samols/0507121b.jpg
images/samols/0507121c.jpgCorrect
Answer: Papillary carcinoma, cribriform morular variant
Histology:
Discussion: The cribriform morular variant (CMVPTC) is a rare, distinct subtype of papillary thyroid carcinoma that usually affects young women. CMVPTC is important to recognize for two reasons:
1) Some (but certainly not all) cases of CMVPTC are seen in the setting of familial adenomatous polyposis (FAP), and this tumor can even be the presenting lesion, preceding colonic adenomas. For that reason, the diagnosis of CMVPTC should prompt further investigation into the possibility of FAP.
2) Its histologic features overlap with variants of PTC (columnar and tall cell) that are associated with more aggressive clinical behavior. The cells in CMVPTC are tall, but in tall cell variant the cells have abundant pink cytoplasm and the nuclei are not stratified. CMVPTC is morphologically more diverse (e.g. cribriforming and trabecular components) that the columnar variant, and it typically lacks the tumor necrosis and sub-nuclear vacuoles that are classic for that aggressive subtype. Unlike the tall cell and columnar variants of PTC, CMVPTC is not more aggressive than conventional PTC. If there is any question about the diagnosis, CMVPTC can be confirmed with immunohistochemistry: it classically displays nuclear and cytoplasmic labeling for beta catenin (as with other FAP-associated tumors) and is usually positive for ER and PR.Reference(s):
– Cameselle-Teijeiro J and Chan JK. “Cribriform morular variant of papillary carcinoma: a distinctive variant repressenting the sporadic counterpart of familial adenomatous polyposis-associated thyroid carcinoma” Mod Pathol. 1999. 12(4):400-11.Incorrect
Answer: Papillary carcinoma, cribriform morular variant
Histology:
Discussion: The cribriform morular variant (CMVPTC) is a rare, distinct subtype of papillary thyroid carcinoma that usually affects young women. CMVPTC is important to recognize for two reasons:
1) Some (but certainly not all) cases of CMVPTC are seen in the setting of familial adenomatous polyposis (FAP), and this tumor can even be the presenting lesion, preceding colonic adenomas. For that reason, the diagnosis of CMVPTC should prompt further investigation into the possibility of FAP.
2) Its histologic features overlap with variants of PTC (columnar and tall cell) that are associated with more aggressive clinical behavior. The cells in CMVPTC are tall, but in tall cell variant the cells have abundant pink cytoplasm and the nuclei are not stratified. CMVPTC is morphologically more diverse (e.g. cribriforming and trabecular components) that the columnar variant, and it typically lacks the tumor necrosis and sub-nuclear vacuoles that are classic for that aggressive subtype. Unlike the tall cell and columnar variants of PTC, CMVPTC is not more aggressive than conventional PTC. If there is any question about the diagnosis, CMVPTC can be confirmed with immunohistochemistry: it classically displays nuclear and cytoplasmic labeling for beta catenin (as with other FAP-associated tumors) and is usually positive for ER and PR.Reference(s):
– Cameselle-Teijeiro J and Chan JK. “Cribriform morular variant of papillary carcinoma: a distinctive variant repressenting the sporadic counterpart of familial adenomatous polyposis-associated thyroid carcinoma” Mod Pathol. 1999. 12(4):400-11.
