Solid Cell Nests Hyperplasia (Ultimobranchial Body Remnants) of the Thyroid: A Pitfall

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
H Bharadwaj ◽  
A Khan
Keyword(s):  
Follicular Adenoma ◽  
Immunohistochemical Analysis ◽  
Hashimoto Thyroiditis ◽  
Follicular Neoplasm ◽  
Transitional Epithelium ◽  
Risk Category ◽  
Cell Hyperplasia ◽  
Diagnostic Dilemma ◽  
Solid Cell Nests ◽  
Solid Cell

Abstract Introduction/Objective Solid cell nests (SCN) are small epithelial cell nests interspersed within thyroid parenchyma, resembling squamous/transitional epithelium. SCNs, which are ultimobranchial remnants, are popularly considered pluripotent stem-cells responsible for developing follicular and C-cells. While SCNs are not an uncommon incidental findings in thyroid, solid cell nest hyperplasia is rare. SCNs are often mistaken for benign entities such as C-cell hyperplasia (CCH) or malignant lesions such as papillary thyroid carcinoma (PTC), metastatic squamous cell carcinoma, or medullary thyroid microcarcinoma (MTC). Methods/Case Report To reiterate this diagnostic dilemma, we present a case of a 57-year-old male with a six-year history of Hashimoto thyroiditis and multiple bilateral thyroid nodules. Ultrasonography revealed two nodules, one in each lobe, measuring 2.0x1.9x1.8cm(right) and 1.6x1.5x1.5cm(left). Both were solid, hypoechoic nodules with smooth margins and no echogenic foci. Fine-needle aspiration of right nodule was suspicious for follicular neoplasm, Hürthle- cell type, and the left nodule was atypia of unknown significance. Right-hemithyroidectomy specimen revealed follicular adenoma and oncocytic adenomatous nodules in a background of florid lymphocytic thyroiditis (Hashimoto). In two blocks, small solid nests of cells were identified, largest focus measuring 0.5 cm. The cells were polygonal to epithelioid with moderate amphophilic cytoplasm. Nuclei were centrally located, irregular to oval with occasional grooves. While nests had a squamoid appearance, they did not have intercellular bridges. Although nuclear grooves and evenly dispersed chromatin and chromocenters were noted, they lacked optical clearing or intra-nuclear inclusions characteristic for PTC. Thus, excluding these two possibilities, primary diagnostic considerations were SCN versus CCH. Immunohistochemical analysis showed cells positive for P63 and CK5/6 and negative for PAX-8, TTF-1, thyroglobulin, CEA, and calcitonin. Results (if a Case Study enter NA) NA Conclusion If wrongly diagnosed as CCH, patients may be placed in a high-risk category for possible development of MTC. It is, thus, necessary to be aware of SCN, which can occasionally become hyperplastic, to prevent misdiagnosis.

scholarly journals Ought to the Changes within the Immunophenotype of Solid Cell Nests (SCNs) and Follicular Cells in Hashimoto’s Thyroiditis be Considered as Premalignant Lesions?

2020 ◽  
Author(s):  
Tran Ngoc Dung ◽  
Nguyen Khac Tuyen ◽  
Truong Dinh Tien ◽  
Pham Van Thinh ◽  
Nhu Binh Do ◽  
...  
Keyword(s):  
Hashimoto’S Thyroiditis ◽  
Premalignant Lesions ◽  
Hashimoto's Thyroiditis ◽  
Follicular Cells ◽  
Cell Hyperplasia ◽  
C Cell Hyperplasia ◽  
Solid Cell Nests ◽  
Solid Cell ◽  
Nuclear Alterations ◽  
Follicular Epithelial

Abstract Background: Papillary thyroid carcinoma (PTC) is more frequently reported in patients with Hashimoto’s thyroiditis (HT), which may be associated with the presence of solid cell nests (SCNs) and focal PTC-like nuclear alterations in the thyroid gland. The point of this consideration was to assess the morphological and immunohistochemical features of SCNs and follicular epithelial changes in Vietnamese patients with HT.Materials and methods: Hematoxylin – Eosin and immunohistochemistry were performed on 20 samples of HT patients who underwent thyroidectomy and were diagnosed with Hashimoto's thyroiditis at Military Medical Hospital 103 from 6/2018 to 6/2019. The expression of five markers (P63, Calcitonin, TTF1, CK19, and HBME-1) to be up-regulated in SCNs and follicular epithelial changes were evaluated.Results: 90% of samples had SCNs with an average of 10 SCNs per section. Only type 1 and type 4 of SCNs were presented (85% and 55%, respectively) and all SCNs were composed of main cells (p63-positive). 15 of 18 cases having SCNs possessed nuclear features of PTC. C-cell hyperplasia was found in one case with 20 clusters. All SCNs showed strong staining with CK19 and weak staining with HBME-1. Follicular epithelial changes were Hürthle cell metaplasia, PTC-like nuclear alterations, atypical solid nodules, papillary and glomerular-like forms (40%, 100%, 25%, and 50%, respectively). Follicular cells of glomerular-like forms (new alteration) especially were positive with CK19 (2 + ~ 3+), HBME-1 (1+), and TTF1, while the components in these follicles were negative with CK19, HBME-1, and TTF1. Among PTC-like nuclear alterations, all of the atypical solid nodules related to HT showed markers related to PTC and without SCNs.Conclusions: Increasing the number of SCNs, as well as PTC-like nuclear alterations of main cells in SCNs and follicular epithelial changes, which were co-expressed CK19 and HBME-1, may suggest precancerous changes in Hashimoto's thyroiditis.

scholarly journals A focal nodular Hürthle cell hyperplasia in Hashimoto′s thyroiditis: A diagnostic dilemma on fine needle aspiration

2014 ◽  
Vol 31 (4) ◽  
pp. 236
Author(s):  
ShirishS Chandanwale ◽  
TanmayiV Kulkarni ◽  
RuchirJ Patel ◽  
Dhaval Thakkar
Keyword(s):  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Cell Hyperplasia ◽  
Diagnostic Dilemma ◽  
Fine Needle ◽  
Hürthle Cell

Pulmonary Preneoplasia

2008 ◽  
Vol 132 (7) ◽  
pp. 1073-1078 ◽  
Author(s):  
Sanja Dacic
Keyword(s):  
Diagnostic Procedures ◽  
World Health ◽  
Preneoplastic Lesions ◽  
Cell Hyperplasia ◽  
Diagnostic Dilemma ◽  
Gene Markers ◽  
Lung Carcinomas ◽  
Molecular Abnormalities ◽  
Prognostic Importance ◽  
Health Organization

Abstract Context.—Improved screening techniques for lung cancer have resulted in detection of lesions that are considered to represent precursors of invasive lung carcinomas. These lesions may cause a diagnostic dilemma particularly on small biopsy or cytology specimens. Ancillary studies are usually not helpful, and diagnosis is based on morphology alone. Recognition of these lesions is very important to prevent potential diagnostic mistakes that may result in inadequate patient management. Future molecular studies may provide clinically useful diagnostic and prognostic gene markers. Objective.—To review currently proposed morphologic criteria for precursor lesions of non–small cell lung carcinomas including squamous dysplasias, atypical adenomatous hyperplasia, and diffuse idiopathic neuroendocrine cell hyperplasia. Major molecular abnormalities are briefly discussed. Data Sources.—Published literature and recent World Health Organization classification of lung tumors. Conclusions.—Practicing surgical pathologists must be familiar with morphology of recognized pulmonary preneoplastic lesions that are more frequently detected radiographically and subjected to diagnostic procedures. Future understanding of underlying molecular abnormalities associated with progression of these lesions into invasive lung carcinoma may result in a development of molecular assays with potential diagnostic and prognostic importance.

scholarly journals Atypical Features Resembling Poorly Differentiated Thyroid Carcinoma Presenting Entirely within a Follicular Adenoma

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Daniel Ching ◽  
Connull Leslie
Keyword(s):  
Thyroid Carcinoma ◽  
Unusual Case ◽  
Follicular Adenoma ◽  
Differentiated Thyroid Carcinoma ◽  
Follicular Neoplasm ◽  
Poorly Differentiated Thyroid Carcinoma ◽  
Biological Potential ◽  
Poorly Differentiated ◽  
High Mitotic Count ◽  
Widely Invasive

Poorly differentiated thyroid carcinoma (PDTC) is rare and is usually widely invasive at presentation. Here we present an unusual case with a component meeting diagnostic criteria for PDTC by Turin consensus proposal arising within a follicular adenoma. A 44-year-old female was found to have an incidental right thyroid nodule that was suggestive of follicular neoplasm on FNA. Histological examination of hemithyroidectomy revealed an 11 mm focus with insular growth pattern, alteration in cell morphology, and high mitotic count meeting criteria for PDTC. In addition there were several regions showing trabecular architecture with increased mitotic activity but not meeting criteria for PDTC. The literature for such cases is sparse but suggests much better prognosis than conventional invasive PDTC, although a biological potential for aggressive behaviour may be possible.

scholarly journals RISK FACTORS OF MALIGNANCY IN PATIENTS WITH FINE NEEDLE ASPIRATION BIOPSY RESULTS INTERPRETED AS “SUSPICIOUS FOR FOLLICULAR NEOPLASM”

2020 ◽  
Vol 73 (7) ◽  
pp. 1323-1329
Author(s):  
Jarosław Świrta ◽  
Michał Romaniszyn ◽  
Marcin Barczyński
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Follicular Adenoma ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Follicular Neoplasm ◽  
Fine Needle ◽  
Risk Of Malignancy ◽  
Needle Aspiration Biopsy ◽  
Aggregate Amount

Introduction: Approximately 10% of fine needle aspiration biopsy (FNAB) of thyroid nodules may be verified as “suspicious for follicular neoplasm”; this category involves follicular adenoma, follicular carcinoma, follicular variants of papillary carcinoma and subclass “suspicious for Hurthle cell neoplasm”. At present, there is no diagnostic tool to discriminate between follicular adenoma and cancer. Most patients are required surgery to exclude malignant process. The aim: To define factors correlating with risk of malignancy in patients with FNAB of thyroid focal lesions and nodules verified as Bethesda tier IV. Materials and Methods: In this study 110 consecutive patients were included. All patients were operated because of FNAB result “suspicious for follicular neoplasm” of thyroid gland at a single institution from January 2016 until March 2020. From this set, six specific categories were defined and the clinical records for patients were collected: sex, age, presence of oxyphilic cells, diameter of the tumour, presence of Hashimoto disease, aggregate amount of clinical and ultrasonographic features of malignancy according to ATA. Results: In 18 patients (16,3%) thyroid cancer occurred. Most frequent subtype turned out to be papillary cancer (66,6%). In group of benign lesion (92 patients) predominance of follicular adenoma was disclosed – (49%). Age, gender, tumour diameter, aggregate amount of clinical and ultrasonografic factors, presence of Hashimoto disease and fine needle aspiration biopsy result suspicious for Hurthle cell neoplasm did not correspond to increased risk of malignancy. Conclusions: In patients with FNAB results classified as Bethesda tier IV there are no reliable clinical features associated with low risk of malignancy and surgery should be consider in every case as most appropriate manner to exclude thyroid cancer

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