Thyroid gland
Papillary carcinoma
Diffuse sclerosing variant

Author: Shahidul Islam, M.D., Ph.D. (see Authors page)

Revised: 23 February 2017, last major update March 2009

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: papillary carcinoma diffuse sclerosing

Cite this page: Diffuse sclerosing variant. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/thyroiddiffusesclerosing.html. Accessed June 27th, 2017.
Definition / general
  • Diffuse involvement of papillary carcinoma with dense sclerosis, abundant psammoma bodies, solid foci, squamous metaplasia, marked lymphocytes and extensive lymphatic invasion
  • First described in 1985 (Semin Diagn Pathol 1985;2:90)
  • Rare; 1 - 2% of papillary thyroid carcinoma
  • Cervical nodal and lung metastases common (Am J Surg Pathol 1989;13:1041)
Epidemiology
  • Often younger female patients or children who present with diffuse goiter
Laboratory
  • Antithyroglobulin and antithyroid peroxidase antigens common, perhaps due to destruction of normal thyroid follicles by tumor and exposure of cryptic antigens
Prognostic factors
Case reports
Gross images

Images hosted on PathOut server:

Both thyroid lobes
show diffuse growth
and fibrosis (AFIP)



Images hosted on other servers:

Fibrotic cut surface

Microscopic (histologic) description
  • Diffuse involvement of one or both lobes, dense sclerosis, numerous micropapillary formations within lymphatic-like spaces, frequent psammoma bodies, extensive solid foci and squamous metaplasia, prominent lymphocytic infiltration
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Andrey Bychkov, M.D., Ph.D.:

Multiple tumor nodules in sclerotic stroma

Dense fibrosis, extensive lyphocytic infiltration

H&E: Large psammoma bodies in sclerotic stroma



Images from AFIP:

Dense fibrosis

Tumor grows within endothelial lined spaces

Tumor cells are within endothelial lined space

Solid growth pattern with lymphocytic inflammation

Marked fibrosclerotic changes



Images hosted on other servers:

(Fig. 1D) Scattered psammoma bodies

Papillary carcinoma
with psammoma
bodies and squa-
mous metaplasia

Fig 1: nodular thyroid (inset is cut surface)
Fig 2: solid nests of tumor cells
Fig 3: irregular nuclear contours, nuclear clefts, occasional nuclear pseudoinclusions
Fig 4: tumor nests within lymphatics


Diffuse infiltration

Chronic inflammatory infiltrate

Sclerosis, squa-
mous metaplasia
and lymphatic
invasion
Cytology description
  • Abundant squamous cells, lymphocytes and follicular epithelial cells with nuclear features of papillary carcinoma, occasional psammoma bodies (Thyroid 2007;17:567)
Cytology images

Images hosted on other servers:

Metaplastic squamous cells with scattered lymphocytes

(Fig. 1C) Scattered follicular cell clusters

Positive stains
Molecular / cytogenetics description
  • No BRAF mutations
  • RET / PTC1 and PTC3 arrangements in 43%, possibly rare RET / PTC rearrangement in remaining cases (Mod Pathol 2007;20:779)