Thyroid gland
Papillary thyroid carcinoma
Main variants
Diffuse sclerosing

Topic Completed: 1 March 2009

Minor changes: 30 July 2020

Copyright: 2003-2017,, Inc.

PubMed Search: papillary carcinoma diffuse sclerosing

Shahid Islam, M.D., Ph.D.
Page views in 2019: 3,890
Page views in 2020 to date: 2,144
Cite this page: Islam S. Diffuse sclerosing. website. Accessed August 8th, 2020.
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)
  • Often younger female patients or children who present with diffuse goiter
  • 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:

Images 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

Prominent sclerosis

Thick fibrous bands

Extensive squamous metaplasia

Contributed by Dr. Roopa Arora, Salmaniya Medical Complex (Bahrain):

H&E, Case of the Week #439

CK19, COW #439

EMA, COW #439

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
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)
Board review style question #1
Which of the following statements is NOT true about diffuse sclerosing variant of papillary thyroid carcinoma?

A. Aggressive type of papillary thyroid carcinoma
B. Histologically characterized by dense sclerosis, squamous metaplasia, numerous psammoma bodies and background Hashimoto thyroiditis
C. Frequent extrathyroidal extension and lymph node metastasis
D. High mortality rate with low 10 year survival (50%)
E. Patients are younger than those with classic papillary thyroid carcinoma
Board review answer #1
D. Despite being an aggressive variant of PTC with some adverse prognostic features, mortality rates are similar to those of classic PTC, with 93% disease specific survival at 10 years.
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