Papillary carcinoma
Follicular variant
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PubMed Search: papillary carcinoma thyroid follicular
See also: Diffuse follicular variant, Encapsulated follicular variant
- Papillary carcinoma composed almost completely of follicles, with classic papillary nuclear features
- First described in 1977 (Am J Surg Pathol 1977;1:123)
- Metastases are usually nodal, not distant, with classic papillary features
- Metastatic tumor to tumor lesions may simulate a thyroid primary (Arch Pathol Lab Med 1999;123:703)
- Suggested to classify encapsulated tumors separately due to their superior prognosis (Cancer 2006;107:1255)
- Recommended to diagnose equivocal cases as well differentiated thyroid tumor of uncertain malignant potential (Int J Surg Pathol 2000;8:181)
- Experts often disagree on diagnosis (Am J Clin Pathol 2008;130:736)
- Same prognosis as typical papillary carcinoma (Arch Surg 2003;138:1362, Cancer 2003;97:1181)
- 22 year old woman with extension to parapharyngeal space (BMC Ear Nose Throat Disord 2006;6:3)
- 46 year old man presenting with pleural effusion (Acta Cytol 2007;51:911)
- 56 year old man with glomeruloid growth pattern (Hum Pathol 2008;39:1540)
- Wide fibrous bands incompletely divide tumor into lobules
- Follicular architecture but papillary cytology
- Usually infiltrative with fibrous trabeculation, psammoma bodies, strongly eosinophilic colloid with scalloping
- Important diagnostic criteria include pseudoinclusions (cytoplasmic invaginations into nucleus), abundant nuclear grooves, ground glass nuclei (Am J Surg Pathol 2004;28:1336); also nuclear clearing, nuclear overlapping and crowding, nuclear enlargement
Images hosted on PathOut server:
Contributed by Andrey Bychkov, M.D., Ph.D.
Bone fragment surrounded by tumor
Developing bone marrow
Infiltrative growth, follicular pattern, bright colloid
Oncocytic PTC:
eosinophilic cyto-
plasm, nuclei,
pseudoinclusions
Vesicular nuclei with irregular membranes
Evident major and minor diagnostic features
"Minor diagnostic
features" include dark
colloid with frequent
scalloping and clefting
Contributed by Mark R. Wick, M.D.
Various Images
Images from AFIP:
Wide fibrous bands
Microfollicular and macrofollicular patterns
formations re-
semble nodular
hyperplasia
Clear cytoplasm
Nuclei are overlapping with empty appearance
Some neoplastic follicles lined by granular acidophilic cells
Clear cell change
Intraluminal colloid
Follicular pattern of papillary carcinoma at bottom
Various images
Images hosted on other servers:
Follicular epithelial cells have ground glass nuclei and occasional nuclear grooves
Vesicular nuclei and hemorrhage in follicular lumina
Crowded nuclei and scalloped colloid
Collision tumor with squamous cell carcinoma
Images hosted on other servers:
Van Gieson
- Increased cellularity, moderate thin watery colloid with variable eosinophilic colloid
- Cells are in sheets, small acini or syncytial fragments
- Nuclear enlargement, but may lack prominent nuclear features of papillary carcinoma (Am J Clin Pathol 1999;111:216)
- Highly suggestive if syncytial clusters, microfollicular architecture, chromatin clearing and nuclear grooves (Acta Cytol 2006;50:663)
- Ultrafast Papanicolaou stained smears makes clear nuclei more conspicuous (Cancer 2006;108:174)
Images hosted on other servers:
with some micro-
follicular aggre-
gates, no colloid
Acinar arrangement with intranuclear inclusion
Fig. 1 (left): Ovoid and pear shaped hypochromatic nuclei and nuclear grooves; cells show nuclear
overlap, round / oval hypochromatic nuclei, eccentric small nucleoli, and nuclear grooves (arrow)
Fig. 2 (center): Cells have powdery chromatin, nuclear grooves and intranuclear cytoplasmic inclusions
Fig. 3 (right): Enlarged round / oval nuclei, but papillary nuclear features are difficult to appreciate
- 25 - 43% have Ras mutations, 3 - 42% have RET / PTC rearrangements (Am J Clin Pathol 2003;120:71, Hum Pathol 2006;37:824)
- May have PAX8-PPARgamma rearrangement of follicular tumors (J Clin Endocrinol Metab 2006;91:213)
- Only 13% have BRAF mutation (Hum Pathol 2009;40:827)
