Thyroid gland
Papillary carcinoma
Columnar cell variant


Topic Completed: 26 May 2020

Minor changes: 26 May 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: papillary carcinoma thyroid WITH "columnar cell"

Shipra Agarwal, M.D.
Andrey Bychkov, M.D., Ph.D.
Page views in 2020 to date: 64
Cite this page: Agarwal S, Bychkov A. Columnar cell variant. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidcolumnarvariant.html. Accessed May 27th, 2020.
Definition / general
  • Rare aggressive variant of papillary thyroid carcinoma
  • Columnar cells with nuclear pseudostratification, scant cytoplasm and absent / minimal nuclear features of papillary thyroid carcinoma
Essential features
  • Aggressive variant of papillary thyroid carcinoma with papillary structures lined by columnar cells showing prominent nuclear stratification and lacking nuclear features of papillary thyroid carcinoma
  • Needs to be differentiated from metastatic colon and endometrial adenocarcinoma
Terminology
  • Papillary carcinoma, columnar cell variant
ICD coding
  • ICD-O: 8344/3 - Papillary carcinoma, columnar cell
  • ICD-10: C73 - Malignant neoplasm of thyroid gland
Sites
  • Lateral lobes or isthmus of thyroid gland
Clinical features
Diagnosis
  • Diagnostic workup is similar to any thyroid mass / nodule
    • Ultrasound with fine needle aspiration cytology
    • CT scan may be useful to evaluate extrathyroidal extension and lymph node metastases
  • Columnar cell variant of papillary thyroid carcinoma is a histopathological diagnosis, made on resection specimen, supplemented by immunohistochemistry
    • Fine needle aspiration cytology can raise a suspicion of columnar cell variant and influence surgical decision making
    • Need to differentiate from adenocarcinoma metastatic to the thyroid gland
Radiology description
Radiology images

Images hosted on other servers:

Ultrasound

Prognostic factors
Case reports
Treatment
Gross description
Gross images

Images hosted on other servers:

Circumscribed and infiltrative

Solid, well circumscribed tan brown tumor

Microscopic (histologic) description
Microscopic (histologic) images

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

Papillary pattern

Pseudostratification

Tightly packed

Invasive

High Ki67

Virtual slides

Images hosted on other servers:

Papillary thyroid carcinoma, columnar cell variant

Cytology description
Cytology images

Contributed by Ayana Suzuki, C.T.

Papillary fragments

Nuclear features



Images hosted on other servers:

Nuclear pseudostratification

Ovoid irregular nuclei with occasional grooves

Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Thyroid, total thyroidectomy:
    • Papillary thyroid carcinoma, columnar cell variant, right lobe, 5.5 cm (see synoptic report)
Differential diagnosis
Board review style question #1

Which of the following is the most likely immunohistochemical profile of this thyroid tumor?

  1. TTF1+, PAX8+, CDX2+
  2. TTF1+, PAX8+, CDX2-
  3. TTF1+, PAX8-, CDX2+
  4. TTF1-, PAX8+, CDX2-
  5. TTF1-, PAX8-, CDX2-
Board review answer #1
A. TTF1+, PAX8+, CDX2+. Cells of columnar cell variant of papillary thyroid carcinoma are positive for thyroid specific markers (TTF1 / PAX8), as well as the intestinal epithelial marker CDX2.

Reference: Columnar cell variant

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Board review style question #2
Which of the following is true about columnar cell variant of papillary thyroid carcinoma?

  1. An indolent clinical course
  2. Abundant oncocytic cytoplasm
  3. Multiple intranuclear pseudoinclusions
  4. One of the most common variants of papillary thyroid carcinoma
  5. Morphology mimics metastatic adenocarcinoma
Board review answer #2
E. Morphology mimics metastatic adenocarcinoma. Columnar cell variant is rare and aggressive papillary thyroid carcinoma type, characterized by scant clear or eosinophilic cytoplasm and lack of well developed nuclear features of papillary thyroid carcinoma. Due to absence of typical nuclear features of papillary thyroid carcinoma, metastatic adenocarcinoma needs to be ruled out.

Reference: Columnar cell variant

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