Thyroid & parathyroid

Papillary thyroid carcinoma

Follicular patterned

Invasive EFVPTC

Topic Completed: 1 May 2016

Minor changes: 29 November 2021

Copyright: 2002-2021,, Inc.

PubMed Search: invasive encapsulated follicular variant of papillary thyroid carcinoma

Rachel Jug, M.B.B.Ch., B.A.O.
Page views in 2020: 3,052
Page views in 2021 to date: 2,814
Cite this page: Jug R, Jiang X. Invasive EFVPTC. website. Accessed December 3rd, 2021.
Definition / general
  • Prognostically distinct entity from counterpart NIFTP (non invasive follicular thyroid neoplasm with papillary-like nuclear features)
  • Same nuclear features and follicular architecture as NIFTP but with vascular or tumor capsule invasion present
Prognostic factors
  • Good prognosis
  • Based on an international, multidisciplinary, retrospective study in which 101 participants had invasive EFVPT, 12 patients experienced an adverse event (including 5 patients developing distant metastases and 2 patients dying of the disease) by a median follow up time of 13 years (JAMA Oncol 2016;2:1023)
Gross description
Microscopic (histologic) description
  • Tumor invades capsule or extends into adjacent thyroid tissue, OR has evidence of lymphovascular invasion

  • Nuclear features of papillary thyroid carcinoma:
    • Size and shape: nuclear enlargement / overlapping / crowding, elongation
    • Nuclear membrane irregularities: irregular contours, grooves, pseudoinclusions
    • Chromatin characteristics: clearing with margination / glassy nuclei

  • Follicular growth pattern may be microfollicular, normofollicular or macrofollicular with abundant colloid
Microscopic (histologic) images

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

Vesicular nuclei with irregular membranes

Evident major and minor diagnostic features

Dark colloid with frequent scalloping and clefting

Free floating of small tumor fragment in vascular lumen

Small piece of tumor floats in vascular lumen

Capsular invastion and extrathyroidal extension

Tumor plug is associated with thrombus

Contributed by Rachel Jug, M.B.B.Ch., B.A.O.

With capsular invasion

High power (40×) H&E images demonstrating nuclear features of PTC:

Overlapping, elongation and a single mitotic figure

Irregular nuclear contours, grooves, pseudoinclusions

Clear chromatin with margination

Cytology description
  • FNA samples are usually hypercellular with neoplastic cells containing nuclear features of papillary thyroid carcinoma arranged in microfollicles
  • Nuclear features are more subtle than conventional papillary thyroid carcinoma
  • Colloid may be present
  • Cannot distinguish invasive EFVPTC from NIFTP on cytology, as cannot evaluate capsule on FNA
Molecular / cytogenetics description
  • Shares molecular features (RAS type mutations) with follicular adenoma, follicular carcinoma (Mod Pathol 2010;23:1191)
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