Papillary thyroid carcinoma with nodular fasciitis-like stroma: a rare variant

Mayur Parkhi; Debajyoti Chatterjee; Anand Bardia; Anwin Joseph Kanaval; Ashwani Sood; Uma Nahar Saikia; Naval Bansal

doi:10.4322/acr.2021.320

Clinical Case Report

Papillary thyroid carcinoma with nodular fasciitis-like stroma: a rare variant

Mayur Parkhi; Debajyoti Chatterjee; Anand Bardia; Anwin Joseph Kanaval; Ashwani Sood; Uma Nahar Saikia; Naval Bansal

http://dx.doi.org/10.4322/acr.2021.320 Autops Case Rep, vol.11, e2021320, 2021

PDF

Downloads: 0

Abstract

Papillary thyroid carcinoma with desmoid-type fibromatosis (PTC-DTF) or nodular fasciitis-like stroma (PTC-NFS) is a rare morphological variant of PTC with a favorable prognosis. There is a paucity of molecular data regarding this entity. We present the case of a 20-year-old female who presented with a palpable mass over the anterior aspect of the neck for the past 3–4 months, which was diagnosed as PTC-NFS. Ultrasonogram of the neck revealed a bulky left lobe of thyroid that contained a well-defined heterogenous lesion measuring around 24 × 26 × 36 mm with involvement of the adjacent isthmus. She underwent a total thyroidectomy with central compartment lymph node dissection. Histological examination revealed a biphasic tumor with epithelial and stromal components resembling nodular fasciitis. Two dissected lymph nodes showed metastasis of the epithelial component only. On immunohistochemistry, BRAF mutant protein expression was evident in the epithelial component only, while β-catenin was negative in both the components. The histopathological diagnosis of papillary thyroid carcinoma with nodular fasciitis-like stroma was offered. Sanger sequencing revealed a BRAFV600E (c.1799T>A, Val600Glu) mutation. Post-operatively, no residual tumor was detected on ultrasound and radioiodine scans. The patient was doing well at follow-up of 9 months. PTC-NFS/DTF is a histological variant of PTC with a favorable prognosis. Our index case was associated with the BRAF mutation, which was restricted to the epithelial component. Thorough sampling of the excised specimen is essential in order not to miss the epithelial component, which, in most reported cases (including ours) appears to be small.

Keywords

Thyroid cancer, papillary, Fasciitis, Myofibroblasts, Beta catenin, Proto-Oncogene Proteins B-raf

References

1 Lloyd R, Osamura R, Kloppel G. WHO classification of tumors of endocrine organs. Lyon: IARC Press; 2017.

2 Amin MB. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.

3 Ostrowski MA, Moffat FL, Asa SL, et al. Myxomatous change in papillary carcinoma of the thyroid. Surg Pathol. 1989;2:249-56.

4 Chan JK, Carcangiu ML, Rosai J. Papillary carcinoma of thyroid with exuberant nodular fasciitis-like stroma. Report of three cases. Am J Clin Pathol. 1991;95(3):309-14. http://dx.doi.org/10.1093/ajcp/95.3.309. PMid:1996541.

5 Wong SBJ, Nga ME, Michal M, Vanecek T, Seet JE, Petersson F. SOX11 expression in a case of papillary thyroid carcinoma with fibromatosis/fasciitis-like stroma containing BRAF c.1799_1801delTGA and CTNNB1 c.133T>C mutations. Virchows Arch. 2019;475(4):519-25. http://dx.doi.org/10.1007/s00428-019-02619-4. PMid:31327063.

6 Zhou L, Shi L, Jiang Z, Xie L. Papillary thyroid carcinoma with nodular fasciitis-like stroma and β-catenin gene mutations: report of a recurrent case. Int J Clin Exp Pathol. 2018;11(5):2879-83. PMid:31938411.

7 Suster D, Michal M, Nishino M, et al. Papillary thyroid carcinoma with prominent myofibroblastic stromal component: clinicopathologic, immunohistochemical and next-generation sequencing study of seven cases. Mod Pathol. 2020;33(9):1702-11. http://dx.doi.org/10.1038/s41379-020-0539-7. PMid:32291398.

8 Roth EM, Barrows CE, Nishino M, Sacks B, Hasselgren PO, James BC. Papillary thyroid cancer with extrathyroidal extension of desmoid-type fibromatosis. A case report of an aggressive presentation of an uncommon pathologic entity. Int J Surg Case Rep. 2019;63:5-9. http://dx.doi.org/10.1016/j.ijscr.2019.08.001. PMid:31499326.

9 Takada N, Hirokawa M, Ito M, et al. Papillary thyroid carcinoma with desmoid-type fibromatosis: a clinical, pathological, and immunohistochemical study of 14 cases. Endocr J. 2017;64(10):1017-23. http://dx.doi.org/10.1507/endocrj.EJ17-0242. PMid:28794344.

10 Takada N, Mussazhanova Z, Hirokawa M, Nakashima M, Miyauchi A. Immunohistochemical and molecular analyses focusing on mesenchymal cells in papillary thyroid carcinoma with desmoid-type fibromatosis. Pathobiology. 2018;85(5-6):300-3. http://dx.doi.org/10.1159/000492117. PMid:30223266.

11 Nandeesh BN, Ananthamurthy A, Inchara YK, Correa MM, Garg I. Papillary thyroid carcinoma with nodular fasciitis-like stroma: a case report. Ear Nose Throat J. 2011;90(10):E8-10. http://dx.doi.org/10.1177/014556131109001017. PMid:22033971.

12 Rebecchini C, Nobile A, Piana S, et al. Papillary thyroid carcinoma with nodular fasciitis-like stroma and β-catenin mutations should be renamed papillary thyroid carcinoma with desmoid-type fibromatosis. Mod Pathol. 2017;30(2):236-45. http://dx.doi.org/10.1038/modpathol.2016.173. PMid:27713418.

13 Basu S, Nair N, Shet T, Borges AM. Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma: treatment outcome and prognosis. J Laryngol Otol. 2006;120(4):338-42. http://dx.doi.org/10.1017/S0022215106000211. PMid:16623982.

14 Yang YJ, LiVolsi VA, Khurana KK. Papillary thyroid carcinoma with nodular fasciitis-like stroma. Pitfalls in fine-needle aspiration cytology. Arch Pathol Lab Med. 1999;123(9):838-41. http://dx.doi.org/10.5858/1999-123-0838-PTCWNF. PMid:10458836.

Submitted date:
06/01/2021

Accepted date:
07/09/2021

Publication date:
08/20/2021

Papillary thyroid carcinoma with nodular fasciitis-like stroma: a rare variant

Mayur Parkhi; Debajyoti Chatterjee; Anand Bardia; Anwin Joseph Kanaval; Ashwani Sood; Uma Nahar Saikia; Naval Bansal

Abstract

Keywords

References

Links

Share

Autops Case Rep