Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 231-233  

Poorly differentiated thyroid carcinoma


Department of Pathology, Dr. D. Y. Patil Medical College and Research Center, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Web Publication13-Mar-2015

Correspondence Address:
Banyameen M Iqbal
Department of Pathology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.153173

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  Abstract 

Poorly differentiated thyroid carcinoma is rare and distinctive due to it's a characteristic uniform cells and sometimes insular architectural pattern. These tumors are aggressive and often lethal type of thyroid tumors often has a rapid and fatal outcome despite appropriate treatment. Here we are presenting a case of a 50 yrs old woman with anterior neck swelling more on right side since five years and increasing in size for the last three months.

Keywords: Insular carcinoma, neck swelling, poorly differentiated thyroid carcinoma


How to cite this article:
Guruwale S, Kambale T, Iqbal BM, Jain A. Poorly differentiated thyroid carcinoma. Med J DY Patil Univ 2015;8:231-3

How to cite this URL:
Guruwale S, Kambale T, Iqbal BM, Jain A. Poorly differentiated thyroid carcinoma. Med J DY Patil Univ [serial online] 2015 [cited 2019 Dec 5];8:231-3. Available from: http://www.mjdrdypu.org/text.asp?2015/8/2/231/153173


  Introduction Top


Poorly differentiated thyroid carcinoma (PDTC) is rare and distinct due to its characteristic uniform cells and sometimes insular architectural pattern. These tumors are aggressive and often lethal and have a rapid and fatal outcome despite appropriate treatment. They may represent intermediate entities in the progression of well-differentiated thyroid carcinoma to anaplastic thyroid carcinoma hence they are classified as PDTC. [1]


  Case Report Top


A 50-year-old woman admitted to the hospital complaining of a palpable anterior neck swelling more on the right side. The neck swelling is present since 5 years and for the last 3 months it is progressively increasing in size. There is no history of any medication, radiation, or trauma.

On admission, physical examination revealed a swelling, which was mainly confined to the right side, moving with deglutition, and painless. Ultrasonography showed enlarged, heterogeneous thyroid gland with multiple nodules suggesting multinodular goiter. Radio scan showed a cold nodule due to hypofunctioning of thyroid. All laboratory tests thyroid-stimulating hormone, T3 and T4 were within normal limits. Patient was stable. There was no deviation or compression of the trachea. There was no change in voice. No lymph nodes were palpable.

Gross

We received a specimen of near total thyroidectomy weighing 90 g, external surface was nodular in appearance, reddish brown in color with a few congested areas. The right lobe measured 6 cm × 8 cm × 4 cm. The upper pole appeared enlarged, globular and on the cut surface showed a nodule measuring 5.5 cm × 4.5 cm × 4 cm, which had a solid and pale cut surface and was partially encapsulated. Rest of the thyroid gland had nodular and colloid cut surface [Figure 1].
Figure 1: Cut surface showed a well-circumscribed solid nodule which is pale, tan in color

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Microscopy

A well-circumscribed nodule shows tumor cells arranged in nests and trabeculae. Tumor cells are small round to oval monomorphic with scant to moderate amount of vacuolated eosinopholic cytoplasm having round convoluted hyperchromatic nuclei. These tumor cell nests are separated by thin fibrovascular channels. There is no follicular or papillary pattern. Mitotic figures are >3/10 high power fields. There are foci of micro invasions of stroma. Tumor shows lymphovascular invasion. Necrosis is absent. Rest of the thyroid gland shows changes of multinodular goiter. Based on the above findings the diagnosis of poorly differentiated carcinoma of the thyroid was made [Figure 2] and conformed by immunohistochemistry, which shows cytokeratin-7 diffusely positive, focal positivity for thyroglobulin (TG) and thyroid transcription factor-1 (TTF-1) positive in some of the nuclei. Calcitonin, chromogranin and S-100 were negative. The increased proliferation rate of poorly differentiated carcinoma can be demonstrated by using Ki-67 which is 50-60% in this case [2] [Figure 3],[Figure 4],[Figure 5],[Figure 6] and [Figure 7].
Figure 2: Microscopic sections show a typical insular pattern of monotonous round cells with scanty cytoplasm and round nuclei (H and E, ×100)

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Figure 3: Micrograph showing Ki-67 positivity with increased proliferation rate of poorly differentiated carcinoma

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Figure 4: Diffuse positivity of cytokeratin-7

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Figure 5: Focal positivity for thyroglobulin

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Figure 6: Thyroid transcription factor-1 positive in some of the nuclei

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Figure 7: Calcitonin negativity

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This patient is on follow-up since last 4 months with no complains until date.


  Discussion Top


Insular carcinoma of the thyroid is derived from follicular epithelium. [3] The first description and illustration of this tumor was given by Langhans in 1907 using the term "wuchernda struma" (proliferating stroma). He described this lesion characterized by distinct nesting pattern, uniform cells and a peritheliomatous arrangement of the nests in 16 cases of thyroid carcinoma. [3] Carcangiu et al. in 1984 termed these tumors as poorly differentiated "insular" thyroid carcinoma because the cellular appearance was similar to that seen in the insular type of carcinoid tumors. Since this revised description in 1984, over 200 cases of insular thyroid carcinoma have been described in the literature. [1] PDTC was described by Sakamoto et al. in 1983 on the basis of presence of nonglandular components with a solid, trabecular, and/or scirrhous growth pattern. [4] PDTC is in its current definition a distinct type of tumor, and as such has been included as one of the reportable histotypes by the College of American Pathologists protocol for the examination of specimens from patients with carcinomas of the thyroid gland based on the 7 th AJCC/UICC TNM edition (October 2009). [2] In our case, tumor is partially capsulated, and carcinomas, which are surrounded by a well-defined capsule may even be relatively indolent. [5] Poorly differentiated carcinoma immunoreactive for TTF-1, which is weaker than conventional follicular and papillary carcinomas and for TG is often focal sometimes displaying a peculiar dot like paranuclear pattern. [2],[6],[7]


  Conclusion Top


Poorly differentiated thyroid carcinomas account for up to 10% of all thyroid cancers. The rarity of this tumor makes it difficult to draw conclusions regarding its prognosis. PDTC is situated in an intermediate position between well-differentiated (papillary and follicular) and the totally undifferentiated thyroid tumors. Totally, undifferentiated thyroid carcinomas have 50% 5 years survival. Due to the recurrences and metastasize, patients with PDTCs need to be kept under close surveillance and serial monitoring of TG levels can be helpful in detecting recurrences.

 
  References Top

1.
Patel KN, Shaha AR. Poorly differentiated and anaplastic thyroid cancer. Cancer Control 2006;13:119-28.  Back to cited text no. 1
    
2.
Tallini G, Garcia-Rostan G, Herrero A, Zelterman D, Viale G, Bosari S, et al. Downregulation of p27KIP1 and Ki67/Mib1 labeling index support the classification of thyroid carcinoma into prognostically relevant categories. Am J Surg Pathol 1999;23:678-85.  Back to cited text no. 2
    
3.
Paik SS, Kim WS, Hong EK, Park MH, Lee JD. Poorly differentiated ("insular") carcinoma of the thyroid gland - Two cases report. J Korean Med Sci 1997;12:70-4.  Back to cited text no. 3
    
4.
Sakamoto A, Kasai N, Sugano H. Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a high-risk group of papillary and follicular carcinomas. Cancer 1983;52:1849-55.  Back to cited text no. 4
    
5.
Rivera M, Ricarte-Filho J, Patel S, Tuttle M, Shaha A, Shah JP, et al. Encapsulated thyroid tumors of follicular cell origin with high grade features (high mitotic rate/tumor necrosis): A clinicopathologic and molecular study. Hum Pathol 2010;41:172-80.  Back to cited text no. 5
    
6.
De Lellis RA, Lloyd RV, Heitz PU, Eng C. World Health Organization Classification of tumours. Pathology and genetics of tumours of endocrine organs. Lyon, France: IARC Press; 2004. p. 73-6.  Back to cited text no. 6
    
7.
Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, et al. Poorly differentiated thyroid carcinoma: The Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 2007;31:1256-64.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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Abstract
Introduction
Case Report
Discussion
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