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      Hyalinizing Trabecular Tumor of the Thyroid Gland, a Diagnostic Challenge in Fine-Needle Aspiration Cytology: Case Report

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          Abstract

          Hyalinizing trabecular tumor (HTT) is a rare thyroid tumor with low to minimal malignant potential. HTT is often misinterpreted as other thyroid tumors, including papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC), on fine-needle aspiration (FNA) cytology, because of its overlapping cytologic features, such as nuclear grooves and intranulcear pseudoinclusions. Although cytopathologists cannot definitely conclude HTT by FNA cytology, suspicion of HTT is necessary to avoid misdiagnosing HTT as PTC or MTC and to avoid unnecessary aggressive treatment. Here, we report a case of HTT with novel cytologic features in CellPrep liquid based cytology that was diagnosed as suspicious for papillary carcinoma by FNA and finally diagnosed as HTT in the surgical specimen.

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          Hyalinizing trabecular adenoma of the thyroid gland.

          Thomas Carney, J Goellner, Jim Ryan (1987)
          The hyalinizing trabecular adenoma, a distinctive lesion, is important because it may mimic medullary and papillary carcinoma microscopically. We describe 11 such tumors obtained from women ages 27-72 years (mean, 46 years). The initial pathologic diagnoses were carcinoma (five cases), adenoma (two cases), paraganglioma (one case), and "indeterminate" (three cases). None of the tumors recurred or metastasized (mean follow-up, 10 years). Grossly, the neoplasms measured 0.3-4 cm in diameter, and were yellow-tan and circumscribed. Microscopically, they were encapsulated or circumscribed and solid, or vaguely lobulated. The polygonal, oval, and elongated tumor cells were arranged in trabeculae, clusters, or both, and were often inserted vertically into capillaries. The sharply outlined cells had finely granular cytoplasm that was either acidophilic, amphophilic, or clear. Typical features included oval and elongated nuclei, perinucleolar vacuoles, acidophilic nuclear inclusions, fine nuclear grooving, and infrequent mitotic figures. Perivascular hyaline fibrosis and cell degeneration mimicked amyloid, but these tumors were Congo red-negative. Occasional trabeculae featured round or irregularly shaped follicles, sometimes with papillary infoldings, that were either empty or contained colloid-like material and psammoma bodies. Immunostaining of tumor cells was positive for thyroglobulin and negative for calcitonin. Among six tumors analyzed by flow cytometry, five displayed a diploid pattern and one showed an aneuploid peak.
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            Hyalinizing trabecular tumors of the thyroid gland are almost all benign.

            Mitsuyoshi Hirokawa, J Aidan Carney, Thomas Sebo … (2008)
            In 1987, Carney et al reported 11 thyroid tumors with the following features: circumscription or encapsulation, trabecular architecture with intratrabecular hyalin and colloid, polygonal and spindle cells, nuclei with frequent grooves and cytoplasmic inclusions, occasional psammoma bodies, and a low mitotic rate. The neoplasms did not recur or metastasize during a follow-up period that averaged 10 years, and they were titled hyalinizing trabecular adenomas. Subsequently, the nuclear features of the neoplasm led to the introduction of 2 modified titles for it, hyalinizing trabecular tumor and hyalinizing trabecular neoplasm. Later, discovery of RET/PTC mutations in the tumor resulted in it being designated as a type of papillary thyroid carcinoma. We studied 119 neoplasms of the type outlined, collected over a 20-year period, for invasion, recurrence and metastasis, and obtained follow-up in 96% of the cases. One hundred eighteen tumors showed no evidence of aggressive behavior (capsular, vascular, and parenchymal invasion), local recurrence, or metastasis. One tumor showed vascular and capsular invasion, and pulmonary metastasis. We conclude that the overwhelming majority of hyalinizing trabecular tumors of the thyroid behave as benign neoplasms and that, at this time, hyalinizing trabecular adenoma is the most appropriate title for them.
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              Molecular profile of hyalinizing trabecular tumours of the thyroid: high prevalence of RET/PTC rearrangements and absence of B-raf and N-ras point mutations.

              Giuliana Salvatore, Massimo Santoro, J Aidan Carney … (2005)
              Hyalinizing trabecular tumour (HTT) of the thyroid is a neoplasm of follicular derivation that shares several morphological similarities with papillary thyroid carcinoma (PTC). In this study, we investigated the prevalence of B-raf point mutations, RET/PTC rearrangements and N-ras point mutations in a large HTT series (28 samples). Twenty benign thyroid lesions and 10 PTC served as control cases. A high (47%) prevalence of RET/PTC rearrangements was found in HTT. By contrast, neither B-raf nor N-ras mutations were found in HTT. These findings suggest that, although RET/PTC, N-ras, and B-raf proteins may act along the same signalling cascade, the biological and morphological outcome of their oncogenic activation is not completely overlapping. Thus, in clinical practice, the detection of B-raf mutations in a thyroid follicular tumour may prove to be a valuable tool, supplementing histological examination, and allowing a differential diagnosis between PTC and HTT.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pathol Transl Med
                Journal ID (iso-abbrev): J Pathol Transl Med
                Journal ID (publisher-id): JPTM
                Title: Journal of Pathology and Translational Medicine
                Publisher: The Korean Society of Pathologists and the Korean Society for Cytopathology
                ISSN (Print): 2383-7837
                ISSN (Electronic): 2383-7845
                Publication date (Print): July 2018
                Publication date (Electronic): 11 June 2018
                Volume: 52
                Issue: 4
                Pages: 252-256
                Affiliations
                Pathology Center, Seegene Medical Foundation, Seoul, Korea
                [1 ]Department of Surgery and Health Care Center, Seran Hospital, Seoul, Korea
                [2 ]Department of Pathology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
                Author notes
                Corresponding Author Soo Hee Kim, MD, PhD Pathology Center, Seegene Medical Foundation, 320 Cheonho-daero, Seongdong-gu, Seoul 04805, Korea Tel: +82-2-2218-9346 Fax: +82-2-2218-9310 E-mail: kshpath@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-6715-8900
                Article
                Publisher ID: jptm-2018-04-28
                DOI: 10.4132/jptm.2018.04.28
                PMC ID: 6056358
                PubMed ID: 29890568
                SO-VID: 416eceac-c5fc-4e43-9ca5-2435f460e828
                Copyright © © 2018 The Korean Society of Pathologists/The Korean Society for Cytopathology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 March 2018
                Date revision received : 18 April 2018
                Date accepted : 27 April 2018
                Categories
                Subject: Case Study

                Keywords: hyalinizing trabecular tumor,thyroid gland,liquid-based cytology
                Data availability:
                Keywords: hyalinizing trabecular tumor, thyroid gland, liquid-based cytology

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