Elsevier

Human Pathology

Volume 32, Issue 1, January 2001, Pages 24-30
Human Pathology

Original Contributions
Pathologic features of Hashimoto's-associated papillary thyroid carcinomas

https://doi.org/10.1053/hupa.2001.21138Get rights and content

Abstract

Some investigators have found an increased incidence of papillary carcinoma (PC) of the thyroid in patients with Hashimoto's (autoimmune) thyroiditis (HT), which raises the possibility that there may be more than an incidental association between these 2 diseases. In this study, we analyzed the pathology of Hashimoto's-associated thyroid carcinomas to see if these tumors showed any distinctive features. The possible significance of solid cellular nodules as preneoplastic lesions in patients with HT was investigated. A review of all the cases of HT during a 16-year period yielded 30 PC and 3 follicular carcinomas (FC). Within the PC there were 7 (23%) follicular variants. Twenty (67%) of the PC showed various degree of intratumoral fibrosis, ranging from thick fibrous septa separating tumor nodules to almost complete obliteration of the tumor by the fibrosis, with only microscopic residual tumor nests. In most of the cases, the desmoplastic response within the tumors was of the fibromatosis-like type with dense hyalinized collagen and bland-appearing spindle cells. All the tumors, independently of the degree of fibrosis, showed the nuclear features of PC. No correlation was found between the degree of fibrosis in the tumors and the thyroid gland outside the tumors. There were tumors with marked fibrosis without fibrosis outside the tumors. Four cases of PC (13%) showed a growth pattern characterized by cystic spaces with thick hyalinized walls and focal papillary hyperplasia lined by flat and cuboidal epithelium, reminiscent of a vascular neoplasm. There were 4 atypical solid microscopic nodules with confluent cellularity; 2 of them associated with a PC and the other 2 with diffuse HT without PC. These nodules were composed of cells with clear nuclei and occasional grooves without nuclear pseudoinclusions. By immunohistochemistry, 2 of 3 nodules showed cytoplasmic reactivity for cytokeratin 19, and 2 of 3 nodules were positive for the RET/PTC (rearranged during transfection, papillary thyroid carcinoma) antibody. In summary, HT-associated PC may frequently display prominent stromal desmoplasia and a pseudovascular pattern, both of which can present diagnostic difficulties if the cytologic features of PC are not recognized because of the marked obliteration of the tumor by the fibrosis. Atypical nodules may represent a precursor lesion of PC in patients with HT. HUM PATHOL 32:24-30. Copyright © 2001 by W.B. Saunders Company

Section snippets

Materials and methods

All the cases of concomitant HT and thyroid carcinomas, over the last 16 years, were retrieved from the files of the Thomas Jefferson Pathology Laboratory. Two of the authors (M.D.P., J.P.P.) reviewed all the available slides of each case to confirm the diagnosis of HT, evaluate its extension, and characterize each carcinoma. The age and sex of all the patients and the size of the tumors were recorded. Only cases that showed the classic pathologic features of HT, consisting of atrophic and

Results

A summary of the clinicopathologic features of patients with HT and carcinomas is presented in Table 1.

. Clinicopathologic Features of HT-Associated Thyroid Carcinomas

Empty CellEmpty CellEmpty CellHTTumor Type
Case No.Age/SexTumor Size (cm)FocalDiffusePapillaryFollicular/Hürthle Cell
122/M3XX
229/F1XX
327/F1XX
428/F1.3XX
524/F2XX
637/F0.3XX
734/F0.3XX
831/F0.5XX
940/F3XX
1047/F0.3XX
1155/F1.8XX
1259/F1.8XX
1351/F0.3XX
1453/F1XX
1553/F0.7XX
1656/F0.2XX
1765/M2XX
1867/M1.8XX
1960/M0.5XX
2081/F0.3XX
2178/F0.7XX
2282/F2XX
2360/F0.7XX
2427/F1.2XX*
2523/F0.4

Discussion

In the current study the pathologic features of Hashimoto's-associated thyroid carcinomas and the possible significance of solid nodules present in these glands have been described. We did not obtain serologic information from our patients and followed the guidelines to classify chronic thyroiditis by Mizukami et al.9 For some investigators, focal chronic thyroiditis may be an early step in the development of HT; however, these patients may not have serologic evidence of auto-antibodies and may

Acknowledgements

The authors thank Dr Federico Monzon for his assistance with microphotography.

References (30)

  • Z Baloch et al.

    Differential expression of cytokeratins in follicular variant of papillary carcinoma: An immunohistochemical study and its diagnostic utility

    Hum Pathol

    (1999)
  • SM Katz et al.

    The fibrous variant of Hashimoto's thyroiditis

    Hum Pathol

    (1974)
  • K Segal et al.

    Hashimoto's thyroiditis and carcinoma of the thyroid gland

    Int Surg

    (1985)
  • BL Eisenberg et al.

    Thyroid cancer with coexistent Hashimoto's thyroiditis. Clinical assessment and management

    Arch Surg

    (1989)
  • RA Ott et al.

    The incidence of thyroid carcinoma in Hashimoto's thyroiditis

    Am Surg

    (1987)
  • RA Ott et al.

    The incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis and solitary cold nodules

    Surgery

    (1985)
  • AP Sclafani et al.

    Hashimoto's thyroiditis and carcinoma of the thyroid: Optimal management

    Laryngoscope

    (1993)
  • I Okayasu et al.

    Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma

    Cancer

    (1995)
  • VE Chesky et al.

    Cancer of the thyroid associated with Hashimoto's disease: Analysis of forty-eight cases

    Am Surg

    (1962)
  • RN Hirabayashi et al.

    The relation of thyroid carcinoma and chronic thyroiditis

    Surg Gynecol Obstet

    (1965)
  • Y Mizukami et al.

    Pathology of chronic thyroiditis: A new clinically relevant classification

    Pathol Ann

    (1994)
  • DJ Powell et al.

    The RET/PTC3 oncogene: Metastatic solid-type papillary carcinomas in murine thyroids

    Cancer Res

    (1998)
  • ML Carcangiu et al.

    Papillary carcinoma of the thyroid: A clinicopathologic study of 241 cases treated at the University of Florence, Italy

    Cancer

    (1985)
  • P Toti et al.

    Scarring in papillary carcinoma of the thyroid: Report of two new cases with exuberant nodular fascitis-like stroma

    Histopathology

    (1999)
  • Y Mizukami et al.

    Papillary carcinoma of the thyroid gland with fibromatosis-like stroma: A case report and review of the literature

    Mod Pathol

    (1995)
  • Cited by (0)

    View full text