Cribriform morular variant of papillary thyroid carcinoma: Cytomorphology, differential diagnosis and diagnostic implications in patients with adenomatous polyposis coli

Priyani, Amarathunga Ah; Opatha, Shamika T; Gunathilake, Nisayuri W; Lokuhetty, M. D. S.

doi:10.4103/0970-9371.190450

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…A characteristic cribriform pattern with dispersed solid and morular formations combined with a spindle cell component, often associated with marked fibrotic bands, are key findings (Figure A–C). The architectural and nuclear features characteristic of the PTC classic variant, such as papillae, grooves, overlapping nuclei, and marginalised chromatin, may be attenuated in this variant …”

Section: Fapmentioning

confidence: 95%

Hereditary and familial thyroid tumours

Guilmette

Nosé

2017

Histopathology

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The worldwide incidence of thyroid malignancies has been increasing rapidly. Sensitive imaging modalities and early detection of thyroid lesions have made thyroid cancers the most rapidly increasing cancers in the USA in 2017 (SEER Cancer Facts, 2017). Clinical awareness of potential risk factors, such as inherited thyroid cancers, has allowed earlier recognition of more vulnerable population clusters. Hereditary thyroid neoplasms arising from calcitonin‐producing C cells are known as familial medullary thyroid carcinomas (FMTCs), and include well‐documented syndromes such as multiple endocrine neoplasia IIA or IIB, and pure familial medullary thyroid carcinoma syndrome. Familial thyroid cancers arising from follicular cells are referred to as familial non‐medullary thyroid carcinoma (FNMTC), or familial follicular cell‐derived carcinoma. Clinicopathological correlations have resulted in the further subclassification of FNMTCs into two groups. Among the first group are found syndromes characterised by a predominance of non‐thyroidal tumours, including familial adenomatous polyposis, Cowden syndrome, Werner syndrome, Carney complex, and Pendred syndrome. The second group encompasses a spectrum of familial syndromes characterised by a predominance of non‐medullary thyroid tumours, such as pure familial papillary thyroid carcinoma with or without oxyphilia, familial papillary thyroid carcinoma with papillary renal cell carcinoma, and familial papillary carcinoma with multinodular goitre. Most familial thyroid cancers have been described as being more aggressive than sporadic thyroid cancers, with a predisposition for lymph node metastasis, extrathyroidal invasion, and a younger age of onset. The distinct thyroid pathology in some of these syndromes should alert the pathologist to a possible familial cancer syndrome.

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Section: Fapmentioning

confidence: 95%

Hereditary and familial thyroid tumours

Guilmette

Nosé

2017

Histopathology

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“…In patients with cribriform-morular variant of thyroid carcinoma, fine needle aspiration biopsy is effective for diagnostic purposes both for thyroid carcinoma in general [30,34,39,42,44,52,56,60,61,[86][87][88], and specifically for cribriform-morular variant recognition of thyroid carcinoma [19,28,31,33,40,42,49,89]. The samples are usually hypercellular, showing papillary fragments having epithelial-cell lining with nucleomegaly and nuclear stratification along with flat monolayers.…”

Section: Cytopathologymentioning

confidence: 99%

Cribriform-morular variant of thyroid carcinoma: a neoplasm with distinctive phenotype associated with the activation of the WNT/β-catenin pathway

et al. 2018

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Cribriform-morular variant of thyroid carcinoma is classically associated with familial adenomatous polyposis but, it can also occur as a sporadic neoplasm. This neoplasm is much more frequently observed in women than in men (ratio of 61:1). In familial adenomatous polyposis patients, tumors are generally multifocal and/or bilateral (multinodular appearance), whereas in the sporadic cases tumors tend to occur as single nodules. The tumors are well delimited, and characteristically show a blending of follicular, cribriform, papillary, trabecular, solid, and morular patterns. Neoplastic cells are tall or cuboidal with the occasional nuclear features of classic papillary thyroid carcinoma. The morules include cells with peculiar nuclear clearing and show positivity for CDX2 and CD10. Angioinvasion and capsular invasion have been described in about 30 and 40% of cases, respectively, with lymph node metastases in less than 10% of patients and distant metastases in 6%. Although this tumor has good prognosis, neuroendocrine and/or poor differentiation have been associated with aggressive behavior. Tumor cells can be focally positive or negative for thyroglobulin, but are always positive for TTF-1, estrogen and progesterone receptors, and negative for calcitonin and cytokeratin 20. Nuclear and cytoplasmic staining for β-catenin is the hallmark of this tumor type; this feature plays a role in fine needle aspiration biopsy. Cribriform-morular variant of thyroid carcinoma has a peculiar endodermal (intestinal-like) type phenotype, activation of the WNT/β-catenin signaling pathway, and belongs to the non-BRAF-non-RAS subtype of the molecular classification of thyroid tumors. Elevated expression of estrogen and progesterone receptors and activation of the WNT/β-catenin pathway may prove useful as putative therapeutic targets in cases that do not respond to conventional therapy. Clinicians should be alerted to the possibility of familial adenomatous polyposis when a diagnosis of cribriform-morular variant of thyroid carcinoma is made. Instead of being considered as a variant of papillary thyroid carcinoma its designation as cribriform-morular thyroid carcinoma seems more appropriate.

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“…Diagnostic pitfalls can happen with FNAC as well. The cytomorphological features of CMTC can be vastly different from one case to another and can often resemble other thyroid cancers, especially the PTC variants including the tall cell, columnar cell and diffuse sclerosing variants 9 . This is particularly significant as the tall cell, columnar cell and diffuse sclerosing variants of PTC often show aggressive clinical behaviour with poor prognosis 10 .…”

Section: Figmentioning

confidence: 99%