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

Rhee, Ye Young; Jung, Hong Kyu; Kim, Se Hoon; Kim, Soo Hee

doi:10.4132/jptm.2018.04.28

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…The challenges to solving the problem of presurgical diagnostics are 3‐fold: First, some of the key cytologic features of PTC and medullary thyroid carcinoma, such as enlarged oval nuclei, nuclear grooves, and intranuclear pseudoinclusions, are typically seen in HTT (Fig. ) . Tabulation of the cytology diagnoses standardized into the Bethesda System for Reporting Thyroid Cytopathology showed that 42.1% and 26.4% of HTT cases were diagnosed on FNA as suspicious for malignancy (Bethesda V) and malignant (Bethesda VI), respectively (Table ), which often triggered total thyroidectomy.…”

Section: Cytologic Challenges Resulting From Httmentioning

confidence: 99%

“…Third, the relative rarity of HTT has limited the opportunity for general cytopathologists to become proficient in recognizing the key cytologic features this entity. Although the exact incidence is not known, the finding that 11 of 26 reports (42%) documenting the cytology of HTT are individual case reports is likely a reflection of its rarity . Therefore, heightened awareness of the subtle cytologic features of HTT and the availability of novel, specific molecular markers are important in the presurgical identification of this neoplasm.…”

Section: Cytologic Challenges Resulting From Httmentioning

confidence: 99%

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GLIS rearrangements in thyroid nodules: A key to preoperative diagnosis of hyalinizing trabecular tumor

Nikiforova

Nikiforov

Ohori

2019

Cancer Cytopathology

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Hyalinizing trabecular tumor (HTT) is a rare thyroid neoplasm with peculiar morphologic features that overlap with those of papillary thyroid carcinoma (PTC). Specifically, the presence of enlarged oval nuclei, nuclear grooves, and intranuclear pseudoinclusions makes precise cytopathologic diagnosis challenging. If the cytopathologic diagnosis is suspicious for malignancy (Bethesda V) or is malignant (Bethesda VI), a total thyroidectomy, which would be considered an overtreatment, may follow. The recent discovery of the strong association between GLIS fusions and HTT sheds light on its pathogenesis and offers a pathway for its presurgical identification. Although the number of cases analyzed is limited, the recent landmark study shows that GLIS fusions are highly specific for HTT and that lobectomy is the likely appropriate surgical treatment, because these neoplasms, which lack invasion, are benign. For overall success, cytopathologic recognition of the subtle features is important to avoid false-positive diagnoses and directing potential HTT cases toward indeterminate cytopathologic diagnoses, which would trigger further molecular testing. Additional studies are needed to determine whether a malignant counterpart of GLIS fusion-positive HTT exists and if more conservative approaches may be taken.Hyalinizing trabecular tumor (HTT) is a rare type of thyroid neoplasm with peculiar morphology, and there is long-standing controversy with respect to its relationship to papillary carcinoma and clinical behavior. A recent study has described a unique molecular profile of these tumors, ending this controversy and paving the way for efficient preoperative detection of these tumors and guiding patients toward optimal management. 1

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Section: Cytologic Challenges Resulting From Httmentioning

confidence: 99%

Section: Cytologic Challenges Resulting From Httmentioning

confidence: 99%

GLIS rearrangements in thyroid nodules: A key to preoperative diagnosis of hyalinizing trabecular tumor

Nikiforova

Nikiforov

Ohori

2019

Cancer Cytopathology

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“…The latter authors described a lesion with peculiar histological features composed of a trabecular growth pattern with prominent deposition of hyaline material. Following this description, several authors published case reports or small series demonstrating that HTT is essentially a benign neoplasm requiring conservative management, even though it is worth noting that very rare cases of invasive HTT have been described …”

Section: Introductionmentioning

confidence: 99%

“…The majority of histological series show that reaching the correct diagnosis of this neoplasm does not pose a diagnostic challenge . However, a review of the literature indicates that reaching the correct preoperative diagnosis of HTT is more elusive, as the correct interpretation was achieved in only 8% of cases .…”

Section: Introductionmentioning

confidence: 99%

“…However, a review of the literature indicates that reaching the correct preoperative diagnosis of HTT is more elusive, as the correct interpretation was achieved in only 8% of cases . More concerning, however, is the fact that the remaining 92% of cases resulted in false‐positive diagnoses . The problem in achieving a correct preoperative diagnosis is largely ascribed to the fact that in cytology samples of HTT, the nuclear features and hyaline material mimic thyroid malignancy.…”

Section: Introductionmentioning

confidence: 99%

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A large series of hyalinizing trabecular tumors: Cytomorphology and ancillary techniques on fine needle aspiration

Dell’Aquila

Gravina

Cocomazzi

et al. 2019

Cancer Cytopathology

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BACKGROUND:Hyalinizing trabecular tumors (HTTs) are rare, essentially benign, follicular cell-derived thyroid neoplasms characterized by a trabecular growth pattern and nuclear pseudoinclusions. Their cytological findings are misleading, because these tumors are often misinterpreted on fine needle aspirate cytology as malignant lesions, such as papillary thyroid cancer and/or medullary thyroid cancer, leading to unnecessary total thyroidectomy. The aim of this study was to analyze the cytomorphological features and application of ancillary techniques in a series of HTTs. METHODS: Of 26 histological cases of HTT collected from September 2001 to December 2018, 18 cases had concomitant cytopathology. Cytological cases were processed with liquid-based cytology (LBC). Immunocytochemistry for HBME-1 and galectine-3 as well as molecular testing for BRAF V600E mutation were performed on both LBC and histological specimens. RESULTS:The 18 lesions with fine needle aspirate cytology ranged in size from 5 to 45 mm. Cytological diagnoses included: 1 benign lesion favoring goiter (5.5%), 4 atypia of undetermined significance (22.2%), 6 follicular neoplasms (33.3%), 5 suspicious for malignancy favoring papillary thyroid cancer (28%), and 2 malignant (11%). Hence, 89% HTT had a negative concordant immunopanel, and they were 100% wild-type BRAF V600E . CONCLUSION: The majority of our HTTs (83.3%) were diagnosed in the indeterminate Bethesda categories, suggesting that their cytomorphological features pose issues for reaching a conclusive cytological diagnosis. The ancillary test results in our series support the fact that HTT is a benign neoplasm.

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Diagnostic Criteria of Suspicious for Malignancy

Kim,

Jung

2023

Thyroid FNA Cytology

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

Cited by 10 publications

References 18 publications

GLIS rearrangements in thyroid nodules: A key to preoperative diagnosis of hyalinizing trabecular tumor

GLIS rearrangements in thyroid nodules: A key to preoperative diagnosis of hyalinizing trabecular tumor

A large series of hyalinizing trabecular tumors: Cytomorphology and ancillary techniques on fine needle aspiration

Diagnostic Criteria of Suspicious for Malignancy

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