Papillary carcinoma with nodular fasciitis‐like stroma—A case report in pregnancy

Abstract

We report a case of Papillary carcinoma with nodular fasciitis-like stroma that is a rare variant of Papillary carcinoma characterized by a prominent stromal cell proliferation that causes difficulties in cytologic and histologic diagnosis. The patient was a 34-year-old woman, pregnant, presented with a 1-year history of a growing mass in neck, dysphagia, and hoarseness. Physical examination revealed a firm nodular mass in thyroid gland. The fine needle aspiration biopsy specimen contained, besides diagnostic epithelial features of Papillary thyroid carcinoma, discohesive arrangement of bland spindle cells. Macroscopically, the specimen consisted of nodular tumor measuring 10 x 6 x 6 cm. Histologically the tumor was composed of small foci of neoplastic epithelial component distributed in abundant stroma. In immunohistochemistry, spindle cells in the stroma were positive for alpha-smooth muscle actin and the neoplastic cells showed positive staining for TTF-1 and progesterone receptor.

Sonographic finding of papillary thyroid carcinoma with nodular fasciitis-like stroma

“…Although the clinical features of this tumor have not been clarified, they may be similar to a classical variant of PTC in previous reports [1][2][3][4][5][6][7][8][9]. In this variant, the size and extension of the neoplastic epithelial component is important to determine prognosis [7].…”

“…In this variant, the size and extension of the neoplastic epithelial component is important to determine prognosis [7].…”

Papillary thyroid carcinoma with nodular fasciitis-like stroma and β-catenin mutations should be renamed papillary thyroid carcinoma with desmoid-type fibromatosis

“…Several studies showed an aberrant immunohistochemical expression of β-catenin in the nucleus and cytoplasm of mesenchymal cells, but the molecular cause for the activation of the Wnt signaling pathway in these tumors remains unknown. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Aberrant nuclear accumulation of β-catenin is reported in different neoplastic and reactive conditions and is related to direct or indirect alterations of the Wnt/β-catenin pathway. 19 Among thyroid carcinomas, cytoplasmic and nuclear accumulation of β-catenin has been reported only in the cribriform-morular variant, which occurs sporadically or as an extra-intestinal manifestation of the familial adenomatous polyposis syndrome; in this case, it is associated with the presence in the follicular cells of activating somatic mutations in CTNNB1, the gene encoding β-catenin.…”

Papillary Thyroid Carcinoma with Nodular Fasciitis-Like Stroma: A Case Report

“…3,4 To the best of our knowledge, only 20 cases have been reported in the English literature. [5][6][7] Th e age at presentation ranges from 20 to 82 years, with a mean of 44.5 years (our patient was 46 years old); a female preponderance has been observed, with a female-to-male ratio of 3:1. 6 No racial predilection has been observed.…”