Post‐radiotherapy cribriform‐morular thyroid carcinoma

Koca, Arzu Or; Şimşek, Gülçin Güler

doi:10.1002/jcla.24819

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…The Ki-67 index that is not required for diagnosis of cribriform morular thyroid cancer may show high despite excellent prognosis [ 4 , 15 ]. Regarding immunohistochemistry, β -catenin expression is prominent in the nuclei or cytoplasm of cells in cribriform morular thyroid carcinoma, whereas in PTC, β -catenin is mainly expressed on plasma membranes [ 3 , 7 ]. Furthermore, morular areas of cribriform morular thyroid carcinoma often lack TTF-1 expression but have CDX2, CD5, and CK5.…”

Section: Discussionmentioning

confidence: 99%

“…The age of onset for this type of cancer tends to be comparatively lower, with the peak incidence occurring in the third decade of life (mean age: 26 years), which contrasts with PTC [ 4 , 6 ]. Additionally, a female predominance was observed, with a female-to-male ratio of approximately 61 : 1 [ 4 ] and with an unclear association of radiation exposure [ 7 ]. In cytological findings, a significant similarity existed between PTC and cribriform thyroid carcinoma such as the presence of ground-glass nuclei and distinctive nuclear clearing or a papillary architecture featuring columnar or spindle cells [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Pan,

Hang,

Chen

et al. 2024

Case Reports in Endocrinology

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Background. Cribriform morular thyroid carcinoma has been recently renamed in the 2022 WHO classification as a thyroid tumor of uncertain histogenesis. The epidemiologic, pathological, and pathophysiological characteristics distinguish it from papillary thyroid carcinoma (PTC). Preoperative genetic testing plays a role in facilitating the differential diagnosis. Methods. This report presents a confirmed case of cribriform morular thyroid carcinoma. Initially, fine-needle aspiration cytology suggested a diagnosis of PTC. However, a genetic analysis did not reveal the typical mutations associated with follicular-cell-derived neoplasms. Results. A 31-year-old woman was found to have a thyroid nodule at the left lobe measuring 11.8 × 10.2 × 12.4 mm. Ultrasonography indicated a hypoechoic, solid nodule with regular margins. Cytology revealed a papillary structure of tall cells, leading to a PTC diagnosis. Nevertheless, the genetic analysis failed to detect mutations such as BRAF V600E, NRAS Q61R, NRAS Q61K, HRAS Q61R, or HRAS Q61K mutation or the fusion of CCDC6-RET, NCOA4-RET, PAX8-PPARG, ETV6-NTRK3, TPM3-NTRK1, IRF2BP2-NTRK1, or SQSTM1-NTRK1 in the aspirated follicular cells. The patient subsequently underwent total thyroidectomy with central lymph node dissection. Pathological examination revealed a cribriform pattern of spindle-shaped cells with morular areas. Immunohistochemical staining showed positive results for β-catenin and TTF-1, except in the morular regions, and negative results for PAX8, thyroglobulin, and BRAF (clone VE1). The diagnosis was confirmed to be cribriform morular thyroid carcinoma. Conclusion. Significant cytological similarity exists between PTC and cribriform morular thyroid carcinoma. Preoperative genetic analysis is important to differentiate these two diseases. Cribriform morular thyroid carcinoma can be differentiated from common follicular-cell-derived tumors by the absence of typical mutations; the presence of nuclear and cytoplasmic expressions of β-catenin; the presence of TTF-1, except in morular areas; and the absence of thyroglobulin.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Pan,

Hang,

Chen

et al. 2024

Case Reports in Endocrinology

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“…1,9 IHC features of the reported cases are mentioned in Table 1. 5,8,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] TTF1 will be strongly positive in the tumor cells in the nonmorular area. PAX8 is focal, with weak reactivity in some cells of the cribriform component while negative in the morular component.…”

Section: Discussionmentioning

confidence: 99%

Cribriform Morular Thyroid Carcinoma: A Rare Case and Associated Uncommon Features

Sahu,

Shahin,

Jain

et al. 2023

Int J Surg Pathol

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Cribriform morular thyroid carcinoma has been added under tumors of uncertain histogenesis. Its peculiar clinical, histomorphological pattern, and immunohistochemical profile have been proved different from papillary thyroid carcinoma. A 59-year-old female patient had a lesion in the left lobe of the thyroid. Fine needle aspiration cytology was reported as medullary thyroid carcinoma. The total thyroidectomy specimen showed a predominantly solid tumor of size 9.5 cm in the left lobe. Microscopy showed a mixed growth pattern with the dominant cribriform and solid morular area. Nuclear features of papillary carcinoma were not seen. Squamoid morules had nuclear clearing. Marked stromal hyalinization and calcification were noted. Extrathyroidal extension, lymphovascular invasion, and lymph node metastasis were not identified. Immunohistochemically the tumor cells were diffuse and strong nuclear positive for β-catenin, TTF1, PAX8, estrogen receptor, focal, and weak positivity for CD5. Synaptophysin, calcitonin, thyroglobulin, and CDX2 were negative. We report this rare cribriform morular thyroid carcinoma case with its associated uncommon histological and immunohistochemical features.

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“…CMTC accounts for 0.16–0.5% of all cases of TC ( 10 , 11 ) and 0.16–0.66% of the cases of PTC ( 3 , 12 , 13 ). Although a case of CMTC has been reported in a 15-year-old female with hypothyroidism secondary to neck radiotherapy due to Hodgkin's disease ( 14 ), no increased prevalence of CMTC was detected in a population exposed to ionizing radiation post-Chernobyl ( 11 ). SARS-CoV-2 infection has been reported in one sporadic case of CMTC and lymphocytic thyroiditis ( 15 ).…”

Section: Epidemiological Characteristicsmentioning

confidence: 99%

“…Most patients with CMTC are euthyroid young women (female-to-male ratio, ~61:1), and the mean age at diagnosis was determined to be 25 years (range, 8–69 years), both for sporadic and for FAP-associated CMTC ( 5 , 12 , 26 ). CMTC may be incidentally detected during physical and/or US examination with or without FNAC ( 19 ) or present as a painless mass, dysphagia and/or hoarseness ( 14 , 27 , 28 ). During US screening, most nodules are observed to be well-defined, oval to round, hypoechoic and solid without calcifications (with benign-looking features) ( 17 , 18 , 29 , 30 ).…”

Section: Clinical Findingsmentioning

confidence: 99%

Cribriform morular thyroid carcinoma: Clinicopathological and molecular basis for both a preventive and therapeutic approach for a rare tumor (Review)

Cameselle‑García,

Abdulkader‑Nallib,

Sánchez‑Ares

et al. 2024

Oncol Rep

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Cribriform morular thyroid carcinoma (CMTC) has been included within the group of thyroid tumors of uncertain histogenesis in the recent World Health Organization classification of endocrine tumors. Most CMTCs occur in young euthyroid women with multiple (and bilateral) thyroid nodules in cases associated with familial adenomatous polyposis (FAP) or as single nodules in sporadic cases. CMTC generally behaves indolently, while aggressiveness and mortality are associated with high-grade CMTC. This tumor histologically displays a distinctive combination of growth patterns with morular structures. Strong diffuse nuclear and cytoplasmic immunostaining for β-catenin is the hallmark of CMTC. Tumor cells are also positive for thyroid transcription factor-1 and for estrogen and progesterone receptors, but negative for thyroglobulin and calcitonin. It is possible that the CMTC phenotype could result from blockage in the terminal/follicular differentiation of follicular cells (or their precursor cells) secondary to the permanent activation of the Wnt/β-catenin pathway. In CMTC, the activation of the Wnt/β-catenin pathway is the central pathogenetic event, which in FAP-associated cases results from germline mutations of the APC regulator of WNT signaling pathway ( APC ) gene, and in sporadic cases from somatic inactivating mutations in the APC, AXIN1 and CTNNB1 genes. Estrogens appear to play a tumor-promoting role by stimulating both the PI3K/AKT/mTOR and the RAS/RAF/MAPK signaling pathways. Additional somatic mutations (i.e. RET rearrangements, or KRAS, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit α, telomerase reverse transcriptase or tumor protein 53 mutations) may further potentiate the development and progression of CMTC. While hemithyroidectomy would be the treatment of choice for sporadic cases without high-risk data, total thyroidectomy would be indicated in FAP-associated cases. There is insufficient clinical data to propose therapies targeting the Wnt/β-catenin pathway, but multikinase or selective inhibitors could be used in a manner analogous to that of conventional thyroid tumors. It is also unknown whether adjuvant antiestrogenic therapy could be useful in the subgroup of women undergoing surgery with high-risk CMTC, as well as when there is tumor recurrence and/or metastasis.

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Post‐radiotherapy cribriform‐morular thyroid carcinoma

Cited by 4 publications

References 10 publications

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Difficulties of Preoperative Diagnosis of Cribriform Morular Thyroid Carcinoma

Cribriform Morular Thyroid Carcinoma: A Rare Case and Associated Uncommon Features

Cribriform morular thyroid carcinoma: Clinicopathological and molecular basis for both a preventive and therapeutic approach for a rare tumor (Review)

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