Pulmonary metastasis of cribriform‐morular variant of thyroid carcinoma mimicking primary adenocarcinoma of the lung: A potential pitfall

Laforga, Juan B.; Pedro, Teresa; Gasent, Joan M.

doi:10.1002/dc.24312

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Solid areas in the C-MV of TC can simulate a poorly differentiated thyroid carcinoma, but coexistence with a cribriform and/or morular pattern together with a lower mitotic index are typical of the C-MV of TC [147]. On the other hand, lung metastasis from C-MV of TC should not be misinterpreted as a primary adenocarcinoma of the lung based exclusively on the positivity for CK7 and TTF1 [148] can be helpful in this situation.…”

Section: Pathological Featuresmentioning

confidence: 99%

Inherited Follicular Epithelial-Derived Thyroid Carcinomas: From Molecular Biology to Histological Correlates

et al. 2021

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Cancer derived from thyroid follicular epithelial cells is common; it represents the most common endocrine malignancy. The molecular features of sporadic tumors have been clarified in the past decade. However the incidence of familial disease has not been emphasized and is often overlooked in routine practice. A careful clinical documentation of family history or familial syndromes that can be associated with thyroid disease can help identify germline susceptibility-driven thyroid neoplasia. In this review, we summarize a large body of information about both syndromic and non-syndromic familial thyroid carcinomas. A significant number of patients with inherited non-medullary thyroid carcinomas manifest disease that appears to be sporadic disease even in some syndromic cases. The cytomorphology of the tumor(s), molecular immunohistochemistry, the findings in the non-tumorous thyroid parenchyma and other associated lesions may provide insight into the underlying syndromic disorder. However, the increasing evidence of familial predisposition to non-syndromic thyroid cancers is raising questions about the importance of genetics and epigenetics. What appears to be “sporadic” is becoming less often truly so and more often an opportunity to identify and understand novel genetic variants that underlie tumorigenesis. Pathologists must be aware of the unusual morphologic features that should prompt germline screening. Therefore, recognition of harbingers of specific germline susceptibility syndromes can assist in providing information to facilitate early detection to prevent aggressive disease.

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Section: Pathological Featuresmentioning

confidence: 99%

Inherited Follicular Epithelial-Derived Thyroid Carcinomas: From Molecular Biology to Histological Correlates

et al. 2021

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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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“…Additional points supporting an origin of CMTC from follicular cells (or their precursor cells) are as follows ( 8 ): a) The cytoarchitectural and immunohistochemical similarities with other neoplasms of follicular lineage, particularly with PTC; and b) the multicentricity of CMTC associated with patients with FAP (usually with molecularly different tumors), which is easier to explain when they are derived from different follicular cells (or precursor thyroid cells) than from multiple intrathyroid thymic or branchial remnants. Of note, a light increase in Tg levels along with a slight iodine uptake in pulmonary metastases of CMTC after treatment with 131 I has been described ( 73 ). Furthermore, a rapid increase in serum Tg levels parallel to histologically confirmed lung metastases has also been reported in another case of CMTC after treatment with 131 I and a selective inhibitor of receptor tyrosine kinases (lenvatinib) ( 74 ).…”

Section: Follicular Lineagementioning

confidence: 98%

“…CMTC generally behaves more indolently than PTC ( 26 , 93 ), with ~12% of cases having lymph node metastases at diagnosis ( 3 , 16 , 18 , 27 , 36 , 45 – 47 , 55 , 58 , 93 , 94 ) and 5% have distant metastases (mainly to the lung, bone and brain) ( 10 , 36 , 44 , 46 , 47 , 51 , 55 , 73 , 74 , 93 ) ( Table II ). To our knowledge, mortality due to CMTC has been reported in only 4 patients ( 10 , 16 , 36 , 44 ).…”

Section: Prognostic Markersmentioning

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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Pulmonary metastasis of cribriform‐morular variant of thyroid carcinoma mimicking primary adenocarcinoma of the lung: A potential pitfall

Cited by 8 publications

References 17 publications

Inherited Follicular Epithelial-Derived Thyroid Carcinomas: From Molecular Biology to Histological Correlates

Inherited Follicular Epithelial-Derived Thyroid Carcinomas: From Molecular Biology to Histological Correlates

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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