Adenoid cystic pattern in follicular variant of papillary thyroid carcinoma: a report of four cases.
OBJECTIVE
An adenoid cystic pattern in thyroid tumours is a rare finding that may be seen in papillary carcinoma of thyroid (PCT), the follicular variant of PCT (FV-PCT), a rare cribriform-morular variant of papillary carcinoma of thyroid (CMV-PCT) and follicular carcinoma. There is little published cytological literature describing these patterns. We report four cases of PCT with this unusual pattern.


METHODS
Fine needle aspiration (FNA) cytology was performed on four patients with a neck lump using a 22-G needle; smears were stained with Giemsa and Papanicolaou stains. Immunocytochemical staining for thyroglobulin was done in all cases.


RESULTS
The patients were female and ranged in age from 18 to 46 years. They presented with a gradually increasing mass in the neck. FNA smears in all cases showed nuclear features of PCT. There were also prominent follicular areas with hyaline globules in some of the cell clusters reminiscent of adenoid cystic carcinoma and, in places, morula-like groups of neoplastic cells were also seen. Immunocytochemistry for thyroglobulin was positive in all cases but negative in the hyaline globules.


CONCLUSIONS
Adenoid cystic areas with morula-like groups in PCT are a rare finding. Cytopathologists and clinicians should be aware of these distinct features in thyroid tumours to avoid diagnosing metastatic adenoid cystic carcinoma. It is also important to rule out CMV-PCT since that variant is mostly associated with familial adenomatous polyposis, although sporadic occurrence is known.
Mandal
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Division of Cytology, Department of Pathology, Maulana Azad Medical College, New Delhi, India.
Jain
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D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D044963:Biopsy, Fine-Needle; D003528:Carcinoma, Adenoid Cystic / Q000378:metabolism / Q000473:pathology* / Q000556:secondary; D018265:Carcinoma, Papillary, Follicular / Q000378:metabolism / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009378:Neoplasms, Multiple Primary; D013954:Thyroglobulin / Q000378:metabolism; D013964:Thyroid Neoplasms / Q000378:metabolism / Q000473:pathology*; D055815:Young Adult
D014408:Biomarkers, Tumor; D013954:Thyroglobulin