Papillary carcinoma of the thyroid with fibromatosislike stroma: case report and review of literature.
OBJECTIVE
To describe a case of papillary carcinoma of the thyroid with fibromatosislike stroma, emphasize the need for a diligent search for papillary thyroid cancer in the presence of a fibroproliferative lesion, highlight the peculiar hormonal response of the stromal component, and review the pertinent literature.


METHODS
We present the clinical, laboratory, radiologic, and pathologic findings in a patient with papillary carcinoma of the thyroid with fibromatosislike stroma and review the related published material.


RESULTS
A 29-year-old woman presented to our surgical department because of a large mediastinal mass. She underwent surgical removal of the mass by means of a median sternotomy and neck extension. Pathology examination revealed macroscopically tan scarlike tissue, which by histologic study consisted of a dominant fibroproliferative lesion overshadowing a minor component of papillary carcinoma of the thyroid. Further neck exploration with total thyroidectomy revealed multifocal papillary carcinoma of the thyroid. Postoperatively, the patient received radioiodine treatment. A local and aggressive recurrent tumor was observed during a subsequent pregnancy; the lesion was not amenable to complete resection but fascinatingly responded to antiestrogen therapy (orally administered tamoxifen).


CONCLUSIONS
The presence of a fibroproliferative lesion could be misleading. A diligent search should be made for a papillary thyroid carcinoma component within fibromatosislike stroma. The mode of manifestation of the tumor and its response to hormonal manipulation are distinctive features of this case.
Khalil
Ali B
AB
Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. khaali771@smkc.gov.ae
Trudel
Michel
M
Creel
Richard
R
D000328:Adult; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005350:Fibroma / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy; D011960:Receptors, Estrogen / Q000378:metabolism; D017154:Stromal Cells / Q000378:metabolism / Q000473:pathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000628:therapy
D004965:Estrogen Antagonists; D011960:Receptors, Estrogen