J Korean Med Sci.  2010 Nov;25(11):1683-1687. 10.3346/jkms.2010.25.11.1683.

Composite Follicular Variant of Papillary Carcinoma and Mucoepidermoid Carcinoma of Thyroid Gland: A Case Report

• Jung YH
• Kang MS

• KMID: 1779245
• DOI: http://doi.org/10.3346/jkms.2010.25.11.1683

Abstract

A 50-yr-old male presented a thyroid mass with dysphasia and hoarseness. He underwent total thyroidectomy and neck node dissection. Pathologically, the tumor had two distinct tumor components with intermingled areas: follicular variant of papillary carcinoma and mucoepidermoid carcinoma. Mucoepidermoid carcinoma composed of columnar cells, mucocytes, and squamoid cells showing solid and cystic lesion. Several small cysts lined by benign ciliated columnar epithelia suggesting that this tumor had originated from solid cell nest were seen around the tumor. By immunohistochemistry, columnar cells and squamoid cells in mucoepidermoid carcinoma were positive for cytokeratin but negative for thyroglobulin, TTF-1 and calcitonin. Positivity of p63 was seen in squamoid cells and basal cells of cysts. Some mucocytes are CEA positive. Tumor cells of papillary carcinoma are positive for TTF-1, thyroglobulin but negative for CEA, calcitonin and p63.

Keyword

Thyroid Gland; Carcinoma, Mucoepidermoid; Carcinoma, Papillary; Solid Cell Nests

MeSH Terms

Calcitonin/metabolism
Carcinoma, Mucoepidermoid/*diagnosis/pathology
Carcinoma, Papillary/*diagnosis/pathology
Humans
Immunohistochemistry
Keratins/metabolism
Male
Membrane Proteins/metabolism
Middle Aged
Nuclear Proteins/metabolism
Thyroglobulin/metabolism
Thyroid Neoplasms/*diagnosis/pathology
Transcription Factors/metabolism

Figure

• 

  Fig. 1 Histopathological findings of the tumor. (A) There are foci of transition from follicular variant of papillary carcinoma to mucoepidermoid carcinoma, H&E stained, ×40. (B) Papillary carcinoma cells show nuclear groove, ground glass nuclei and intranuclear psudoinclusions, H&E stained, ×400. (C) Mucoepidermoid carcinoma is solid and cystic lesion composed of columnar cells and squamous cells, H&E stained, ×40. (D) Columnar tumor cells have cilia, H&E stained, ×400. (E) Mucinous material in cystic space, mucocytes and cytoplasmic border of columnar cells are positive by PAS staining, ×200. (F) Small cysts lined with ciliated columnar cells (solid cell nests) are seen around the main tumor, H&E stained, ×200.

• 

  Fig. 2 Immunohistochemical findings of the tumor. Thyroid transcription factor-1 (TTF-1) was expressed in papillary carcinoma tumor cells (A) but negative in columnar cells of mucoepidermoid carcinoma (B). Papillary carcinoma tumor cells were positive for thyroglobulin (C), and cytokeratin 19 (D). Squamoid cells and basal cells of ductal structure of mucoepidermoid carcinoma were positive for p63 (E). Carcinoembryonic antigen (CEA) was expressed in squamoid and columnar tumor cells (F) and benign ciliated respiratory epithelial cells (G). (LSAB. Magnification: ×200)

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