Macrofollicular variant of papillary thyroid carcinoma: an uncommon entity

Arzu Gedik; Merve Yilmaz; Tevfik Demir; Merih Guray Durak; Ahmet Omer Ikiz; Mehmet Ali Kocdor; Ozhan Ozdogan; Firat Bayraktar; Abdurrahman Comlekci

doi:10.1530/endoabs.32.P1117

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Endocrine Abstracts (2013) 32 P1117 | DOI: 10.1530/endoabs.32.P1117

ECE2013 Poster Presentations Thyroid cancer (64 abstracts)

Macrofollicular variant of papillary thyroid carcinoma: an uncommon entity

Arzu Gedik ¹ , Merve Yilmaz ¹ , Tevfik Demir ¹ , Merih Guray Durak ² , Ahmet Omer Ikiz ³ , Mehmet Ali Kocdor ⁴ , Ozhan Ozdogan ⁵ , Firat Bayraktar ¹ & Abdurrahman Comlekci ¹

Err

Author affiliations

¹Endocrinology Department, Dokuz Eylul University Medical Faculty, Izmir, Turkey; ²Pathology Department, Dokuz Eylul University Medical Faculty, Izmir, Turkey; ³Department of Ear Nose Throat and Head & Neck Surgery, Dokuz Eylul University Medical Faculty, Izmir, Turkey; ⁴General Surgery Department, Dokuz Eylul University Medical Faculty, Izmir, Turkey; ⁵Nuclear Medicine Department, Dokuz Eylul University Medical Faculty, Izmir, Turkey.

Background: Macrofollicular variant (MV) is a rarely seen variant of papillary thyroid carcinoma (PTC). We herein present clinical characteristics of four patients carrying this variant of PTC. Case 1: 62-year-old female patient underwent total thyroidectomy (TT) due to euthyroid multinodular goiter (MNG) with a cytology of ‘indeterminate nodule’. The pathology revealed ‘papillary thyroid microcarcinoma MV with a diameter of 8×6 mm, without capsule or lymphovascular invasion (LVI)’. Case 2: 61-year-old female patient underwent TT due to toxic MNG. Pathology revealed ‘thyroid papillary microcarcinoma MV with a diameter of 9×9 mm, without capsule or LVI’. Case 3: 60-year-old man underwent TT due to euthyroid MNG with pressure symptoms on his neck. Pathology revealed ‘bilateral multisentric PTC; a focus of MV with a diameter of 2×2 cm in the right lobe; two foci of classical variant with diameters of 3×2 and 2×2 mm in the left lobe’. No local/distant metastasis were identified in cases 1, 2 and 3. Case 1 and 2 were started TSH suppression therapy and case 3 received radioactive iodine (RAI) and suppression therapy afterwards. Case 4: 50-year-old male patient with a previous diagnosis of metastatic PTC after left cervical lymph node (LN) excision, underwent TT, central and lateral neck dissection. Pathology revealed ‘PTC MV focus of 2.7 cm with capsule and LVI, and metastatic LN on left lateral neck (biggest in diameter 5 cm) and left paratracheal compartment (5.5 cm in diameter)’. No distant metastases were identified. He has been referred for RAI ablation therapy.

Conclusion: Macrofollicles in PTC-MV may cause diagnostic pitfalls during cytology which may be incorrectly defined as benign goiter. The presence of macrofollicles >200 μm in >50% of the cross-sectional area is pathognomonic for PTC-MV. Despite its rarity and benign course, these patients should be evaluated for local/distant metastases.