Endocrine Abstracts

Diffuse sclerosing variant of papillary thyroid carcinoma is a rare variant. It is usually seen in children and young adults.The thyroid gland is diffusely involved. It is characterized by scattered microscopic tumor islands, diffuse fibrosis, calcification, abundant lymphocytic infiltration and psammom body when compared with conventional papillary thyroid carcinoma. Usually the lesion does not cause mass but rather a dominant nodule in one lobe is present in 50% of cases. Lymph node metastasis is found in nearly all of the cases and distant metastasis is often present.Although the prognosis is not good, it responds to treatment.

Case: A 18-year-old female patient with Hashimoto’s thyroiditis applied to the Numune State Hospital for enlargement in right thyroid gland. Thyroid ultrasound showed nothing except roughness and heterogeneous appearance in the thyroid. The patient was called to follow-up visits. As the patient felt further enlargement in the thyroid, a repeat USG was performed which showed a heterogenous appearance with microcalcifications. Thyroidal fine needle aspiration was done for exclusion of thyroidal lymphoma. The smear showed hurthle cells having prominent nucleoli and pleomorphic nuclei with highly atypical features on the ground of chronic inflammatory cells. The cells were forming papillary structures in three-dimensional pattern. Total thyroidectomy and cervical lymph node dissection was done to the patient. She was reported as ‘Thyroidal papillary carcinoma, diffuse sclerosing variant’ after pathological examination.

Discussion: Diffuse sclerosing variant is a rare variant of papillary thyroid carcinoma. It is characterized histopathologically by psammom bodies, papillary structures within lymphovascular structures, squamous metaplasia, stromal fibrosis and dense lymphoid infiltration.

A 18-year-old female patient having a rare variant of papillary carcinoma who applied with complaints of enlargement in thyroid and was diagnosed by blind biopsy not from a nodule is discussed in this report.