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Year : 2019  |  Volume : 16  |  Issue : 3  |  Page : 128-136

A case-based approach to aggressive variants of papillary thyroid carcinoma with literature review

1 Department of Pathology, Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol, Philippines
2 Department of Pathology, Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol; Department of Pathology, MHAM College of Medicine, Cebu City, Philippines

Correspondence Address:
Dr. Joseph Antoine Flordelis Chatto
Department of Pathology, Governor Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/trp.trp_37_19

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Papillary thyroid caarcinoma (PTC) is the most common thyroid and endocrine malignancy. Although considered to be indolent, aggressive variants have been identified, including the Tall Cell (TCV), Columnar Cell (CCV), Hobnail (HPTC) and Solid Variants (SVPTC). The objective of this study is to pre-operatively recognize the cytologic features of these variants. Four cases with final diagnoses of TCV, CCV, HPTC and SVPTC were reviewed and compared with Fine Needle Aspiration Biopsy (FNAB) smears. The first case is a 44-year-old female diagnosed with TCV pre-operatively through FNAB and was confirmed through tissue biopsy showing malignant glands in papillary formation with greater than 50% of tall cells. The second patient is a 54-year-old female with CCV showing stratified columnar cells with cytoplasmic supranuclear and subnuclear vacuoles. Third is a 57-year-old female with HPTC exhibiting eccentrically-located nuclei imparting a hobnail appearance with cellular dyscohesiveness. The fourth case is a 59-year-old female diagnosed with SVPTC showing predominantly solid sheets surrounded by thin, delicate fibrous stroma. They all have nuclear features of PTC. TCV, CCV, HPTC and SVPTC are related to extrathyroidal extension, angiolymphatic invasion, positive surgical margin and lymph node metastasis. FNAB is an important tool to recognize these variants preoperatively and plan for amore comprehensive management.

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