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Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth

SUMMARY: We present the case of a 47-year-old Caucasian previously healthy woman with a voluminous thyroid nodule occupying almost the entire anterior neck region. The lesion had progressively increased in size during the previous 3 months and the patient presented intermittent symptoms of dysphagia...

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Autores principales: Naciu, Anda Mihaela, Verri, Martina, Crescenzi, Anna, Taffon, Chiara, Longo, Filippo, Frasca, Luca, Tabacco, Gaia, Monte, Lavinia, Palermo, Andrea, Crucitti, Pierfilippo, Cesareo, Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849458/
https://www.ncbi.nlm.nih.gov/pubmed/33522492
http://dx.doi.org/10.1530/EDM-20-0184
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author Naciu, Anda Mihaela
Verri, Martina
Crescenzi, Anna
Taffon, Chiara
Longo, Filippo
Frasca, Luca
Tabacco, Gaia
Monte, Lavinia
Palermo, Andrea
Crucitti, Pierfilippo
Cesareo, Roberto
author_facet Naciu, Anda Mihaela
Verri, Martina
Crescenzi, Anna
Taffon, Chiara
Longo, Filippo
Frasca, Luca
Tabacco, Gaia
Monte, Lavinia
Palermo, Andrea
Crucitti, Pierfilippo
Cesareo, Roberto
author_sort Naciu, Anda Mihaela
collection PubMed
description SUMMARY: We present the case of a 47-year-old Caucasian previously healthy woman with a voluminous thyroid nodule occupying almost the entire anterior neck region. The lesion had progressively increased in size during the previous 3 months and the patient presented intermittent symptoms of dysphagia and odynophagia with a slight change in voice. Fine needle aspiration showed papillary carcinoma. Based on imaging and cytological findings, the patient underwent total thyroidectomy. The surgical sample revealed a totally enlarged thyroid gland (weight: 208 g) with the presence of a poly-lobulated lesion centrally located and involving the isthmus and both lobes. Hobnail features were present in more than 30% of the neoplastic cells in agreement with the criteria for this subtype. Psammoma bodies and focal necrosis were also present. The extra-thyroidal extension included strap muscles and peri-esophageal glands. Immunohistochemistry using VE1 antibody for detecting BRAF-V600E mutation resulted positive. The final diagnosis was papillary thyroid carcinoma (PTC) hobnail variant (HVPTC)-pT4a. The HVPTC is a rare entity and, in most cases, appears like a unifocal lesion with a maximum tumor size of 8 cm reported so far. To our knowledge, this represents the largest tumor ever described (14 cm), showing rapid growth and with multinodular goiter-like aspect. LEARNING POINTS: HVPTC is an aggressive variant of PTC, usually associated with radioactive iodine refractoriness, and a higher mortality rate compared to classic PTC. However, there is a marked individual variability in this association. HVPTC usually appears as small unifocal lesion but a multinodular goiter presentation may occur. The present case highlights that despite of the histology, our patient achieved a high ablation success rate after radioactive iodine therapy.
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spelling pubmed-78494582021-02-03 Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth Naciu, Anda Mihaela Verri, Martina Crescenzi, Anna Taffon, Chiara Longo, Filippo Frasca, Luca Tabacco, Gaia Monte, Lavinia Palermo, Andrea Crucitti, Pierfilippo Cesareo, Roberto Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease SUMMARY: We present the case of a 47-year-old Caucasian previously healthy woman with a voluminous thyroid nodule occupying almost the entire anterior neck region. The lesion had progressively increased in size during the previous 3 months and the patient presented intermittent symptoms of dysphagia and odynophagia with a slight change in voice. Fine needle aspiration showed papillary carcinoma. Based on imaging and cytological findings, the patient underwent total thyroidectomy. The surgical sample revealed a totally enlarged thyroid gland (weight: 208 g) with the presence of a poly-lobulated lesion centrally located and involving the isthmus and both lobes. Hobnail features were present in more than 30% of the neoplastic cells in agreement with the criteria for this subtype. Psammoma bodies and focal necrosis were also present. The extra-thyroidal extension included strap muscles and peri-esophageal glands. Immunohistochemistry using VE1 antibody for detecting BRAF-V600E mutation resulted positive. The final diagnosis was papillary thyroid carcinoma (PTC) hobnail variant (HVPTC)-pT4a. The HVPTC is a rare entity and, in most cases, appears like a unifocal lesion with a maximum tumor size of 8 cm reported so far. To our knowledge, this represents the largest tumor ever described (14 cm), showing rapid growth and with multinodular goiter-like aspect. LEARNING POINTS: HVPTC is an aggressive variant of PTC, usually associated with radioactive iodine refractoriness, and a higher mortality rate compared to classic PTC. However, there is a marked individual variability in this association. HVPTC usually appears as small unifocal lesion but a multinodular goiter presentation may occur. The present case highlights that despite of the histology, our patient achieved a high ablation success rate after radioactive iodine therapy. Bioscientifica Ltd 2021-01-27 /pmc/articles/PMC7849458/ /pubmed/33522492 http://dx.doi.org/10.1530/EDM-20-0184 Text en © 2021 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (http://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Naciu, Anda Mihaela
Verri, Martina
Crescenzi, Anna
Taffon, Chiara
Longo, Filippo
Frasca, Luca
Tabacco, Gaia
Monte, Lavinia
Palermo, Andrea
Crucitti, Pierfilippo
Cesareo, Roberto
Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
title Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
title_full Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
title_fullStr Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
title_full_unstemmed Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
title_short Hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
title_sort hobnail variant of papillary thyroid carcinoma showing goiter-like presentation and rapid growth
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849458/
https://www.ncbi.nlm.nih.gov/pubmed/33522492
http://dx.doi.org/10.1530/EDM-20-0184
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