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CASE REPORT Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 548-550
Squamous cell carcinoma associated with tall cell variant of papillary carcinoma of the thyroid


1 Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
2 Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran

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Date of Web Publication22-Oct-2010
 

   Abstract 

We report the simultaneous occurrence of the tall cell variant of papillary carcinoma and squamous cell carcinoma in the thyroid gland. Histology and immunohistochemical findings are discussed and it seems that the malignant squamous component was transformed from the tall cell variant of papillary carcinoma. Metastasis from the squamous cell carcinoma is diagnosed in the regional lymph node.

Keywords: Carcinoma, squamous, thyroid, papillary

How to cite this article:
Ashraf M J, Azarpira N, Khademi B, Peiravi M. Squamous cell carcinoma associated with tall cell variant of papillary carcinoma of the thyroid. Indian J Pathol Microbiol 2010;53:548-50

How to cite this URL:
Ashraf M J, Azarpira N, Khademi B, Peiravi M. Squamous cell carcinoma associated with tall cell variant of papillary carcinoma of the thyroid. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Aug 1];53:548-50. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/548/68286



   Case Report Top


A 65-year-old, non-smoker female patient presented with a painless lump in her neck since one month. On physical examination, she was clinically euthyroid, and had a 6 cm, hard, non-tender mass in the lateral part of neck. There was no associated thyromegally, lymphadenopathy or any abnormal finding in the upper aero digestive tract examination. The pathologic report of resected mass was metastatic squamous cell carcinoma. To find the primary site of this tumor, the neck ultrasound showed a multinodular goiter. The largest nodule was of 3 cm size, with mainly solid component as well as cystic areas. The computed tomography (CT) of the chest and abdomen were normal.

At surgery, the mass lesion was palpable and the thyroid gland was attached to surrounding muscles. We performed a total thyroidectomy with dissection of palpable lymph nodes. The patient showed a good postoperative recovery with no voice changes. Macroscopically, the total thyroidectomy specimen weighed 40 g and measured 100x 60x 40 mm. The left lobe was enlarged and almost completely replaced by a partially cystic and necrotic white to creamy tumor. The isthmus contained firm white areas and the left lobe was grossly unremarkable.

Microscopic examination revealed the diffuse involvement of left lobe and isthmus of thyroid by a biphasic tumor, cystic areas with delicate papillae containing fibro vascular cores and focal calcification, merging with areas of infiltrating islands of moderately to poorly differentiated squamous cell carcinoma. The cells lining the papilla were columnar with abundant eosinophilic cytoplasm, and many cells were twice as long as they were wide [Figure 1]a-c. These tall cell features were present in over 60% of the tumoral mass. Some of the nuclei were round and optically clear or grooved. The squamous cells had hyper chromatic nuclei with eosinophilic cytoplasm. Focal keratinisation was observed. The tumor showed invasion into perithyroidal soft tissue. Four lymph nodes showed metastases of the squamous cell carcinoma component. Both endoscopic and radiological examinations were normal and no primary site of squamous cell carcinoma or any contiguous spread from neighboring structures was identified.
Figure 1: (a-c): The malignant squamous islands (arrow) merged with the papillary carcinoma (H and E, ×100), papillae lined by tall columnar cells (H and E, ×400)

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Immunohistochemistry showed positivity for antibody to pancytokeratin (AE1/3) in both the papillary and the squamous cell component. Thyroglobulin was positive in the papillary but negative in the squamous cell areas [Figure 2]. Tumor cells of both components were negative for calcitonin [Figure 3]. A p53 stain showed strong and frequent nuclear positivity in the squamous cells but was completely negative in the papillary tumor cells. Ki-67 (MIB1) labeling index (KI) values were also determined by counting at least 1,000 tumor cells, and KI was calculated as a percentage. If KI was below 25%, it was considered as weak expression, 25-50% as moderate and above 50% was considered as strong expression. The KI index showed strong expression in squamous cells [Figure 4] with weak expression in papillary cells. All the above mentioned antibodies were from Dako Company, Denmark. Surgery was followed by radiotherapy, but the patient died six months later.
Figure 2: Thyroglobulin expression in papillary components (IHC, ×400)

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Figure 3: Negati ve staining for calcitonin in tumoral cells (IHC ×400)

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Figure 4: Strong KI index in malignant squamous cells (IHC ×400)

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   Discussion Top


The presence of squamous cells in the thyroid gland has been found in some conditions such as thyroglossal ducts, remnant of branchial pouch or as squamous metaplasia in Hashimoto's thyroiditis. [1],[2] Pure squamous cell carcinoma of the thyroid is a very rare finding. [3],[4] Most high-grade tumors with squamous foci belong to undifferentiated carcinoma. In the presence of malignant squamous nests in the thyroid, the possibility of secondary direct invasion from tumor of the larynx or trachea, or a metastasis from lung, esophagus, nasopharynx or other sites should be considered. [1] Hawk and Hazard described the tall cell variant of papillary carcinoma in 1976. [5] The cells are columnar in shape with abundant eosinophilic cytoplasm and twice as long as they are wide. These tumors occurred in older patients, with frequent recurrence and aggressive behavior. [5],[6],[7]

Coexistence of tall cell papillary carcinoma with squamous cell carcinoma, implying transformation of the former to the latter, has rarely been reported in the literature. [8],[9],[10]

Tumor proliferative activity has been studied in many tumors and seems to provide important biologic information that correlates with tumor behavior. [11] In this report, the KI is higher in the malignant squamous nests than in the papillary carcinoma component. It is suggested that the tall cell variant of papillary carcinoma has a tendency to transform into the squamous cell carcinoma with more aggressive behavior.

 
   References Top

1.LiVolsi VA, Merino MJ. Squamous cell in the human thyroid gland. Am J Surg Pathol 1978;2:133-40.  Back to cited text no. 1  [PUBMED]    
2.Kebapci N, Efe B, Kabukcuoglu S, Akalin A, Kebapci M. Diffuse sclerosing variant of papillary thyroid carcinoma with papillary squamous cell carcinoma. J Endocrinol Invest 2002;25:730-4.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Makay O, Kaya T, Ertan Y, Icoz G, Akyildiz M, Yilmaz M, et al. Primary squamous cell carcinoma of the thyroid: Report of three cases. Endocr J 2008;55:359-64.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Prakash A, Kukreti SC, Sharma MP. Primary squamous cell carcinoma of the thyroid gland. Int Surg 1968;50:538-41.  Back to cited text no. 4  [PUBMED]    
5.Hawk WA, Hazard JB. The many appearances of papillary carcinoma of the thyroid. Cleve Clin Q 1976;43:207-15.  Back to cited text no. 5  [PUBMED]    
6.Leung AK, Chow SM, Law SC. Clinical features and outcome of the tall cell variant of papillary thyroid carcinoma. Laryngoscope 2008;118:32-8.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Ghossein R, Livolsi VA. Papillary thyroid carcinoma tall cell variant. Thyroid 2008;18:1179-81.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Sutak J, Armstrong JS, Rusby JE. Squamous cell carcinoma arising in a tall cell papillary carcinoma of the thyroid. J Clin Pathol 2005;58:662-4.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Kleer CG, Giordano T, Merino MJ. Squamous cell carcinoma of the thyroid: An aggressive tumor associated with tall cell variant of papillary thyroid carcinoma. Mod Pathol 2000;13:742-6.  Back to cited text no. 9      
10.Bronner MP, LiVolsi VA. Spindle cell squamous carcinoma of the thyroid: an unusual anaplastic tumor associated with tall cell papillary cancer. Mod Pathol 1991;4:637-43.  Back to cited text no. 10  [PUBMED]    
11.Barbareschi M, Girlando S, Mauri FM, Forti S, Eccher C, Mauri FA, et al. Quantitative growth fraction evaluation with MIB1 and Ki-67 antibodies in breast carcinomas. Am J Clin Pathol 1994;102:171-5.  Back to cited text no. 11  [PUBMED]    

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Correspondence Address:
N Azarpira
Organ Transplant Research Center, Zand street, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68286

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Update on clinically important variants of papillary thyroid carcinoma
Peter M. Sadow,Jennifer L. Hunt
Diagnostic Histopathology. 2011; 17(3): 106
[Pubmed] | [DOI]
2 Update on clinically important variants of papillary thyroid carcinoma
Sadow, P.M., Hunt, J.L.
Diagnostic Histopathology. 2011; 17(3): 106-113
[Pubmed]



 

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